髋关节囊周围神经阻滞联合单侧蛛网膜下腔麻醉在老年全髋关节置换术中的应用优势评估

Evaluation of the advantages of pericapsular nerve group block combined with unilateral lumbar anesthesia in elderly pa⁃tients undergoing total hip arthroplasty

目的:评估髋关节囊周围神经阻滞(pericapsular nerve group block, PENGB)联合单侧蛛网膜下腔麻醉在老年患者全髋关节置换术(total hip arthroplasty, THA)中的应用优势。方法:选择行单侧THA老年患者74例,采用随机数字表法分为两组(每组37例):超声引导下PENGB组(P组)和超声引导下髂筋膜间隙阻滞(fascia iliaca compartment block, FICB)组(F组)。两组患者神经阻滞均在行单侧蛛网膜下腔麻醉前30 min实施。记录患者神经阻滞实施前(T_(0))、神经阻滞实施后5 min(T_(1))、神经阻滞实施后15 min(T_(2))、神经阻滞实施后30 min(T_(3))以及术后6 h(T_(4))、术后12 h(T_(5))、术后24 h(T_(6))静息和动态数字分级评分法(Numerical Rating Scale, NRS)疼痛评分;记录两组患者术后24 h内镇痛情况[首次患者自控静脉镇痛(patient-controlled intravenous analgesia, PCIA)按压时间、PCIA有效按压次数、舒芬太尼总用量、补救镇痛率]以及患者镇痛满意度;记录T_(4)、T_(5)和T_(6)时的股四头肌肌力以及患者术后首次下床活动时间、首次步行距离和术后住院天数;比较两组患者术前1 d及术后1、3、7、30 d匹兹堡睡眠质量指数(Pittsburgh sleep quality index, PSQI)评分,术后24 h不良反应发生情况。 结果:与F组比较:P组T_(1)~T_(5)时静息和动态NRS疼痛评分和术后1、3、7 d PSQI评分均降低( P<0.05);P组术后首次PCIA按压时间延长,PCIA有效按压次数减少,舒芬太尼总用量减少,患者镇痛满意度升高,首次下床活动时间、住院天数缩短,首次步行距离延长( P<0.05);P组T_(4)、T_(5)时股四头肌肌力升高( P<0.05)。P组T_(1)~T_(3)时和F组T_(2)~T_(3)时静息NRS疼痛评分低于T_(0)时( P<0.05),两组患者T_(1)~T_(3)时动态NRS疼痛评分低于T_(0)时( P<0.05)。其余指标差异无统计学意义( P>0.05)。 结论:超声引导PENGB联合单侧蛛网膜下腔麻醉在老年人THA术后镇痛中效果显著,并有助于改善患者术后的睡眠质量,促进术后早期康复。

Objective To evaluate the advantage of pericapsular nerve group block(PENGB)combined with unilateral lum‑bar anesthesia in elderly patients undergoing total hip arthroplasty(THA).Methods A total of 74 elderly patients who were sched‑uled for unilateral THA were enrolled.According to the random number table method,they were divided into two groups(n=37):an ul‑trasound-guided PENGB group(group P),and an ultrasound‑guided fascia iliaca compartment block(FICB)group(group F).Nerve block in both groups was administered 30 min before unilateral subarachnoid anesthesia.The static and dynamic Numerical Rating Scale(NRS)scores were recorded before nerve block(T_(0)),5 min(T_(1)),15 min(T_(2)),and 30 min(T_(3))after nerve block,and 6 h(T_(4)),12 h(T_(5)),and 24 h(T_(6))after surgery.The analgesia condition within 24 h after surgery,including the first pressing time of patient-controlled intravenous analgesia(PCIA),the effective pressing times of PCIA,the total consumption of sufentanil,and the rate of rescue analgesia,as well as the satisfaction of patients toward analgesia were recorded.Quadriceps muscle strength at T_(4),T_(5) and T_(6),as well as the time of first postoperative off-bed activity,the distance of first postoperative walking,and the length of postoperative hospitalization stay were recorded.Both groups were compared for their Pittsburgh sleep quality index(PSQI)scores 1 day before surgery and 1,3,7 d and 30 d after surgery as well as the incidence of adverse reactions 24 h after surgery.Results Compared with group F,group P showed de‑creases in the static and dynamic NRS scores at T_(1)‒T_(5),and PSQI scores at postoperative 1,3 d and 7(P<0.05).For group P,the first pressing time of PCIA was prolonged,the effective pressing times of PCIA was decreased,the total consumption of sufentanil was re‑duced,the satisfaction of patient toward analgesia was enhanced,the time of first off-bed activity and the length of hospitalization stay were shortened,and the first walking distance was extended(P<0.05).Furthermore,enhanced quadriceps muscle strength was seen in group P at T_(4) and T_(5)(P<0.05).Compared with those at T0,the static NRS scores were reduced in group P at T_(1)‒T_(3) and in group F at T_(2)‒T_(3)(P<0.05),while both groups showed lower dynamic NRS scores at T_(1)‒T_(3) than those at T0(P<0.05).There was no statistical difference in other indexes(P>0.05).Conclusions Ultrasound-guided PENGB combined with unilateral lumbar anesthesia has significant an‑algesic effect in the elderly patients after THA,which is helpful to improve postoperative sleep quality and promote early postoperative recovery.