超声引导下髂腰肌平面阻滞联合股外侧皮神经阻滞在髋部骨折术中的麻醉效果分析

Analgesic efficacy of ultrasound-guided iliopsoas plane block combined with lateral femoral cutaneous nerve block in hip fracture surgery

摘要:

目的 分析超声引导髂腰肌平面阻滞+股外侧皮神经阻滞在髋部骨折术中麻醉效果。方法 前瞻性选取2023年5月—2024年6月宝鸡市中医医院收治的髋部骨折患者83例。采用随机数字表法将患者分为两组，42例采用髂腰肌平面阻滞+股外侧皮神经阻滞方案设为观察组，41例采用髂筋膜间隙阻滞方案设为对照组。比较两组患者神经阻滞相关指标、镇痛效果、肌肉力量情况及不良反应。结果 观察组操作时间、起效时间和首次下床时间均低于对照组（P <0.05）。观察组舒芬太尼追加例数、术后镇痛泵有效按压次数均少于对照组，术后8 h静息视觉模拟评分（VAS）、术后8 h抬髋15° VAS评分低于对照组（P <0.05）。观察组与对照组阻滞后10 min（T₁）、阻滞后2 h（T₂）、阻滞后4 h（T₃）、阻滞后6 h（T₄）、阻滞后12 h（T₅）的徒手肌力评定（MMT）等级比较，结果 ①不同时间点MMT等级比较，差异无统计学意义（P >0.05）；②两组MMT等级比较，差异有统计学意义（P <0.05）；③两组MMT等级变化趋势比较，差异有统计学意义（P <0.05）。观察组与对照组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 髂腰肌平面阻滞+股外侧皮神经阻滞方案操作时间短、起效快，能提升镇痛效果，患者术后能更早地下床活动，且不良反应少。

Abstract:

Objective To analyze the intraoperative anesthetic efficacy of ultrasound-guided iliopsoas plane block (IPB) combined with lateral femoral cutaneous nerve block (LFCNB) in hip fracture surgery.Methods Eighty-three hip fracture patients admitted to Baoji Hospital of Traditional Chinese Medicine from May 2023 to June 2024 were prospectively enrolled. Using a random number table, patients were divided into two groups: the observation group (n = 42) received IPB+LFCNB, and the control group (n = 41) received fascia iliaca compartment block (FICB). Outcomes included block-related parameters (procedure time, onset time, first ambulation time), analgesic effects (intraoperative sufentanil boluses, postoperative PCA pump activations, VAS scores), muscle strength [manual muscle testing (MMT) grades], and adverse reactions.Results The observation group demonstrated shorter procedure time, faster onset time, and earlier first ambulation compared to the control group (all P < 0.05). The observation group required fewer intraoperative sufentanil boluses (P < 0.05), fewer postoperative PCA activations (P < 0.05), and exhibited lower VAS scores at rest (P < 0.05) and during 15° hip elevation (P < 0.05) at 8 hours postoperatively. Comparison of MMT grades of observation group and control group at 10 min (T₁), 2 h (T₂), 4 h (T₃), 6 h (T₄) and 12 h (T₅) after block anesthesia: (1) No significant temporal differences in MMT grades within groups (P > 0.05); (2) Significant intergroup differences in MMT grades (P < 0.05); (3) Significant divergence in MMT grade trends between groups (P < 0.05). No intergroup difference in adverse reaction rates was observed (P > 0.05).Conclusion The IPB + LFCNB protocol reduces procedural time, accelerates anesthesia onset, facilitates early postoperative ambulation, enhances analgesia, and maintains safety in hip fracture surgery.