超声引导髂筋膜间隙阻滞在髋关节镜手术中的应用

摘要

Objective To investigate the efficiency of ultrasound guided fascia iliaca compartment block in hip arthroscopy. Methods A total of 40 patients undergoing hip arthroscopy from October 2016 to February 2017 were included and randomly divided into two groups with 20 patients in each group,the Blocking Group and the Control Group.Total intravenous anesthesia and laryngeal mask ventilation were applied in both groups.In the Blocking Group, fascia iliaca compartment block with 0.5% ropivacaine 30 ml was given before the surgery.In the Control Group, the surgery was implemented after general anesthesia without any local block. Bispectral index(BIS)40-55 was maintained intra-operatively in both groups.Intra-operative dose of sufentanyl consumption and visual analogue scale(VAS)when leaving postanesthesia care unit(PACU)were recorded.The 4 h,8 h, 12 h, and 24 h post-operative static VAS and 4 h and 24 h post-operative motional VAS(flexion,internal rotation,and external rotation)were recorded. And doses of patient controlled analgesia(PCA)consumption were also documented. Results As compared with the Control group, the Blocking Group had significantly less sufentanyl consumption during the surgery[(17.0 ±5.7)μg vs.(24.5 ±8.4)μg, t=-3.308,P=0.002]and PCA consumption 24 h post-operation[(48.1 ±2.6)ml vs.(52.4 ±2.8)ml,t=-4.909,P=0.000]. The time leaving PACU and the 4 h,8 h,12 h,and 24 h post-operative static VAS and 4 h post-operative motional VAS were all less in the Blocking Group than those in the Control Group(P<0.05). Conclusion Ultrasound guided fascia iliaca compartment block can offer a better intra-and post-operative analgesia in hip arthroscopy.%目的 探讨超声引导髂筋膜间隙阻滞在髋关节镜手术中的应用效果. 方法 2016年10月~2017年2月择期髋关节镜手术40例,随机分为阻滞组和对照组各20例.均行全凭静脉麻醉,喉罩通气.阻滞组全麻后在超声引导下行髂筋膜间隙阻滞(0.5%罗哌卡因30 ml),随后手术;对照组直接在全麻下手术.术中均维持脑电双频指数40~55.记录术中舒芬太尼用量,术后离麻醉恢复室静息疼痛视觉模拟评分(visual analogue scale,VAS),术后4、8、12、24 h静息和术后4、24 h运动(屈曲、内旋、外旋)疼痛VAS,以及术后24 h静脉患者自控镇痛(patient controlled analgesia,PCA)药物用量. 结果 阻滞组术中舒芬太尼用量[(17.0 ±5.7)μg vs.(24.5 ±8.4)μg,t=-3.308,P=0.002]、术后24 h PCA用量[(48.1 ±2.6)ml vs. (52.4 ±2.8)ml,t=-4.909,P=0.000]均明显少于对照组;阻滞组离麻醉恢复室及术后4、8、12、24 h静息疼痛VAS及术后4 h运动疼痛VAS明显低于对照组(P<0.05). 结论 超声引导下髂筋膜间隙阻滞可为髋关节镜手术提供良好术中及术后镇痛.