两种入路持续髂筋膜间隙阻滞在全髋关节置换术中的应用

Application of two approaches for continuous iliofascial space block in total hip arthroplasty

目的探讨超声引导内侧入路和外侧入路持续髂筋膜间隙阻滞在全髋关节置换术中的应用效果。方法按照麻醉与术后镇痛方式不同将130例行全髋关节置换的患者分为全身麻醉联合内侧入路髂筋膜间隙阻滞组(A组,48例)、全身麻醉联合外侧入路髂筋膜间隙阻滞组(B组,42例)和全身麻醉静脉自控镇痛组(C组,40例)。记录3组手术情况、术后不同时间点静息和活动时疼痛VAS评分、恶心呕吐发生情况,比较A、B组神经阻滞相关情况。结果手术时间、术中出血量、输液量3组比较差异均无统计学意义(P>0.05),术中使用附加镇痛药物率及术后恶心呕吐发生率A、B组明显低于C组(P<0.05)。术后24、48 h静息和活动时VAS评分A、B组均明显低于C组(P<0.05)。导管重新固定率和术后48 h罗哌卡因总用量、置管时间、置管深度A组均优于B组(P<0.05),超声准备和成像时间、穿刺注药时间A、B组比较差异均无统计学意义(P>0.05)。术后24、48 h股外侧皮神经阻滞满意度A组高于B组(P<0.05)。结论超声引导内侧入路持续髂筋膜间隙阻滞能减少罗哌卡因用量,置管更具优势。

Objective To investigate the application effect of ultrasound-guided medial approach and lateral approach for continuous iliofascial space block in total hip arthroplasty(THA).Methods According to the different ways of anesthesia and postoperative analgesia,the 130 patients who underwent THA were divided into general anesthesia combined with medial approach iliofascial space block group(group A,48 cases),general anesthesia combined with lateral approach iliofascial space block group(group B,42 cases)and general anesthesia patient-controlled intravenous analgesia group(group C,40 cases).The operation situation,pain VAS during rest and activity at postoperative different time points,the incidence of nausea and vomiting in the three groups were recorded,and the related situation of nerve block in the group A and B was compared.Results There were no significant differences in operation time and intraoperative blood loss and transfusion volume among the three groups(P>0.05),the group A and B were significantly lower than group C in the rate of intraoperative using additional analgesic drugs and the incidence of postoperative nausea and vomiting(P<0.05).At 24,48 h postoperation,VAS in resting and activity of group A and group B were significantly lower than group C(P<0.05).The catheter reattachment rate and the total dosage of ropivacaine within 48 h after operation,the catheter insertion time,the catheter insertion depth in group A were superior to group B(P<0.05).There were no significant differences in ultrasound preparation and imaging time,puncture injection drugs time between group A and B(P>0.05).At 24,48 h postoperation,the satisfaction of lateral femoral nerve block in group A was higher than that in group B(P<0.05).Conclusions Ultrasound-guided medial approach continuous iliofascial space block can reduce the dosage of ropivacaine,and catheterization is more advantageous.