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| 超声引导下不同入路髂筋膜间隙阻滞用于老年患者股骨近端防旋髓内针内固定术围术期镇痛效果的比较 |
| Comparison of fascia iliaca compartment in different ways for perioperative analgesia in elderly patients with intertrochanteric fracture treated with proximal femoral nail antirotation |
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| DOI：10.12089/jca.2020.10.003 |
| 中文关键词: 髂筋膜间隙阻滞 腹股沟韧带 股骨粗隆间骨折 围术期镇痛 超声引导 |
| 英文关键词: Fascia iliacacompartment block Inguinal ligament Intertrochanteric fracture Perioperative analgesia Ultrasound guidance |
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| 中文摘要: |
目的 比较超声引导下腹股沟韧带上髂筋膜间隙阻滞（S-FICB）与腹股沟韧带下髂筋膜间隙阻滞（I-FICB）在行股骨近端防旋髓内针内固定术老年患者围术期的镇痛作用。
方法 限期行股骨近端防旋髓内针内固定术的股骨粗隆间骨折患者80例，男43例，女37例，年龄65～85岁，ASA Ⅰ—Ⅲ级，随机分为两组：S-FICB组（S组）和I-FICB组（I组），每组40例。S组和I组分别注射0.4%罗哌卡因40 ml行S-FICB和I-FICB。记录阻滞操作时间、股神经及股外侧皮神经阻滞起效时间及阻滞效果。记录术后2、6、12、24、48 h静息及运动时VAS疼痛评分、自控镇痛按压次数及补救镇痛情况。记录术后不良反应的发生情况。
结果 两组阻滞操作时间、股神经阻滞效果差异无统计学意义。S组股神经及股外侧皮神经阻滞起效时间明显短于I组（P<0.05），股外侧皮神经阻滞效果明显优于I组（P<0.05）。S组术后2、6、12 h运动时VAS疼痛评分明显低于I组（P<0.05）。两组术后自控镇痛、补救镇痛及不良反应发生率差异无统计学意义。
结论 与I-FICB比较，S-FICB阻滞起效更快，股外侧皮神经阻滞效果更好，患者术后变换体位时镇痛效果更好。 |
| 英文摘要: |
Ojective To compare the analgesic effects of ultrasound-guided inguinal ligament superior iliac fascial space block (S-FICB) and sub-inguinal ligament iliac fascial space block (I-FICB) in elderly patients undergoing proximal femoral nail antirotation operation.
Methods Eighty patients with intertrochanteric fracture scheduled for proximal femoral nail antirotation operation under intravertebral anesthesia, 43 males and 37 females, aged 65-85 years, falling into ASA physical status Ⅰ-Ⅲ, were randomly divide into two groups (n = 40 each): S-FICB group (goup S) and I-FICB group (group I). The patients in group S received S-FICB using ultrasound-guided injection of 0.4% ropivacaine 40 ml, while the patients received I-FICB in group I. The time of ultrasound-guided nerve block was recorded. The block operation time, the onset time and the block effect of the femoral nerve (FN) and lateral femoral cutaneous nerve (IFCN) block were recorded. The rest and exercise VAS pain scores at 2, 6, 12, 24, and 48 h postoperatively, the number of self-controlled analgesia compressions, and remedial analgesia were recorded. Adverse reactions occurred after surgery were recorded.
Results There was no statistically significant difference between the two groups in the time of block operation and the effect of FN block (P < 0.05). Both the onset times of FN and LFCN block in group S were significantly shorter than those in group I (P < 0.05). Compared with group I, the VAS scores during movement at postoperaive 2, 6, 12 h were lower in group S (P < 0.05). There were no significant differences in the dosage of analgesic, rescue analgesia between the two groups, as well as the incidence of nausea and vomiting.
Conclusion For elderly patients with intertrochanteric fracture, ultrasound-guided S-FICB produces FN and LFCN block faster compared with I-FICB, S-FICB provides better postoperative analgesia when patients change position． |
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