超声引导髂筋膜腔隙与髂腹下/髂腹股沟神经复合阻滞在老年患者髋关节置换术术后镇痛中的作用

目的 观察超声引导下髂筋膜腔隙与髂腹下/髂腹股沟神经联合阻滞在老年患者全髋关节置换术术后镇痛的作用. 方法 选择2015年1月～2015年11月全身麻醉下行单侧前外侧入路全髋关节置换术的患者50例,年龄61～75岁,ASA分级Ⅱ、Ⅲ级,采用随机数字表法将患者分为两组(每组25例):单纯髂筋膜间隙阻滞组(单纯组)和髂筋膜腔隙与髂腹下/髂腹股沟神经复合阻滞组(复合组).手术结束后即刻行患侧超声引导下神经阻滞.单纯组于髂筋膜腔隙注射0.3％罗哌卡因30 ml;复合组分别于髂筋膜腔隙与髂腹下/髂腹股沟注射0.3％罗哌卡因15 ml.记录患者一般情况,术后6、12、18、24 h患者静息及运动VAS评分,超声成像时间,穿刺注药时间,患者自控镇痛(patient controlled analgesia,PCA)芬太尼累计用量及术后镇痛相关副作用的发生情况. 结果 两组患者一般情况差异无统计学意义(P＞0.05).两组患者术后各时点静息VAS评分差异均无统计学意义(P＞0.05).复合组运动VAS评分在术后6 h (3.8±0.9)分]和12 h(3.6±1.3)分]时点较单纯组(5.5±11)分和(5.3±1.0)分]降低(P＜0.05);在术后18h和24 h时点,2组运动VAS评分差异均无统计学意义(P＞0.05).两组患者超声成像时间和穿刺注药时间差异均无统计学意义(P＞0.05).复合组PCA芬太尼累计用量(0.54±0.03) mg]较单纯组(0.69±0.05) mg]降低(P＜0.05).两组患者术后镇痛相关副作用发生率差异无统计学意义(P＞0.05). 结论 在老年患者髋关节置换术后,超声引导髂筋膜腔隙与髂腹下/髂腹股沟神经复合阻滞可安全、有效地用于术后镇痛,显著缓解患者甲早期的运动疼痛同时减少芬太尼用量.

Effects of ultrasound-guided combinatorial block of fascia iliaca compartment and ilioinguinal/iliohypogastric nerves on postoperative analgesia in elderly patients with hip replacement

Objective To observe effects of ultrasound-guided combinatorial block of fascia iliaca compartment and ilioinguinal/iliohypogastric nerves on postoperative analgesia in elderly patients with hip replacement.Methods A total of fifty 61 to 84 years old patients with ASA category of Ⅱ or Ⅲ were enrolled in this study.These patients received total hip replacement via unilateral approach under general anesthesia between April and October in 2015.The patients were randomly divided into 2 groups (n=25):fascia iliaca block only (FI group) and fascia iliacus block combined with ilioinguinal/iliohypogastric nerve block group (combined group).Immediately after the operation,the patients received ipsilateral nerve block with 0.3％ ropivacaine under the guidance of ultrasound.We recorded general parameters of the patients,including resting and motion VAS scores,ultrasound imaging time,puncture administration time,cumulative dosage of fentanyl,and incidences of various adverse reactions.Results There was no statistical difference between the two groups of patients in general parameters and resting pain scores at each time point after operation.Compared with FI group,motion pain scores of the combined group decreased at postoperative 6 h and 12 h,while there was no statistical difference in motion pain scores at postoperative 18 h and 24 h.There was no statistical difference between the two groups of patients in ultrasound imaging time and puncture administration time.Compared with the FI group,the combined group had smaller cumulative dosage of fentanyl for patient controlled analgesia(PCA).There was no statistical difference between the two groups of patients in incidences of postoperative analgesia-related adverse reactions.Conclusions Ultrasound-guided combinatorial block of fascia iliaca compartment and ilioinguinal/iliohypogastric nerve is safe and effective for postoperative analgesia in elderly patients receiving total hip replacement.It can significantly alleviate patients' pain and reduce the dosage of fentanyl.