腰方肌阻滞与髂筋膜阻滞对老年人全髋关节置换术后镇痛效果的比较研究

Comparative study of quadratus lumborum block and fascia iliaca compartment block in postoperative analgesia in elderly patients with total hip arthroplasty

目的比较超声引导下腰方肌阻滞与髂筋膜阻滞在老年人全髋关节置换术后镇痛效果。方法选择单次蛛网膜下腔麻醉下行单侧全髋关节置换术的老年患者60例为研究对象。ASA分级Ⅱ、Ⅲ级,采用随机数字表法将患者分成两组:A组术毕使用0.25%罗哌卡因30 ml行超声引导下后方穿刺入路腰方肌阻滞(QL3),B组术毕使用行0.25%罗哌卡因30 ml行超声引导下髂筋膜阻滞;每组30例。术后均留置静脉自控镇痛泵。记录患者一般情况,分别记录A组与B组操作完成时间,术后6 h(T_1)、8 h(T_2)、12 h(T_3)、24 h(T_4)患者的静息状态及被动运动VAS评分;舒芬太尼使用累计量;麻醉相关并发症;术后24 h患者麻醉满意度评价。结果两组患者术后不同时间点的静息及被动运动VAS评分比较,差异有统计学意义(P<0.05)。A组术后T_1、T_2、T_3、T_4静息及被动运动VAS评分均低于B组(P<0.05)。A组静脉自控镇痛泵舒芬太尼使用量少于B组(P<0.05)。A组恶心呕吐发生率低于B组(P<0.05)。A组总体满意度高于B组。结论超声引导下腰方肌阻滞在老年人全髋关节置换术术后镇痛效果好,安全可行,能减少术后静脉镇痛药物的使用量,提高患者的总体满意度。

Objective To evaluate the analgesic effect of quadratus lumborum block and fascia iliaca compartment block in elderly patients with total hip arthroplasty.Methods A total of sixty elderly patients with ASAⅡorⅢreceived total hip arthroplasty via unilateral approach under single spinal anesthesia.Patients were enrolled and randomly divided into 2 groups(n=30):quadratus lumborum block ground(ground A)and fascia iliaca compartment block ground(ground B).Patients in group A ground received posterior puncture approach of quadratus lumborum block(QL3)with 0.25%ropivacaine under the guidance of ultrasound.Patients in group B received fascia iliaca compartment block with 0.25%ropivacaine under the guidance of ultrasound.All the patients received patientscontrolled intravenous analgesia.General parameters of the patients,the performance time,resting and the exercise VAS scores at various time points[6 h(T1),8 h(T2),12 h(T3),24 h(T4)after the operation],amount of Sufentanil,complications,and satisfaction score at postoperative 24 h were recorded.Results Patients in group A experienced decreased levels of resting and the exercise VAS scores at the T1,T2,T3,T4 compared with those in ground B(P<0.05).Cumulative amount of sufentanil in group A were significantly less than that of group B(P<0.05).The satisfaction score of ground A were significantly increased than that of ground B(P<0.05).Conclusions Ultrasound-guide quadratus lumborum block is a safe and satisfactory approach for postoperative analgesia in elderly patients with total hip arthroplasty.