多神经阻滞联合全身麻醉对老年踝关节骨折患者术后疼痛的影响

Effect of Multi-Nerve Block Combined with General Anesthesia on Postoperative Pain in Elderly Patients with Ankle Fracture

目的:探索多神经阻滞联合全身麻醉对老年踝关节骨折患者术后疼痛的影响。方法:选取2023年1月—2024年1月天津市天津医院收治的96例老年踝关节骨折患者为研究对象,采用随机数字表法将其分为研究组与对照组,各48例。两组术中均行全身麻醉,对照组采用股神经+坐骨神经阻滞,研究组在对照组基础上加用闭孔神经+股外侧皮神经阻滞。比较两组手术相关指标、生理指标、术后疼痛情况、不良反应发生情况。结果:研究组的手术时间、神经阻滞操作时间均较对照组长,术后苏醒时间、术后拔管时间均较对照组短,差异均有统计学意义(P<0.05)。术中30 min、1 h、术后10 min,研究组平均动脉压、心率均较对照组低,差异均有统计学意义(P<0.05)。术后12、24 h,研究组疼痛视觉模拟评分均较对照组低,差异均有统计学意义(P<0.05)。研究组不良反应发生率为12.50%,高于对照组的8.33%,但两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:多神经阻滞在老年踝关节骨折手术患者中的应用能有效减轻术后疼痛程度,加速苏醒,对患者生理影响更小的同时具有良好的安全性。

Objective:To explore the effect of multi-nerve block combined with general anesthesia on postoperative pain in elderly patients with ankle fracture.Methods:A total of 96 elderly patients with ankle fracture admitted to Tianjin Hospital from January 2023 to January 2024 were selected as the research objects,and were divided into a study group and a control group by random number table method,with 48 cases in each group.General anesthesia was performed in both groups.Femoral nerve+sciatic nerve block was used in the control group,and obturator nerve+lateral femoral cutaneous nerve block was used in the study group on the basis of the control group.Operation related indexes,physiological indexes,postoperative pain and occurrence of adverse reactions were compared between the two groups.Results:The operation time and nerve block operation time of the study group were longer than those of the control group,and the postoperative recovery time and extubation time were shorter than those of the control group,the differences were statistically significant(P<0.05).Intraoperative 30 min,1 h,postoperative 10 min,the mean arterial pressure and heart rate of the study group were lower than those of the control group the differences were statistically significant(P<0.05).At 12 and 24 h after surgery,the pain Visual Analogue Scale scores of the study group were lower than those of the control group,the differences were statistically significant(P<0.05).The incidence of adverse reactions in the study group was 12.50%,which was higher than 8.33%in the control group,but there was no statistical significance between the two groups(P>0.05).Conclusion:The application of multi-nerve block in elderly patients undergoing ankle fracture surgery can effectively reduce the degree of postoperative pain,accelerate recovery,have less physiological impact on patients and have good safety.