超声引导下髂筋膜联合腰方肌阻滞用于髋关节置换术后镇痛的效果

Effects of ultrasound guided fascia iliaca compartment-quadratus lumborum block in analgesia after hip arthroplasty

目的观察超声引导下髂筋膜联合腰方肌阻滞用于髋关节置换术后镇痛的效果。方法选择2017年3—12月拟行择期髋关节置换术患者60例,男26例,女34例,年龄55~75岁,体重45~70 kg,ASA Ⅰ或Ⅱ级。采用随机数字表法将患者随机分为两组:髂筋膜组(N组)和髂筋膜联合腰方肌组(T组),每组30例。T组术后行超声引导下髂筋膜联合腰方肌阻滞,各注射0.375%罗哌卡因15 ml。N组术后行超声引导下髂筋膜阻滞,注射0.375%罗哌卡因30 ml。术后两组均采用PCIA至术后48 h。记录阻滞操作前(T0)、术后3 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、36 h(T5)、48 h(T6)时静息状态VAS评分以及T4—T6时运动状态VAS评分;记录阻滞后0~4 h、4~8 h、8~12 h、12~24 h、24~36 h、36~48 h各时段PCIA有效按压次数;记录T3—T6时术侧髋关节最大屈曲和外展活动度;记录术后不良反应。结果 T组T1—T6时静息状态VAS评分和T4—T6时运动状态VAS评分明显低于N组(P<0.01)。阻滞后48 h内各时段T组PCIA有效按压次数明显少于N组(P<0.01)。T组髋关节最大屈曲和外展活动度明显大于N组(P<0.01)。T组术后恶心呕吐和尿储留发生率明显低于N组(P<0.05)。结论超声引导下髂筋膜联合腰方肌阻滞用于髋关节置换术后镇痛效果显著,镇痛作用确切,不良反应发生率低。

Objective To observe the efficacy of ultrasound guided fascia iliaca compartment combined with quadratus lumborum block for postoperative analgesia after hip arthroplasty. Methods Sixty patients scheduled for hip arthroplasty from March to December 2017, 26 males and 34 females, aged 55-75 years, weighing 45-70 kg, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into fascia iliaca compartment block(group N, n = 30) and fascia iliaca compartment-quadratus lumborum block(group T, n = 30). Group T was implemented on the affected side at the end of operation and 15 ml 0.375% ropivacaine were administrated separately, while group N was administered 30 ml 0.375% ropivacaine. The two groups received patient controlled intravenous analgesia(PCIA) till 48 h after surgery. The rest visual analogue score(VAS) was recorded at 0 h(T0), 3 h(T1), 6 h(T2), 12 h(T3), 24 h(T4), 36 h(T5), 48 h(T6) after sugery and the VAS scores on movement were recorded at T4-T6. The demands of PCIA during 0-4 h, 4-8 h, 8-12 h,12-24 h, 24-36 h, 36-48 h after blocking were recorded. The maximal flexion and abduction degrees of hip joint at T3—T6 were evaluated. The postoperative adverse effects were recorded. Results The VAS at rest were lower in group T than those in group N at T1-T6( P < 0.01). The VAS on movement were lower in group T than those in group N at T4 -T6 (P < 0.01). The demands of PCIA were lower in group T than those in group N within 48 h after block(P < 0.01). The maximum flexion degrees and the abduction degrees were increased in group T more than group N at all time points(P < 0.01). The cases of postoperative nausea and vomiting, retention of urin in group T were less than those in group N(P < 0.05). Conclusion Ultrasound guided fascia iliaca compartment combined with quadratus lumborum block can offer effective analgesia after hip arthroplasty, the analgesic effect is more precise and safe.