超声引导神经阻滞复合连续硬膜外麻醉在高龄患者髋部骨折手术的应用

Ultrasound guided nerve block combined with epidural anesthesia in aged patients undergoing hip fracture surgery

目的研究超声引导下股神经股外侧皮神经阻滞复合连续硬膜外麻醉在高龄患者髋部骨折手术中的应用。方法择期行髋部骨折手术的高龄患者32例,首先平卧位超声引导下行患侧股神经及股外侧皮神经阻滞,然后侧卧位行硬膜外穿刺,术中按需分次追加硬膜外用药。评估患者侧卧位时、术中、术后12 h时VAS评分以及体位摆放时合作程度,记录硬膜外用药总量以及芬太尼使用剂量,观察术后并发症的发生。结果所有患者均顺利完成手术,神经阻滞后患者疼痛减轻,体位摆放合作,术中术后镇痛完善,硬膜外用药总量(10.5±1.7)ml,芬太尼总剂量(107.3±10.6)μg,所有患者未见明显术后并发症。结论超声引导下股神经股外侧皮神经阻滞复合连续硬膜外麻醉的方法用于髋部骨折可有效减轻高龄患者体位摆放时疼痛不适,麻醉效果完善,术中生命体征稳定,术后疼痛减轻,是高龄危重患者行该类手术时值得采用的麻醉方式。

Objective To explore the application of ultrasound guided femoral nerve block and lateral femoral cutaneous nerve block combined with continuous epidural anesthesia in aged patients undergoing hip fracture surgery. Methods On the supine, the ultrasound guided femoral nerve block and lateral femoral cutaneous nerve block was implemented in 32 aged patients. Then follow by epidural anesthesia at lateral position, assessed the VAS when change position, during operation and 12 h after surgery and the level of cooperation when from the supine to the lateral position;Recorded the does of epidural administration and dosage of Fentanyl via the vein;The postoperative complication was observed. Results All patients underwent surgery successfully, the pain was relieved after nerve block; The patients were cooperated when change position; There was no obvious pain during and after operation. The total dosage of epidural administration was 10.5±1.7 ml and 107.3±10.6 ug of Fentanyl. No complication was observed after operation. Conclusions Ultrasound guided femoral nerve block and lateral femoral cutaneous nerve block combined with continuous epidural anesthesia in aged patients undergoing hip fracture surgery can alleviate pain when changing position, the anesthesia effect was reliable during operation, and pain after surgery was relieved. It is appropriate anesthesia method for patients of this type.