髂筋膜腔隙阻滞在骨科麻醉中的应用研究进展

Research progress in application of iliac fascia lacunar block in orthopedic anesthesia

当前多数骨外科手术在临床上的应用比较成熟,但是很多患者术后疼痛与应激反应比较剧烈,术后需要阻滞多根神经。同时很多患者伴随有各种基础疾病,对麻醉及手术的耐受性都比较低,为此在临床上需要选择更加合理的麻醉方法,有效缓解患者术后疼痛,提高治疗有效率和生活质量。随着超声技术的发展,髂筋膜腔隙阻滞(FICB)已被推广为一种有价值的区域麻醉和下肢手术镇痛技术,髂筋膜间隙是髂窝内的一个潜在腔隙,股外侧皮神经、股神经、闭孔神经均走行于髂筋膜后,在此间隙注入麻醉药物可对上述神经全部阻滞,并且具有操作简单、定位准确等优势,在临床中已有大量研究。本文首先概述了髂筋膜腔隙组成结构及医学解剖结构,总结了FICB的方法与药物,重点综述了FICB在骨科麻醉中的应用研究进展,并阐述了FICB在骨科麻醉中可能存在的问题,以期为临床FICB在骨科麻醉中的应用提供参考与支持。

At present,most orthopedic surgery is relatively mature in clinical application,but many patients have severe postoperative pain and stress response,and multiple nerves need to be blocked after surgery.At the same time,many patients are accompanied by various basic diseases,and their tolerance to anesthesia and surgery is relatively low.Therefore,it is necessary to choose the more reasonable anesthesia method in clinical practice to effectively alleviate the patients’postoperative pain,improve treatment effective rate and quality of life.With the development of ultrasound technology,iliac fascial cavity block(FICB)has been promoted as a valuable technique for regional anesthesia and lower extremity surgical analgesia.The iliac fascial space is a potential space in the iliac fossa.The lateral cutaneous nerve,femoral nerve and obturator nerve all run behind the iliac fascia,injecting anesthetics into this gap can block all the above-mentioned nerves,and has the advantages of simple operation and accurate positioning.There have been a lot of clinical studies.This article first summarizes the structure of the iliac fascia cavity and the medical anatomy,summarizes the methods and drugs of the FICB,and focuses on the research progress in application of the FICB in orthopedic anesthesia,and expounds the possible problems of FICB in orthopedic anesthesia,in order to provide reference and support for clinical FICB in orthopaedic anesthesia.