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| 超声引导下髋关节囊周围神经阻滞联合椎管内麻醉在老年患者全髋关节置换术中的应用 |
| Application of preoperative ultrasound-guided pericapsular nerve group block combined with intraspinal anesthesia for elderly patients in total hip arthroplasty |
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| DOI：10.12089/jca.2021.05.002 |
| 中文关键词: 超声 全髋关节置换术 关节囊 神经阻滞 镇痛 |
| 英文关键词: Ultrasonography Total hip arthroplasty Capsule Nerve block Analgesia |
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| 中文摘要: |
目的 评价超声引导下髋关节囊周围神经（PENG）阻滞应用于老年患者全髋关节置换术中的有效性及安全性。
方法 选择2019年8月至2020年1月择期因股骨颈骨折于椎管内麻醉下行全髋关节置换术的老年患者40例，男23例，女17例，年龄65~80岁，BMI 16~28 kg/m2, ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：超声引导下PENG阻滞组（P组）和对照组（C组）。P组于体位摆放前20 min行超声引导下PENG阻滞，将0.5%罗哌卡因10 ml注入腰大肌肌腱与耻骨之间间隙；C组于体位摆放前20 min静脉注射舒芬太尼0.1 μg/kg。随后两组均行椎管内麻醉，术后均行羟考酮PCIA，维持NRS评分<4分，若NRS评分≥4分，静脉注射羟考酮1 mg补救镇痛。记录患者入室时（T0）、体位摆放前即刻（T1）、体位摆放时（T2）和体位摆放后即刻（T3）的NRS评分。记录椎管内麻醉操作时间、麻醉科医师对体位摆放满意情况、患者满意情况、PCIA首次按压时间、术后24 h内羟考酮总用量和补救镇痛例数。记录恶心、呕吐、局麻药中毒、穿刺部位感染、呼吸抑制等不良反应的发生率。
结果 与C组比较，P组T1—T3时NRS评分明显降低（P<0.05），椎管内麻醉操作时间明显缩短（P<0.05），麻醉科医师对体位摆放满意率、患者满意率明显升高（P<0.05），PCIA首次按压时间明显延长（P<0.05），术后24 h内羟考酮总用量明显减少（P<0.05），补救镇痛率明显降低（P<0.05）。两组均未发生不良反应。
结论 超声引导下髋关节囊周围神经阻滞联合椎管内麻醉应用于老年患者全髋关节置换术，可增强术后镇痛效果，缩短椎管内麻醉操作时间，提高患者椎管内麻醉体位摆放时的舒适度，减少术后24 h内羟考酮总用量，兼具有效性和安全性。 |
| 英文摘要: |
Objective To evaluate the effect of preoperative ultrasound-guided pericapsular nerve group block for positioning patients and postoperative analgesia in total hip arthroplasty.
Methods Forty elderly patients undergoing total hip arthroplasty by spinal anesthesia from August 2019 to January 2020, aged 65-80 years, 23 males and 17 females, BMI 16-28 kg/m2, ASA physical status Ⅱ or Ⅲ, were randomly divided into two groups, 20 patients in each group: ultrasound-guided pericapsular nerve group block (group P) and control group (group C). Ultrasound-guided pericapsular nerve group block was performed in group P with 0.5% ropivacane 10 ml injected in the space between psoas major tendon and pubis 20 minutes before spinal anesthesia, and sufentanil 0.1 μg/kg was injected intravenously 20 minutes before anesthesia in group C, respectively. All the patients received patient-controlled intravenous analgesia with oxycodone after surgery to maintain the NRS score less than 3 points. Oxycodone 1 mg was injected intravenously as rescue analgesic when NRS score was more than 4 points. NRS score when patients entering the operation room (T0), before positioning (T1), during positioning (T2), and after positioning (T3), the time of spinal anesthesia, the satisfaction rate of anesthesiologists on body position, the satisfaction rate of patients, the first pressing time of PCIA, the total amount of oxycodone within 24 hours after operation, the rate of rescue analgesia, and adverse reactions such as nausea, vomiting, local anesthetic poisoning, puncture site infection and respiratory depression were all recorded.
Results Compared with group C, the NRS scores at T1 - T3 in group P were significantly lower (P < 0.05), the time of spinal anesthesia in group P was shorter (P < 0.05), the satisfaction rate of anesthesiologists on body position and patients were increased (P < 0.05), the first pressing time of PCIA was prolonged (P < 0.05), the total amount of oxycodone within 24 hours after operation and the rate of rescue analgesia were decreased (P < 0.05). Postoperative oxycodone consumption was lower, the time to first dose demand was longer, times needed for rescue analgesic was shorter, and patient satisfaction rates were higher in group P (P < 0.05). There were no adverse reactions occurred in the two groups.
Conclusion Performing an ultrasound-guided pericapsular nerve group block before positioning for spinal anesthesia can enhance the effect of postoperative analgesia, shorten the operation time of spinal anesthesia, improve the comfort of anesthesia position in spinal canal, reduce the dosage of oxycodone within 24 hours after operation. |
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