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| 超声引导下髂腰肌平面阻滞用于人工髋关节置换术后镇痛效果及对运动功能的影响 |
| Effect of ultrasound-guided iliopsoas plane block on postoperative analgesia and motor function after artificial hip arthroplasty |
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| DOI：10.12089/jca.2023.05.005 |
| 中文关键词: 超声 髂腰肌平面阻滞 人工髋关节置换术 镇痛效果 |
| 英文关键词: Ultrasound Iliopsoas plane block Artificial hip replacement Analgesic effect |
| 基金项目:保定市科技计划项目（2241ZF238） |
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| 中文摘要: |
目的 探讨超声引导下髂腰肌平面阻滞用于人工髋关节置换术后镇痛的效果及对运动功能的影响。
方法 选择择期全麻下行人工髋关节置换术患者60例，男34例，女26例，年龄31～80岁，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：髂腰肌平面阻滞组（I组）和股神经阻滞组（F组），每组30例。I组在超声引导下行髂腰肌平面阻滞，注射0.5%罗哌卡因10 ml；F组在超声引导下行股神经阻滞，注射0.5%罗哌卡因10 ml。两组均行股外侧皮神经阻滞，注射0.5%罗哌卡因5 ml。随后两组均行全麻。术后若患者VAS疼痛评分≥4分，静脉注射地佐辛5 mg。记录入PACU即刻及术后2、4、6、24、48 h静息和活动时VAS疼痛评分和股四头肌徒手肌力（MMT）分级。记录术后首次下床时间、补救镇痛情况和患者满意情况。记录恶心呕吐、头晕、神经损伤、血管损伤及穿刺部位感染的发生情况。
结果 与F组比较，I组入PACU即刻及术后2、4、6、24 h MMT分级明显升高（P＜0.05），首次下床时间明显缩短（P＜0.05）。两组入PACU即刻及术后2、4、6、24、48 h静息和活动时VAS疼痛评分差异无统计学意义。两组补救镇痛率、患者满意率、术后48 h MMT分级差异无统计学意义。两组恶心呕吐、头晕的发生情况差异无统计学意义。两组无一例发生穿刺相关并发症。
结论 超声引导下髂腰肌平面阻滞为人工髋关节置换术患者提供良好的术后镇痛效果的同时保留患者运动能力，安全性较好，能够促进患者术后早期康复。 |
| 英文摘要: |
Objective To investigate the analgesic effect and effect on motor function after ultrasound-guided iliopsoas plane block for artificial hip arthroplasty.
Methods Sixty patients, 34 males and 26 females, aged 31-80 years, ASA physical status Ⅰ-Ⅲ, undergoing artificial hip arthroplasty under general anesthesia were selected. The patients were randomly divided into two groups: iliopsoas plane block group (group I) and femoral nerve block group (group F), 30 patients in each group. In group I, the iliopsoas plane was blocked under ultrasound guidance, and 0.5% ropivacaine 10 ml was injected. In group F, femoral nerve was blocked under ultrasound guidance, and 0.5% ropivacaine 10 ml was injected. Both groups received lateral femoral cutaneous nerve block and 0.5% ropivacaine 5 ml was injected, followed by general anesthesia. After operation, if the VAS pain score of the patient was ≥ 4 points, intravenous injection of 5 mg of dexamethasone was used for rescue analgesia. The VAS pain score at rest and in activity and the free hand muscle strength (MMT) grade of quadriceps femoris were recorded entering PACU immediately and 2, 4, 6, 24, and 48 hours after operation. The time of getting out of bed for the first time, the rate of rescue analgesia and the rate of patient satisfaction were recorded. The incidence of nausea and vomiting, dizziness, nerve injury, vascular injury and puncture site infection were also recorded.
Results Compared with group F, the MMT grade in group I was significantly increased entering PACU immediately and 2, 4, 6, and 24 hours after surgery (P < 0.05), and the first time of getting out of bed was significantly shortened (P < 0.05). There were no significant differences in VAS pain score at rest and in activity between two groups entening PACU immediately and 2, 4, 6, 24, and 48 hours postoperatively. There were no significant differences in the rescue analgesia rate, patient satisfaction rate, and MMT grade 48 hours after surgery between two groups. There were no significant differences in the occurrence of postoperative nausea and vomiting and dizziness between two groups. There were no patients puncture related complications in either group.
Conclusion Ultrasound-guided iliopsoas plane block can provide good postoperative analgesia for patients undergoing artificial hip arthroplasty while preserving exercise capacity, with a better safety profile, and is able to promote early postoperative recovery. |
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