超声引导下腰方肌阻滞与髂筋膜间隙阻滞在老年髋关节术后镇痛的比较

Comparison of ultrasound-guided quadratus lumborum block and fasciailiaca compartment block on post-operation analgesia for total hip archropalsty

中文关键词: 超声  腰方肌阻滞  髂筋膜间隙阻滞；髋关节置换

英文关键词: Ultrasound  Quadratus lumborum block  Fasciailiaca compartment block  Total hip archropalsty

中文摘要:

      
目的 比较腰方肌阻滞(quadratus lumborum block, QLB)和髂筋膜间隙阻滞(fasciai-liaca compartment block, FICB)在老年髋关节置换术的镇痛效果。
方法 选择择期拟行腰麻下全髋关节置换术的老年患者55例,男22例，女33例，年龄65～85岁，ASA Ⅰ或Ⅱ级, 随机分为QLB组(n=28)和FICB组(n=27)。术后分别于超声引导下行QLB和FICB, 予0.375％罗哌卡因30 ml。所有患者术后行舒芬太尼静脉自控镇痛。记录术后6、12、24、48 h镇痛泵按压次数及舒芬太尼用量;记录静息及运动时VAS疼痛评分;记录术后恶心呕吐、眩晕等不良反应情况。
结果 术后12、24、48 h QLB组镇痛泵按压次数及舒芬太尼用量明显少于FICB组(P<0.05)；术后12、24、48 h QLB组运动时VAS评分明显低于FICB组(P<0.05),两组不同时点静息时VAS评分差异无统计学意义；QLB组恶心呕吐发生率明显低于FICB组［2(7.1％) vs 9(33.3％), P<0.05］。
结论 腰方肌阻滞较髂筋膜间隙阻滞更能明显减轻髋关节置换术后活动痛, 减少阿片类药物的使用及不良反应发生率。

英文摘要:

      
Objective To compart the effects of quadratus lumborum block (QLB) and fasciailiaca compartment block (FICB) in analgesia after total hip arthroplasty.
Methods Fifty-five patients undergoing total hip arthroplasty, 22 males and 33 females, all falling into ASA physical status Ⅰ or Ⅱ, were randomized into group QLB (n = 28) and group FICB (n = 27). Ultrasound-guided QLB and FICB was performed at the end of operation and 30 ml of 0.375％ ropivacaine hydrochloride was used. Postoperative VAS scores at 6, 12, 24 and 48 h were recorded. Compressing numbers and the consumption of sufentanil were recorded as well. Postoperative nausea and vomiting, dizziness were recorded.
Results Patients in group QLB used significantly less sufentanil than those of group FICB (P < 0.05) at 12, 24, 48 h as well as compressing numbers. Silent VAS score had no differences after operation. But VAS score during movement in group of QLB was less than that of group FICB at 12, 24, 48 h. Side effects shuch as postoperative nausea and vomiting of group QLB were significantly less than of group FICB ［2 (7.1％) vs 9 (33.3％), P < 0.05］.
Conclusion QLB can more effectively reduce postoperative sufentanil consumption and side effects compared to FICB.