不同入路髂筋膜腔阻滞对全髋关节 置换术后镇痛的比较

Postoperative analgesic effect of 2 different ultrasound-guided fascia iliaca compartment block on patients undergoing hip prosthesis surgery

摘要:

目的 比较垂直和水平腹股沟平面入路行髂筋膜腔阻滞对全髋关节置换术后镇痛的影响。方法 40 例全身麻醉下行单侧全髋关节置换术的患者，术前30 min 随机在超声引导下行垂直腹股沟平面入路（实验 组）或水平腹股沟平面入路（对照组）髂筋膜腔阻滞，分别注射0.25% 罗哌卡因30 ml。术后采用静脉患者自 控镇痛（PCA），记录术后2、6、12、24、36 和48 h 静息时视觉模拟疼痛评分（VAS）、PCA 追加次数及不良反应。 结果 实验组术后2、6、12 和24 h 的VAS 评分低于对照组（P <0.05），实验组的PCA 追加次数在6 ～ 12 h 和 12 ～ 24 h，也低于对照组（P <0.05）；两组恶心、呕吐发生率差异无统计学意义（P >0.05）。结论 垂直腹股 沟平面入路行髂筋膜腔阻滞对全髋关节置换术后镇痛效果优于水平入路，这可能与药液向头端扩散增加，更 充分阻滞了手术区域内股外侧皮神经、股神经的痛觉分布有关。

Abstract:

Objective To compare the postoperative analgesic efficiency of 2 different ultrasound-guided fascia iliaca compartment block (FICB) methods in patients undergoing hip prosthesis surgery. Methods Forty patients undergoing total hip replacement were enrolled in the study, and randomly divided into perpendicular approach group and parallel approach group receiving ultrasound-guided FICB. Both groups were administered with 0.25% Ropivacaine 30 ml at 30 min before surgery. General anesthesia was performed, and intravenous Sulfentanil (2 μg/kg, 100 ml) patient-controlled analgesia (PCA) was performed after surgery. Visual Analog Scale (VAS) scores and PCA times were recorded at 2, 6, 12, 24, 36 and 48 h after block. The adverse events of nausea and vomiting were also recorded. Results The VAS scores in the perpendicular approach group were significantly lower than those in the parallel approach group at 2, 6, 12 and 24 h after operation. The number of times of adding PCA in the perpendicular approach group was smaller than that in the parallel approach group in 6-12 h and 12-24 h after operation (P < 0.05). There were similar adverse effect rates of nausea and vomiting between the two groups (P > 0.05). Conclusions The perpendicular pathway has better analgesic effect in hip prosthesis surgery receiving ultrasound-guided FICB.