老年全髋置换术患者不同术后镇痛方法的疗效比较

A Comparative Study on the Effects of Different Postoperative Analgesia in Elderly Patients Undergoing Total Hip Arthroplasty

中文关键词: 老年  全髋置换术  连续髂筋膜间隙阻滞  连续股神经阻滞  静脉自控镇痛

英文关键词: the elderly  total hip arthroplasty (THA)  fascia iliaca compartment block (FICB)  femoral nerve block (FNB)  patient-controlled intravenous analgesia (PCIA)

中文摘要:

      目的 比较超声引导的连续髂筋膜间隙阻滞(fascia iliaca compartment block,FICB)、连续股神经阻滞(femoral nerve block,FNB)和静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)对老年全髋置换术患者的术后镇痛效果.方法 择期拟行全髋置换术的老年患者60例,随机接受超声引导的连续髂筋膜间隙阻滞(FICB组);超声引导的连续股神经阻滞(FNB组)和静脉自控镇痛(PCIA组).记录患者基本情况,包括患者年龄、体重、置管时间、手术时间和出血量等.行镇痛效果评估:(1)术中舒芬太尼用量及术后苏醒拔管时间;(2)病房镇痛药物补救量;(3)自控镇痛按压(patient-controlled analgesia,PCA)次数;(4)3组患者术后2h、4h、6h、12h、24h和48h的静息痛评分(rest visual analogue scale,RVAS)和被动活动痛评分(passive visual analogue scale,PVAS).记录镇痛后相关不良反应,包括:(1)嗜睡、恶心呕吐、瘙痒、低血压(血压下降超过基础血压20％)等的发生例数;(2) 12 h后延迟性并发症,包括尿潴留、注射部位压痛、局部瘀点、感觉和运动异常等的发生例数.结果 HCB和FNB组的术中舒芬太尼消耗和PCA次数低于PCIA组,且其术后4h、6h和12h时的RVAS和PVAS均低于PCIA组,FICB和FNB组的镇痛效果无统计学差异.PCIA组的药物不良反应高于FICB组和FNB组.相对FNB组,HCB组导管置入的时间缩短(5.8±1.8min vs 8.1±3.3 mm),差异有统计学意义.FICB组没有发生并发症,FNB组有3例出现大腿前部感觉迟钝.结论 在老年全髋置换术后疼痛管理中,FICB和FNB的镇痛效果优于PCIA,且药物不良反应更少.此外,超声引导下FICB比FNB更安全、神经损伤发生率更低.

英文摘要:

      Objective To make a comparative study on the postoperative analgesic effects after fascia iliaca compartment block (FICB) and femoral nerve block (FNB) and the effect of patient-controlled intravenous analgesia (PCIA) in elderly patients undergoing total hip arthroplasty (THA).Methods 60 elderly patients scheduled for THA were randomly divided into 3 groups:FICB group,FNB group and PCIA group;the general information of the patients were recorded,including age,body weight,tube indwelling time,operation time length and bleeding volume;the analgesic effects were assessed:(1) intraoperative sufentanil consumption and extubation time after awakening;(2) analgesic drug remedy in ward;(3) times of patient-controlled analgesia (PCA);(4) scores of rest visual analogue scale (RVAS) and passive visual analogue scale (PVAS) of the patients in the 3 groups at the time point of 2 hours,4 hours,6 hours,12 hours,24 hours and 48 hours after operation;post-analgesia adverse events were recorded:(1) the occurrence of serious sedation,nausea,vomiting,pruritus,hypotension (blood pressure decreased more than 20％ of basal blood pressure);(2) the occurrence of delayed complications after 12h,including urinary retention,tenderness at the injection site,local petechiae,sensory and motor abnormalities.Results The intraoperative sufentanil consumption and the time number of PCA in FICB group and FNB group were significantly less than those in PCIA group,as well as the postoperative RVAS and PVAS scores at the time point of 4 hours,6 hours and 12 hours;there existed no statistical difference in analgesic effect between FICB group and FNB group;the occurrence of adverse events in PCIA group was higher than those in FICB group and FNB group;the tube indwelling time in FICB group was shorter than that in FNB group (5.84 ± 1.77 vs 8.12 ± 3.29 min) with statistical difference;no adverse events occurred in FICB group while anterior thigh dysesthesia occurred in 3 patients in FNB group.Conclusions In pain management of the elderly patients after THA,FICB and FNB produce better analgesic effects than PCIA and lead to less adverse events,and ultrasound-guided FICB is even safer and of lower possibility of nerve injury than FNB.