超声引导下“三叶草”法腰丛阻滞与髂筋膜间隙阻滞用于髋关节镜术中的镇痛效果研究

Analgesic effects of ultrasound-guided lumbar plexus block by means of Shamrock method in hip arthroscopy

目的比较超声引导下“三叶草”法腰丛阻滞与超声引导下髂筋膜间隙阻滞用于髋关节镜手术的镇痛效果和安全性。方法单侧髋关节镜患者60例。随机分为腰丛阻滞组(L组)和髂筋膜间隙阻滞组(F组),每组30例。L组行“三叶草”法超声引导腰丛阻滞,F组行超声引导髂筋膜间隙阻滞,局麻药均予0.4%罗哌卡因25 ml。术中喉罩通气,全身麻醉瑞芬太尼血浆靶浓度4 ng/ml并调节异丙酚泵入量。记录阻滞操作时间和起效时间。记录全麻诱导后(T0)、牵引后(T1)、切皮(T2)、术中30 min(T3)、术中60 min(T4)、术毕(T5)、拔除喉罩后(T6)的平均动脉压(MBP)和心率(HR),计算异丙酚泵入量和关节腔灌洗液用量。术后记录拔除喉罩时间、苏醒期躁动发生率和镇痛满意率。观察外周神经阻滞和全身麻醉相关并发症。结果L组术中MBP和HR无明显波动(P>0.05),较F组血流动力学稳定(P<0.05)。与F组比较,L组操作时间明显升高,起效时间明显降低(P<0.01);术中异丙酚泵入量和关节腔灌洗液用量降低;术后拔除喉罩时间降低,苏醒期躁动发生率降低,镇痛满意率升高(P<0.05)。2组均未见外周神经阻滞和全身麻醉相关并发症。结论超声引导下“三叶草”法腰丛阻滞用于髋关节镜,镇痛效果满意,术中血流动力学更加平稳,可减少全麻药用量。

Objective To investigate and compare thw analgesic effects and safety between ultrasound-guided lumbar plexus block by Shamrock method and ultrasound-guided fascia iliaca compartment block in hip arthroscopy.Methods Sixty patients who underwent unilateral hip arthroscopy were randomly divided into lumbar plexus block group(group L)and fascia iliaca compartment block group(group F),with 30 cases in each group.Shamrock method ultrasound-guided lumbar plexus block was performed in group L,and ultrasound-guided fascia iliaca compartment block was performed in group F.The local anesthesia of 0.4%ropivacaine 25ml was injected in both groups,and the laryngeal mask airway and general anesthesia were used during operation,maintaining the effects with 4ng/ml of remifentanil plasma target concentration and adjusting infusion dose of propofol.The block operation time and onset time of local anesthetic were recorded.MBP and HR were recorded respectively at the different time points including after induction(T0),after traction(T1),incision(T2),30 minutes in operation(T3),60 minutes in operation(T4),immediately after operation(T5)and removing laryngeal mask(T6).Moreover the infusion dose of propofol and usage amount;of irrigating solution used in articular cavity were calculated.The time of removing laryngeal mask,incidence rate of emergence agitation and satisfaction rate of analgesia after operation,and the complications related to peripheral nerve block or general anesthesia were observed and compared between the two groups.Results In group L,there was no obvious fluctuation in MBP and HR during operation(P>0.05),and the hemodynamics indexes in group L were much more stable than those in group F(P<0.05).As compared with that in group F,the block operation time in group L was significantly increased,but the onset time of local anesthesia was significantly decreased(P<0.01),and the infusion dose of propofol and usage amount of irrigating solution used in articular cavity during operation were significantly decreased,and the time of removing laryngeal mask and the incidence rate of emergence agitation were significantly decreased,however,the satisfaction rate of analgesic effects after operation was significantly increased(P<0.05).No complication related to peripheral nerve block or general anesthesia were observed in both groups.Conclusion The analgesic effects of ultrasound-guided lumbar plexus block by means of Shamrock method in hip arthroscopy are satisfactory,with more stable hemodynamics indexes,which can decrease the dosage amount of general anesthesia drugs.