一种安全简单的超声引导髂筋膜间隙阻滞新方法:“沙漏法”

Hourglass Pattern:a Safe and Effective Method of Ultrasound-guided Fascia Iliaca Compartment Block

目的：探讨“沙漏法”超声引导髂筋膜间隙阻滞（fascia iliaca compartment block，FICB）用于全髋关节置换术后镇痛的有效性。方法经伦理委员会批准，选择2014年1～5月我院择期全髋关节置换术30例，腰硬联合麻醉前应用“沙漏法”行超声引导 FICB，辨认出“沙漏征”（腹内斜肌与缝匠肌），放置导管，给予负荷量0．2％罗哌卡因40 ml，随后连接镇痛泵，0．2％罗哌卡因10 ml ／h 持续输注，使用时间48 h。记录30 min 内股神经和股外侧皮神经感觉阻滞起效情况，阻滞后4、8、12、24、36、48 h 患者静息状态疼痛评分，阻滞后48 h 患者满意度评分，以及不良反应发生率。结果30 min 内股神经和股外侧皮神经感觉阻滞成功率100％，阻滞后4、8、12、24、36、48 h 疼痛数字评价量表（numerical rating pain scale，NRPS）中位数均＜4分，阻滞后48 h 患者满意度评分为（8．0±0．9）分。无一例出现感染、局麻药中毒、出血及血肿等并发症。结论全髋关节置换术应用“沙漏法”进行超声引导 FICB，操作安全、简便，能够为患者提供有效的术后镇痛，可在临床上推广应用。

Objective To confirm the efficacy of the “Hourglass Pattern”of ultrasound-guided fascia iliaca compartment block （FICB）. Methods Approved by the medical ethics committee,we selected 30 patients undergoing selective total hip arthroplasty （THA ） in our hospital between January and May 2014.Before neuraxial anesthesia,ultrasound-guided FICB was performed.After identification of the “Hourglass Pattern”（internal oblique muscle and the sartorius muscle）,a catheter was inserted. The sheath between the fascia iliaca and the iliacus muscle was distended with 40 ml of 0.2% ropivacaine,and then a continuous infusion of ropivacaine at a rate of 10 ml /h was administered for 48 h.Loss of sensation in the distribution areas of the femoral nerve and lateral femoral cutaneous nerve within 30 min was recorded.Patients were interviewed at 4 h,8 h,12 h,24 h,36 h and 48 h after block for pain intensity.Patients’ satisfaction scores at 48 h after block and the occurrence of adverse events （infection,local anesthetic toxicity,hemorrhage and hematoma）was recorded. Results The successful rate of the block was 100% without any adverse events.The median of numerical rating pain scale （NRPS）was below 4 points at 4 h,8 h,12 h,24 h,36 h and 48 h after block,and the patients’satisfaction score was （8.0 ＆#177;0.9 ）points at 48 h after block.No adverse events occurred. Conclusions Ultrasound-guided FICB by using the “Hourglass Pattern”technique can offer effective analgesia after THA.It’s a safe method and can be easily performed.