髂筋膜阻滞对髋关节置换术后镇痛的麻醉价值

Anesthetic Value of Tendon Fascia Block for Analgesia after Hip Replacement

目的评价超声引导下髂筋膜阻滞对于全髋关节术后镇痛效果。方法该次研究对象为该院从2017年8月-2018年4月收治的76例全髋关节置换术患者,术后0.5 h内实施患侧超声引导下髂筋膜腔隙阻滞,按照随机数字法分为两组,甲组38例于髂筋膜间隙注射罗哌卡因,乙组38例于髂筋膜间隙注射生理盐水,对比两组术后镇痛效果。结果甲组术后静息下术后4 h、术后8 h、术后12 h、术后24 h、术后48 h的VAS评分(1.85±0.54)分、(1.75±0.51)分、(1.66±0.52)分、(1.58±0.40)分、(1.55±0.38)分低于乙组(2.10±0.60)分、(1.98±0.62)分、(1.88±0.55)分、(1.75±0.48)分、(1.72±0.45)分,差异有统计学意义(t=1.909、1.766、1.792、1.677、1.779,P<0.05),运动状态下的术后4 h、术后8 h、术后12 h、术后24 h、术后48 h的VAS评分(2.15±0.56)分、(2.05±0.54)分、(1.95±0.46)分、(1.84±0.50)分、(1.80±0.50)分低于乙组(2.55±0.65)分、(2.50±0.61)分、(2.35±0.55)分、(2.20±0.59)分、(2.07±0.60)分,差异有统计学意义(t=2.872、3.405、3.439、2.870、2.131,P<0.05),甲组术后0~12 h、12~24 h、24~48 h、48~72 h的芬太尼用量分别为(0.00±0.00)mg、(0.00±0.01)mg、(0.00±0.01)mg、(0.00±0.00)mg少于乙组(0.20±0.11)mg、(0.10±0.07)mg、(0.06±0.03)mg、(0.04±0.01)mg,对比差异有统计学意义(t=11.208、8.718、11.696、24.658,P<0.05)。结论全髋关节置换术经超声引导下髂筋膜阻滞麻醉镇痛效果显著,应用安全可靠。

Objective To evaluate the effect of ultrasound-guided iliac fascia block on postoperative analgesia in total hip arthroplasty.Methods The study included 76 patients with total hip arthroplasty who were admitted to the hospital from August 2017 to April 2018.The ultrasound-guided fascial lacunar space block was performed within 0.5 hours after surgery.The method was divided into two groups.38 patients in group A were injected with ropivacaine in the temporal fascia,and 38 patients in group B were injected with normal saline in the temporal and fascial space.The postoperative analgesic effect was compared between the two groups.Results The VAS scores(1.85±0.54)points,(1.75±0.51)points,and(1.66±0.52)points of group A were postoperatively resting 4 h,postoperative 8 h,postoperative 12 h,postoperative 24 h,and postoperative 48 h.(1.58±0.40)points and(1.55±0.38)points are lower than group B(2.10±0.60)points,(1.98±0.62)points,(1.88±0.55)points,(1.75±0.48)points,(1.72±0.45)points.The difference was statistically significant(t=1.909,1.766,1.792,1.677,1.779,P<0.05),4 h after surgery,8 h after surgery,12 h after surgery,24 h after surgery,48 h after surgery,VAS scores(2.15±0.56)points,(2.05±0.54)points,(1.95±0.46)points,(1.84±0.50)points,and(1.80±0.50)points were lower than group B(2.55±0.65)points,(2.50±0.61)points,(2.35±0.55)points,(2.20±0.59)points,(2.07±0.60)points,the difference was statistically significant(t=2.872,3.405,3.439,2.870,2.131,P<0.05),group A of the doses of fentanyl at 0-12 h,12-24 h,24-48 h and 48-72 h after operation were(0.00±0.00)mg,(0.00±0.01)mg,(0.00±0.01)mg,(0.00±0.00)mg,less than group B(0.20±0.11)mg,(0.10±0.07)mg,(0.06±0.03)mg,(0.04±0.01)mg,the comparison was statistically significant(t=11.208,8.718,11.696,24.658,P<0.05).Conclusion Total hip arthroplasty is effective in the analgesia of fascia fascia block under ultrasound guidance.The application is safe and reliable.