Chudinov A, Berkenstadt H, Salai M, Cahana A, Perel A
Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tal Hashomer, Israel.
Reg Anesth Pain Med. 1999 Nov-Dec;24(6):563-8. doi: 10.1016/s1098-7339(99)90050-0.
The perioperative use of continuous psoas compartment block (CPCB) was compared with traditional pain management for patients with fracture of the femur. The anatomy of CPCB was also tested in cadavers.
Forty consecutive patients (range, 67-96 years old) were prospectively randomized either to group A (given local anesthetics using a CPCB) or group B (given perioperative analgesia with meperidine). In another part of the study, CPCB was performed in 15 fresh cadavers, and dissection of the lumbar region was performed after dye injection.
Continuous psoas compartment block was performed successfully in all patients in group A and was used in the pre- (16-48 hours) and postoperative (72 hours) periods. Visual analog scale score in group A was lower than in group B in 5/7 preoperative and 9/9 postoperative 8 hourly assessments. Differences reached statistical significance (P < .05) in 3 and 5 of the assessments, respectively. Patient satisfaction was higher in group A in the pre- (P < .05) and postoperative periods (P<.03). The block failed to achieve surgical anesthesia in 85% (17/20) of the patients, and additional anesthesia was needed. The anatomic study failed to support the existence of a defined "psoas compartment" previously described, and supported the clinical findings. Injected dye was found in the region of the origin of the sciatic nerve (essential for the production of anesthesia for hip surgery) in only 26% (4/15) of cadavers.
The CPCB seems to be an appropriate technique for efficient and safe perioperative pain control. However, in our dissections, the psoas compartment was not well defined in all patients, thus, using this route for anesthesia may result in only partial success.
比较股骨骨折患者围手术期持续腰大肌间隙阻滞（CPCB）与传统疼痛管理方法的效果。同时在尸体上对CPCB的解剖结构进行研究。
连续纳入40例患者（年龄范围67 - 96岁），前瞻性随机分为A组（采用CPCB给予局部麻醉药）和B组（采用哌替啶进行围手术期镇痛）。在研究的另一部分，对15具新鲜尸体进行CPCB操作，并在注射染料后对腰部区域进行解剖。
A组所有患者均成功实施了持续腰大肌间隙阻滞，并在术前（16 - 48小时）和术后（72小时）使用。在术前7次评估中的5次以及术后9次每8小时评估中的9次，A组视觉模拟评分低于B组。分别在3次和5次评估中差异具有统计学意义（P < 0.05）。A组患者在术前（P < 0.05）和术后（P < 0.03）的满意度更高。85%（17/20）的患者该阻滞未能达到手术麻醉效果，需要追加麻醉。解剖学研究未能支持先前描述的明确“腰大肌间隙”的存在，并支持了临床发现。仅在26%（4/15）的尸体中，在坐骨神经起始部位（对髋部手术麻醉的产生至关重要）发现了注入的染料。
CPCB似乎是一种有效且安全的围手术期疼痛控制技术。然而，在我们的解剖中，并非所有患者的腰大肌间隙都界定清晰，因此，采用该途径进行麻醉可能仅部分成功。
