超声引导下髂筋膜腔隙阻滞对全髋关节置换术患者术后镇痛的效果

目的 评价超声引导下髂筋膜腔隙阻滞对全髋关节置换术患者术后镇痛的效果.方法 择期行全髋关节置换术患者36例,年龄54～82岁,体重48～72 kg,ASA分级Ⅰ～Ⅲ级,采用随机数字表法,将其随机分为2组(n=18):生理盐水组(NS组)和罗哌卡因组(R组).手术结束后30 min内行患侧超声引导下髂筋膜腔隙阻滞.R组髂筋膜腔隙注射0.25％罗哌卡因30 ml；NS组注射等容量生理盐水.阻滞完成后,采用0.01 mg/ml芬太尼行PCIA,无背景输注,PCA量2ml,锁定时间15 min.于阻滞前即刻(T0)、阻滞后3 h(T1)、6 h(T2)、8 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)和72 h(T7)时,记录静态VAS评分；于T4、T5、T6和T7时,记录被动运动VAS评分；于T5、T6和T7时,记录主动运动VAS评分.记录阻滞后0～12h、12～24 h、24～48 h、48～ 72 h各时段内芬太尼用量.记录术后不良反应的发生情况.结果 与NS组比较,R组T1～T7时静态VAS评分、T4～T7时被动运动VAS评分和T5～T7时主动运动VAS评分均降低,各时段芬太尼用量减少(P＜0.05).两组不良反应发生率差异无统计学意义(P＞0.05).结论 全髋关节置换术患者超声引导下髂筋膜腔隙阻滞的镇痛效果好,安全性良好.

Efficacy of ultrasound-guided fascia iliaca compartment block on postoperative analgesia in patients undergoing total hip arthroplasty

Objective To investigate the efficacy of ultrasound-guided fascia iliaca compartment block (FICB) on postoperative analgesia in patients undergoing total hip arthroplasty.Methods Thirty-six ASA Ⅰ-Ⅲ patients aged 54-82 yr weighing 48-72 kg undergoing total hip arthroplasty were randomly divided into 2 groups (n =18 each): normal saline group(group NS)and ropivacaine group (group R).Ultrasound-guided FICB was performed within 30 min after operation.Group R received 0.25 ％ ropivacaine 30 ml,while the equal volume of normal saline was used instead of ropivacaine in group NS.All patients received PCIA with 0.01 mg/ml fentanyl after FICB.PCIA included a bolus dose of 2 ml with a 15 min lockout interval and no background infusion.Pain at rest was evaluated using VAS (RVAS) score before FICB (T0 ）and at 3 h(T1 ),6 h(T2 ),8 h(T3 ),12 h(T4 ),24 h(T5 ),48 h(T6 )and 72 h(T7 )after FICB.The passive exercise VAS (PVAS) score at T4-6,T7 and active exercise VAS (AVAS) score at T5-7 were recorded.The consumption of fentanyl at 0-12 h,12-24 h、24-48 h and 48-72 h after FICB and the adverse effects were also recorded.Results Compared with group NS,RVAS score,PVAS score,AVAS score and the consumption of fentanyl were significantly decreased in group R.There was no significant difference in the adverse effects between the two groups.Conclusion Ultrasound-guided FICB can provide better postoperative analgesia with little adverse effects in patients undergoing total hip arthroplasty.