髂筋膜间隙阻滞对老年全髋关节置换术后疼痛的影响

Effects of fascia iliaca compartment block with ropivacaine combined with dexmedetomidine on postoperative pain in elderly patients underwent total hip arthroplasty

目的 探讨右美托咪定复合罗哌卡因髂筋膜间隙阻滞对老年全髋关节置换术后疼痛的影响。方法选取2013年4月-2015年10月在该院择期行全髋关节置换术的患者96例,年龄65~79岁。按随机数字表法将患者分为联合组(48例)和罗哌卡因组(48例),全身麻醉前,两组患者行超声引导下髂筋膜间隙穿刺,罗哌卡因组给予0.5%罗哌卡因35 ml,联合组给予含右美托咪定1.0μg/kg的0.5%罗哌卡因35 ml,髂筋膜间隙阻滞后行全身麻醉。记录两组患者手术一般情况分别于阻滞后6(T_0)、12(T_1)、24(T_2)和48h(T_4)时,对患肢股神经和股外侧神经支配区域阻滞情况进行测定,对患者静态和动态疼痛程度进行评分,记录首次自控镇痛(PCA)时间、累计按压次数,以及舒芬太尼使用量,记录两组患者术后24 h内不良反应发生情况及两组患者对镇痛效果满意度。结果联合组患者T_2、T_3及T_4时股神经阻滞率高于罗哌卡因组,T_3和T_4时股外侧神经阻滞率高于罗哌卡因组(P<0.05)联合组患者T_2、T_3及T_4时静态VAS评分均低于罗哌卡因组,T_(1~4)时动态视觉模拟评分法评分均低于罗哌卡因组义(P<0.05);联合组患者首次PCA时间长于罗哌卡因组,而累计舒芬太尼使用量低于罗哌卡因组(P<0.05);联合组患者术后24 h内不良反应发生率为8.3%,低于罗哌卡因组的25.0%,联合组患者对镇痛效果满意度评分高于罗哌卡因组(P<0.05)。结论右美托咪定复合罗哌卡因髂筋膜间隙阻滞可有效缓解老年全髋关节置换术术后疼痛减少术后阿片类药物用量,提高患者对镇痛效果的满意度。

Objective To investigate the effects of fascia iliaca compartment block with ropivacaine com-bined with dexmedetomidine on postoperative pain in elderly patients underwent total hip replacement. Methods From April 2013 to October 2015, 96 cases of patients in our hospital underwent elective total hip arthro-plasty were selected. The ages were 65 to 79 years old. All patients were randomly divided into combined group （ =48） and ropivacaine group （ =48）. Before general anesthesia, patients in the two groups were accepted ultrasound-guided fascia iliaca compartment puncture. Patients in ropivacaine group were given 0.5% ropivacaine 35 ml. Patients in combined group were given 0.5% ropivacaine 35 ml containing dexmedetomidine 1.0μg/kg. After fascia iliaca compartment block, all patients were accepted general anesthesia. Respectively, 6 h （T0）, 12 h （T1）, 24 h （T2）, 36 h （T3） and 48 h （T4） after fascia iliaca compartment block, the innervation of block areas of femoral nerve and lateral femoral nerve were measured, the scores of static and dynamic pains were accessed. PCA time for the first time, the cumulative number of compressions and the cumulative sufentanil usage amount were recorded. The adverse events within 24 h after surgery in the two groups were recorded. The satisfaction on analgesia of patients in the two groups were recorded. Results The femoral nerve block rates at T2-4 in the combined group were higher than the ropivacaine group, the femoral lateral nerve block rates at T3-4 in the combined group were higher than the ropivacaine group （P〈0.05）. The static VAS scores at T2-4 in the combined group were lower than the ropivacaine group, and the dynamic VAS scores at T1-4 were lower than the ropivacaine group （P〈0.05）. The PCA time for the first time in the combined group was longer than the ropivacaine group, while the cumulative sufentanil usage amount was lower than the ropiva-caine group （P〈0.05）. The adverse reaction rate within 24 h in the combined group was 8.3%, which was lower than 25.0% in the ropivacaine group, and the satisfaction score on the analgesic effect in the combined group was higher than the ropivacaine group （P〈0.05）. Conclusions Fascia iliaca compartment block with ropivacaine combined with dexmedetomidine could effectively alleviate postoperative pain in elderly total hip arthroplasty, reduce the postoperative opioid consumption, and improve patient satisfaction on analgesia.