腰麻髋关节置换术是否髂腰肌间隙阻滞术后镇痛比较

Comparison of postoperative analgesia of hip arthroplasty under spinal anesthesia with or without iliopsoas space block

摘要:

[目的] 探讨超声引导下前路髂腰肌间隙阻滞对髋关节置换术后镇痛及功能恢复的影响。[方法] 选取 2023 年 6 月 —2024 年 5 月江苏大学附属医院髋关节置换患者 60 例，随机分为阻滞组与非阻滞组，每组 30 例。两组均行蛛网膜下腔阻滞，阻滞组术前加行前路髂腰肌间隙阻滞，术后均用静脉自控镇痛。比较两组术中镇痛情况及术后效果。[结果]两组患者均顺利完成手术。阻滞组的下床行走时间 [(4.2±0.9) d vs (6.0±1.2) d, P＜0.001]、术后总舒芬太尼消耗量 [(19.3±3.1) μg vs (22.7±5.6) μg, P=0.007]、补救镇痛率 [4 (13.3%) vs 18 (60.0%), P＜0.001]、总不良反应发生率 [7 (23.3%) vs 24 (80.0%), P＜0.001] 均显著小于非阻滞组，两组之间术后尿潴留、呼吸抑制以及谵妄发生率的差异均无统计学意义（P＞0.05）。术后 6 h 及 1、3、7 d 阻滞组 VAS 评分均显著优于非阻滞组 [(1.8±1.0) 分 vs (3.5±1.5) 分, P＜0.001; (2.4±0.5) 分 vs (3.0±0.9) 分, P=0.005; (1.9±0.6) 分 vs (2.3±0.6) 分, P=0.017; (0.9±0.6) 分 vs (1.3±0.6) 分, P=0.012]；阻滞组术后 24、48 h 的 2 min 步行距离均显著优于非阻滞组 [(44.2±12.0) m vs (36.2±10.5) m, P=0.020; (170.4±9.9) m vs (120.9±18.2) m, P＜0.001] 。[结论] 超声引导下前路髂腰肌间隙阻滞可有效减轻髋关节置换术后疼痛， 促进功能恢复，且不增加不良反应。

Abstract:

[Objective] To investigate the analgesic effect of ultrasound-guided anterior iliopsoas space block on pain relief and functional recovery after hip arthroplasty (HA). [Methods] A total of 60 patients who were undergoing HA in the Affiliated Hospital of Jiangsu University from June 2023 to May 2024 were enrolled into this study, and randomly divided into the block group and the non-block group, with 30 cases in each group. Both groups received subarachnoid anesthesia, additionally, the block group received anterior iliopsoas space block before the operation, while the non-block group received no block. Both groups received patient-controlled intravenous analgesia after the operation. The data regarding postoperative analgesia were compared between the two groups. [Results] All patients in both groups had HA performed successfully. The block group proved significantly superior to the nonblock group in terms of ambulation time [(4.2±0.9) days vs (6.0±1.2) days, P＜0.001], total sufentanil consumption after surgery [(19.3±3.1) μg vs (22.7±5.6) μg, P=0.007], rescue analgesia rate [4 (13.3%) vs 18 (60.0%), P＜0.001], and total adverse reaction rate [7 (23.3%) vs 24 (80.0%), P＜0.001], although there were no statistically significant differences in the incidence of postoperative urinary retention, respiratory depression, and delirium between the two groups (P＞ 0.05). In addition, the block group was significantly better than the non-block group in the pain VAS scores at 6 hours, 1, 3, and 7 days after surgery [(1.8±1.0) score vs (3.5±1.5) score, P＜0.001; (2.4±0.5) score vs (3.0±0.9) score, P=0.005; (1.9±0.6) score vs (2.3±0.6) score, P= 0.017; (0.9±0.6) score vs (1.3±0.6) score, P=0.012], and the 2-minute walking distance at 24 and 48 hours after surgery [(44.2±12.0) m vs (36.2±10.5) m, P=0.020; (170.4±9.9) m vs (120.9±18.2) m, P＜0.001]. [Conclusion] The ultrasound-guided anterior iliopsoas space block does effectively alleviate postoperative pain after hip arthroplasty, promote functional recovery, and does not increase adverse reactions.