【摘要】 目的比较超声引导下不同入路持续髂筋膜阻滞用于全髋关节置换术后镇痛的效果。方法选择2016年6~12月择期行单侧全髋关节置换术患者40例,男21例,女19例,ASAⅠ或Ⅱ级,按照随机数字表法将其分为平行穿刺组和垂直穿刺组,每组20例。手术结束后,平行穿刺组采取平行腹股沟韧带平面内进针置管,垂直穿刺组采取垂直腹股沟韧带平面内进针置管,注入负荷量1%利多卡因10ml预镇痛,并连续泵注0.2%罗哌卡因4ml/h至术后48h。记录两组患者持续髂筋膜阻滞的超声成像时间、穿刺注药时间、导管置入深度。记录术后6、12、18、24、30、36、42、48h患者自控神经阻滞镇痛(patient-controlled nerve blockade analgesia,PCNA)有效按压次数、罗哌卡因累积用量、疼痛数字评分(numerical rating scales,NRS)、感觉阻滞效果、镇痛满意度评分和相关并发症等。结果垂直穿刺组超声成像时间、穿刺注药时间、置管深度明显长于平行穿刺组(P<0.05)。术后30、36、42和48h垂直穿刺组PCNA有效按压次数明显少于平行穿刺组(P<0.05)。术后6、12、18、24、30、36、42和48h垂直穿刺组股外侧皮神经阻滞成功率明显高于平行穿刺组(P<0.05)。术后24、30和36h垂直穿刺组罗哌卡因累积用量明显少于平行穿刺组(P<0.05)。术后24、30、36、42和48h垂直穿刺组静息NRS评分明显低于平行穿刺组(P<0.05)。两组股神经阻滞成功率、镇痛满意度评分及相关并发症发生率差异无统计学意义。结论平行穿刺入路和垂直穿刺入路实施持续髂筋膜置管均能提供良好的全髋关节置换术后镇痛效果;垂直穿刺组能更有效地降低患者术后静息疼痛评分,减少罗哌卡因累积用量,提高股外侧皮神经阻滞成功率。更多还原

【Abstract】 Objective To compare the analgesic effect of continuous iliac fasicia block with different approaches for patients undergoing total hip arthroplasty(THA).Methods Forty patients,21 males and 9 females,ASA physical statusⅠ orⅡ,scheduled for elective hip arthroplasty surgery in Tongji Hospital from June to December 2016 were enrolled and randomly divided into two groups:parallel group(n=20)or vertical group(n=20).Patients received ultrasound-guided continuous iliac fasicia block with a short-axis in-plane technique in the parallel group and a long-axis in-plane technique in the vertical group after the surgery.All patients had a 10 ml bolus of lidocaine 1% via the catheter followed by an infusion of ropivacaine 0.2% at 4 ml/h for 48 h.The ultrasound imaging time,procedure time and the depth of catheter were recorded.Cumulative frequency of patient-controlled nerve blockade analgesia(PCNA),ropivacaine consumption,pain scores at rest,the success rate of block,satisfaction scores and postoperative complications were recorded at every six hours during 48 h after the surgery.Results The ultrasound imaging time and procedure time in the vertical group were longer than in the parallel group(P<0.05).The depth of catheter in the vertical group was significantly greater than in the parallel group(P<0.05).The cumulative frequency of PCNA in the vertical group was significantly less than the parallel group(P<0.05).The success rate of the lateral femoral cutaneous nerve block in the vertical group was significantly higher than the parallel group at 6,12,18,24,30,36,42,48 h.The cumulative ropivacaine consumption at 24,30,36 h in the vertical group was significantly less compared with the parallel group(P<0.05).The pain intensity at rest was less in the vertical group compared with the parallel group at 24,30,36,42,48 h(P<0.05).There were no significant differences in the success rate of the femoral nerve block,satisfaction scores and related complications between the two groups.Conclusion Continuous iliac fasicia block with the short-axis in-plane and long-axis in-plane technique can effectively provide the postoperative analgesic effects for patients undergoing THA.The long-axis in-plane technique in the vertical group with a higher success rate of the lateral femoral cutaneous nerve block can significantly reduce the ropivacaine consumption and pain scores.更多还原