超声引导下腹股沟韧带上髂筋膜间隙阻滞应用于髋关节置换术的镇痛效果评价

Evaluation of Analgesic Effect of Ultrasound-guided Superior Iliac Fascia Space Block of Inguinal Ligament in Hip Replacement

目的:探讨超声引导下腹股沟韧带上髂筋膜间隙阻滞应用于髋关节置换术的镇痛效果,为患者临床镇痛提供相关指导。方法:选取某院2020年7月~2021年6月行髋关节置换术的患者80例为研究对象,随机分为研究组和对照组各40例,研究组先采用超声引导下腹股沟韧带上髂筋膜间隙阻滞,再予腰硬联合麻醉下手术;对照组先采用腰硬联合麻醉下手术,术毕再予单次硬膜外镇痛。比较两组患者的镇痛效果,以椎管内穿刺体位VAS疼痛评分、术后VAS疼痛评分、术后各时刻FN、ON、LFCN阻滞率、术后开始主动活动时间、术后住院天数作为评价指标。结果:研究组患者椎管内穿刺体位VAS疼痛评分为(2.90±0.67)分,小于对照组的(5.58±0.87)分,差异有统计学意义且呈现显著性差异(P<0.01);研究组患者术后VAS疼痛评分为6h(2.10±0.30)分、12h(2.33±0.57)分、24h(3.25±0.54)分、48h(4.22±0.58)分,小于对照组的6h(3.02±0.36)分、12h(3.85±0.43)分、24h(5.05±0.45)分、48h(4.72±0.45)分,差异有统计学意义且呈现显著性差异(P<0.01);研究组患者术后住院天数为(5.22±0.86)d,少于对照组的(5.70±0.65)d,差异有统计学意义(P<0.05);两组FN阻滞率T1、T2、T3时刻,差异无统计学意义(P>0.05);但研究组T1、T2、T3时刻ON、LFCN阻滞率高于对照组,差异有统计学意义(P<0.05);且研究组术后开始主动活动时间(26.82±3.16)h,短于对照组的(35.47±4.23)h,差异有统计学意义(P<0.05)。结论:超声引导下腹股沟韧带上髂筋膜间隙阻滞应用于髋关节置换术的镇痛,使镇痛提前,术后镇痛持续时间长,术后住院天数少,符合ERAS理念,应用效果明显,值得临床推广。

Objective:To investigate the analgesic effect of ultrasound-guided superior iliac fascia space block of inguinal ligament in hip replacement,and to provide relevant guidance for clinical analgesia.Methods:80 patients who underwent hip replacement in a hospital from July 2020 to June 2021 were selected and randomly divided into study group and control group,with 40 cases in each group.The patients in the study group were first blocked by ultrasound-guided superior iliac fascia space of inguinal ligament,and then operated under combined spinal epidural anesthesia;The control group was operated under combined spinal epidural anesthesia,and then given single epidural analgesia after operation.The analgesic effects of the two groups were compared.The VAS pain score of intraspinal puncture position,postoperative VAS pain score,FN,ON,LFCN block rate at each time after operation,the time of active activity after operation and the number of days in hospital after operation were used as evaluation indexes.Results:The VAS pain score of intraspinal puncture position in the study group was(2.90±0.67),which was lower than that in the control group(5.58±0.87),and the difference was statistically significant(P<0.01).The VAS pain scores of patients in the study group at 6h,12h,24h,and 48h after treatment were(2.10±0.30),(2.33±0.57),(3.25±0.54)and(4.22±0.58),which were significantly lower than those in the control group[(3.02±0.36),(3.85±0.43),(5.05±0.45)and(4.72±0.45)],and the difference was statistically significant(P<0.01).The postoperative hospital stay in the study group was(5.22±0.86)days,which was less than(5.70±0.65)days in the control group(P<0.05).There was no significant difference in FN block rate between the two groups at T1,T2 and T3(P>0.05).However,the block rates of ON and LFCN in study group at T1,T2 and T3 were significantly higher than those in control group,and the difference was statistically significant(P<0.05).The active activity time after operation in the study group was(26.82±3.16)h,which was shorter than that in the control group[(35.47±4.23)h],and the difference was statistically significant(P<0.05).Conclusion:The application of ultrasound-guided superior iliac fascial space block of inguinal ligament in the analgesia of hip replacement can advance the analgesia,prolong the duration of postoperative analgesia and reduce postoperative hospital stay,which conforms to the concept of ERAS,has obvious application effect,and is worthy of clinical promotion.