腰骶丛神经阻滞与髂筋膜间隙阻滞在全髋关节置换术中镇痛效果比较

General anesthesia combined with lumbosacral plexus block or iliac fascia block for total hip arthroplasty

关键词:  髂筋膜间隙阻滞  腰丛神经阻滞  骶丛神经阻滞  全髋关节置换术  术后镇痛

Key words:  fascia iliaca compartment block  lumbar plexus block  sciatic plexus block  total hip arthroplasty  post-operative analgesia

摘要:

目的 比较全身麻醉复合腰骶丛神经阻滞（lumbosacral plexus block, LPB）与髂筋膜间隙阻滞（fascia iliaca compartment block, FICB）在全髋关节置换术中镇痛效果。方法 选择择期行全髋关节置换术患者150例，采用随机数字表法随机分为： 全身麻醉复合腰骶丛阻滞组(LPB组，n=50)，全身麻醉复合髂筋膜间隙阻滞组（FICB组,n=50）和单纯全身麻醉组（G组,n=50）。3组患者全身麻醉诱导和维持用药相同，术后采用持续静脉自控镇痛（patient controlled analgesia, PCA）至术后48h。全身麻醉诱导前LPB组行超声引导下腰骶丛神经阻滞，FICB组行超声引导下髂筋膜间隙阻滞。记录术中舒芬太尼使用量，术后1、8、12、24、48h患者静息状态下疼痛视觉模拟评分（visual analogue scales, VAS），术后不良反应和患者满意度，神经阻滞操作时间、操作时VAS评分及穿刺成功率。结果 LPB组和FICB组术中舒芬太尼用量，术后帕瑞昔布钠使用人次明显少于G组（P<0.05）。LPB组和FICB组在术后1、8、12、24、48h VAS评分明显低于G组（P<0.05）。LPB组和FICB组48h患者的满意度明显高于G组（P<0.05）。LPB组在术后8、12、24h的VAS评分明显低于FICB组。LPB组操作时间明显长于FICB组（P<0.05），穿刺成功率明显低于FIBC组（P<0.05）。结论 超声引导下腰骶丛神经阻滞与髂筋膜间隙阻滞应用于全髋关节置换术均可以取得良好的镇痛效果，腰骶丛神经阻滞镇痛效果更佳且镇痛时间更长，但腰骶丛神经阻滞操作难度较大，失败率较高。

Abstract:

Objective To compare the analgesic efficacy of general anesthesia combined with fascia iliaca compartment block (FICB) or lumbosacral plexus block (LPB) for total hip arthroplasty. Methods One hundred and fifty patients scheduled to undergo total hip arthroplasty were randomly divided into FICB group, LPB group and G group with 50 cases in each. General anesthesia was applied for all patients, in addition patients in LPB group received ultrasound-guided lumbarsacral plexus block and patients in FICB group received ultrasound-guided fascia iliaca compartment block. Same anesthesia induction and maintenance medication were used and patient controlled analgesia (PCA) was given after surgery for 48 hours in three groups. The amount of sufentanil used during surgery was documented. The pain visual analogue scales (VAS) of resting state were evaluated at 1,8,12,48h after the surgery. The postoperative adverse reactions, patient satisfaction, operation time, intraoperative visual analogue scales (VAS) and the success rate of nerve block were compared among three groups. Results The consumption of sufentanil in LPB group and in FICB group were significantly less than that in G group (P<0.05). VAS cores in LPB group and in FICB group at 1,8,12,24 and 48h after surgery were significantly lower than those in G group (P<0.05).The patient satisfcation in LPB group or in FICB group was significantly higher than that in G group (P<0.05).VAS cores in LPB group at 8,12 and 24h after surgery were significantly less than those in FICB (P<0.05). The operation time of LPB was significantly longer than that of FIBC (P<0.05). The success rate of LPB was significantly lower than that of FICB (P<0.05). Conclusion Ultrasound-guided lumbarsacral plexus block or fascia iliaca compartment block combined with general anesthesia can obtain good analgesic effect in total hip arthroplasty.Although analgesic effect of LPB is better and longer than FICB, but LPB is more difficult and has higher failure rate than FICB.