Cuvillon P, Ripart J, Debureaux S, Boisson C, Veyrat E, Mahamat A, Bruelle P, Viel E, Eledjam J-J
Fédération des départements anesthésie douleur et urgences réanimation, hôpital universitaire Caremeau, avenue du Professeur-Debré, 30029 Nîmes, France.
Ann Fr Anesth Reanim. 2007 Jan;26(1):2-9. doi: 10.1016/j.annfar.2006.06.025. Epub 2006 Dec 4.
The usefulness of peripheral femoral nerve block for pain management after hip fracture has been established. This prospective and randomised study compared the analgesia effect of a continuous femoral nerve block (CF) versus two conventional analgesia procedures after hip fracture.
Patients. (n=62) scheduled for surgery under spinal anaesthesia were prospectively included. After surgery, analgesia (48 hours) was randomised: group FC (femoral catheter, anterior paravascular approach, initial bolus followed by continuous infusion of ropivacaine 0.2%), group P (iv 2 g propacetamol/6 hours), group M (sc morphine, 0.05 mg/kg per 4 hour). Intravenous morphine titration was performed, followed by subcutaneous (sc) morphine every 4 hours according to the VAS score. The primary end-point was the morphine requirements. Secondary end-points were VAS score, side effects, and mortality.
Demographic data and surgical procedures were similar between groups. After morphine titration, the VAS pain score did not differ between groups. All patients in-group M received additional morphine. Morphine mean consumption was increased in CF group: 26 mg (5-42) versus P: 8 mg (3-12) (p=0.0001) or M: 19 mg (8-33) (p<0.006) while constipation was decreased in P group vs CF. Percentage of patients requiring no morphine was similar between P (n=6; 28%) and CF (n=6; 28%) and greater than M (n=0; 0%). Hospital discharge, cardiovascular or pulmonary complications and mortality after 6 months showed no statistical difference.
Continuous femoral nerve block provided limited pain relief after hip fracture did not reduced side effects and induced an expensive cost.
外周股神经阻滞用于髋部骨折后疼痛管理的有效性已得到证实。本前瞻性随机研究比较了持续股神经阻滞（CF）与髋部骨折后两种传统镇痛方法的镇痛效果。
前瞻性纳入计划在脊髓麻醉下接受手术的患者（n = 62）。术后，镇痛（48小时）随机分组：FC组（股动脉导管，血管旁前路，初始推注后持续输注0.2%罗哌卡因），P组（静脉注射2g丙帕他莫/每6小时），M组（皮下注射吗啡，每4小时0.05mg/kg）。进行静脉吗啡滴定，然后根据视觉模拟评分（VAS）每4小时皮下注射吗啡。主要终点是吗啡需求量。次要终点是VAS评分、副作用和死亡率。
各组间人口统计学数据和手术操作相似。吗啡滴定后，各组间VAS疼痛评分无差异。M组所有患者均接受了额外的吗啡。CF组吗啡平均消耗量增加：26mg（5 - 42），而P组为8mg（3 - 12）（p = 0.0001）或M组为19mg（8 - 33）（p < 0.006），而P组便秘发生率低于CF组。无需吗啡的患者百分比在P组（n = 6；28%）和CF组（n = 6；28%）相似，且高于M组（n = 0；0%）。6个月后的出院情况、心血管或肺部并发症及死亡率无统计学差异。
持续股神经阻滞在髋部骨折后提供的疼痛缓解有限，未减少副作用且成本高昂。
