超声引导下股神经阻滞联合纳布啡术前镇痛对髋部骨折患者椎管内穿刺前体位痛的镇痛效果

Analgesia effects of preoperative analgesia using femoral nerve block guided by ultrasound combined with nalbuphine on postural pain before intraspinal anesthesia in patients with hip fracture

目的探讨超声引导下股神经阻滞联合纳布啡术前镇痛对髋部骨折患者椎管内麻醉前体位痛的镇痛效果。方法选择90例髋部骨折患者,采用随机数字表法将患者分为纳布啡组(N组)、股神经阻滞组(F组)和股神经阻滞联合纳布啡组(FN组),每组30例。所有患者入院后均静脉注射氟比洛芬酯50 mg,3次/d。入手术室后,N组给予静脉滴注纳布啡0.2 mg/kg;F组给予超声引导联合神经刺激仪行股神经阻滞,注入0.375%罗哌卡因15 mL;FN组同时给予F组和N组的镇痛方案。记录患者术前镇痛实施前(T0)、术前镇痛实施后(T1)、过床后5 min(T2)和摆侧卧位后5 min(T3)静态和动态VAS评分、平均动脉压(MAP)、心率(HR)、外周血氧饱和度(SpO 2);比较三组术前镇痛不良反应(恶心、呕吐、头晕、过度镇静及呼吸抑制)发生率、镇痛失败率及相关并发症情况。结果三组患者的静态和动态VAS评分差异有统计学意义,且静态和动态VAS评分均有随时间变化的趋势,分组与时间存在交互作用(均P<0.05);FN组的静息VAS评分在T3时明显低于N组、F组(P<0.05),而其余时点比较差异无统计学意义(均P>0.05)。FN组动态VAS评分在T1、T2、T3时明显低于N组、F组(均P<0.05)。三组的MAP、HR差异有统计学意义,且MAP、HR均有随时间变化的趋势,分组与时间存在交互作用(均P<0.05)。三组各时点SpO 2比较差异无统计学意义(均P>0.05)。三组患者均未出现恶心、呕吐、头晕、过度镇静及呼吸抑制等不良反应;F组、FN组未出现局麻药中毒反应、血肿等神经阻滞相关的并发症;三组患者术前镇痛的失败率比较差异无统计学意义(P>0.05)。结论超声引导下股神经阻滞联合纳布啡用于髋部骨折患者椎管内穿刺前体位痛,安全有效,是较为可靠的术前镇痛方法。

Objective To investigate the analgesia effects of preoperative analgesia employing ultrasound-guided femoral nerve block combined with nalbuphine on postural pain before intraspinal anesthesia in patients with hip fracture.Methods A total of 90 patients with hip fracture were selected and assigned to nalbuphine group(N group),femoral nerve block group(F group),and femoral nerve block combined with nalbuphine group(FN group)by the random number table method,with 30 cases in each group.All patients were intravenously injected flurbiprofen axetil 50 mg,3 times per day after admission.After entering the operation room,the N group was intravenously dripped nalbuphine 0.2 mg/kg,whereas the F group received ultrasound-guided combined with nerve stimulator femoral nerve block,and the patients were injected 0.375%ropivacaine 15 mL;meanwhile,the FN group received the analgesic solution of the F and N groups simultaneously.The static and dynamic VAS scores,mean arterial pressure(MAP),heart rate(HR)and peripheral oxygen saturation(SpO 2)were recorded before preoperative analgesia implementation(T0),after preoperative analgesia implementation(T1),5 min after crossing the bed(T2),and 5 min after side lying(T3).The incidence of preoperative analgesia adverse reactions,including nausea,vomiting,dizziness,excessive sedation and respiratory depression,as well as the incidence of analgesic failure and the conditions of related complications were compared between the three groups.Results There were statistically significant differences in static and dynamic VAS scores between the three groups,and both static and dynamic VAS scores had a tendency to change with time;moreover,there was interaction between grouping and time(all P<0.05);the static VAS score in T3 of the FN group was significantly lower than that of the N and F groups(P<0.05),whereas no statistically significant differences were interpreted in the rest of the time(all P>0.05).The dynamic VAS scores in T1,T2 and T3 of the FN group were significantly lower than those of the N and F groups(all P<0.05).There were statistically significant differences in MAP and HR between the three groups,the indicators mentioned above had a tendency to change with time,and there was interaction between grouping and time(all P<0.05).There was no statistically significant difference of SpO 2 at each time point between the three groups(all P>0.05).No adverse reactions including nausea,vomiting,dizziness,excessive sedation and respiratory depression occurred in the three groups.No nerve block related complications including anesthetic toxicosis,hematoma,etc.occurred in the F and FN groups.There was no statistically significant difference of preoperative analgesia failure rate between the three groups(P>0.05).Conclusion Ultrasound-guided femoral nerve block combined with nalbuphine is safe and effective for postural pain before intraspinal analgesia in patients with hip fracture,and it is a more reliable preoperative analgesic method.