骶丛神经阻滞联合髂筋膜间隙阻滞在全髋置换老年患者中的应用效果
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摘要
目的探讨单侧蛛网膜下腔麻醉与髂筋膜间隙阻滞+骶丛神经阻滞方案对行全髋关节置换术老年患者阻滞效果、疼痛程度及术后并发症的影响。方法选取2016年2月至2018年6月平煤神马医疗集团总医院收治行全髋关节置换术老年患者共152例,按随机数字表法分为蛛网膜下腔组和联合阻滞组,每组各76例,其中蛛网膜下腔组采用单侧蛛网膜下腔麻醉方案镇痛,联合阻滞组采用髂筋膜间隙阻滞+骶丛神经阻滞方案镇痛,比较两组患者麻醉阻滞时间、不同时间点VAS评分、多巴胺使用率及不良反应发生率。结果联合阻滞组阻滞时间均长于蛛网膜下腔组,差异有统计学意义(P <0. 05);联合阻滞组体位摆放前1min、体位摆放即刻及术后24 h VAS评分均低于蛛网膜下腔组,差异有统计学意义(P <0. 05);联合阻滞组手术切皮即刻和手术开始后30 min VAS评分均高于蛛网膜下腔组,差异有统计学意义(P <0. 05);联合阻滞组术后24 h Ramsay评分均显著低于蛛网膜下腔组,手术切皮即刻和手术结束即刻30 min Ramsay评分均显著高于蛛网膜下腔组,差异均有统计学意义(P <0. 05);联合阻滞组多巴胺使用率低于蛛网膜下腔组,差异有统计学意义(P <0. 05);同时联合阻滞组术后不良反应发生率均低于蛛网膜下腔组,差异有统计学意义(P <0. 05)。结论髂筋膜间隙阻滞+骶丛神经阻滞方案用于行全髋关节置换术老年患者可有效提高早期镇痛镇静效果,减少多巴胺使用率,并有助于降低不良反应发生风险,优于单侧蛛网膜下腔麻醉。
Objective To investigate the influence of unilateral spinal anesthesia and iliac fascial space block + sacral plexus block on block effects,pain degree and postoperative complications of elderly patients undergoing total hip replacement. Methods A total of 152 elderly patients undergoing total hip replacement were chosen from February 2016 to June 2018 in General Hospital of Pingmei Shenma Medical Group and randomly divided into two groups,namely group A( 76 cases) with unilateral spinal anesthesia and group B( 76 cases) with iliac fascial space block + sacral plexus block; and the blocking time,VAS score at different time points,dopamine utilization rate and adverse reaction incidence of both groups were compared. Results The blocking time of group B was significantly longer than that of group A( P < 0. 05). The VAS scores 1 min before position,position immediately and 24 h after operation of group B were significantly lower than those of group A( P < 0. 05). The VAS scores immediately after incision and 30 min after starting operation of group B were significantly higher than those of group A( P < 0. 05). The Ramsay scores 1 min before position,position immediately and 24 h after operation of group B were significantly lower than those of group A( P < 0. 05). The Ramsay scores immediately after incision and 30 min after starting operation of group B were significantly higher than those of group A( P < 0. 05). The dopamine utilization rate of group B was markedly lower than that of group A( P < 0. 05). The adverse reaction incidence of group B was evidently lower than that of group A( P < 0. 05). Conclusion Compared with unilateral spinal anesthesia,iliac fascial space block + sacral plexus block in the treatment of elderly patients undergoing total hip replacement can efficiently elevate the analgesic and sedative effects for early stage,decrease the dopamine utilization rate and also be helpful to reduce the risk of adverse reactions.
