髂筋膜阻滞联合外侧入路坐骨神经阻滞与静脉自控镇痛对下肢骨折手术术后镇痛效果的比较

Effect of iliofascial block combined with lateral approach sciatic nerve block and intravenous controlled analgesia on postoperative analgesia after lower limb fracture surgery

目的 比较髂筋膜阻滞联合外侧入路坐骨神经阻滞与静脉自控镇痛对下肢骨折手术术后的镇痛效果。方法 以2021年3月-2022年10月中国人民解放军联勤保障部队第九〇四医院麻醉科收治的80例择期全麻下行膝关节及以下骨折切开复位内固定手术的患者为研究对象,采用随机数字法分为腹股沟韧带上髂筋膜间隙阻滞联合外侧入路坐骨神经阻滞组(N组,40例)和静脉自控镇痛组(P组,40例)。分析比较两组术后2、6、12、24、48、72 h静息和活动时VAS疼痛评分、曲马多镇痛补救情况、患者术后镇痛满意度评分、术后24、48、72 h的QoR-15评分、术后首次下床活动时间、不良反应发生情况。结果 与P组相比,N组术后12 h内静息时VAS疼痛评分及术后24 h内活动时VAS疼痛评分较低,使用曲马多镇痛补救例数减少,患者镇痛满意度评分及48 h内QoR-15评分升高,首次下床活动时间缩短,恶心呕吐和不良反应总例数减少,差异有统计学意义(P<0.05)。结论 腹股沟韧带上髂筋膜间隙阻滞联合外侧入路坐骨神经阻滞用于下肢骨折切开复位内固定术后镇痛效果好,并发症少,可促进患者早日下床活动,患者镇痛满意度及QoR-15评分高。

Objective To compare the analgesic effects of iliofascia block combined with lateral approach sciatic nerve block and intravenous controlled analgesia after lower limb fracture surgery.Methods A total of 80 patients underwent open reduction and internal fixation surgery for knee and below fractures under elective general anesthesia in the hospital from March 2021 to October 2022 were selected as the research objects.By random number method,the patients were divided into supringuinal ligament iliofascialspace block combined with lateral approach sciatic nerve block group(Group N,n=40)and controlledintravenous analgesia group(Group P,n=40).VAS pain score atrest and activity at 2 h,6 h,12 h,24 h,48 h,72 h after surgery were analyzed and compared between the two groups,tramadol analgesic relief,postoperative analgesic satisfaction scores of patients,QoR-15 scores at 24 h,48 h,and 72 h after surgery,first postoperative activity time and occurrence of adverse reactions.Results Compared with Group P,the VAS pain scores at resting 12h after the operation and the VAS pain scores at activities 24 h after operationin group N were lower,the the number of patients using tramadol analgesic relief was less,patients′analgesic satisfaction score and QoR-15 score within 48 h were high,the first time of getting out of bed was earlier,the total number of nausea and vomiting and adverse reactions was less,and the difference was statistically significant(P<0.05).Conclusion Ultrasound-guided supra-inguinal ligament iliofascial space block combined with lateral approach sciatic nerve block after open reduction and internal fixation for lower limb fractures has good analgesic effect and fewer complications,which can promote patients to get out of bed as soon as possible,and patients′satisfaction with analgesia and QoR-15 scores are high.