Kullenberg Björn, Ysberg Benita, Heilman Martin, Resch Sylvia
Ortopedkliniken, Blekingesjukhuset, Karlshamn, Sweden.
Lakartidningen. 2004 Jun 10;101(24):2104-7.
Almost 25% of all patients with hip fracture experience temporary confusion pre- and directly postoperatively due to trauma, advanced age, transport between units, and the use of analgesics, 35-50% of the patients suffer temporary or chronic decubitus. Analgesics often lead to nausea. A femoral nerve block can interrupt sensory impulses from the hip joint and provide complete pain relief without affecting the CNS, thus making preoperative care easier and postoperative rehabilitation can be started earlier. 80 consecutive patients with hip fracture were randomized to femoral nerve block or pharmacological treatment only. Paracetamol and tramadol were the standard analgesics used. All patients were followed up with regard to pain, duration of the block, number of analgesics doses, temporary confusion and time for postoperative mobilization. Pain was estimated by the patients using the visual analogue scale (VAS). A nerve block was performed to block the femoral nerve, the lateral femoral cutaneous nerve and the obturator nerve with 30 ml of ropivacaine 7.5 mg/ml. Mental status was evaluated with Pfeiffer-test. All patients experienced relatively intense pain on admission with an average VAS of 6. After nerve block the VAS was 2. Pain relief was the same in the control group. Pain relief was sustained for 15 hours. The time for mobilization after surgery was significantly lower, 23 hours compared to 36 for the control group. There was a lower number of patients temporarily confused in the block group compared to the control group, however no significant differences were seen. Femoral nerve block provides adequate pain relief, equivalent to pharmacological treatment in most patients. The time for postoperative mobilization was shorter and less temporary confusion was seen. There were no complications in this group, making nerve block a good alternative to traditional pharmacological preoperative treatment for patients with hip fractures.
几乎25%的髋部骨折患者在术前和术后直接因创伤、高龄、科室间转运及使用镇痛药而出现短暂性意识模糊，35 - 50%的患者有暂时性或慢性褥疮。镇痛药常导致恶心。股神经阻滞可阻断来自髋关节的感觉冲动，在不影响中枢神经系统的情况下提供完全的疼痛缓解，从而使术前护理更轻松，术后康复可更早开始。80例连续的髋部骨折患者被随机分为股神经阻滞组或仅接受药物治疗组。对乙酰氨基酚和曲马多是使用的标准镇痛药。对所有患者进行疼痛、阻滞持续时间、镇痛药剂量、短暂性意识模糊及术后活动时间的随访。患者使用视觉模拟量表（VAS）评估疼痛。用30 ml浓度为7.5 mg/ml的罗哌卡因对股神经、股外侧皮神经和闭孔神经进行阻滞。用普费弗测试评估精神状态。所有患者入院时疼痛相对剧烈，平均VAS为6分。神经阻滞后VAS为2分。对照组的疼痛缓解情况相同。疼痛缓解持续15小时。术后活动时间显著缩短，阻滞组为23小时，而对照组为36小时。与对照组相比，阻滞组出现短暂性意识模糊的患者数量较少，但差异无统计学意义。股神经阻滞可提供充分的疼痛缓解，在大多数患者中与药物治疗效果相当。术后活动时间更短，短暂性意识模糊更少。该组无并发症发生，这使得神经阻滞成为髋部骨折患者传统术前药物治疗的一个良好替代方法。