Objective To investigate the influence of unilateral spinal anesthesia and iliac fascial space block + sacral plexus block on block effects,pain degree and postoperative complications of elderly patients undergoing total hip replacement. Methods A total of 152 elderly patients undergoing total hip replacement were chosen from February 2016 to June 2018 in General Hospital of Pingmei Shenma Medical Group and randomly divided into two groups,namely group A( 76 cases) with unilateral spinal anesthesia and group B( 76 cases) with iliac fascial space block + sacral plexus block; and the blocking time,VAS score at different time points,dopamine utilization rate and adverse reaction incidence of both groups were compared. Results The blocking time of group B was significantly longer than that of group A( P < 0. 05). The VAS scores 1 min before position,position immediately and 24 h after operation of group B were significantly lower than those of group A( P < 0. 05). The VAS scores immediately after incision and 30 min after starting operation of group B were significantly higher than those of group A( P < 0. 05). The Ramsay scores 1 min before position,position immediately and 24 h after operation of group B were significantly lower than those of group A( P < 0. 05). The Ramsay scores immediately after incision and 30 min after starting operation of group B were significantly higher than those of group A( P < 0. 05). The dopamine utilization rate of group B was markedly lower than that of group A( P < 0. 05). The adverse reaction incidence of group B was evidently lower than that of group A( P < 0. 05). Conclusion Compared with unilateral spinal anesthesia,iliac fascial space block + sacral plexus block in the treatment of elderly patients undergoing total hip replacement can efficiently elevate the analgesic and sedative effects for early stage,decrease the dopamine utilization rate and also be helpful to reduce the risk of adverse reactions.
引文
[1]许安平,陈琛.双髋关节同期置换与分期置换的疗效比较[J].安徽医学,2016,37(8):982-984.
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[4] KEARNS R,MACFARLANE A,GRANT A,et al. A randomised,controlled,double blind,non‐inferiority trial of ultrasound‐guided fascia iliaca block vs. spinal morphine for analgesia after primary hip arthroplasty[J]. Anaesth,2016,71(12):1431-1440.
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[7] THYBO K H,MATHIESEN O,DAHL J B,et al. Lateral femoral cutaneous nerve block after total hip arthroplasty:a randomised trial[J]. Acta Anaesth Scand,2016,60(9):1297-1305.
[8] HARVEY N R,WOLF B J,BOLIN E D,et al. Comparison of analgaesia with lumbar epidurals and lumbar plexus nerve blocks in patients receiving multimodal analgaesics following primary total hip arthroplasty:a retrospective analysis[J].Int Orthop,2017,41(11):2229-2235.
[9] UESHIMA H,YOSHIYAMA S,OTAKE H. The ultrasound-guided continuous transmuscular quadratus lumborum block is an effective analgesia for total hip arthroplasty[J].J Clin Anesth,2016,31(4):35-41.
[10] BAVA E P,RAMACHANDRAN R,REWARI V,et al.Analgesic efficacy of ultrasound guided transversus abdominis plane block versus local anesthetic infiltration in adult patients undergoing single incision laparoscopic cholecystectomy:a randomized controlled trial[J]. Anesth Essays Res,2016,10(3):561-567.
[11] LU R,SHEN C,YANG C,et al. Comparison of lumbar plexus block using the short axis in-plane method at the plane of the transverse process and at the articular process:a randomized controlled trial[J]. Bmc Anesth,2018,18(1):17.
[12] BANG S,CHUNG J,JEONG J,et al. Efficacy of ultrasoundguided fascia iliaca compartment block after hip hemiarthroplasty:A prospective,randomized trial[J]. Medicine,2016,95(39):e5018.
[13] BADIOLA I,LIU J,HUANG S,et al. A comparison of the fascia iliaca block to the lumbar plexus block in providing analgesia following arthroscopic hip surgery:a randomized controlled clinical trial[J]. J Clin Anesth,2018,49(4):26–29.
[14] KEARNS R,MACFARLANE A,KINSELLA J,et al. Fascia iliaca block for primary hip arthroplasty-a reply[J].Anaesthesia,2017,72(3):409-416.
[15] MEI B,ZHA H,LU X,et al. Peripheral Nerve Block as a Supplement to Light or Deep General Anesthesia in Elderly Patients Receiving Total Hip Arthroplasty:A Prospective Randomized Study[J]. Clin J Pain,2017,33(12):1053-1059.
