超声引导下髂筋膜间隙阻滞用于老年患者股骨近端骨折的早期镇痛

Ultrasound-guided fascia iliaca compartment block for early analgesia in elderly patients suffering from proximal femoral fractures

目的评价超声引导下髂筋膜间隙阻滞(FICB)用于老年患者股骨近端骨折早期疼痛的镇痛效果。方法选择股骨粗隆间骨折或股骨颈骨折老年患者120例,年龄65～94岁,BMI 17.4～28.3kg/m^2,美国麻醉医师协会(ASA)分级Ⅱ或Ⅲ级,采用计算机随机分组法将患者随机分为超声引导组和传统解剖定位组,每组60例,分别采用超声引导和传统解剖定位行FICB,在髂筋膜间隙注入0.4%盐酸罗哌卡因注射液30mL。记录阻滞完成时间(开始定位至注药完毕所需的时间),记录股外侧皮神经、股神经和闭孔神经阻滞起效时间(从注药完毕到相应神经支配皮肤区域针刺痛觉消失时间),计算阻滞有效率。记录行FICB前5min(T_0)和行FICB后5min(T_1)、15min(T_2)、30min(T_3),以及搬动患肢时(T_4)的疼痛VAS评分。记录行FICB后穿刺部位血肿、局部麻醉药中毒等并发症的发生情况。结果超声引导组的股神经、股外侧皮神经和闭孔神经阻滞起效时间有较传统解剖定位组缩短的趋势,但差异均无统计学意义(P值均>0.05)。超声引导组的闭孔神经阻滞有效率显著高于传统解剖定位组(P<0.05),但两组间阻滞完成时间和股神经、股外侧皮神经阻滞有效率的差异均无统计学意义(P值均>0.05)。超声引导组T_2至T_4时间点和传统解剖定位组T_2和T_3时间点的疼痛VAS评分均显著低于同组T_0时间点(P值均<0.05)。超声引导组T_3和T_4时间点的疼痛VAS评分均显著低于传统解剖定位组同时间点(P值均<0.05),两组间其余时间点疼痛VAS评分的差异均无统计学意义(P值均>0.05)。两组患者均未出现穿刺部位血肿、局部麻醉药中毒等FICB相关并发症。结论超声引导下FICB用于老年股骨近端骨折的早期镇痛操作简便、安全,阻滞效果更加确切。

Objective To evaluate the efficacy of ultrasound-guided fascia iliaca compartment block （FICB） for early analgesia in elderly patients suffering from proximal femoral fractures. Methods One hundred and twenty elderly patients with femoral intertrochanteric fracture or femoral neck fracture, aged 65-94 years, body mass index （BMI） 17.4-28.3 kg/m^2, American Society of Anesthesiologists （ASA） physical status Ⅱ or Ⅲ, were randomly divided into 2 groups using a random number by computer （n =60 each）. FICB was performed under ultrasonic guidance （group U） or by traditional anatomical positioning （group T）. A dose of 0. 4% ropivacaine 30 mL was injected in both groups. The blocking time, the onset time of femoral nerve, obturator nerve and lateral femoral cutaneous nerve block and the success rate of the three nerve blocks were recorded. At 5 min before FICB （T0）, 5 min （T1）, 15 rain （T2） and 30 min （T3） after FICB, and during moving limb （T4）, visual analog scale （VAS） scores were recorded. The complications such as hematoma and local anesthetic toxicity were also recorded. Results Compared with group T, the onset time of femoral nerve, obturator nerve and lateral femoral cutaneous nerve block was slightly decreased in group U, but the difference was not statistically significant （all P〉0.05）. The success rate of obturator nerve block was significantly higher in group U than that ingroup T （ P〈0.05）. But there were no significant differences in the blocking time, femoral nerve or lateral femoral cutaneous nerve block success rate between two groups （all P〉0.05）. The VAS scores at T2 and T3 in group T and VAS score from T2to T4 in group U were significantly lower than those at To （all P〈0.05）. The VAS scores at T3 and T4 in group U were significantly lower than those in group T （both P〈0.05）. No FICB related complications, such as hematoma or local anesthetic toxicity, were found in two groups. Conclusion Ultrasound-guided FICB is a simple, safe and more precise method for early analgesia in elderly patients suffering from proximal femoral fractures. （Shanghai Med J, 2018, 41, 603-606）