超声引导连续髂筋膜间隙阻滞用于全膝关节置换术后镇痛

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1、超声引导连续髂筋膜间隙阻滞用于全膝关节置换术后镇痛张庆芬林惠华杨庆国【摘要】目的评估超声引导下连续髂筋膜间隙阻滞用于全膝关节置换术后的镇痛效果。方法前瞻性、随机、平行对照临床研究。66例行单侧全膝关节置换术患者随机接受超声引导下连续髂筋膜间隙阻滞或神经刺激器定位的连续股神经阻滞。观察阻滞实施后感觉阻滞范围和镇痛效果，记录相关不良反应及并发症。结果两组患者术后疼痛评分、疼痛对睡眠的影响评分、使用自控镇痛冲击量的次数和追加镇痛药物等方面差异无统计学意义(P>0.05)。首次注药后连续髂筋膜间隙阻滞组对股外侧

2、皮神经的阻滞显著延迟（P=0.035），且在术后4小时、24小时持续输注药液过程中阻滞率显著下降（P=0.004）。术后0.5小时连续髂筋膜间隙阻滞组对股外侧皮神经的阻滞率高于连续股神经阻滞组（P=0.007）。两组患者在随访过程中均未观察到明显不良反应和并发症。结论超声引导下连续髂筋膜间隙阻滞用于全膝关节置换术后镇痛效果同神经刺激器定位的连续股神经阻滞相似，其感觉阻滞范围更广，但连续阻滞过程中阻滞范围不稳定。【关键词】髂筋膜间隙阻滞；术后镇痛；超声引导UltrasoundGuidedContinuou

3、sFasciaIliacCompartmentBlockforPostoperativeAnalgesiaafterTotalKneeArthroplastyZHANGQing-fen，LINHui-hua，YANGQing-guo[Abstract]Objective.Toevaluatetheanalgesicefficacyandtheterritoryofsensoryblockadeoftheultrasoundguidedcontinuousfasciailiaccompartmentblo

4、ck(cFICB)forpainmanagementaftertotalkneearthroplasty(TKA).Methods.Inthisprospectiverandomizedcontrolledstudy,66patientsscheduledforunilateralTKAwererandomizedtoreceiveeithercFICB(cFICBgroup)withultrasound-guidanceorcontinuousfemoralnerveblockade(cFNBgrou

5、p)withneurostimulator.Nerveblockadewasperformed30minutesbeforesurgeryandabolusofropivacaine0.5%(5mgkg-1)20mlwasadministered.From0.5hourto48hoursaftersurgery,continuousinfusionofropivacaine0.2%wasmaintained.EfficacyofpainmanagementwasevaluatedbyVASscore,n

6、ightsleepqualityandextrarequirementofanalgesicsthroughoutthetrial.Sensoryblockadewasalsoassessed.Theadverseeffectsandcomplicationsofnerveblockwererecorded.Results.TherewasnosignificantdifferencebetweentwogroupsconcerningtheVASscore,nightsleepquality,resc

7、uedrugconsumptionandpatient-controlledbolusoflocalanalgesicinthecourse.InthecFICBgroup,lateralfemoralcutanousnerve(LFCN)blockadewasimprovedat0.5houraftersurgerycomparedwith10minutesafterinjection(P=0.035),whiledecreasedovertimeduringthecontinuousinfusion

8、(P=0.004).Sensoryblockadewassimilarbetweentwogroupsexceptforthelateralfemoralcutaneous(LFC)nerveblockat0.5hourpostsurgery(P=0.007).Noconsequentialadverseeffectswerenotedinthisstudy.Conclusions.TheultrasoundguidedcFICBprovi