髋关节囊周围神经阻滞和髂筋膜间隙阻滞在老年髋部骨折患者早期镇痛中的应用

Application of pericapsular nerve group block and fascia iliaca compartment block to early analgesia in the elderly patients with hip fracture in emergency department

目的比较髋关节囊周围神经阻滞(pericapsular nerve group block,PNGB)和腹股沟韧带上髂筋膜间隙阻滞(supra-in-guinal fascia iliaca compartment block,S-FICB)在老年髋部骨折患者早期镇痛中的效果。方法按随机数字表法将2021年10月至2022年5月急诊科就诊的老年髋部骨折患者分为两组:PNGB组和S-FICB组,每组25例。记录两组患者一般情况,记录神经阻滞前(T0)、阻滞后15 min(T1)、阻滞后30 min(T2)、阻滞后2 h(T3)、阻滞后6 h(T4)、阻滞后12 h(T5)和阻滞后24 h(T6)的静息和抬髋15度时相应的数字评定量表(numerifal rating scale,NRS)评分,记录两组起效时间、超声成像时间、穿刺操作时间和患者镇痛满意度及不良反应发生情况。结果与T0比较,两组静息和抬髋15度时T1~T6的NRS评分明显降低(均P<0.05);与S-FICB组比较,PNGB组静息和抬髋15度时T1~T6的NRS评分明显降低(均P<0.05)。与S-FICB组比较,PNGB组起效时间、超声成像时间和穿刺操作时间明显缩短,镇痛满意度评分明显提高(均P<0.05)。两组均未发生神经阻滞相关并发症。结论PNGB和S-FICB对老年髋部骨折患者均有良好的镇痛效果,PNGB操作所需时间更少,起效更快,患者满意度更高。

Objective To compare the effect of pericapsular nerve group block(PNGB)and supra-in-guinal fascia iliaca compartment block(S-FICB)on early analgesia in the elderly patients with hip fracture.Methods According to the random number table method,the elderly patients with hip fracture in the emergency room were divided into two groups,PNGB group and S-FICB group,25 cases in each group.The general conditions of patients in the two groups,numerifal rating scale(NRS)scores before nerve block(T0),at 15 min after nerve block(T1),at 30 min after nerve block(T2),at 2 h after nerve block(T3),at 6 h after nerve block(T4),at 12 h after nerve block(T5)and at 24 h after nerve block(T6)were recorded during resting state and hip lift at 15°.The onset time,ultrasound imaging time,puncture operation time,analgesia satisfaction and adverse reactions of the two groups were recorded.Results Compared with T0,NRS score was significantly decreased at T1 to T6 resting state and hip lift at 15°(P<0.05).Compared with S-FICB group,NRS score in PNGB group was significantly decreased at T1 to T6 resting state and hip lift at 15°(P<0.05).Compared with S-FICB group,the onset time,ultrasound imaging time and puncture operation time shortened significantly,and the satisfaction score of analgesia improved significantly in PNGB group(P<0.05).There were no complications related to nerve block in both groups.Conclusions Both PNGB and S-FICB have good early analgesic effect on the elderly patients with hip fracture,but PNGB requires less time,takes the faster effect and has the higher patients′satisfaction.