髋关节囊周围神经阻滞联合股外侧皮神经阻滞用于老年髋部骨折患者围手术期镇痛的效果

Efficacy of perioperative analgesia with pericapsular nerve group block combined with lateral femoral cutaneous nerve block in elderly patients with hip fractures

目的观察超声引导下髋关节囊周围神经(PENG)阻滞联合股外侧皮神经(LFCN)阻滞用于老年髋部骨折患者围手术期镇痛的效果。方法蛛网膜下腔阻滞下行髋部骨折切开复位内固定术的老年患者60例随机分为两组,每组30例。PL组采用超声引导下PENG阻滞联合LFCN阻滞,P组患者单用超声引导下PENG阻滞。记录两组神经阻滞前(T0)、阻滞后5 min(T1)、10 min(T2)和20 min(T3)时的静息与活动状态下VAS疼痛评分及摆放蛛网膜下腔阻滞体位(T4)时的活动状态下VAS疼痛评分。记录两组患者术后6、12、24、48 h静息与活动状态下VAS疼痛评分以及术后48 h内患者自控镇痛(PCA)泵有效按压次数、总按压次数和羟考酮用量。结果两组T1~T3时静息VAS疼痛评分均低于T0时(P<0.05),T1~T4时活动VAS疼痛评分均低于T0时(P<0.05)。PL组术后6、12、24、48 h静息和活动VAS疼痛评分均低于P组(P<0.05)。PL组术后48 h内PCA泵有效按压次数、PCA泵总按压次数及羟考酮用量均少于P组(P<0.05)。结论与单用PENG阻滞比较,加用LFCN阻滞用于老年髋部骨折患者的围手术期镇痛效果更好。

Objective To observe the efficacy of perioperative analgesia with pericapsular nerve group(PENG)block combined with lateral femoral cutaneous nerve(LFCN)block in elderly patients with hip fractures.Methods Sixty elderly patients undergoing open reduction and internal fixation for hip fractures under subarachnoid block were randomly divided into two groups with 30 cases each.Group P received ultrasound-guided PENG block alone and group PL received additional ultrasound-guided LFCN block.The VAS pain scores of two groups were recorded before nerve block(T0),and 5 minutes(T1),10 minutes(T2)and 20 minutes(T3)after block at both resting and activity states,as well as in subarachnoid block positioning(T4)at activity states.The VAS pain scores were evaluated at 6,12,24 and 48 hours postoperatively.The numbers of effective patient-controlled analgesia(PCA)compression and total compression and the consumption of oxycodone were recorded within 48 hours postoperatively.Results The resting VAS pain scores of two groups at T1 to T3 were lower than those at T0(P<0.05).The activity VAS pain scores of two groups at T1 to T4 were lower than those at T0(P<0.05).The resting and activity VAS pain scores at 6,12,24,48 hours postoperatively were lower in group PL than those in group P(P<0.05)The effective PCA compression number and total PCA compression number and dosage of oxycodone within 48 hours after surgery were all less in group PL than those in group P(P<0.05).Conclusion Compared with PENG block alone,combined use of PENG block and LFCN block has a better perioperative analgesic efficacy in elderly patients with hip fractures.