【罂粟摘要】腰丛阻滞与腹股沟上髂筋膜阻滞用于儿童髋部和股骨术后镇痛的比较——一项病例系列分析

腰丛阻滞与腹股沟上髂筋膜阻滞用于儿童髋部和股骨术后镇痛的比较——一项病例系列分析

贵州医科大学 麻醉与心脏电生理课题组

翻译：安丽    编辑：张中伟    审校：曹莹

引言   

       对于涉及髋部和股骨的外科手术，可以使用各种区域麻醉技术来提供镇痛。虽然腰丛阻滞（LPB）的使用较多见，但该技术相对较耗时并常可能伴有并发症。腹股沟上髂筋膜阻滞(FICB)是一个潜在的更容易和安全的替代方案。本研究对LPB和腹股沟上FICB进行了前瞻性比较。

方法  

       这项前瞻性、双盲、随机的研究包括接受髋部和/或股骨择期矫形手术的患者，所研究的患者均接受全身麻醉，并使用0.5%罗哌卡因、肾上腺素和地塞米松随机实施LPB或腹股沟上FICB操作。如术后患者疼痛，可通过静脉注射氢吗啡酮，对乙酰氨基酚和酮咯酸来控制疼痛。监测的数据包括：记录实施LPB或腹股沟上FICB操作时间、围手术期阿片类药物用量、术后疼痛评分(VAS)和住院时间。

结果   

       研究队列包括15例7 - 16岁的患者(LPB N = 7, FICB N = 8)。LPB组的平均阻滞时间为6分钟(IQR: 4.11)， FICB组的平均阻滞时间为3分钟(IQR: 3.6) (p = 0.107)。LPB组术后疼痛评分平均为4分(IQR: 0.6)， FICB组术后疼痛评分平均为2分(IQR: 0.5) (p = 0.032)。两组在术中或术后阿片类药物和非甾体抗炎药的使用没有差异。

结论 

       在髋部和股骨手术后，腹股沟上FICB提供的镇痛与LPB疗效一致。由于患者仰卧位和进针轨迹便于操作实施，FICB进行阻滞的时间较短。本次研究中虽然两组我们均没有发现不良反应，但是FICB表面的进针轨迹提供了一种侵入性较低的入路，并可能降低不良反应的风险。

        原始文献来源

Lauren DeLong ，Senthil Krishna， Catherine Roth ， Giorgio Veneziano，Mauricio Arce Villalobos， Kevin Klingele ， Joseph D Tobias.Short Communication: Lumbar Plexus Block versus Suprainguinal Fascia Iliaca Block to Provide Analgesia Following Hip and Femur Surgery in Pediatric-Aged Patients - An Analysis of a Case Series.Local Reg Anesth 2021;14.DOI：10.2147/LRA.S334561.

       英文原文

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Short Communication: Lumbar Plexus Block versus Suprainguinal Fascia Iliaca Block to Provide Analgesia Following Hip and Femur Surgery in Pediatric-Aged Patients - An Analysis of a Case Series

Abstract

Introduction:For surgical procedures involving the hip and femur, various regional anesthetic techniques may be used to provide analgesia. Although there has been an increase in the use of lumbar plexus block (LPB), the technique may be time consuming and associated with complications. Suprainguinal fascia iliaca compartment block (FICB) is a potentially easier and safer alternative. The current study prospectively compares LPB with suprainguinal FICB.

Methods:This prospective, double-blinded, randomized, study included patients undergoing elective orthopedic procedures of the hip and/or femur. All study patients received general anesthesia with randomization to either an LPB or suprainguinal FICB using 0.5% ropivacaine with epinephrine and dexamethasone. Postoperative pain control was achieved with intravenous hydromorphone delivered by patient-controlled analgesia with scheduled acetaminophen and ketorolac. Outcome data included time to perform the block, perioperative opioid consumption, postoperative pain scores (VAS) and hospital length of stay.

Results:The study cohort included 15 patients between the ages of 7 and 16 years (LPB N = 7, FICB N = 8). The median block time was 6 minutes (IQR: 4.11) for the LPB group and 3 minutes (IQR: 3.6) for the FICB group (p = 0.107). Median postoperative pain scores were 4 (IQR: 0.6) for the LPB group and 2 (IQR: 0.5) for the FICB group (p = 0.032). There were no differences in the intraoperative or postoperative opioid and NSAID use between the two groups.

conclusion:The suprainguinal FICB provides analgesia that is at least as effective as a LPB following hip and femur surgery. Time to perform the block was shorter with the FICB due to the supine patient position and limited needle trajectory. Although we noted no adverse effects, the superficial needle trajectory of the FICB offers a less invasive approach and the potential for decreased risks of adverse effects.

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