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| 髂腰肌平面联合股外侧皮神经阻滞对老年患者全髋关节置换术后早期镇痛的影响 |
| Effect of iliopsoas plane block combined with lateral femoral cutaneous nerve block on early postoperative analgesia in elderly patients undergoing total hip arthroplasty |
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| DOI：10.12089/jca.2026.08.009 |
| 中文关键词: 髂腰肌平面阻滞 股外侧皮神经阻滞 全髋关节置换术 镇痛 老年 |
| 英文关键词: Iliopsoas plane block Lateral femoral cutaneous nerve block Total hip arthroplasty Analgesia Aged |
| 基金项目:甘肃省自然科学基金(26JRRA398) |
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| 摘要点击次数: 26 |
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| 中文摘要: |
目的： 探究超声引导下髂腰肌平面阻滞（IPB）联合股外侧皮神经阻滞（LFCNB）对老年患者全髋关节置换术（THA）后早期镇痛的影响。
方法： 选择2025年2—9月全身麻醉下行单侧THA的老年患者，年龄≥65岁，BMI 18.5～30.0 kg/m2，ASA Ⅱ—Ⅳ级。采用随机数字表法将患者分为两组：IPB+LFCNB组（IL组）和IPB组（I组）。IL组麻醉诱导前于超声引导下行IPB联合LFCNB，I组麻醉诱导前于超声引导下行单纯IPB。主要指标为术后24 h内曲马多用量。次要指标包括术中丙泊酚、瑞芬太尼用量，手术时间，出PACU即刻、术后6、12、24、48 h静息和活动时数字等级评定量表（NRS）评分与股四头肌徒手肌力测试（MMT）分级，术后镇痛满意度评分，术后首次下床活动时间和术后住院时间。穿刺并发症包括穿刺部位感染、局部麻醉药毒性中毒、血肿和神经损伤。不良反应包括术后恶心呕吐、头晕和血栓形成。
结果： 共纳入患者120例，每组60例。与I组比较，IL组术后24 h内曲马多用量明显减少，术中丙泊酚和瑞芬太尼用量明显减少，出PACU即刻、术后6、12、24、48 h静息和活动时NRS评分明显降低，出PACU即刻和术后6 h MMT分级明显升高，术后首次下床活动时间明显缩短，镇痛满意度评分明显升高（P＜0.05）。两组术后12、24、48 h MMT分级、术后住院时间、穿刺并发症和不良反应发生率差异无统计学意义。
结论： 超声引导下IPB联合LFCNB能够优化老年患者THA术后早期的镇痛效果，还可有效保留患者的下肢运动功能，促进早期下床活动，且不良反应较少，是值得推广的镇痛方法。 |
| 英文摘要: |
Objective: To investigate the effect of ultrasound-guided iliopsoas plane block (IPB) combined with lateral femoral cutaneous nerve block (LFCNB) on early perioperative analgesia in elderly patients undergoing total hip arthroplasty (THA).
Methods: Elderly patients from February 2025 to September 2025, scheduled for elective unilateral THA under general anesthesia were enrolled, aged ≥ 65 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅱ-Ⅳ. Patients were divided into two groups by using a random number table: the IPB + LFCNB group (group IL) and the IPB group (group I). Before anesthesia induction, group IL received ultrasound-guided IPB combined with LFCNB, while group I received ultrasound-guided IPB alone. The primary outcome measure was postoperative tramadol consumption within 24 hours postoperatively. Secondary outcomes included intraoperative consumption of propofol and remifentanil, operative time, the NRS scores at rest and during activity immediately upon leaving the post-anesthesia care unit (PACU), and 6, 12, 24, and 48 hours postoperatively, along with the manual muscle testing (MMT) scores of the quadriceps, postoperative analgesia satisfaction scores, time to first ambulation after surgery, and postoperative length of hospital stay. Puncture-related complications included infection at the puncture site, local anesthetic toxicity, hematoma, and nerve injury. Adverse reactions included postoperative nausea and vomiting, dizziness, and thrombosis.
Results: A total of 120 patients were enrolled in the study, 60 patients in each group. Compared with group I, the amount of tramadol consumption within 24 hours postoperatively and intraoperative consumption of propofol and remifentanil were significantly reduced, NRS scores at rest and during activity immediately upon leaving the PACU and 6, 12, 24, and 48 hours postoperatively were significantly reduced, MMT scores immediately upon leaving the PACU and 6 hours postoperatively were significantly increased, the time to first ambulation after surgery was significantly shortened, and the analgesia satisfaction score was significantly increased in group IL (P < 0.05). There were no statistically significant differences between the two groups in MMT grades 12, 24, and 48 hours postoperatively, length of postoperative hospital stay, and the incidence of puncture-related complications and adverse reactions.
Conclusion: Ultrasound-guided IPB combined with LFCNB can enhance earlypostoperative analgesia in elderly patients undergoing THA, effectively preserve lower limb motor function, promote early ambulation, and is associated with fewer adverse reactions, making it a worthy analgesic technique to promote. |
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