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-现代医学

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

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

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.

参考文献：

[1] 郭长春,丁文刚.髂筋膜间隙阻滞在髋关节置换术后的镇痛应用[J].东南大学学报(医学版), 2017,36(1):126-128.
[2] 邓海泽,陈潮世.术前镇痛对老年人股骨颈骨折行髋关节置换术后早期认知功能障碍的影响[J].现代医学, 2020, 48(3):361-365.
[3] 单国法,夏焱志,郭明仁,等. "领结征"髂筋膜间隙阻滞联合闭孔神经阻滞在老年髋部骨折患者早期镇痛中的临床应用[J].现代医学, 2019,47(7):812-815.
[4] BULLOCK W M, YALAMURI S M, GREGORY S H,et al.Ultrasound-guided suprainguinal fascia iliaca technique provides benefit as an analgesic adjunct for patients undergoing total hip arthroplasty[J].J Ultrasound Med, 2017,36(2):433-438.
[5] GARNER M, ALSHAMEERI Z, SARDESAI A,et al.A prospective randomized controlled trial comparing the efficacy of fascia iliaca compartment block versus local anesthetic infiltration after hip arthroscopic surgery[J].Arthroscopy, 2017, 33(1):125-132.
[6] MCCARTHY D, MCNAMARA J, GALBRAITH J,et al.A comparison of the analgesic efficacy of local infiltration analgesia vs intrathecal morphine after total knee replacement:a randomised controlled trial[J].Eur J Anaesthesiol,2019, 36(4):264-271.
[7] 吴健,赵亮.超声引导下连续改良腹股沟韧带上髂筋膜阻滞对全髋关节置换术后镇痛效果的影响[J].临床麻醉学杂志,2019,35(10):969-972.
[8] GAO Y, TAN H, SUN R,et al.Fascia iliaca compartment block reduces pain and opioid consumption after total hip arthroplasty:a systematic review and meta-analysis[J].Int J Surg,2019, 65(5):70-79.
[9] DESMET M, VERMEYLEN K, VAN HERREWEGHE I,et al.A longitudinal supra-inguinal fascia iliaca compartment block reduces morphine consumption after total hip arthroplasty[J].Reg Anesth Pain Med, 2017,42(3):327-333.
[10] KUMAR K, PANDEY R K, BHALLA A P,et al.Comparison of conventional infrainguinal versus modified proximal suprainguinal approach of fascia iliaca compartment block for postoperative analgesia in total hip arthroplasty. A prospective randomized study[J].Acta Anaesthesiol Belg, 2015,66(3):95-100.
[11] SRAMPICKAL G M, JACOB K M, KANDOTH J J,et al.How effective is periarticular drug infiltration in providing pain relief and early functional outcome following total hip arthroplasty?[J].J Clin Orthop Trauma,2019,10(3):550-554.
[12] MAYR H O, PRALL W C, HAASTERS F,et al.Pain relieve without impairing muscle function after local infiltration anaesthesia in primary knee arthroplasty:a prospective randomized study[J].Arch Orthop Trauma Surg, 2019,139(7):1007-1013.
[13] KUCHÁLIK J, MAGNUSON A, LUNDIN A,et al.Local infiltration analgesia or femoral nerve block for postoperative pain management in patients undergoing total hip arthroplasty. A randomized, double-blind study[J].Scand J Pain, 2017,16(1):223-230.
[14] NASSAR I, FAHEY J, MITCHELL D,et al.Rapid recovery following hip and knee arthroplasty using local infiltration analgesia:length of stay, rehabilitation protocol and cost savings[J].ANZ J Surg,2020,90(3):355-359.
[15] BOBER K, KADADO A, CHARTERS M,et al.Pain control after total hip arthroplasty:a randomized controlled trial determining efficacy of fascia iliaca compartment blocks in the immediate postoperative period[J].J Arthroplasty, 2020, 35(6S):S241-S245.
[16] BEHRENDS M, YAP E N, ZHANG A L,et al.Preoperative fascia iliaca block does not improve analgesia after arthroscopic hip surgery, but causes quadriceps muscles weakness[J].Anesthesiology, 2018, 129(3):536-543.
[17] FAHS A M, KOUEITER D M, KURDZIEL M D,et al.Psoas compartment block vs periarticular local anesthetic infiltration for pain management after anterior total hip arthroplasty:a prospective, randomized study[J].J Arthroplasty, 2018, 33(7):2192-2196.
[18] MACRINICI G I, MURPHY C, CHRISTMAN L,et al.Prospective, double-blind, randomized study to evaluate single-injection adductor canal nerve block versus femoral nerve block:postoperative functional outcomes after total knee arthroplasty[J].Reg Anesth Pain Med, 2017,42(1):10-16.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录