髋关节囊周围神经阻滞与髂筋膜间隙阻滞对老年股骨粗隆间骨折患者镇痛效果的对比研究

Comparison of the analgesic effects of pericapsular nerve group block and fascia iliaca compartment block on intertrochanteric fractures in elderly patients

目的 探讨髋关节囊周围神经(pericapsular nerve group, PENG)阻滞与髂筋膜间隙阻滞(fascia iliaca compartment block, FICB)对老年股骨粗隆间骨折(intertrochanteric femur fracture, IFF)患者股骨近端防旋髓内钉(proximal femoral nail anti-rotation, PFNA)内固定术的镇痛效果。方法 选取2022年1—12月首都医科大学附属北京积水潭医院老年IFF患者60例,随机分为P组和F组,每组各30例。P组采用PENG阻滞,F组采用FICB。两组患者均接受椎管内麻醉进行手术,术后均给予患者静脉自控镇痛(patient controlled intravenous analgesia, PCIA)。比较两组患者不同时点(T1,神经阻滞前;T2,神经阻滞后30 min;T3,术后6 h;T4,术后24 h;T5,术后48 h)静息和运动时的视觉模拟评分(visual analogue score, VAS)、术后补救镇痛率、镇痛满意度评分、住院时间、PCIA按压次数及不良反应发生率。结果 60例患者中,男23例,女37例,年龄65~85岁,平均(70.6±6.0)岁。两组T2~T5时点静息和运动时VAS均低于T1时点,差异均有统计学意义(P <0.05);两组静息和运动时所有时点VAS、术后补救镇痛率、镇痛满意度评分、住院时间、PCIA按压次数及不良反应发生率的比较,差异均无统计学意义(P>0.05)。结论 PENG阻滞与FICB均可缓解老年IFF患者PFNA内固定术的镇痛,且镇痛效果相当。

Objective To explore the analgesic effect of pericapsular nerve group(PENG)block and fascia iliaca compartment block(FICB)on postoperative analgesic effect in elderly patients with intertrochanteric femur fracture(IFF)undergoing proximal femoral nail anti-rotation(PFNA).Methods A total of 60 elderly IFF patients in Beijing Jishuitan Hospital Capital Medical University from January to December 2022 were selected,and were randomly divided into P group and F group,with 30 cases in each group.PENG block was used in P group,and FICB was used in F group.Patients in both groups were operated under spinal anesthesia,and patients were given patient controlled intravenous analgesia(PCIA)after operation.The visual analogue score(VAS)at different time points(T1,before nerve block;T2,30 min after nerve block;T3,6 h after operation;T4,24 h after operation;T5,48 h after operation)at rest and during exercise,postoperative salvage analgesia rate,analgesia satisfaction score,hospitalization time,PCIA compression times and incidence of adverse reactions were compared between the two groups.Results Among the 60 patients,there were 23 male and 37 female,aged from 65 to 85 years old,with an average age of(70.6±6.0)years.The VAS at rest and during exercise at T2-T5 in the two groups were lower than those at T1,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups in VAS during different postoperative time periods,postoperative salvage analgesia rate,analgesia satisfaction score,hospitalization time,PCIA compression times and the incidence of adverse reactions(P>0.05).Conclusions PENG block and FICB can relieve the pain of PFNA internal fixation in elderly patients with IFF,and the analgesic effect is equivalent.