超声引导下连续髂筋膜阻滞用于老年全髋关节置换术后镇痛和功能恢复的效果

Efficacy of ultrasound-guided continuous fascia iliaca compartment block for postoperative analgesia and function recovery in elderly patients undergoing total hip arthroplasty

目的观察超声引导下连续髂筋膜阻滞(continuous fascia iliaca compartment block,CFICB)用于老年全髋关节置换(total hip arthroplasty,THA)术后镇痛和功能恢复的效果。方法择期全身麻醉下行THA老年患者60例,采用随机数字表法将患者分为两组(每组30例):CFICB组和对照组。CFICB组患者在全身麻醉前30min行CFICB,术后镇痛行CFICB,对照组患者术后行自控静脉镇痛。评估术后6、12、24、48h静息时VAS评分及术后24、48h运动时VAS评分,记录术后补救镇痛情况,术后24、48h肌力评分,副作用的发生情况,48h患者满意度,术后2周髋关节Harris评分,术后下地时间和住院天数。结果CFICB组静息和运动时的各时点VAS评分明显低于对照组(P<0.05),其中CFICB组有3例(10.0%)患者,对照组有16例(53.3%)患者追加了地佐辛补救镇痛,两组间差异有统计学意义(P<0.05);两组患者术后患肢肌力评分差异无统计学意义(P>0.05);CFICB组患者术后恶心呕吐发生率(6.7%)低于对照组(50.0%)(P<0.05);CFICB组患者术后满意度(90.0%)高于对照组(63.3%)(P<0.05);CFICB组患者术后2周髋关节Harris评分高于对照组(P<0.05);两组患者术后下地时间和住院天数差异无统计学意义(P>0.05)。结论超声引导下CFICB能有效地为THA患者提供良好的镇痛,减少全身麻醉药物的用量,降低相关副作用的发生率,促进患者早期康复锻炼。

Objective To observe the efficacy of ultrasound-guided continuous fascia iliaca compartment block (CFICB) for postoperative analgesia and function recovery in elderly patients undergoing total hip arthroplasty (THA). Methods Sixty elderly patients undergoing elective THA were enrolled under general anesthesia. The patients were randomly divided into two groups (n=30):group CFICB and group control. Patients in group CFICB received CFICB by ultrasound at 30 min before anesthesia and received CFICB for postoperative analgesia while the group control was provided with patient-controlled intravenous analgesia. Postoperative pain at rest and movement were evaluated. The postoperative requirement of remedy analgesics, muscle strength score at 24 h and 48 h postoperatively, the incidence of adverse effect, satisfaction at 48 h after surgery, Harris hip joint score, time to first walk and duration of hospital stay were recorded. Results The VAS at rest and movement was improved significantly in group CFICB when compared with group control (P<0.05). There were 3 (10.0%) patients in group CFICB and 16 (53.3%) patients in group control were given dezocine, the difference between the two groups was statistically significant (P<0.05). There was no significant difference in limb muscle strength between the two groups after operation (P>0.05). The incidence of postoperative nausea and vomiting was 6.7% in group CFICB and 50.0% in group control (P<0.05) respectively. The postoperative satisfaction of group CFICB was 90.0%, which was higher than that of group control (63.3%, P<0.05). Harris hip joint score in group CFICB was higher than that score in group control (P<0.05). No significant difference in day of first walk and duration of hospital stay was detected (P>0.05). Conclusions Ultrasound-guided CFICB can effectively provide good analgesia for THA patients, reduce the amount of general anesthetics and the incidence of adverse events, and promote early rehabilitation exercise. It is deserved to be promoted in clinical application.