超声引导下改良髂筋膜间隙阻滞在老年髋部骨折患者摆放体位过程中的阻滞效果

Application of ultrasound-guided modified-fascia iliaca compartment block in the supine position in elderly patients with hip fracture

目的观察超声引导下改良髂筋膜间隙阻滞(modified-fescia iliac compartment block,M-FICB)用于老年髋部骨折患者体位变动的镇痛效果。方法限期行手术治疗老年髋部骨折患者60例,男17例,女43例,ASAⅡ或Ⅲ级,采用随机数字表法将患者分为两组:改良M-FICB组(M组)和FICB组(F组),每组30例。M组采用超声引导注射0.4%罗哌卡因5ml于闭孔神经,15ml于髂筋膜间隙;F组采用超声引导注射0.4%罗哌卡因20ml于髂筋膜间隙。两组患者20 min后进行椎管内麻醉体位摆放。记录超声引导下神经阻滞操作时间和神经阻滞起效时间。记录神经阻滞前(T_0)、神经阻滞后10min(T_1)、20min(T_2)、摆放椎管内麻醉体位时(T_3)、术后24h(T_4)VAS评分。结果 M组闭孔神经阻滞起效时间明显短于F组[(4.1±1.4)min vs(10.1±3.9)min,P<0.05]。两组神经阻滞操作时间差异无统计学意义[(2.2±0.5)min vs(2.1±0.5)min]。T_1~T_3时M组VAS评分明显低于F组(P<0.05);与T_0时比较,T_1~T_4时两组VAS评分明显降低(P<0.05)。结论超声引导下改良髂筋膜间隙阻滞有效阻滞闭孔神经,可以减轻老年髋部骨折患者体位摆放过程中的疼痛,并降低患者术后疼痛。

Objective To compare the analgesic effect of the ultrasound-guided modified-fascia iliaca compartment block with ultrasound-guided fascia iliaca compartment block injection in the treatment of elderly patients with hip fracture.Methods Sixty elderly patients with hip fracture,17 males and 43 females,falling into ASA physical statusⅡ orⅢ,were randomly divide into two groups（n=30 each）：ultrasound-guided modified fascial iliaca compartment block group（group M）and ultrasound-guided fascial iliaca compartment block group（group F）.The patients in group M received MFICB using ultrasound-guided injection of 0.4%ropivacaine 5 ml in obturator nerve,15 ml in the fascial iliac space.The patients in group F received ultrasound-guided injection of 0.4% ropivacaine 20 ml in the fascial iliac space.FICB or MFICB was performed 20 min before epidural anesthesia in group F or group M respectively.The time of ultrasound-guided nerve block was recorded,and the onset time of femoral nerve,lateral femoral cutaneous nerve and obturator nerve block were recorded in the two groups.Visual analogue pain scores（VAS）were recorded before nerve block（T0）,after nerve block,10 min（T1）,20 min（T2）,placing spinal anesthesia position（T3）,and postoperative 24 h（T4）.Results The onset time of obturator nerve block in group M was significantly shorter than that in group F [（4.1±1.4）min vs（10.1±3.9）min,P〈0.05].The time of ultrasound-guided nerve block has no difference between the two groups [（2.2±0.5）min vs（2.1±0.5）min].Compared with group F,the VAS scoress at T1-T3 were lower in group M（P〈0.05）.Compared with T0,the VAS scores at T1-T4 decreased in both groups（P〈 0.05）.Conclusion Ultrasound-guided fascia iliaca compartment block is more effective in reducing the VAS scores during the supine position and reducing postoperative pain.