摘要
目的通过比较超声引导下髋关节囊周神经与腹股沟韧带上髂筋膜间隙阻滞用于全髋关节置换术后镇痛的效果,为临床探索理想镇痛方案、实现术后尽早活动及最佳功能恢复提供依据。方法选择两院2021年3月至2022年12月择期行全髋关节置换术的患者80例,男55例,女25例,年龄18~60岁,ASAⅠ或Ⅱ级,按照随机数字表法将入选患者分为髋关节囊周神经阻滞组(P组)和腹股沟韧带上髂筋膜间隙阻滞组(S组),每组40例。P组在全身麻醉诱导前行患侧髋关节囊周神经阻滞,于髂腰肌腱和耻骨后支之间的筋膜平面推注0.5%罗哌卡因20 mL,S组在相同时间点行患侧腹股沟韧带上髂筋膜间隙阻滞,探头垂直于腹股沟韧带放置,利用水分离技术于髂腰肌与髂筋膜之间缓慢推注0.5%罗哌卡因20 mL。两组患者均接受全身麻醉,术后镇痛方案为舒芬太尼PCIA。记录两组患者拔管后30 min术后3、6、12和24 h的静息及运动VAS评分、补救镇痛情况、相关不良反应(恶心呕吐、呼吸抑制)及术后住院时间等。记录两组患者术后3、6、12和24 h改良Bromage评分。记录阻滞相关并发症(局麻药全身急性毒性反应、穿刺部位感染、血肿)。结果P组在拔管后30 min和术后3、6 h的动态VAS评分[2.0(0.0,5.0)、2.5(0.0,7.0)、4.0(0.0,8.0)]显著低于S组[3.5(0.0,7.0)、4.0(0.0,8.0)、5.5(0.0,9.0)](P<0.05)。两组患者不同时间静息VAS评分差异无统计学意义(P>0.05)。P组患者术后3、6 h改良Bromage评分[1.0(1.0,2.0)、1.0(1.0,2.0)]显著低于S组[2.0(1.0,2.0)、2.0(1.5,2.0)](P<0.05)。术后12和24 h,两组患者静息VAS评分、动态VAS评分及改良Bromage评分差异无统计学意义(P>0.05)。两组患者补救镇痛比例、术后恶心呕吐发生率及术后住院时间差异无统计学意义(P>0.05)。两组均未出现局麻药全身急性毒性反应、穿刺部位感染和血肿等阻滞相关并发症。结论超声引导下髋关节囊周阻滞可有效降低全髋关节置换患者术后6 h内动态疼痛评分及改良Bromage评分,保留患者运动功能,优化术后镇痛效果。
Objective To compare the postoperative analgesic effects of ultrasound-guided pericapsular nerve group(PENG)block and suprainguinal fascia iliaca compartment(SIFI)block in total hip arthroplasty(THA).The goal is to explore an optimal pain management strategy to facilitate early postoperative mobilization and functional recovery.Methods A total of 80 patients(55 males,25 females),aged 18-60 years,classified as ASAⅠorⅡ,undergoing elective THA between March 2021 and December 2022 at two hospitals were enrolled in the study.Patients were randomly assigned to either the PENG block group(P group)or the SIFI block group(S group),with 40 patients in each.In Group P,Prior to general anesthesia induction,ultrasound-guided PENG block was performed on the affected side by injecting 20 mL of 0.5%ropivacaine into the fascial plane between the iliopsoas tendon and the pubic ramus.In Group S,at the same time point,ultrasound-guided SIFI block was administered on the affected side.The probe was placed perpendicular to the inguinal ligament,and 20 mL of 0.5%ropivacaine was slowly injected between the iliopsoas muscle and the iliac fascia using the hydrodissection technique.All patients received general anesthesia and postoperative analgesia with sufentanil patient-controlled intravenous analgesia(PCIA).Post-extubation at 30 min,and at 3,6,12,and 24 hours postoperatively,the resting and dynamic Visual Analog Scale(VAS)pain scores,need for rescue analgesia,incidence of adverse reactions(nausea,vomiting,respiratory depression),and postoperative length of hospital stay were recorded.Additionally,modified Bromage scores were assessed at 3,6,12,and 24 hours postoperatively.Any block-related complications,such as systemic local anesthetic toxicity,puncture site infection,or hematoma,were monitored.Results The dynamic VAS scores in the P group at 30 min,3 h,and 6 h postoperatively[2(0,5),2.5(0,7),4(0,8)]were significantly lower than those in the S group[3.5(0,7),4(0,8),5.5(0,9)](P<0.05).However,no significant differences were found in resting VAS scores between the two groups.The modified Bromage scores in the P group at 3 h and 6 h postoperatively[1(1,2),1(1,2)]were significantly lower than those in the S group[2(1,2),2(1.5,2)](P<0.05),indicating better motor function preservation in the P group.At 12 and 24 hours postoperatively,there were no significant differences between the two groups in terms of resting and dynamic VAS scores or modified Bromage scores.Furthermore,no significant differences were observed between the groups in terms of rescue analgesia requirements,incidence of nausea and vomiting,or postoperative hospital stay.No cases of systemic local anesthetic toxicity,puncture site infection,or hematoma were reported in either group.Conclusion Ultrasound-guided pericapsular nerve group(PENG)block effectively reduces dynamic pain and improves motor function within the first 6 hours after THA.Compared to the suprainguinal fascia iliaca compartment(SIFI)block,PENG block provides superior postoperative analgesia while preserving early mobility,making it an optimal choice for postoperative pain management in THA patients.
作者
魏宏
许之乔
彭七华
李朝阳
吴茜
WEI Hong;XU Zhi-qiao;PENG Qi-hua;LI Chao-yang;WU Xi(Department of Anesthesiology,Huazhong University of Science and Technology Union Shenzhen Hospital,Shenzhen 518000,Guangdong,China;不详)
出处
《广东医学》
2025年第4期547-552,共6页
Guangdong Medical Journal
基金
深圳市科技计划项目(JCYJ20210324112208023)。
