目的评价腹股沟韧带上方髂筋膜间隙阻滞(S-FICB)用于髋部骨折患者镇痛的效果。
方法本研究为单中心、随机对照试验。选择2023年4月至9月因临床诊断股骨颈或股骨粗隆间骨折急诊入院的患者48例，通过IBM SPSS Statistics 20生成随机数列，按1∶1分为S-FICB组和腹股沟韧带下方髂筋膜间隙阻滞(I-FICB)组，每组24例。2组均在超声引导下进行神经阻滞，注射0.25%罗哌卡因40 ml。主要指标：阻滞后24 h内舒芬太尼消耗量；次要指标：阻滞后0.5 h时CT检查局麻药扩散情况，髋部皮肤针刺感觉减退范围，首次镇痛泵按压时间，阻滞24 h内镇痛泵有效按压次数，阻滞后0.5 h时被动搬运时疼痛数字评价量表(NRS)评分，阻滞前以及阻滞后0.5、3、6、12和24 h时静态NRS评分。
结果与I-FICB组比较，S-FICB组舒芬太尼消耗量减少，局麻药覆盖腰丛神经分支数增多，被动搬运时NRS评分降低，首次镇痛泵按压时间延长，有效按压次数减少，阻滞后24 h时静态NRS评分降低( P<0.01)。I-FICB组未见局麻药覆盖髂腹下髂腹股沟神经，2组患者均未见局麻药覆盖闭孔神经。
结论相较于I-FICB，S-FICB(0.25%罗哌卡因40 ml)局麻药扩散范围更广，可覆盖更多的腰丛神经分支，用于髋部骨折患者镇痛效果较好；两种阻滞方法均未直接阻滞闭孔神经。
ObjectiveTo evaluate the analgesic efficacy of supra-inguinal fascia iliac compartment block (S-FICB)in patients with hip fracture.
MethodsThis study was a single-center, randomized controlled trial. Forty-eight patients who were admitted to the emergency department due to clinically diagnosed femoral neck or intertrochanteric fractures from April to September 2023 were selected. A random sequence was generated using IBM SPSS Statistics 20, and the patients were divided into 2 groups in a 1∶1 ratio( n=24 each): S-FICB group and infra-inguinal fascia iliac compartment block (I-FICB) group. Both groups received nerve blocks under ultrasound guidance, with an injection of 0.25% ropivacaine 40 ml. The primary outcome measure was sufentanil consumption within 24 h post-block. Secondary outcome measures included the distribution of local anesthetic spread as observed on CT at 0.5 h post-block, the extent of hip skin sensory reduction to pinprick, the time to first analgesic pump pressing, the number of effective analgesic pump pressing within 24 h post-block, the Numeric Rating Scale (NRS) score for pain during passive movement at 0.5 h post-block, and the static NRS scores at baseline (pre-block) and at 0.5, 3, 6, 12 and 24 h post-block.
ResultsCompared to I-FICB group, the consumption of sufentanil was significantly decreased, the coverage of lumbar plexus nerve branches by local anesthetics was increased, NRS scores were decreased during passive movement, the time to the first analgesic pump pressing was prolonged, the number of effective pump pressing was reduced, and static NRS scores were decreased at 24 h post-block in S-FICB group( P<0.01). In I-FICB group, no local anesthetic coverage of the iliohypogastric or ilioinguinal nerves was observed. Neither group showed coverage of the obturator nerve by the local anesthetic.
ConclusionsCompared to I-FICB, S-FICB (0.25% ropivacaine 40 ml) provides a wider range of local anesthetic spread and can cover more branches of the lumbar plexus, which exerts better analgesic efficacy in patients with hip fracture. However, neither approach directly blocks the obturator nerve.
仲浩,王鑫怡,覃琴,等. 腹股沟韧带上髂筋膜间隙阻滞用于髋部骨折患者镇痛的效果[J]. 中华麻醉学杂志,2024,44(12)：1450-1455.
DOI:10.3760/cma.j.cn131073.20240507.01210版权归中华医学会所有。
未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。
除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
仲浩：酝酿设计试验和实施研究；王鑫怡：分析解释数据和起草文章；覃琴：实施研究；张福玲：统计分析；孙浩：对文章的内容作批评性审阅；俞又佳：统计分析；李艳：行政/技术和材料支持；朱江：对文章的知识性作批评性审阅、获取研究经费和指导支持
文档即答
智问智答
机器翻译
你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。
