Wang N, Li M, Geng J, Chen X L, Guo X Y
Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China.
Zhonghua Yi Xue Za Zhi. 2016 Jun 14;96(22):1750-4. doi: 10.3760/cma.j.issn.0376-2491.2016.22.008.
To compare two different regimens of continuous ultrasound-guided fascia iliaca compartment block (FICB) for postoperative analgesia after total hip arthroplasty (THA).
Approved by the Peking University Third Hospital ethics committee, sixty patients undergoing selective single total hip replacement in Peking University Third Hospital from May.2015 to Mar.2016 were included. Before neuraxial block, continuous ultrasound-guided FICB were administered. Patients were randomly divided into the continuous infusion group(n=30) and the automated intermittent boluses group(n=30). 10 ml/h of 0.2% ropivacaine was continuously infused for 48 hours in the continuous infusion group. 10 ml of 0.2% ropivacaine was automated injected every 60 mins in the automated intermittent boluses group. Numerical Rating Pain Scale(NRPS)was used to assess pain intensity at 4, 8, 12, 24, 36, 48 h after block at rest and during functional exercise. The usage of pethidine postoperatively, the incidence of opioid related adverse effect and patient satisfaction scores at 48 h were also recorded.
The pain score at rest 8, 12, 24, 36 h of the automated intermittent boluses group were 2 (1-3), 2 (1-3), 2 (1-3), 2 (1-3) score, which were lower than the continuous infusion group: 4 (2-6), 3 (2-5), 4 (3-5), 2 (1-4) score, the differences were statistically significant (Z=-6.493, -6.267, -6.235, -3.244, all P<0.05). The pain score during active and passive functional exercise at 8, 12, 24, 36 h of the automated intermittent boluses group were 4 (3-5), 4 (3-5), 2 (1-3), 1(0-3) score, which were lower than the continuous infusion group: 6 (4-7), 5 (4-7), 4 (2-6), 4 (2-5) score, the differences were statistically significant (Z=-6.499, -6.499, -5.081, -6.667, all P<0.05). The usage of pethidine postoperatively and the incidence of opioid related adverse effect of the automated intermittent boluses group were 10.0% and 3.3%, which were lower than the continuous infusion group: 33.3% and 26.7% , the differences were statistically significant (χ(2)=5.057, 4.500, all P<0.05). Patient satisfaction score at 48 h of the automated intermittent boluses group was (8.3±0.7)score, which was higher than the continuous infusion group: (7.4±0.7)score, the difference was statistically significant (t=-5.632, P<0.05).
Both regimens can provide effective analgesia after total hip arthroplasty. Compared with the continuous infusion group, the automated intermittent boluses group for continuous fascia iliaca block can provide better analgesic effect , with less remedial analgesia.
比较两种不同方案的连续超声引导下髂筋膜间隙阻滞（FICB）用于全髋关节置换术（THA）术后镇痛的效果。
经北京大学第三医院伦理委员会批准，纳入2015年5月至2016年3月在北京大学第三医院接受选择性单髋关节置换术的60例患者。在实施椎管内阻滞前，进行连续超声引导下FICB。患者随机分为持续输注组（n = 30）和自动间断推注组（n = 30）。持续输注组以10 ml/h的速度持续输注0.2%罗哌卡因48小时。自动间断推注组每60分钟自动推注10 ml 0.2%罗哌卡因。采用数字疼痛评分量表（NRPS）评估阻滞后4、8、12、24、36、48小时静息及功能锻炼时的疼痛强度。记录术后哌替啶的使用情况、阿片类药物相关不良反应的发生率以及48小时时的患者满意度评分。
自动间断推注组静息时8、12、24、36小时的疼痛评分分别为2（1 - 3）分、2（1 - 3）分、2（1 - 3）分及2（1 - 3）分，低于持续输注组的4（2 - 6）分、3（2 - 5）分、4（3 - 5）分及2（1 - 4）分，差异有统计学意义（Z = -6.493、-6.267、-6.235、-3.244，均P < 0.05）。自动间断推注组主动及被动功能锻炼时8、12、24、36小时的疼痛评分分别为4（3 - 5）分、4（3 - 5）分、2（1 - 3）分及1（0 - 3）分，低于持续输注组的6（4 - 7）分、5（4 - 7）分、4（2 - 6）分及4（2 - 5）分，差异有统计学意义（Z = -6.499、-6.499、-5.081、-6.667，均P < 0.05）。自动间断推注组术后哌替啶的使用情况及阿片类药物相关不良反应的发生率分别为10.0%和3.3%，低于持续输注组的33.3%和26.7%，差异有统计学意义（χ² = 5.057、4.500，均P < 0.05）。自动间断推注组48小时时的患者满意度评分为（8.3 ± 0.7）分，高于持续输注组的（7.4 ± 0.7）分，差异有统计学意义（t = -5.632，P < 0.05）。
两种方案均可为全髋关节置换术后提供有效的镇痛效果。与持续输注组相比，自动间断推注组连续髂筋膜间隙阻滞能提供更好地镇痛效果，补救性镇痛更少。
