腹股沟韧带上髂筋膜间隙阻滞联合羟考酮用于老年髋部骨折术后的镇痛效果

Postoperative analgesic effect of supra-inguinal fascia iliaca compartment block combined with oxycodone for elderly patients undergoing surgery of hip fracture

目的:观察腹股沟韧带上髂筋膜间隙阻滞联合羟考酮用于老年髋部骨折术后的镇痛效果。方法:选择拟行髋部骨折手术的患者60例,美国麻醉医师学会(American Society of Anesthesiologists,ASA)评分Ⅱ或Ⅲ级,年龄65~89岁,随机分为腹股沟韧带上髂筋膜间隙阻滞联合羟考酮静脉自控镇痛组(SQ组)与腹股沟韧带下髂筋膜间隙阻滞联合羟考酮静脉自控镇痛组(IQ组),每组30例。SQ组腹股沟韧带上髂筋膜间隙阻滞给予0.33%罗哌卡因40 mL,IQ组腹股沟韧带下髂筋膜间隙阻滞给予0.33%罗哌卡因40 mL。两组均蛛网膜下腔注射0.33%轻比重布比卡因2.0 mL,并留置硬膜外导管。术毕连接患者自控静脉镇痛泵,药物配方为羟考酮注射液50 mg用0.9%氯化钠注射液稀释到100 mL,背景剂量为0 mL/h,单次按压注药为4 mL,锁定时间为15 min,镇痛至术后48 h。记录患者入室(T_(0))、摆放体位(T_(1))、术后6 h(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))及术后48 h(T_(5))的视觉模拟量表(Visual Analogue Scale,VA S)评分。记录羟考酮用量、患者满意度及局部麻醉药中毒、神经损伤、恶心呕吐、头晕、瘙痒、心动过缓等不良事件发生情况。结果:与IQ组比较,SQ组患者T_(1)、T_(2)时点静态VAS评分及T_(1)、T_(2)、T_(3)时点动态VAS评分降低(P<0.05)。与IQ组比较,SQ组羟考酮用量减少(P<0.05)。与IQ组比较,SQ组恶心呕吐、头晕发生率均降低(均P<0.05)。两组患者满意度、局部麻醉药中毒、神经损伤、瘙痒、心动过缓发生率差异均无统计学意义(均P>0.05)。结论:腹股沟韧带上髂筋膜间隙阻滞联合羟考酮可为老年髋部骨折患者提供完善的术后镇痛效果。

Objective:To observe the postoperative analgesic effect of supra-inguinal fascia iliaca compartment block combined with oxycodone for elderly patients undergoing surgery of hip fracture.Methods:Sixty elderly patients undergoing surgery of hip fracture,aged 65-89 years,with ASA Ⅱ or Ⅲ,were randomly assigned into 2 groups(n=30):a supra-inguinal fascia iliaca compartment block combined with oxycodone group(Group SQ)and a infra-inguinal fascia iliaca compartment block combined with oxycodone group(Group IQ).In Group SQ,supra-inguinal fascia iliaca compartment block was performed with 0.33%ropivacaine 40 mL.In Group IQ,infra-inguinal fascia iliaca compartment block was performed with 0.33%ropivacaine 40 mL.In both groups,2.0 mL of 0.33%light specific gravity of bupivacaine was injected into the subarachnoid space and an epidural catheter was left in place.The patient-controlled intravenous analgesia pump was connected after the operation.The patient-controlled intravenous analgesia solution contained oxycodone 50 mg diluted to 100 mL with 0.9%sodium chloride injection.The patient-controlled intravenous analgesia pump was set up with a bolus dose 4 mL,a 15-min lockout interval,and without background infusion,and the analgesia lasted to 48 h after the operation.The Visual Analogue Scales(VAS)of patients at entering the operation room(T_(0)),position change(T_(1)),6 hours after surgery(T_(2)),12 hours after surgery(T_(3)),24 hours after surgery(T_(4))and 48 hours after surgery(T_(5))were recorded.The consumption of oxycodone,satisfaction of patients were recorded.Adverse events such as local anesthetic poisoning,nerve injury,nausea and vomiting,dizziness,pruritus and bradycardia were recorded.Results:Compared with Group IQ,the static VAS scores at T_(1),T_(2) and the dynamic VAS scores at T_(1),T_(2),T_(3) in Group SQ decreased(P<0.05).Compared with Group IQ,the consumption of oxycodone was decreased in Group SQ(P<0.05).Compared with Group IQ,the incidence of nausea and vomiting and dizziness decreased in Group SQ(P<0.05).There was no significant difference between the 2 groups in term of the satisfaction of patients and the incidence of local anesthetic poisoning,nerve injury,pruritus,and bradycardia(P>0.05).Conclusion:Supra-inguinal fascia iliaca compartment block combined with oxycodone can provide perfect postoperative analgesic effect for elderly patients with hip fracture.