[16] BENDTSEN T F,PEDERSEN E M,HAROUTOUNIAN S,et al. The suprasacral parallel shift vs lumbar plexus blockade with ultrasound guidance in healthy volunteers-a randomised controlled trial[J]. Anaesthesia,2015,69(11):1227-1240.
[2] JAKOBSSON J G. Peer review report 3 on “Comparison of femoral nerve block and fascia iliaca block for pain management in total hip arthroplasty:a meta-analysis”[J]. Int J Surg,2017,37(4):488-493.
[3] KE X,JI L,YONG L,et al. Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus,sacral plexus block for hip replacement in ankylosing spondylitis:CARE-compliant 4 case reports[J]. BMC Anesth,2017,17(1):86-91.
[4] KEARNS R,MACFARLANE A,GRANT A,et al. A randomised,controlled,double blind,non‐inferiority trial of ultrasound‐guided fascia iliaca block vs. spinal morphine for analgesia after primary hip arthroplasty[J]. Anaesth,2016,71(12):1431-1440.
[5]艾登斌,帅训军,姜敏.简明麻醉学[M].第2版.人民卫生出版社,2016:27-29,34.
[6] CAPPELLERI G,GHISI D,AMBROSOLI A L,et al. Stimulating versus non-stimulating catheter for lumbar plexus continuous infusion after total hip replacement[J]. Minerva Anestesiologica,2018,11(5):1145-1151.
[7] THYBO K H,MATHIESEN O,DAHL J B,et al. Lateral femoral cutaneous nerve block after total hip arthroplasty:a randomised trial[J]. Acta Anaesth Scand,2016,60(9):1297-1305.
[8] HARVEY N R,WOLF B J,BOLIN E D,et al. Comparison of analgaesia with lumbar epidurals and lumbar plexus nerve blocks in patients receiving multimodal analgaesics following primary total hip arthroplasty:a retrospective analysis[J].Int Orthop,2017,41(11):2229-2235.
[9] UESHIMA H,YOSHIYAMA S,OTAKE H. The ultrasound-guided continuous transmuscular quadratus lumborum block is an effective analgesia for total hip arthroplasty[J].J Clin Anesth,2016,31(4):35-41.
[10] BAVA E P,RAMACHANDRAN R,REWARI V,et al.Analgesic efficacy of ultrasound guided transversus abdominis plane block versus local anesthetic infiltration in adult patients undergoing single incision laparoscopic cholecystectomy:a randomized controlled trial[J]. Anesth Essays Res,2016,10(3):561-567.
[11] LU R,SHEN C,YANG C,et al. Comparison of lumbar plexus block using the short axis in-plane method at the plane of the transverse process and at the articular process:a randomized controlled trial[J]. Bmc Anesth,2018,18(1):17.
[12] BANG S,CHUNG J,JEONG J,et al. Efficacy of ultrasoundguided fascia iliaca compartment block after hip hemiarthroplasty:A prospective,randomized trial[J]. Medicine,2016,95(39):e5018.
[13] BADIOLA I,LIU J,HUANG S,et al. A comparison of the fascia iliaca block to the lumbar plexus block in providing analgesia following arthroscopic hip surgery:a randomized controlled clinical trial[J]. J Clin Anesth,2018,49(4):26–29.
[14] KEARNS R,MACFARLANE A,KINSELLA J,et al. Fascia iliaca block for primary hip arthroplasty-a reply[J].Anaesthesia,2017,72(3):409-416.
[15] MEI B,ZHA H,LU X,et al. Peripheral Nerve Block as a Supplement to Light or Deep General Anesthesia in Elderly Patients Receiving Total Hip Arthroplasty:A Prospective Randomized Study[J]. Clin J Pain,2017,33(12):1053-1059.
[16] BENDTSEN T F,PEDERSEN E M,HAROUTOUNIAN S,et al. The suprasacral parallel shift vs lumbar plexus blockade with ultrasound guidance in healthy volunteers-a randomised controlled trial[J]. Anaesthesia,2015,69(11):1227-1240.