静脉复合髋关节囊周围神经阻滞镇痛在全髋关节置换术中的应用效果

Efficacy of patient-controlled intravenous analgesia combined hip capsule peripheral nerve block in total hip arthroplasty

目的 探讨静脉复合髋关节囊周围神经阻滞镇痛在全髋关节置换术中的应用效果。方法 选取2023年1~8月行全髋关节置换术的患者50例,按数字随机表法分为对照组和观察组,每组25例。对照组给予静脉自控镇痛,观察组给予静脉复合髋关节囊周围神经阻滞镇痛。比较2组患者的镇痛效果、术后炎性反应、不良事件发生情况、术后康复质量。结果 观察组术后24、36、48 h时静息与运动状态下的视觉模拟评分法(VAS)评分均低于对照组(P<0.05);观察组术后24 h的肿瘤坏死因子α(TNF-α)、白介素-1β(IL-1β)、C-反应蛋白(CRP)水平低于对照组,差异有统计学意义(P<0.05);观察组不良事件发生率为4.00%低于对照组的28.00%,差异有统计学意义(P<0.05);观察组首次下床活动时间、住院时间短于对照组(P<0.05),且观察组术后4周恢复质量量表(QoR-15)、髋关节Harris评分高于对照组,差异有统计学意义(P<0.05)。结论 静脉复合髋关节囊周围神经阻滞镇痛用于全髋关节置换术中,可进一步提升镇痛效果,减少不良事件的发生,并降低术后炎性反应,提升术后康复质量。

Objective To investigate the effect of patient-controlled intravenous analgesia(PCIA)combined hip capsule peripheral nerve block in total hip arthroplasty(THA).Methods Fifty patients who underwent THA from January to August 2023 were enrolled and randomly assigned into control group(n=25)and observation group(n=25),All were given PCIA,and those in the observation group were additionally given hip capsule peripheral nerve block.The analgesic effect,postoperative inflammatory reaction,adverse events,and postoperative rehabilitation quality were compared between the two groups.Results The visual analogue scale(VAS)scores in resting and motion state at 24,36,48 hours postoperatively were significantly lower in the observation group than in the control group(P<0.05).The tumor necrosis factor alpha(TNF-α),interleukin-1β(IL-1β),C-reactive protein(CRP)at 24 hours postoperatively decreased notably in the observation group compared with the control group(P<0.05).The incidence of adverse events in the observation group was significantly lower than that of the control group(4.00%vs 28.0%,P<0.05).The first out-of-bed activity time and hospitalization time were significantly shorter in the observation group relative to the control group(P<0.05).The Quality of Recovery-15(QoR-15)scale,Harris Hip Score(HHS)at 4 weeks postoperatively were significantly higher in the observation group than in the control group(P<0.05).Conclusion The PCIA combined hip capsule peripheral nerve block in THA patients can further improve analgesic effect,reduce adverse events and postoperative inflammation,and improve the postoperative rehabilitation quality.