术前髂筋膜间隙阻滞对老年髋部骨折手术患者加速康复的作用

The effect of preoperative fascial iliac compartment block on enhanced recovery after surgery for elderly patients with hip fracture

目的研究术前髂筋膜间隙阻滞(fascia iliac compartment block,FICB)对老年髋部骨折手术患者加速康复的影响。方法拟入院后48 h内行手术治疗的髋部骨折的老年患者56例,根据随机表法分为FICB组和对照组各28例。在超声引导下定位神经阻滞针尖至髂筋膜间隙,FICB组注入0.3%盐酸罗哌卡因和右美托咪定(1μg/ml)混合液30 ml,对照组注入生理盐水30 ml。观察两组患者术前等待手术时间、术后住院时间、不同时点盐酸曲马多用量和疼痛视觉模拟评分、术后呕吐以及神经阻滞相关并发症的发生率。结果与对照组比较,FICB组术后住院时间和术前等待手术时间较短,术前及术后48 h盐酸曲马多用量较少,阻滞后至术后次晨各时点疼痛视觉模拟评分较低,术后48 h呕吐的发生率较低,差异均有统计学意义(P<0.05)。两组患者均无神经阻滞相关并发症发生,术后48 h内未出现跌倒。结论术前采用FICB镇痛可缩短老年髋部骨折手术患者的术后住院时间和术前等待手术时间,减轻疼痛程度,对患者的加速康复具有促进作用。

Objective To investigate the effect of preoperative fascial iliac compartment block(FICB)on the enhanced recovery after surgery for elderly patients with hip fracture.Methods This is a prospective randomized control study.Total of 56 patients with hip fracture aged 65 years or older and scheduled for surgery within 48 h were enrolled in this study.The patients were randomly assigned into FICB group and control group according to a randomized block design,28 in each group.The nerve block tips were guided into fascial iliac compartment with ultrasound.In the FICB group,a mixed solution of 30 ml contained 0.3%ropivacaine hydrochloride and dexmedetomidine 1μg/ml was injected,while in the control group,a normal saline of 30 ml was injected.The preoperative waiting duration to surgery,postoperative in-hospital stay,tramadol hydrochloride usage and visual analogue scale(VAS)score at different points of time,the incidence of vomiting and nerve block-related complications were observed.Results Compared to the control group,the postoperative in-hospital stay and the preoperative waiting duration to surgery in the FICB group were shorter.The patients in the FICB group had less preoperative and postoperative tramadol hydrochloride usage,lower pain VAS score after nerve block until the next morning after surgery,and lower incidence rate of vomiting in 48 h after surgery when comparing with the patients in the control group(P<0.05).No nerve block-related complication and fall in the 48 h after surgery happened in both two groups.Conclusion Preoperative analgesia with FICB shorten the postoperative in-hospital stay and the preoperative waiting duration to surgery,relieve the degree of pain,and promote enhanced recovery after surgery for the elderly patients with hip fracture.