Department of Anesthesiology, St Luke's-Roosevelt Hospital Center, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY,USA.
Reg Anesth Pain Med. 2013 May-Jun;38(3):201-5. doi: 10.1097/AAP.0b013e31828a3c7c.
Fascia iliaca block (FIB) is often used to treat pain after total hip arthroplasty (THA), despite a lack of randomized trials to evaluate its efficacy for this indication. The objective of this study was to assess the analgesic benefit of FIB after THA. Our primary hypothesis was administration of FIB decreases the intensity of postoperative pain (numeric rating scale [NRS-11] score) compared with sham block (SB) in patients after THA.
After institutional review board approval and informed consent, 32 eligible patients having THA were recruited. In the postoperative care unit, although all patients received intravenous morphine sulfate patient-controlled analgesia, patients reporting pain of 3 or greater on the NRS-11 scale were randomized to receive ultrasound-guided fascia iliaca (30 mL 0.5% ropivacaine) or SB (30 mL 0.9% NaCl) using identical technique, below fascia iliaca. The primary outcome was pain intensity (NRS-11) after FIB.
Thirty-two patients (16 in each group) completed the study; all patients received an FIB. There was no difference in pain intensity (NRS-11 = 5.0 ± 0.6 vs 4.7 ± 0.6, respectively) after FIB versus SB or in opioid consumption (8.97 ± 1.6 vs 5.7 ± 1.6 mg morphine, respectively) between the groups at 1 hour. The morphine consumption after 24 hours was similar in both groups (49.0 ± 29.9 vs 50.4 ± 34.5 mg, P = 0.88, respectively).
The evidence in these data suggests that the difference in average pain intensity after FIB versus SB was not significant (95% confidence interval, -2.2-1.4 NRS units).
尽管缺乏随机试验来评估其在该适应证中的疗效，但筋膜髂腹股沟阻滞（FIB）常用于治疗全髋关节置换术后（THA）的疼痛。本研究旨在评估 FIB 在 THA 后的镇痛效果。我们的主要假设是与 sham 阻滞（SB）相比，FIB 可降低 THA 后患者的术后疼痛强度（数字评分量表[NRS-11]评分）。
在机构审查委员会批准和知情同意后，纳入了 32 名符合条件的接受 THA 的患者。在术后护理病房，尽管所有患者均接受静脉注射硫酸吗啡患者自控镇痛，但报告 NRS-11 评分为 3 或更高的患者随机接受超声引导下的筋膜髂腹股沟阻滞（30 mL 0.5%罗哌卡因）或 SB（30 mL 0.9%NaCl），采用相同的技术，在筋膜髂腹股沟下方。主要结局是 FIB 后的疼痛强度（NRS-11）。
32 名患者（每组 16 名）完成了研究；所有患者均接受了 FIB。FIB 与 SB 后疼痛强度（NRS-11=5.0±0.6 与 4.7±0.6）或阿片类药物消耗（8.97±1.6 与 5.7±1.6 mg 吗啡）之间无差异。两组 24 小时内的吗啡消耗量相似（分别为 49.0±29.9 和 50.4±34.5 mg，P=0.88）。
这些数据中的证据表明，FIB 与 SB 后平均疼痛强度的差异无统计学意义（95%置信区间，-2.2-1.4 NRS 单位）。
