经股神经长轴髂筋膜阻滞在老年髋部骨折患者镇痛中的应用

目的 探讨超声平面内经股神经长轴髂筋膜阻滞在老年髋部骨折患者疼痛管理中的应用效果。方法 选取2023年3月至6月嘉兴学院附属第二医院收治的老年髋部骨折患者60例，根据随机数字表法将其分为S组和L组，每组各30例。S组患者行经股神经短轴髂筋膜阻滞，L组患者行经股神经长轴髂筋膜阻滞，比较神经阻滞前（T0）、神经阻滞后10min（T1）、2h（T2）、6h（T3）和12h（T4）两组患者的静态数字评分量表（numerical rating scale，NRS）评分、动态NRS评分，各神经分支阻滞有效例数和神经阻滞相关不良事件发生情况。结果 两组患者的静态和动态NRS评分随着时间的延长，先降低后略有升高。L组患者T2、T3时点的静态和动态NRS评分均显著低于S组（P<0.05）；L组患者的股外侧皮神经阻滞和闭孔神经阻滞有效例数均显著多于S组（P<0.05）；两组患者均无局部麻醉药中毒、外周神经损伤、镇痛掩盖病情等不良事件发生。结论 超声引导下经股神经长轴髂筋膜阻滞可有效减轻老年髋部骨折患者的早期疼痛，且安全性较高。

Application of long axis iliac fascia block through femoral nerve for analgesia in elderly patients with hip fractures

Objective To explore the application effect of ultrasound-guided long axis iliac fascia block through femoral nerve for pain management in elderly patients with hip fractures. Methods A total of 60 elderly patients with hip fractures admitted to the Second Affiliated Hospital of Jiaxing University from March to June 2023 were selected, and they were divided into S group and L group according to random number table method, with 30 cases in each group. Patients in S group underwent short axis iliac fascia block through femoral nerve by ultrasound, while patients in L group underwent long axis iliac fascia block through femoral nerve by ultrasound. The static numerical rating scale (NRS) scores, dynamic NRS scores of two groups were compared before nerve block (T0), and 10min (T1), 2h (T2), 6h (T3) and 12h (T4) after nerve block, effective cases of nerve branch block, and occurrence of adverse events related to nerve block were compared between two groups. Results The static and dynamic NRS scores of two groups decreased first and then increased slightly with the extension of time. At time points T2 and T3, the static and dynamic NRS scores of patients in L group were significantly lower than those in S group (P<0.05). The effective cases of lateral femoral cutaneous nerve block and obturator nerve block in L group were significantly higher than those in S group (P<0.05). No adverse events such as local anesthetic poisoning, peripheral nerve injury, and analgesia covering up the disease occurred in both groups. Conclusion Ultrasound-guided long axis iliac fascia block through femoral nerve can effectively reduce early pain in elderly patients with hip fracture, and it is safe.