腰方肌阻滞联合髋关节囊周围神经阻滞在老年患者髋关节置换术后镇痛中的应用

Application of quadratus lumborum block combined with pericapsular nerve group block in postoperative analgesia of elderly patients after hip replacement

目的:探讨腰方肌阻滞(QLB)联合髋关节囊周围神经阻滞(PENGB)在老年患者髋关节置换术后镇痛中的应用效果。方法:根据麻醉方式不同将100例髋关节置换术老年患者分为QLB组与联合组,每组各50例。术后,QLB组予以超声引导下QLB治疗,联合组予以QLB联合PENGB,两组术后均予以自控静脉镇痛(PCIA);记录两组患者术后6、12、24、48 h静息状态和运动状态下的视觉模拟评分(VAS);记录两组患者术后48 h内镇痛泵有效按压次数、舒芬太尼总用量、补救镇痛率及不良反应发生情况;记录两组患者首次步行时间、首次行走距离和术后住院时间。结果:术后6~48 h各时间点,联合组静息状态与运动状态下的VAS评分均低于QLB组(P<0.05)。相比QLB组,联合组术后48 h内恶心呕吐发生率及总不良反应发生率均降低(P<0.05),术后首次步行时间缩短(P<0.05),首次行走距离增长(P<0.05);两组术后住院时间比较,差异无统计学意义(P>0.05)。结论:QLB联合PENGB用于老年患者髋关节置换术后镇痛中的效果优于单一QLB,可减少术后阿片类药物用量,减少不良反应,促进术后早期恢复。

Objective:To investigate the effect of quadratus lumborum block(QLB) combined with pericapsular nerve group block(PENGB) on postoperative analgesia in elderly patients undergoing hip replacement.Methods:A total of 100 elderly patients with hip replacement were divided into QLB group and combined group according to different anesthesia methods, 50 cases in each group.After operation, the QLB group was given ultrasound-guided QLB,and the combined group was given QLB combined with PENGB.Patient-controlled intravenous analgesia(PCIA) was performed in both groups.The visual analogue scale(VAS) at rest and exercise at 6,12,24 and 48 h after operation was recorded in the two groups.The effective pressing times of analgesia pump, total dosage of sufentanil, remedial analgesia rate and incidence of adverse reactions within 48 h after operation were recorded in the two groups.The first walking time, first walking distance and postoperative hospital stay of the two groups were recorded.Results:At each time point 6~48 h after operation, the VAS scores at resting state and motion state in the combined group were lower than those in the QLB group(P<0.05).Compared with the QLB group, the incidence of nausea and vomiting and the incidence of total adverse reactions in the combined group within 48 h after operation were decreased(P<0.05),the first walking time were shortened(P<0.05),and the first walking distance was increased(P<0.05).There was no significant difference in postoperative hospital stay between the two groups(P>0.05).Conclusion:The effect of QLB combined with PENGB on postoperative analgesia in elderly patients with hip replacement is better than that of single QLB,which can reduce the dosage of opioids, reduce adverse reactions and promote early postoperative recovery.