不同路径超声引导下髂筋膜间隙阻滞在老年全髋关节置换手术中的效果比较

Efficacy of ultrasound-guided fascia iliac space block in total hip replacement for elderly patients:medial puncture approach versus lateral puncture approach

目的比较不同穿刺路径超声引导下持续髂筋膜间隙阻滞在老年全髋关节置换手术中的应用效果。方法收集2019年10月至2022年4月浙江中医药大学附属金华中医院骨科行全髋关节置换手术的老年患者100例,按穿刺入路的不同分为研究组和对照组,每组50例。研究组经超声引导下行内侧入路方式穿刺置管,对照组经超声引导下行外侧入路方式穿刺置管。比较两组患者术中及术后情况(手术时间、术中出血量、输液量、舒芬太尼用量、拔管时间、首次下床活动时间、镇痛泵按压次数、其他镇痛药物使用率)、术后24、48 h疼痛视觉模拟评分(VAS)、置管相关情况(包括重新固定导管率、超声成像时间、置管时间、置管深度、罗哌卡因用量等)及神经阻滞效果满意率。结果研究组舒芬太尼用量、拔管时间、首次下床活动时间、镇痛泵按压次数以及其他镇痛药物使用率均明显少于对照组(均P<0.05),两组患者术后48 h的VAS评分较术后24 h明显下降(均P<0.05)。研究组重新固定导管率、罗哌卡因用量、置管时间、置管深度等均明显优于对照组(均P<0.05)。研究组术后24、48 h股外侧皮神经以及闭孔神经阻滞满意率明显高于对照组(均P<0.05)。结论内外侧入路持续髂筋膜间隙阻滞均能为患者提供良好的术后镇痛,促进患者术后恢复,内侧入路路径行髂筋膜间隙阻滞术操作时间短,镇痛药物使用量少,股外侧皮神经以及闭孔神经阻滞满意率高。

Objective To compare the analgesic effect of ultrasound-guided continuous iliofascial space block in total hip replacement for elderly patients with different puncture paths.Methods One hundred elderly patients who underwent total hip replacement in Jinhua TCM Hospital Affiliated to Zhejiang Chinese Medical University from October 2019 to April 2022 were divided into two groups with 50 cases in each group.Patients in the study group received ultrasound-guided puncture and catheterization through the medial approach after general anesthesia,while those in the control group received puncture and catheterization through the lateral approach.The intraoperative and postoperative conditions,the visual analogue score(VAS)at 24 h and 48 h after surgery,the catheterization related information and satisfaction rate of ne-rve block effect were compared between two groups.Results The frequency of using pain relief pump in the study group was significantly lower than that in the control group within 48 h(P<0.05).VAS scores in both groups were significantly decreased in 48 h compared in 24 h after surgery(P<0.05).The rate of refixation catheter,times of ropivacaine use,ca-theterization time and intubation depth in the study group were significantly better than those in the control group(P<0.05).At 24 h and 48 h after surgery,the satisfaction rate of femoral lateral cutaneous nerve and obturator nerve block in the study group was significantly increased compared with the control group(P<0.05).Conclusion Both mediate and lateral approaches can provide good postoperative analgesia and promote postoperative recovery.However,compared with lateral approach the operation time of medial approach is shorter,analgesic drug use is less,and the satisfaction rate of lateral femoral cutaneous nerve and obturator nerve block is higher.