超声引导下股神经与髂筋膜间隙阻滞的效果比较

摘要

目的：比较超声引导下股神经与髂筋膜间隙阻滞的效果。方法择期拟行膝关节镜手术的成年患者60例，随机分为股神经阻滞组(FB组)和髂筋膜间隙阻滞组(FICB组)。两组均采用超声引导技术行神经阻滞。观察并记录：①阻滞后5 min、10 min、15 min、20 min和30 min股外侧皮神经、股神经、闭孔神经的感觉神经阻滞；②同上各时点股神经行运动神经阻滞评估；③神经阻滞麻醉的并发症；④术后48 h随访患者对术后疼痛控制的满意度评分。结果股外侧皮神经的感觉阻滞率，FB组在各时点绝对值均低于FICB组，但差异均无统计学意义(P>0.05)，而闭孔神经的感觉阻滞率在阻滞操作完成后各时点皆明显高于FICB组，差异均有统计学意义(P<0.05)，但是股神经的感觉阻滞在各时点两组间差异则均无统计学意义(P>0.05)。在股神经运动阻滞方面，除5 min时间点外，FB组均明显高于FICB组(P<0.05)。两组患者48 h对术后疼痛的满意度评分差异无统计学意义(P>0.05)。结论超声引导下股神经阻滞与髂筋膜间隙阻滞都可以较好地阻滞股神经，但是前者不能有效阻滞股外侧皮神经，后者很少阻滞闭孔神经。%Objective To compared the analgesic efficacy of femoral nerve block and fascia iliaca compart-ment block (FICB). Methods Sixty adult patients who presented for artbroscopic knee surgery were interviewed and considered for enrollment, and randomized to undergo a femoral nerve block (FB group) or fascia iliaca compart-ment block (FICB group). The two groups of patients were treated with nerve block by ultrasound-guided technolo-gy. 5 min, 10 min, 15 min, 20 min and 30 min after operation, anesthetic effect of sensory block of femoral, lateral femoral cutaneous (LFC), and obturator nerves were measured and recorded in all patients. The motor block of femo-ral nerves were assessed at the same time points. Nerve block complications were recorded. The satisfaction evaluation form of patients' pain control was evaluated after 48 hours of surgery. Results Sensory block for the LFC was higher in the FICB group at all time points compared with the FB group, but the difference was no statistically significant (P>0.05). Sensory block for the obturator nerve 5 min, 10 min, 15 min, 20 min and 30 min following block placement was significantly higher in the FB group than the FICB group (P<0.05). The sensory blockade for the femoral nerve was not significantly different between groups at any time point measured (P>0.05), but the FB group did have a higher degree of motor blockade in the femoral nerve at every time point except at 5 minutes following block placement (P<0.05). Conclusion The femoral nerve block and fascia iliaca compartment block both can provide good femoral nerve block, but the former could not effectively block the lateral femoral cutaneous nerve and the latter rarely blocks the obturator nerve.