前路腰方肌阻滞复合髋关节囊周围浸润与髂筋膜阻滞对全髋关节置换患者术后疼痛研究

Study on Anterior Quadratus Lumborum Block Combined with Infiltration Around Hip Joint Capsule and Iliac Fascia Block on Postoperative Pain in Patients with Total Hip Replacement

目的探讨超声引导下前路腰方肌阻滞复合髋关节囊周围浸润麻醉与超声引导下腹股沟上髂筋膜阻滞对全髋关节置换患者术后疼痛影响。方法选取2019年2月-2020年2月该院收治的全麻下行THA患者60例为研究对象,随机将患者分为两组(每组30例):前路腰方肌阻滞复合髋关节囊周围浸润麻醉组(Q组)和腹股沟上髂筋膜阻滞组(F组)。两组患者术后均使用自控静脉镇痛泵。评估两组患者术后4、8、24、48 h静息时和被动运动时视觉模拟疼痛评分。结果两组患者术后各时间段静息时VAS评分无统计学差异(P>0.05),Q组患者术后4、8 h被动运动时VAS评分分别为(2.3±1.3)分、(4.3±1.1)分,明显低于F组,差异有统计学意义(t=3.100、9.704,P<0.05)。两组患者术后24、48 h被动运动时VAS评分比较差异无统计学意义(P>0.05)。结论超声引导下前路腰方肌阻滞复合髋关节囊周围浸润麻醉用于髋关节置换术中效果要优于超声引导下腹股沟上髂筋膜阻滞,可提高临床应用价值。

Objective To investigate the effect of ultrasound-guided anterior quadratus lumbar muscle block combined with infiltration anesthesia around the hip joint capsule and ultrasound-guided inguinal suprailiac fascia block on postoperative pain in patients with total hip replacement.Methods Sixty patients with THA under general anesthesia admitted to the hospital from February 2019 to February 2020 were selected as the research objects.The patients were randomly divided into two groups(30 cases in each group):anterior quadratus lumbar muscle block combined with hip joint pericapsular infiltration anesthesia group(Q group)and inguinal supenor iliac fascia block group(F group).Patients in both groups used self-controlled intravenous analgesia pump after operation.The visual analogue pain scores of patients in the two groups were evaluated at 4 h,8 h,24 h,and 48 h after operation.Results There was no statistically significant difference in the VAS scores of the two groups of patients at rest at various time periods after surgery(P>0.05).The VAS scores of patients in group Q were(2.3±1.3)points and(4.3±1.1)points during passive exercise at 4 h and 8 h after surgery,which was significantly lower than that of group F,the difference was statistically significant(t=3.110,9.704,P<0.05).There was no statistically significant difference in VAS scores between the two groups of patients during passive exercise at 24 h and 48 h after surgery(P>0.05).Conclusion The effect of ultrasound-guided anterior quadratus lumbar muscle block combined with infiltration anesthesia around the hip joint capsule in hip arthroplasty is better than that of ultrasound-guided inguinal epiiliac fascia block,which can improve the clinical application value.