超声引导下腰方肌阻滞与髂筋膜间隙阻滞在老年髋关节术后镇痛的比较
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摘要
目的比较腰方肌阻滞(quadratus lumborum block,QLB)和髂筋膜间隙阻滞(fasciailiaca compartment block,FICB)在老年髋关节置换术的镇痛效果。方法选择择期拟行腰麻下全髋关节置换术的老年患者55例,男22例,女33例,年龄65～85岁,ASAⅠ或Ⅱ级,随机分为QLB组(n=28)和FICB组(n=27)。术后分别于超声引导下行QLB和FICB,予0.375%罗哌卡因30ml。所有患者术后行舒芬太尼静脉自控镇痛。记录术后6、12、24、48h镇痛泵按压次数及舒芬太尼用量;记录静息及运动时VAS疼痛评分;记录术后恶心呕吐、眩晕等不良反应情况。结果术后12、24、48h QLB组镇痛泵按压次数及舒芬太尼用量明显少于FICB组(P<0.05);术后12、24、48hQLB组运动时VAS评分明显低于FICB组(P<0.05),两组不同时点静息时VAS评分差异无统计学意义;QLB组恶心呕吐发生率明显低于FICB组[2(7.1%)vs 9(33.3%),P<0.05]。结论腰方肌阻滞较髂筋膜间隙阻滞更能明显减轻髋关节置换术后活动痛,减少阿片类药物的使用及不良反应发生率。
Objective To compart the effects of quadratus lumborum block(QLB)and fasciailiaca compartment block(FICB)in analgesia after total hip arthroplasty.Methods Fifty-five patients undergoing total hip arthroplasty,22 males and 33 females,all falling into ASA physical statusⅠ or Ⅱ,were randomized into group QLB(n = 28)and group FICB(n = 27).Ultrasoundguided QLB and FICB was performed at the end of operation and 30 ml of 0.375% ropivacaine hydrochloride was used.Postoperative VAS scores at 6,12,24 and 48h were recorded.Compressing numbers and the consumption of sufentanil were recorded as well.Postoperative nausea and vomiting,dizziness were recorded.Results Patients in group QLB used significantly less sufentanil than those of group FICB(P < 0.05)at 12,24,48 has well as compressing numbers.Silent VAS score had no differences after operation.But VAS score during movement in group of QLB was less than that of group FICB at 12,24,48 h.Side effects shuch as postoperative nausea and vomiting of group QLB were significantly less than of group FICB[2(7.1%)vs 9(33.3%),P <0.05].Conclusion QLB can more effectively reduce postoperative sufentanil consumption and side effects compared to FICB.
Objective To compart the effects of quadratus lumborum block(QLB)and fasciailiaca compartment block(FICB)in analgesia after total hip arthroplasty.Methods Fifty-five patients undergoing total hip arthroplasty,22 males and 33 females,all falling into ASA physical statusⅠ or Ⅱ,were randomized into group QLB(n = 28)and group FICB(n = 27).Ultrasoundguided QLB and FICB was performed at the end of operation and 30 ml of 0.375% ropivacaine hydrochloride was used.Postoperative VAS scores at 6,12,24 and 48h were recorded.Compressing numbers and the consumption of sufentanil were recorded as well.Postoperative nausea and vomiting,dizziness were recorded.Results Patients in group QLB used significantly less sufentanil than those of group FICB(P < 0.05)at 12,24,48 has well as compressing numbers.Silent VAS score had no differences after operation.But VAS score during movement in group of QLB was less than that of group FICB at 12,24,48 h.Side effects shuch as postoperative nausea and vomiting of group QLB were significantly less than of group FICB[2(7.1%)vs 9(33.3%),P <0.05].Conclusion QLB can more effectively reduce postoperative sufentanil consumption and side effects compared to FICB.
引文
[1]魏长娜,王琛,单海华,等.超声引导下髂筋膜腔隙阻滞对全髋关节置换术患者术后镇痛的效果.中华麻醉学杂志,2011,31(10):1175-1177.
[2]韩彬,王武涛,何爱萍.超声引导下腰方肌阻滞或腹横肌平面阻滞联合舒芬太尼PCIA在阑尾切除术后镇痛中的比较.临床麻醉学杂志,2017,33(10):984-986.
[3]Murouchi T,Iwasaki S,Yamakage M.Quadratus lumborum block:analgesic effects and chronological ropivacaine concentra tions after laparoscopic surgery.Reg Anesth Pain Med,2016,41(2):146-150.
