关节囊周围神经阻滞对髋关节置换术后镇痛及快速康复的影响

Effect of pericapsular nerve group block on analgesia and rapid rehabilitation after total hip arthroplasty

摘要:

摘要 目的 前瞻性研究关节囊周围神经阻滞麻醉对髋关节置换术后镇痛及快速康复的影响。方法 2020年6月至2021年9月选择我院关节外科收治全髋关节置换术患者108 例，按单双数随机分为试验组（PENG阻滞）和对照组（FIC阻滞），其中试验组54例，对照组55例。比较手术时间、术中出血量、首次下床活动时间及住院时间；术前、术后12h、24h、36h视觉模拟疼痛评分、股四头肌肌力、自控静脉镇痛泵用量、恶心呕吐评分。结果 ①手术时间、术中出血量、住院时间比较，差异无统计学意义（P>0.05）。②术后12h、24h的VAS评分比较，差异有统计学意义（P<0.001）。术后36h，两组患者VAS评分比较无显著差异（P>0.05）。术后12h、24h试验组PCIA用量均显著少于对照组，差异有统计学意义（P<0.001）。术后12h，试验组的股四头肌肌力显著高于对照组，差异有统计学意义（P<0.001）。③术后25例患者发生恶心呕吐，其中试验组为8(14.81%)、对照组为17(30.91%)，差异有统计学意义（P<0.05）。结论 关节囊周围神经阻滞能够缓解全髋关节置换术后疼痛，减少阿片类药物的用量，镇痛效果优于髂筋膜间隙阻滞。

Abstract:

Abstract Objective Prospective study on the effect of pericapsular nerve group block on analgesia and rapid rehabilitation after total hip arthroplasty. Methods From June 2020 to September 2021, 108 patients with total hip arthroplasty were randomly divided into experimental group (pericapsular nerve group block, PNGB) and control group ( fascia iliaca compartment block, FIC), including 54 cases in experimental group and 55 cases in control group. The operation time, intraoperative bleeding, first landing time and hospital stay were compared; Visual analog pain score（VAS）, quadriceps femoris muscle strength, dosage of patient-controlled intravenous analgesia (PCIA), Postoperative nausea and vomiting（PONV） before and 12 hours, 24 hours and 36 hours after operation.Results ① there was no significant difference in operation time, intraoperative bleeding and hospital stay (P > 0.05). ② At 12h and 24h after operation, the VAS of the experimental group was significantly lower than that of the control group (P < 0.001). At 36h , there was no significant difference between the two groups (P > 0.05). The dosage of PCIA in the experimental group was significantly lower than that in the control group at 12h and 24h after operation (P < 0.001). At 12 hours ,the muscle strength of quadriceps femoris in experimental group was significantly higher than control group (P < 0.001). ③ PONV occurred in 25 patients after operation, including 8 (14.81%) in the experimental group and 17 (30.91%) in the control group,the difference was significant (P<0.05)..Conclusion Periarticular capsule nerve block can relieve the pain after total hip replacement and reduce the dosage of opioids. The analgesic effect is better than that of iliac fascia compartment block