超声引导下髂腰肌平面阻滞与髂筋膜间隙阻滞在髋关节置换围术期镇痛效果的比较

Comparison of the efficacy of ultrasound guided iliopsoas plane block and fascia iliaca compartment block in patients undergoing hip arthroplasty

中文关键词: 髂腰肌平面阻滞  髂筋膜间隙阻滞  髋关节置换  围术期镇痛  全身麻醉

英文关键词: Iliopsoas plane block  Fascia iliaca compartment block  Hip arthroplasty  Perioperative analgesia  General anesthesia

中文摘要:

      
目的 比较超声引导下髂腰肌平面阻滞与髂筋膜间隙阻滞在髋关节置换围术期镇痛效果。
方法 选择择期行单侧髋关节置换术患者50例，男28例，女22例，年龄18～95岁，BMI 17～35 kg/m²，ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组：髂腰肌平面阻滞组（I组）和髂筋膜间隙阻滞组（S组），每组25例。I组在髂股韧带和髂腰肌之间注射0.3%罗哌卡因10 ml，S组在腹股沟韧带上髂筋膜间隙注射0.3%罗哌卡因40 ml。术后采用舒芬太尼行患者自控静脉镇痛，VAS疼痛评分≥4分时，静脉注射氟比洛芬酯50 mg补救镇痛。记录神经阻滞操作时间、起效时间。记录术中丙泊酚、瑞芬太尼用量和舒芬太尼追加次数、术后2、6、8、12和24 h静息和活动（抬髋15°）时VAS疼痛评分、术后24 h镇痛泵有效按压次数和总按压次数、术后24 h舒芬太尼用量和补救镇痛情况。记录术后恶心呕吐、谵妄、感染、局麻药中毒和股四头肌无力发生情况。
结果 与S组比较，I组神经阻滞操作时间和起效时间明显缩短，术中舒芬太尼追加率、术后8 h活动时VAS疼痛评分、术后股四头肌无力发生率明显降低（P<0.05）。两组术中丙泊酚和瑞芬太尼用量、术后2、6、12、24 h静息和活动时VAS疼痛评分、术后24 h镇痛泵有效按压次数、总按压次数、舒芬太尼用量、补救镇痛率、恶心呕吐、谵妄、感染、局麻药中毒发生率差异均无统计学意义。
结论 超声引导下髂腰肌平面阻滞和髂筋膜间隙阻滞均可为行髋关节置换术患者提供满意镇痛，其中髂腰肌平面阻滞不影响患者髋部运动能力，有利于早期活动。

英文摘要:

      
Objective To compare the efficacy of ultrasound-guided iliopsoas plane block (IPB) and ultrasound-guided supra-inguinal fascia iliaca compartment block(S-FICB) in patients undergoing hip arthroplasty.
Methods Fifty patients scheduled for elective unilateral hip arthroplasty, aged 18-95 years, 28 males and 22 females, BMI 17-35 kg/m², ASA physical status Ⅰ-Ⅲ, were selected. Patients were divided into two groups using random number table method: IPB group (group I) and S-FICB group (group S), 25 patients in each group. In group I, 0.3% ropivacaine 10 ml was injected between the iliopsoas muscle and the iliofemoral ligament. In gourp S, 0.3% ropivacaine 40 ml was injected into the supra-inguinal fascia iliaca compartment. After surgery, patients were underwent patient-controlled intravenous analgesia with sufentanil. When VAS pain scores were more than 4, flurbiprofen axetil 50 mg was intravenously injected. The procedure time and onset time of nerve block were recorded. The dosage of propofol and remifentanil and the proportion of sufentanil injected during operation were recorded. VAS pain scores were recorded at rest and during exercise (hip lift at 15°) 2, 6, 8, 12, and 24 hours after operation. The number of effective and total PCIA, the dosage of sufentanil and the proportion of rflurbiprofen axetil injected 24 hours after operation were recorded. Postoperative nausea and vomiting, delirium, infection, local anesthetic poisoning, and quadriceps muscle weakness were recorded.
Results Compaired with group S, the procedure time and onset time of nerve block in group I were significantly shortened, the proportion of sufentanil injected, VAS pain score during exercise 8 hours after operation, the incidence of quadriceps weakness was significantly decreased in group I (P < 0.05). There were no significant differences in VAS pain scores at rest and during exercise 2, 6, 12, and 24 hours after operation, the dosage of propofol and remifentanil during the operation, the numer of effective and total PCIA, the dosage of sufentanil, or the proportion of rflurbiprofen axetil injected 24 hours after operation between the two groups. There were no significant differences in nausea,delirium or infection between the two groups.
Conclusion Ultrasound-guided iliopsoas plane block can provide adequate perioperative analgesia for patients undergoing hip arthroplasty without affecting hip motion ability, which is beneficial for early activity of the patients.