吗啡复合罗哌卡因髂筋膜间隙阻滞在股骨粗隆间骨折术后镇痛中的应用效果

Analgesic Effects of Morphine Combined with Ropivacaine for Iliac Fascia Space Block After Receiving Intertrochanteric Fracture Surgery

目的探讨吗啡复合罗哌卡因髂筋膜间隙阻滞在股骨粗隆间骨折术后镇痛中的应用效果。方法选择2017年9月至2020年9月于医院择期行单侧股骨粗隆间骨折闭合复位内固定手术的患者60例作为研究对象,采用随机数字表法分为两组,每组30例。两组均采用超声引导患侧髂筋膜间隙阻滞联合静脉全身麻醉(未行气管插管)的标准化麻醉方案,对照组采用0.2%罗哌卡因40 ml行髂筋膜间隙阻滞,试验组则采用加入2 mg吗啡的0.2%罗哌卡因混合液40 ml行髂筋膜间隙阻滞,比较两组感觉阻滞、运动阻滞的起效时间和持续时间,术后2、4、6、12、24、48 h的疼痛评分,初次氟比洛芬酯补救性镇痛时间及氟比洛芬酯补救性镇痛率,以及术后48 h内麻醉相关并发症发生率。结果试验组感觉阻滞、运动阻滞起效时间均短于对照组,持续时间均长于对照组,差异有统计学意义(P<0.05);试验组术后12 h的视觉模拟评分法(VAS)评分低于对照组,差异有统计学意义(P<0.05);两组术后2、4、6、24、48 h的VAS评分比较,差异无统计学意义(P>0.05);试验组初次氟比洛芬酯补救性镇痛时间长于对照组,差异有统计学意义(P<0.05);两组氟比洛芬酯补救性镇痛率比较,差异无统计学意义(P>0.05);两组术后48 h内均未发生麻醉相关并发症。结论吗啡复合罗哌卡因髂筋膜间隙阻滞在股骨粗隆间骨折术后镇痛中的应用效果优于罗哌卡因单独应用,可缩短阻滞起效时间,延长持续时间,且可延长初次氟比洛芬酯补救性镇痛时间。

Objective The analgesic effects of morphine combined with ropivacaine for iliac fascia space block after receiving intertrochanteric fracture surgery were explored.Methods 60 patients with unilateral intertrochanteric fracture who underwent closed reduction and internal fixation in the hospital from September 2017 to September 2020 were selected as the subjects in this study and they were divided into two groups according to the random number table method,with 30 cases in each.The standardized anesthesia scheme of ultrasound-guided iliac fascia space block of affected side combined with intravenous general anesthesia without tracheal intubation was used in both groups.40 ml of 0.2%ropivacaine was used in the control group and the test group were given 40 ml of 0.2%ropivacaine mixed with 2 mg morphine during iliac fascia block.The onset time of sensory and motion block,the duration of sensory and motion block,scores of static pain at 2,4,6,12,24,48 h after operation,the elapsed time of the first rescue analgesia with flurbiprofen axetil,the incidence of rescue analgesia with flurbiprofen axetil and the anesthesia related complications within 48 hours after operation were compared between the two groups.Results The onset time of sensory and motor block in the test group were earlier than those in the control group,the duration of sensory and motor block in the test group were longer than those in the control group,and the differences were all statistically significant(P<0.05);The visual analogue scale(VAS)scores of static pain in the test group at 12 h after operation was lower than that in the control group,and the difference was statistically significant(P<0.05).When the VAS scores between the two groups at 2,4,6,24,48 h were compared,the differences were not statistically significant(P>0.05);The elapsed time of the first rescue analgesia with flurbiprofen axetil in the test group was longer than that in the control group,and the difference was statistically significant(P<0.05);When the incidence of rescue analgesia with flurbiprofen axetil were compared,the difference was not statistically significant(P>0.05);There was no anesthesia related complications within 48 hours after operation in the two groups.Conclusion The application effects of morphine combined with ropivacaine iliac fascia space block for postoperative analgesia of intertrochanteric fracture of were better than those of ropivacaine alone,with shorten onset time of block,prolonged duration and the elapsed time of the first rescue analgesia with flurbiprofen axetil.