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| 超声引导下髂筋膜间隙联合骶丛神经阻滞在老年全髋关节置换术中的应用 |
| Application of ultrasound-guided fascia iliaca compartment block combined with sacral plexus block in elderly patients undergoing total hip arthroplasty via posterolateral approach |
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| DOI： |
| 中文关键词: 髂筋膜间隙阻滞 骶丛神经阻滞 老年 全髋关节置换术 |
| 英文关键词: Fascia iliaca compartment block Sacral plexus block The elderly Total hip arthroplasty |
| 基金项目: |
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| 中文摘要: |
目的：评价超声引导下髂筋膜间隙联合骶丛神经阻滞在老年全髋关节置换后外侧入路手术中的应用效果。
方法：选择择期行单侧人工全髋关节置换术(后外侧入路)患者60例,男24例,女36例,年龄65～90岁,ASA Ⅱ或Ⅲ级,随机分为研究组(NB组)和对照组(SA组),每组30例。NB组在超声引导下先行髂筋膜间隙阻滞(0.4％罗哌卡因50 ml),然后行骶丛神经阻滞(0.5％罗哌卡因20 ml);SA组行轻比重单侧腰麻2.0～2.5 ml(0.5％布比卡因2 ml+灭菌注射用水1 ml)。记录两组的感觉、运动阻滞起效及完善时间。记录患者入室时(T0)、摆放体位前1 min(T1)、摆体位时(T2)、手术切皮时(T3)、手术开始后30 min(T4)、手术结束时(T5)、术后24 h(T6)的VAS评分。记录两组患者术中辅助使用多巴胺、阿托品的情况及并发症的发生情况。
结果：NB组感觉、运动阻滞起效及完善时间明显长于SA组(P＜0.05)。T1、T2、T6时NB组VAS评分明显低于SA组,T3、T5时NB组VAS评分明显高于SA组(P＜0.05)。NB组使用多巴胺2例(6.7％),明显少于SA组的8例(26.7％)(P＜0.05)。NB组头痛、恶心、呕吐、尿潴留发生率明显低于SA组(P＜0.05)。
结论：超声引导下髂筋膜间隙联合骶丛神经阻滞应用于老年全髋关节置换后外侧入路手术,可减轻摆放体位所致的疼痛,减少血管活性药物的用量,且术后早期镇痛效果好,不良反应较少。 |
| 英文摘要: |
Objective: To evaluate the efficacy of ultrasound-guided fascia iliaca compartment block combined with sacral plexus block in elderly patients undergoing posterolateral approach total hip arthroplasty (THA).
Methods: Sixty patients, 24 males and 36 females, aged 65-90 years, ASA physical status Ⅱ or Ⅲ, undergoing THA via posterolateral approach were randomized into two groups with 30 cases in each group. Group SA received unilateral hypobaric spinal anesthesia with 2.0 2.5 ml local anesthetics (2 ml of 0.5％ bupivacaine mixed 1 ml of sterile water for injection). Group NB received ultrasound-guided fascia iliaca compartment block (50 ml of 0.4％ ropivacaine) combined with sacral plexus block (20 ml of 0.5％ ropivacaine). The onset time and success time of sensory and motor block were evaluated. The visual analogue scale (VAS) at entring into the operating room (T0), 1 min before positioning change (T1), positioning change (T2), skin incision (T3), 30 min after skin incision (T4), end of surgery (T5), 24 h postoperatively (T6). The use of dopamine and atropine and incidence of complications were recorded.
Results: Compared with group SA, the onset time and success time of sensory and motor nerve block of group NB were longer (P＜0.05). The VAS decreased at T1, T2, T6 and increased at T3, T5 in group NB (P＜0.05). The use of dopamine in group NB (6.7％) was less than that in group SA (26.7％). Headache, nausea, vomiting, urinary retention were significantly decreased in group NB (P＜0.05).
Conclusion: Ultrasound-guided fascia iliaca compartment block combined with sacral plexus block relieves the pain caused by positioning changes. This technique may be used in elderly patients undergoing THA via posterolateral approach with less use of vasoactive drugs, better postoperative analgesic effects, fewer complications and higher degree of patient satisfaction. |
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