摘要
目的观察髋关节囊周围神经阻滞(HPCNB)在半髋关节置换术患者的围术期镇痛效果。方法在蛛网膜下腔阻滞下行单侧半髋关节置换术患者56例均分为D组和P组,分别采用直接前入路和后外侧入路手术。腰麻前,两组均行超声引导下0.5%罗哌卡因15 mL HPCNB。记录患者HPCNB前(T0)和术后6 h(T1)、12 h(T2)、24 h(T3)和48 h(T4)时的静息与活动(被动抬腿15度)状态VAS疼痛评分。术毕开启羟考酮静脉患者自控镇痛(PCA),记录PCA镇痛泵按压次数、术后48 h内羟考酮总用量及补充镇痛例数。观察不良反应发生情况,评估患者满意度。结果与T0时比较,两组T1~T4时静息与活动状态VAS疼痛评分均减少(P<0.05)。D组T1和T2时静息VAS疼痛评分和T1~T3时的活动状态VAS疼痛评分均少于P组(P<0.05)。D组术后的PCA按压次数少于P组,羟考酮补充镇痛的应用较少(P<0.05)。D组患者镇痛满意度高于P组(P<0.05)。镇痛期间,P组出现恶心呕吐1例,两组均无穿刺部位感染、血肿、呼吸抑制和局麻药中毒等不良反应发生。结论超声引导下HPCNB可有效减轻半髋关节置换术患者术后疼痛,其对直接前入路半髋关节置换术患者的镇痛效果更佳。
Objective To observe the perioperative analgesic efficacy of hip pericystic nerve block(HPCNB) in the patients undergoing hemi-hip replacement.Methods Fifty-six patients undergoing unilateral hemi-hip replacement under subarachnoid block were divided into two groups with 28 cases each.The surgery was performed via direct anterior approach(group D) or via posterolateral approach(group P).Ultrasound-guided HPCNB with 0.5% ropivacaine 15 mL was performed before lumbar anesthesia.Intravenous patient-controlled analgesia(PCA) was used after operation.The VAS scores in the rest and active(passive leg lift 15 degrees) status were evaluated at the time points of before nerve block(T0) and 6 hours(T1),12 hours(T2),24 hours(T3) and 48 hours(T4) after operation.The number of PCA pressing and oxycodone intravenous injection during analgesia were recorded.The occurrence of adverse responses was observed.The satisfaction degree of the patients to analgesia was scaled.Results The VAS scores in the rest and active status at T1-T4 were significantly less than those at T0 in both groups(P<0.05).The VAS scores in the rest status at T1 and T2 and in the active status at T1-T3 were less in group D than those in group P(P<0.05).The number of PCA pressing and oxycodone injection during analgesia were less in group D than those in group P(P<0.05).The satisfaction degree of the patients to analgesia was higher in group D than that in group P(P<0.05).During analgesia, nausea and vomiting occurred in one case of group P,and neither group had any adverse responses such as puncture site infection, hematoma, respiratory suppression, and local anesthetic poisoning.Conclusion Ultrasound-guided HPCNB can effectively reduce pain sensation after operation in the patients undergoing hemi-hip replacement, especially in the patients operated by direct anterior approach.
作者
张芳芳
孙清纯
ZHANG Fangfang;SUN Qingchun(Department of Anesthesiology,Affiliated Nanjing Hospital,Nanjing Medical University,Nanjing 210006,CHINA)
出处
《江苏医药》
CAS
2021年第12期1247-1249,共3页
Jiangsu Medical Journal
