不同入路髂筋膜间隙神经阻滞对全髋关节置换术闭孔神经阻滞和围术期镇痛的影响

Effects of fascia iliaca compartment block by different approaches on obturator nerve block and perioperative analgesia in total hip replacement

目的探讨不同入路髂筋膜间隙阻滞对全髋关节置换术闭孔神经阻滞和围术期镇痛的影响。方法采用前瞻性研究方法,选取2020年5月至2021年5月金华市中心医院收治行全髋关节置换术的老年患者60例,采用随机数字表法分为腹股沟韧带处髂筋膜间隙阻滞组(I组)和腹股沟韧带上髂筋膜间隙阻滞组(S组),每组30例。两组患者阻滞完毕后,使用酒精棉签测试股神经、闭孔神经及股外侧皮神经阻滞起效时间,测量阻滞后10、20、30 min时阻滞侧大腿内收肌肌力。采用视觉模拟评分法(VAS)评估两组患者入手术室(T_(0))、术后6 h(T_(1))、术后12 h(T_(2))、术后24 h(T_(3))、术后48 h(T_(4))静态及动态的疼痛程度。记录术中舒芬太尼和瑞芬太尼使用量、术后48 h内累计静脉患者自控镇痛(PCIA)按压次数、首次下床行走时间、患者疼痛满意度及术后并发症发生情况。结果与I组比较,S组闭孔神经阻滞起效时间明显缩短(P<0.05);S组患者在阻滞后20、30 min测得大腿内收肌肌力下降率大于I组(均P<0.05);S组患者在T_(1)、T_(2)时静态及动态VAS评分均明显低于I组(均P<0.05);S组患者术中舒芬太尼、瑞芬太尼的使用量以及术后48 h内累计PCIA按压次数及首次下床行走时间较I组均明显减少(均P<0.05)。结论超声引导下腹股沟韧带上髂筋膜间隙神经阻滞对全髋关节置换术的老年患者闭孔神经阻效果显著,可减轻疼痛,有利于患者早期下床活动,是一种安全、有效的方法。

Objective To investigate the effects of different fascia iliaca compartment blocks on obturator nerve block and perioperative analgesia in total hip replacement.Methods Sixty elderly patients undergoing total hip replacement surgery who were admitted to Jinhua Central Hospital from May 2020 to May 2021 were selected and divided into inguinal fascia iliaca compartment block(group I)and supra-inguinal fascia iliaca compartment block(group S)according to random number table method,30 cases in each group.After the completion of block,alcohol swab was used to test the onset time of blocks on the femoral nerve,obturator nerve and lateral femoral cutaneous nerve,and the muscle strength of the adductor muscle of the thigh was measured 10,20 and 30 min after block.Visual analogue scale(VAS)was used to evaluate the postoperative pain degree of patients in the two groups:entry(T_(0)),6 h(T_(1)),12 h(T_(2)),24 h(T_(3))and 48 h(T_(4)).The intraoperative doses of sufentanil and remifentanil used,the accumulative number of effective compressions for patientcontrolled intravenous analgesia(PCIA)within 48 h after surgery,the first time to walk out of bed,patients'pain satisfaction and postoperative complications were recorded.Results Compared with group I,the onset time of obturator nerve block in group S was significantly shortened(P<0.05).The muscle strength reduction rate of thigh adductor muscle in group S was larger than that of group I at 20 and 30 min after block(all P<0.05).The decrease of static and dynamic VAS scores in group S was significantly greater than that of group I at T_(1) and T_(2)(all P<0.05).The intraoperative usage of sufentanil and remifentanil,the accumulative number of effective compressions for PCIA,and the first time to get out of bed in group S were significantly reduced compared with group I(all P<0.05).Conclusion Ultrasound-guided supra-inguinal fascia iliaca compartment block has a significant effect on obturator nerve block in elderly patients with total hip replacement,which can reduce pain and facilitate patients to get out of bed earlier.It is a safe and effective method.