地塞米松联合罗哌卡因用于老年髋部骨折患者术前镇痛的临床效果

Dexamethasone combined with ropivacaine for preoperative analgesia in elderly patients with hip fracture

目的:探讨地塞米松联合罗哌卡因用于超声引导下髋关节囊周围神经阻滞在术前老年髋部骨折患者镇痛中的应用。方法:选取2017年1月—2022年3月到我院就诊的老年髋部骨折患者103例,采用随机数字表法分为对照组(n=51)与治疗组(n=52),两组患者在腰麻前均进行超声引导下髋关节囊周围神经阻滞,对照组注射0.5%的罗哌卡因,治疗组注射0.5%的罗哌卡因+8 mg地塞米松。观察比较术后6 h、12 h、24 h、48 h患者分别于静息状态、运动状态时的NRS疼痛评分、两组患者的术后情况(住院时间、下床时间、镇痛药物使用次数及首次按压镇痛泵时间)、两组患者术后并发症发生情况(心律失常、穿刺血肿、恶心呕吐、神经损伤等)。结果:治疗组静息状态和运动状态时6 h、12 h、24 h、48 h的NRS评分均低于对照组,差异有统计学意义(P<0.05),术后治疗组患者住院时间、下床时间、镇痛药物使用次数均低于对照组,差异有统计学意义(P<0.05),首次按压镇痛泵时间长于对照组,差异有统计学意义(P<0.05)。治疗组患者术后心律失常、穿刺血肿、恶心呕吐、神经损伤等并发症发生率为5.77%(3/52),低于对照组的21.57%(11/51),差异有统计学意义(P<0.05)。结论:地塞米松联合罗哌卡因用于超声引导下髋关节囊周围神经阻滞,在术前老年髋部骨折患者镇痛中的应用效果较好,可以有效减轻患者疼痛,缩短患者住院时间,减少术后并发症的发生,值得临床推广应用。

Objective To investigate the application of dexamethasone combined with ropivacaine in ultrasound-guided pericapsular nerve block of hip joint for preoperative analgesia in elderly patients with hip fracture.Methods From January 2017 to March 2022,103 elderly patients with hip fracture who visited our hospital were gathered and grouped into control group(n=51)and therapy group(n=52)according to random number table method.Before spinal anesthesia,the patients in the group underwent ultrasound-guided pericapsular nerve block of hip joint,the control group was injected with 0.5%ropivacaine,and the therapy group was injected with 0.5%ropivacaine+8 mg dexamethasone.The NRS pain scores of patients in resting state and exercise state were observed and compared at 6 h,12 h,24 h and 48 h after operation,respectively,the postoperative conditions(including hospitalization time,time to get out of bed,the number of analgesic drugs used,and the time of first pressing the analgesic pump)of patients of the two groups were compared,the postoperative complications(arrhythmia,puncture hematoma,nausea and vomiting,nerve injury,etc.)were compared between the two groups.Results The NRS scores of the therapy group at 6 h,12 h,24 h and 48 h were lower than those of the control group at rest(P<0.05).The NRS scores at 6 h,12 h,24 h and 48 h in the therapy group were lower than those in the control group at the exercise state(P<0.05).After operation,the length of hospital stay,time to get out of bed,and the frequency of analgesic use in the therapy group were lower than those in the control group(P<0.05),and the time of first pressing an analgesic pump was higher than that in the control group(P<0.05).The incidence of postoperative complications such as arrhythmia,puncture hematoma,nausea and vomiting,and nerve injury in the therapy group was 5.77%(3/52),which was lower than that in the control group,21.57%(11/51),the difference was statistically significant(P<0.05).Conclusion Dexamethasone combined with ropivacaine for ultrasound-guided peripheral nerve block of the hip joint has a good preoperative analgesic effect in elderly patients with hip fracture,which can effectively reduce the pain and shorten the hospitalization time of the patients,reduce the incidence of postoperative complications,worthy of clinical application.