无背景剂量的髂筋膜间隙阻滞术后镇痛在髌骨骨折切开复位内固定患者中的应用效果

Application effect of postoperative analgesia without background dose of fascia iliaca compartment block in patients with open reduction and internal fixation of patellar fractures

目的探讨无背景剂量的髂筋膜间隙阻滞术后镇痛在髌骨骨折切开复位内固定患者中的应用效果。方法选取2023年2月至10月南通大学附属江阴医院收治的60例拟行髌骨骨折切开复位内固定患者作为研究对象,根据随机数字表法分为对照组(n=30)和观察组(n=30)。两组患者在蛛网膜下腔阻滞下麻醉,然后在超声引导下行髂筋膜间隙置管。手术结束后,两组均注射负荷剂量0.2%罗哌卡因30 ml,术后行髂筋膜间隙阻滞术后自控镇痛,对照组采用有背景剂量患者自控镇痛(持续背景剂量0.2%罗哌卡因5 ml/h,追加剂量5 ml/次,锁定时间15 min),观察组采用无背景剂量患者自控镇痛[患者根据视觉模拟评分法(VAS)≥4分自控注射0.2%罗哌卡因10 ml,而无锁定时间]。记录两组患者术后6、12、24 h的心率(HR)、经皮动脉血氧饱和度(SpO_(2))、平均动脉压(MAP)、静息VAS评分、运动VAS评分、Ramsay评分、暴发痛发生次数,记录两组患者术后镇痛药物罗哌卡因的用量及镇痛泵按压次数,并观察两组术后不良反应的发生情况。结果两组患者术后6、12、24 h的HR、SpO_(2)、MAP时间、组间、交互作用比较,差异无统计学意义(P>0.05)。观察组术后罗哌卡因用量少于对照组,差异有统计学意义(P<0.05);观察组术后镇痛泵按压次数多于对照组,差异有统计学意义(P<0.05)。术后6、12、24 h,两组患者的静息VAS评分、Ramsay评分时间、组间、交互作用比较,差异无统计学意义(P>0.05)。术后12、24 h,观察组的运动VAS评分低于对照组,暴发痛发生次数少于对照组,差异有统计学意义(P<0.05)。对照组发生镇痛导管渗液4例(13.3%)、恶心2例(6.7%)、头晕2例(6.7%);观察组发生恶心1例(3.3%)、头晕1例(3.3%),观察组的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论无背景剂量的髂筋膜间隙阻滞能明显降低髌骨骨折患者术后的运动VAS评分,减少术后暴发痛发生次数,同时减少术后麻醉药物的用量和术后不良反应的发生。

Objective To investigate the application effect of postoperative analgesia without background dose of fascia iliaca compartment block in patients with open reduction and internal fixation of patellar fractures.Methods A total of 60 patients who underwent open reduction and internal fixation of patellar fractures in Jiangyin Hospital Affiliated to Nantong University from February 2023 to October 2023 were selected as the research objects.According to the random number table method,they were divided into the control group(n=30)and the observation group(n=30).Patients in both groups were anesthetized under subarachnoid block followed by catheterization in the fascia iliaca space under ultrasound guidance.After the operation,both groups were injected with a loading dose of 0.2% Ropivacaine 30 ml,and postoperative patient-controlled analgesia was performed for fascia iliac compartment block.Patients in the control group received patient-controlled analgesia with background dose(continuous background dose of 0.2% Ropivacaine 5 ml/h,additional dose 5 ml/time,lockout time 15 min),while patients in the observation group received patient-controlled analgesia without background dose(patients were injected with 0.2% Ropivacaine 10 ml according to visual analogue scale[VAS]score≥4 points,and patients in the observation group were injected with 0.2% Ropivacaine 10 ml according to VAS score≥4 points.There was no lock time).The heart rate(HR),percutaneous arterial oxygen saturation(SpO_(2)),mean arterial pressure(MAP),resting VAS score,exercise VAS score,Ramsay score,and the number of breakout pain at 6,12 and 24 h after operation in the two groups were recorded.The dosage of postoperative analgesic drug ropivacaine and the pressing times of analgesic pump in the two groups were recorded.The postoperative adverse reactions of the two groups were observed.Results There were no statistically significant differences in HR,SpO_(2),MAP of time,inter-group and interaction between the two groups at 6,12 and 24 h after operation(P>0.05).The amount of ropivacaine in the observation group was less than that in the control group,and the difference was statistically significant(P<0.05).The pressing times of postoperative analgesic pump in the observation group were more than those in the control group,and the difference was statistically significant(P<0.05).At 6,12 and 24 h after operation,there were no statistically significant differences in resting VAS score,Ramsay score of time,inter-group and interaction between the two groups(P>0.05).At 12 and 24 h after operation,the VAS scores of movement in the observation group were lower than those in the control group,and the frequency of outbreak pain were less than those in the control group,and the differences were statistically significant(P<0.05).In the control group,there were 4 cases(13.3%)of analgesic catheter exudation,2 cases(6.7%)of nausea,and 2 cases(6.7%)of dizziness,and there was 1 case(3.3%)of nausea and 1 case(3.3%)of dizziness in the observation group.The total incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Fascia iliaca compartment block without background dose can significantly reduce the VAS score of postoperative movement in patients with patellar fracture,reduce the frequency of postoperative burst pain,and reduce the dosage of postoperative anesthetic drugs and the occurrence of postoperative adverse reactions.