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腹股沟韧带上髂筋膜阻滞与关节周围浸润镇痛对全髋关节置换术后镇痛效果的比较
作者:黄礼兵1  赵峰1  汤洋1  杨程1  季沐梵2  季方兵1 
单位:1. 江苏省中医院 麻醉科, 江苏 南京 210029;
2. 南通大学 医学院, 江苏 南通 226001
关键词:超声引导 髂筋膜阻滞 全髋关节置换术 局部浸润 术后镇痛 
分类号:R614;R687.4
出版年·卷·期(页码):2021·49·第一期(59-63)
摘要:

目的: 比较超声引导下腹股沟韧带上髂筋膜阻滞(suprainguinal fascia iliaca compartment block,SFICB)及关节周围浸润镇痛(periarticular local infiltration analgesia,PLIA)对全髋关节置换术后镇痛效果和功能恢复的影响。方法: 择期行单侧后路全髋关节置换术患者60例中,男37例,女23例;年龄40~75岁;美国麻醉医师协会(American Society of Anesthesiology,ASA)Ⅰ或Ⅱ级。将60例患者随机均分为SFICB组和PLIA组,每组30例。两组患者的局麻药配方为0.25%罗哌卡因100 mg和肾上腺素100 μg共40 ml。比较术后转入麻醉后恢复室(postanesthesia care unit,PACU)、2 h、6 h、12 h、24 h、48 h患者静息和运动时的疼痛视觉模拟评分(visual analog scale,VAS);记录PACU内镇痛药需求,术后24 h及48 h镇痛泵有效按压次数、补救镇痛例数和恶心呕吐发生率;比较术后24 h及48 h“起立-行走”计时测试(timed-up-and-go,TUG)时间、感觉异常和股四头肌肌力下降的发生情况、首次下床时间以及住院时间。结果:两组患者术后各时点静息和运动时VAS疼痛评分差异无统计学意义(P>0.05)。两组患者在PACU镇痛药需求、0~24 h和24~48 h镇痛泵按压次数、补救镇痛人数以及恶心呕吐发生率等方面差异均无统计学意义(P>0.05)。术后24 h,SFICB组患者TUG时间长于PLIA组,感觉异常和肌无力发生例数显著多于PLIA组(P<0.05);两组48 h TUG时间、下床时间和出院时间差异均无统计学意义(P>0.05)。结论: 超声引导下SFICB和PLIA均可用于全髋关节置换术后镇痛,但是PLIA对术后肢体感觉和股四头肌肌力影响小。

Objective: To compare ultrasound-guided suprainguinal fascia iliaca compartment block (SFICB) with periarticular local infiltration analgesia (PLIA) on pain and functional recovery in patients undergoingtotal hip arthroplasty(THA).Methods: Sixty patients, 37 males and 23 females, aged 40 years to 75 years, American Society of Anesthesiology(ASA) physical status Ⅰ or Ⅱ, scheduled for elective THA were randomized to SFICB group or PLIA group, with 30 cases in each group. The local anesthetic solution for both the groups included 40 ml 0.25% ropivacaine 100 mg and epinephrine 100 μg. Postoperative pain visual analog scale(VAS) scores at rest and on movement were measured at postanesthesia care unit(PACU),2 h,6 h,12 h,24 h,48 h postoperatively. Analgesics demand at PACU, effective PCA pressing times at 24 h and 48 h, numbers of patients who required rescue analgesia and postoperative nausea and vomitmg(PONV) incidence were recorded. Timed-up-and-go (TUG) test at postoperative 24 h and 48 h, incidence of sensory changes and quadriceps muscle weakness, time to ambulation and time to discharge readiness were also compared.Results: The pain scores at rest and on movement were similar at all recorded time points(P>0.05). There were no differences between the groups with respect to analgesics demand at PACU, number of PCA pressing at postoperative 0-24 h and 24-48 h, need for rescue analgesia and incidence of PONV(P>0.05). Compored with the PLIA group, TUG time of SFICB group at 24 h was significantly longer, and significantly more patients in the SFICB group experienced sensory changes and quadriceps muscle weakness at 24 h after surgery (P<0.05). There were no significant differences in TUG time at 48 h, time to ambulation and time to discharge readiness(P>0.05).Conclusion: In patients undergoing THA, both SFICB and PLIA provides the similar pain relief, but LIA is associated with less sensory changes and muscle weakness postoperatively.

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