| 徐姝珺,张振,左琴蓉,等.氢吗啡酮复合罗哌卡因髂筋膜间隙联合骶丛神经阻滞在老年全髋关节置换术中的应用.骨科,2021,12(4): 339-343. |
| 氢吗啡酮复合罗哌卡因髂筋膜间隙联合骶丛神经阻滞在老年全髋关节置换术中的应用 |
| Hydromorphone Compounded Ropivacaine in Iliac Fascial Space Combined with Sacral Plexus Block in Elderly Total Hip Arthroplasty |
| 投稿时间：2020-12-29 |
| DOI：10.3969/j.issn.1674-8573.2021.04.009 |
| 中文关键词: 氢吗啡酮 髂筋膜间隙阻滞 骶丛神经阻滞 全髋关节置换术 术后镇痛 |
| 英文关键词: Hydromorphone Iliac fascia space block Sacral plexus block Total hip arthroplasty Postoperative analgesia |
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| 中文摘要: |
| 目的 探讨氢吗啡酮复合罗哌卡因髂筋膜间隙联合骶丛神经阻滞在老年病人全髋关节置换术后镇痛的效果及不良反应。方法 选取2019年6月至2020年2月在襄阳市第一人民医院行单侧全髋关节置换术的病人90例，随机分为R组（罗哌卡因+肌注生理盐水组）、H组（罗哌卡因、氢吗啡酮+肌注生理盐水组）和RH组（罗哌卡因+肌注氢吗啡酮组）。三组术前30 min均在超声引导下行髂筋膜间隙联合骶丛神经阻滞，R组在髂筋膜间隙阻滞用药为0.35%罗哌卡因40 mL，骶丛神经阻滞用药为0.4%罗哌卡因20 mL，随后臀大肌肌注生理盐水2 mL；H组在髂筋膜间隙阻滞用药为0.35%罗哌卡因+10 mg/kg氢吗啡酮共40 mL，骶丛神经阻滞用药为0.4%罗哌卡因+10 mg/kg氢吗啡酮共20 mL，随后臀大肌肌注生理盐水2 mL；RH组在髂筋膜间隙阻滞用药为0.35%罗哌卡因40 mL，骶丛神经阻滞用药为0.4%罗哌卡因20 mL，随后臀大肌肌注氢吗啡酮2 mL。待神经阻滞起效后行喉罩全麻。观察记录各组神经阻滞起效及维持时间，术后6、12、24、48 h静息及运动状态下的疼痛视觉模拟量表（visual analogue scale, VAS）评分、术后镇痛药的使用、恢复质量及不良反应发生情况。结果 三组神经阻滞起效时间的差异无统计学意义（P＞0.05），H组术后神经阻滞维持时间长于R组和RH组（P均＜0.05）。H组术后6、12、24 h VAS评分低于R组和RH组（P均＜0.05）。H组术后首次按压镇痛泵晚于R组和RH组（P均＜0.05）。H组术后首次下床活动时间早于R组和RH组（P均＜0.05）。H组术后舒芬太尼用量、住院天数、恶心呕吐的发生率均少于R组和RH组（P均＜0.05）。结论 氢吗啡酮复合罗哌卡因髂筋膜间隙联合骶丛神经阻滞在老年全髋置换术中可以延长阻滞时间，减少阿片类药物的消耗及术后不良反应的发生率，利于病人术后康复。 |
| 英文摘要: |
| Objective To investigate the effect of hydromorphone compounded with ropivacaine in iliac fascial space combined with sacral plexus block on postoperative analgesia and adverse effects of total hip arthroplasty (THA) in the elderly. Methods Ninety patients who underwent unilateral THA in Xiangyang No. 1 People's Hospital from June 2019 to February 2020 were selected and randomly divided into ropivacaine + intramuscular infusion saline group (R group), ropivacaine & hydromorphone + intramuscular infusion saline group (H group) and ropivacaine + intramuscular infusion hydromorphone group (RH group). In R group, 0.35% ropivacaine 40 mL was used for iliac fascial space block and 0.4% ropivacaine 20 mL was used for sacral plexus block, followed by gluteus maximus muscle infusion with 2 mL saline; in H group, 0.35% ropivacaine + 10 mg/kg hydromorphone were used for iliac fascial space block (40 mL), 20 mL of ropivacaine + 10 mg/kg of hydromorphone, and 2 mL of saline were used in the gluteus maximus muscle; in the RH group, 40 mL of ropivacaine (0.35%), 20 mL of ropivacaine (0.4%), and 2 mL of hydromorphone were used in the gluteus maximus muscle. Total anesthesia of the laryngeal mask was done. The onset and maintenance time of nerve block, visual analogue scale (VAS) scores at 6, 12, 24 and 48 h postoperation under rest and exercise, use of postoperative analgesics, quality of recovery and incidence of adverse events were recorded. Results There was no significant difference in the onset of nerve block among the three groups (P＞0.05), and the postoperative nerve block in H group was maintained longer than that in R group and RH group (P＜0.05). At 6th, 12th and 24th h postoperation, VAS scores were significantly lower in H group than in R group and RH group (P＜0.05). The use of first postoperative analgesic pump in H group was later than that in R group and RH group (P＜0.05). Postoperative sufentanil dosage, hospital days, and incidence of nausea and vomiting were significantly reduced lower in H group as compared with those in R group and RH group (P＜0.05). Conclusion Hydromorphone compounded with ropivacaine in iliac fascia gap combined with sacral plexus nerve block in elderly THA can prolong the block time, reduce the consumption of opioids and the incidence of postoperative adverse effects, and facilitate the patient's postoperative recovery. |
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