超声引导下囊周神经组阻滞与髂筋膜间隙阻滞对髋部骨折患者术后镇痛效果的比较

Analgesic effect of ultrasound-guided pericapsular nerve block and fascia iliaca compartment block on postoperative patients with hip fracture

目的 比较超声引导下囊周神经组(pericapsular nerve group, PENG)阻滞与髂筋膜间隙(fascia iliaca compartment, FIC)阻滞对髋部骨折患者术后的镇痛效果。方法 选取2019年8月至2020年12月期间于台州市中医院手术治疗的髋部骨折患者。随机分为PENG组和FIC组,分别于术前超声引导下进行PENG阻滞和FIC阻滞,比较两组术后不同时间NRS评分,髋关节最大屈曲角度,术后镇痛药使用情况和不良反应。结果 PENG组术后不同时间被动运动与主动运动NRS评分均低于FIC组,差异有统计学意义(P<0.05),两组患者术后6 h髋关节最大屈曲角度差异无统计学意义(P>0.05),PENG组术后12 h, 24 h和48 h髋关节最大屈曲角度均大于FIC组,差异有统计学意义(P<0.05),术后首次使用镇痛药时间PENG组(8.23±3.11)h,对照组(4.04±1.51)h,两组比较差异有统计学意义(P<0.05),术后补充镇痛率PENG组低于FIC组,差异有统计学意义(P<0.05),恶心呕吐及谵妄发生率两组差异无统计学意义(P>0.05)。结论 在髋部骨折手术患者中,囊周神经组阻滞比髂筋膜间隙阻滞提供了更好的术后镇痛效果,减少了患者补充性使用镇痛药的需求。

Objective To compare the analgesic effects of ultrasound-guided pericapsular nerve group(PENG) block and fascia iliaca space(FIC) block in patients with hip fracture.Methods Patients with hip fractures who were surgically treated in our hospital from August 2019 to December 2020 were selected.They were randomly divided into PENG group and FIC group.PENG block and FIC block were performed under preoperative ultrasound guidance respectively.The NRS score, maximum flexion angle of hip joint, use of postoperative analgesics and adverse reactions were compared between the two groups at different times after operation.Results The NRS scores of passive and active motion in PENG group were lower than those in FIC group at different times after operation, and the difference was statistically significant(P<0.05).There was no significant difference in the maximum flexion angle of hip joint between the two groups at 6 h after operation(P>0.05).The maximum flexion angle of hip joint in PENG group was higher than that in FIC group at 12 h, 24 h and 48 h after operation, and the difference was statistically significant(P<0.05).The time of first use of analgesics in PENG group was(8.23±3.11)h, The control group was(4.04±1.51)h, the difference between the two groups was statistically significant(P<0.05).The postoperative supplementary analgesia rate in PENG group was lower than that in FIC group, the difference was statistically significant(P<0.05).There was no significant difference in the incidence of nausea, vomiting and delirium between the two groups(P>0.05).Conclusion In patients undergoing hip fracture surgery, pericapsular nerve block provides better postoperative analgesic effect than iliac fascia space block, and reduces the need for supplementary analgesics.