髋关节置换术后不同入路腰方肌阻滞镇痛效果比较

Comparison of analgesic effects of different quadratus lumborum block after hip arthroplasty

目的:比较髋关节置换术后不同入路腰方肌阻滞(QLB)的镇痛效果。方法:选择2017年1月至2018年6月于广东省汕头市中心医院择期行髋关节置换术患者120例,随机分为腰方肌外侧路麻醉组(外侧路组)、腰方肌后路麻醉组(后路组)、腰方肌前路组(前路组)和对照组,每组30例,外侧路组、后路组、前路组术后在超声引导下行QLB,对照组不进行QLB,于术后即刻(T0)、术后12 h(T1)、术后24 h(T2)、术后48 h(T3)记录患者静态疼痛视觉模拟(VAS)评分,于T2及T3时点记录患者动态VAS评分,记录患者术后0～24 h、25～48 h使用镇痛泵补救镇痛的例数,比较4组T2和T3时点髋关节最大屈曲和外展活动度,以及T3内不良反应发生率。结果:T1、T2及T3时点外侧路组、后路组及前路组静态下VAS评分明显低于对照组(P<0.05),T1和T3时点外侧路组、后路组及前路组静态下VAS评分无明显差异(P>0.05),T2时点后路组和前路组静态下VAS评分显著低于外侧路组(P<0.05);T2、T3时点外侧路组、后路组及前路组动态下VAS评分明显低于对照组(P<0.05),而外侧路组、后路组及前路组无明显差异(P>0.05)。术后0～48 h外侧路组、后路组及前路组使用镇痛泵补救镇痛的比率明显低于对照组(P<0.05),而外侧路组、后路组及前路组无明显差异(P>0.05)。外侧路组、后路组及前路组髋关节最大屈曲和外展活动度明显高于对照组(P<0.05),且前路组>后路组>外侧路组(P<0.05);对照组总不良反应发生率明显高于外侧路组、后路组及前路组(P<0.05),而外侧路组、后路组及前路组无明显差异(P>0.05)。结论:超声引导下QLB在髋关节置换术后起到较好的镇痛作用,能减少术后镇痛药物的使用,减少并发症发生,而前路QLB的方式患者髋关节活动度优于后路及外侧路。

Objective:To compare the analgesic effect of different approaches to quadratus lumborum block(QLB)after hip replacement.Methods:120 patients with hip arthroplasty were randomly divided into lateral approach group,posterior approach group,anterior approach and control group(without QLB),with 30 cases in each group.Lateral approach group,posterior approach group and anterior approach group patients were treated with ultrasound-guided QLB.The visual analog scale(VAS)scores were recorded at different time points.The analgesic pump use times during 0-24 h and 24-48 h after operation,hip flexion and abduction activity after 24 h and 48 h of operation,and the incidence of adverse reactions within 4 hours after operation were compared.Results:The static state VAS scores at 12 h,24 h and 48 h after surgery in the lateral approach group,posterior approach group and anterior approach group were significantly lower than those in the control group(P<0.05).There was no significant difference among the lateral approach group,posterior approach group and anterior approach group at 12 h and 48 h after surgery(P>0.05).After 24 h of surgery,posterior approach group and anterior approach group patients had higher static state VAS score than the lateral approach group patients(P<0.05).After 24 h and 48 h of surgery,the cough state VAS scores in the lateral approach group,posterior approach group and anterior approach group were significantly lower than those in the control group(P<0.05),and no significant difference was found among the three approaches groups(P>0.05).The analgesic pump use times during 0-48 h after operation in the lateral approach group,posterior approach group and anterior approach group were lower than those in the control group(P<0.05),and no significant difference was found among the three approaches groups(P>0.05).The hip flexion and abduction activity of the lateral approach group,posterior approach group and anterior approach group were higher than that of the control group(P<0.05),and anterior approach group>posterior approach group>lateral approach group(P<0.05).The incidence of adverse reactions in the control group was significantly higher than that in the lateral approach group,posterior approach group and anterior approach group(P<0.05),while no significant difference was found among the three approaches groups(P>0.05).Conclusion:Ultrasound-guided QLB had good analgesic effect after hip replacement.It could reduce the use of postoperative analgesic drugs and the incidence of complications.The anterior approach of QLB was superior to the posterior and lateral approaches in hip joint mobility.