[4]Ueshima H,Yoshiyama S,Otake H.The ultrasound-guided continuous transmuscular quadrates lumborum block is an effective analgesia for total hip arthroplasty:a case report.JClin Anesth,2016,31:35.
[5]Hockett MM,Hembrador S,Lee A.Continuous quadrates lumborum block for postoperative pain in total hip arthroplasty:a case report.A A Case Rep,2016,7(6):129-131.
[6]Baidya DK,Maitra S,Arora MK,et al.Quadratus lumborum block:an effective method of perioperative analgesia in children undergoing pyeloplasty.J Clin Anesth,2015,27(8):694-696.
[7]Blanco R,Ansari T,Girgis E.Quadratus lumborum block for postoperative pain after caesarean section:a randomised controlled trial.Eur J Anaesthesiol,2015,32(11):812-818.
[8]Diakomi M,Papaioannou M,Mela A,et al.Preoperative hsciailiaca compartment block for positioning patients with hip fractures for central nervous blockade:a randomized trial.Reg Anesth Pain Med,2014,39(5):394-398.
[9]余卓颖,翟文雯,李民.腰方肌阻滞的临床应用研究进展.中国微创外科杂志,2017,17(8):725-727.
[10]Carline L,McLeod GA,Lamb C.A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks.Br J Anaesth,2016,117(3):387-394.
[11]El-Boghdadly K,Elsharkawy H,Short A,et al.Quadratus lumborum block nomenclature and anatomical considerations.Reg Anesth Pain Med,2016,41(4):548-549.
[12]Kadam VR.Ultrasound-guided quadrates lumborum block as apostoperative analgesic technique for laparotomy.J Anaesthesiol Clin Pharmacol,2013,29(4):550-552.
[13]Johnston DF,Sondekoppam RV.Continuous quadrates lumborum block analgesia for total hip arthroplasty revision.JClin Anesth,2016,35:235-237.
[2]韩彬,王武涛,何爱萍.超声引导下腰方肌阻滞或腹横肌平面阻滞联合舒芬太尼PCIA在阑尾切除术后镇痛中的比较.临床麻醉学杂志,2017,33(10):984-986.
[3]Murouchi T,Iwasaki S,Yamakage M.Quadratus lumborum block:analgesic effects and chronological ropivacaine concentra tions after laparoscopic surgery.Reg Anesth Pain Med,2016,41(2):146-150.
[4]Ueshima H,Yoshiyama S,Otake H.The ultrasound-guided continuous transmuscular quadrates lumborum block is an effective analgesia for total hip arthroplasty:a case report.JClin Anesth,2016,31:35.
[5]Hockett MM,Hembrador S,Lee A.Continuous quadrates lumborum block for postoperative pain in total hip arthroplasty:a case report.A A Case Rep,2016,7(6):129-131.
[6]Baidya DK,Maitra S,Arora MK,et al.Quadratus lumborum block:an effective method of perioperative analgesia in children undergoing pyeloplasty.J Clin Anesth,2015,27(8):694-696.
[7]Blanco R,Ansari T,Girgis E.Quadratus lumborum block for postoperative pain after caesarean section:a randomised controlled trial.Eur J Anaesthesiol,2015,32(11):812-818.
[8]Diakomi M,Papaioannou M,Mela A,et al.Preoperative hsciailiaca compartment block for positioning patients with hip fractures for central nervous blockade:a randomized trial.Reg Anesth Pain Med,2014,39(5):394-398.
[9]余卓颖,翟文雯,李民.腰方肌阻滞的临床应用研究进展.中国微创外科杂志,2017,17(8):725-727.
[10]Carline L,McLeod GA,Lamb C.A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks.Br J Anaesth,2016,117(3):387-394.
[11]El-Boghdadly K,Elsharkawy H,Short A,et al.Quadratus lumborum block nomenclature and anatomical considerations.Reg Anesth Pain Med,2016,41(4):548-549.
[12]Kadam VR.Ultrasound-guided quadrates lumborum block as apostoperative analgesic technique for laparotomy.J Anaesthesiol Clin Pharmacol,2013,29(4):550-552.
[13]Johnston DF,Sondekoppam RV.Continuous quadrates lumborum block analgesia for total hip arthroplasty revision.JClin Anesth,2016,35:235-237.