“三叶草”法超声引导下腰丛阻滞应用于髋关节镜术后镇痛的前瞻性随机对照研究

Analgesic Effect of “Shamrock”Method Ultrasound-guided Lumbar Plexus Block After Hip Arthroscopy: a Prospective Randomized Controlled Study

目的探讨“三叶草”法超声引导腰丛阻滞用于髋关节镜术后的镇痛效果及安全性。方法选择单侧髋关节镜手术80例,随机分为2组:术后神经阻滞组和单纯全麻组,每组40例。术中采用喉罩通气,静脉吸入复合麻醉。术毕即刻行“三叶草”法超声引导腰丛阻滞,术后神经阻滞组给予0.4%罗哌卡因25 ml,单纯全麻组给予生理盐水25 ml。2组术后48 h内均采用静脉患者自控镇痛(patient controlled analgesia,PCA),比较2组术后0~4 h、4~8 h、8~12 h、12~24 h、24~48 h内最大疼痛程度评分(Visual Analogue Scale max,VASmax),记录术后PCA首次使用时间,0~24 h和24~48 h内PCA使用次数、有效按压率及舒芬太尼用量,观察术后恶心呕吐、呼吸抑制、瘙痒、尿潴留、双侧阻滞、肾损伤及穿刺部位出血、血肿等并发症。结果与单纯全麻组比较,术后神经阻滞组术后PCA首次使用时间明显延长[(6.2±1.6)h vs.(3.8±1.8)h,t=6.382,P=0.000];0~24 h内PCA使用次数明显减少[(18.4±6.4)次vs.(31.8±7.5)次,t=-8.619,P=0.000];有效按压率明显升高[(89.2±3.6)%vs.(85.8±4.2)%,t=3.814,P=0.000];舒芬太尼用量减少[(37.9±11.8)μg vs.(59.9±14.0)μg,t=-7.586,P=0.000]。术后神经阻滞组术后0~4 h、4~8 h、8~12 h内VASmax评分均明显低于单纯全麻组(P=0.000)。单纯全麻组出现术后恶心呕吐9例(22.5%),瘙痒1例(2.5%),术后神经阻滞组无相关并发症。结论髋关节镜术后采用“三叶草”法超声引导腰丛阻滞镇痛效果明显,可明显减少术后24 h内舒芬太尼用量,且并发症少。

Objective To evaluate the analgesic effect and safety of ultrasound-guided lumbar plexus block with the"shamrock"method after hip arthroscopy.Methods Eighty patients receiving unilateral hip arthroscopy were randomly divided into two groups with 40 cases in each group:lumbar plexus block group(group L)and control group(group C).Mechanical ventilation established with laryngeal mask airway and general anesthesia maintained with sevoflurane inhalation and propofol intravenous administration were used during the surgery.Ultrasound-guided lumbar plexus block with the“shamrock”method was performed immediately after operation.The 0.4%ropivacaine 25 ml were injected in the group L,and 0.9%normal saline 25 ml were injected in the group C.Intravenous patient controlled analgesia(PCA)was used continuously for 48 hours after surgery in both groups.Postoperative pain evaluated by visual analogue scale of maximum(VASmax)during 0-4 h,4-8 h,8-12 h,12-24 h,and 24-48 h was compared between the two groups.The first time to use PCA,frequency of using PCA,effective pressing rate,and consumption of sufentanil within 0-24 h and 24-48 h after surgery were recorded respectively.Meanwhile,the postoperative nausea and vomiting(PONV),respiratory depression,pruritus,urinary retention,bilateral block,renal injury,bleeding or hematoma and other complications were observed.Results Compared with the group C,the group L had much longer first time to use PCA[(6.2±1.6)h vs.(3.8±1.8)h,t=6.382,P=0.000],less frequency of using PCA[(18.4±6.4)times vs.(31.8±7.5)times,t=-8.619,P=0.000],higher effective pressing rate[(89.2±3.6)%vs.(85.8±4.2)%,t=3.814,P=0.000],and lower consumption of sufentanil within 0-24 h[(37.9±11.8)μg vs.(59.9±14.0)μg,t=-7.586,P=0.000].The VASmax were significantly lower in the group L during 0-4 h,4-8 h,and 8-12 h than those in the group C(P=0.000).There were 9 cases(22.5%)of PONV and 1 case(2.5%)of pruritus in the group C,and no complication was observed in the group L.Conclusion Ultrasound-guided lumbar plexus block with the"shamrock"method after hip arthroscopy has obvious analgesia effect,reduces consumption of sufentanil within 24 hours after surgery,and results in few complications.