超声引导下不同入路持续髂筋膜阻滞对全髋关节置换术后镇痛效果的影响

发布时间：2018-04-21 10:22

本文选题：术后镇痛 + 髂筋膜阻滞　；参考：《临床麻醉学杂志》2017年10期

【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(P0.05)。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(P0.05)。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(P0.05)。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(P0.05)。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(P0.05)。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。
[Abstract]:Objective to compare the analgesic effect of continuous iliac fascia block under ultrasound guidance in patients with total hip arthroplasty. Methods 40 patients (21 males and 19 females) undergoing unilateral total hip arthroplasty from June to December 2016 were randomly divided into parallel puncture group (n = 20) and vertical puncture group (n = 20). After the operation, the parallel puncture group was treated with parallel inguinal ligament needle insertion in the plane, and the vertical puncture group with the vertical inguinal ligament needle insertion in the plane, with the injection of 1% lidocaine 10ml for preemptive analgesia. Continuous infusion of 0.2% ropivacaine 4ml/h to 48 hours after operation. The time of ultrasound imaging, the time of puncture injection and the depth of catheter implantation were recorded. The effective times of patient-controlled nerve blockade analgesia (PCNA), the cumulative dosage of ropivacaine, the number of nociceptive rating scales, the effect of sensory block, the analgesic satisfaction score and related complications were recorded in patients with patient-controlled nerve blockade analgesia for 48 h after operation. Results the ultrasonic imaging time, the injection time and the depth of catheterization in the vertical puncture group were significantly longer than those in the parallel puncture group (P 0.05). The effective pressing times of PCNA in the vertical puncture group were significantly less than that in the parallel puncture group at 30 ~ 36 ~ 42 and 48 hours postoperatively (P < 0.05). The success rate of lateral femoral cutaneous nerve block in vertical puncture group was significantly higher than that in parallel puncture group (P 0.05). The cumulative dose of ropivacaine in the perpendicular puncture group was significantly lower than that in the parallel puncture group at 30 and 36 hours postoperatively. The resting NRS score of the vertical puncture group was significantly lower than that of the parallel puncture group (P 0.05). There was no significant difference in the success rate of femoral nerve block, the score of analgesic satisfaction and the incidence of related complications between the two groups. Conclusion the continuous iliac fascial catheterization can provide good analgesic effect after total hip arthroplasty, and the vertical puncture group can reduce the postoperative resting pain score more effectively. To reduce the cumulative dose of ropivacaine and improve the success rate of lateral femoral cutaneous nerve block.
【作者单位】：华中科技大学同济医学院附属同济医院麻醉科;
【基金】：湖北省卫生计生委青年人才项目(WJ2015Q008) 贝朗基金(2015020)
【分类号】：R614

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