超声引导下小儿及青少年腹股沟上髂筋膜间隙阻滞用于髋关节镜手术的技术成功率
Technical success of the ultrasound-guided supra-inguinal fascia iliaca compartment block in older children and adolescents for hip arthroscopy.
作者信息
Eastburn Elizabeth, Hernandez Maria A, Boretsky Karen
机构信息
Department of Anesthesia Perioperative & Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, MA, USA.
出版信息
Paediatr Anaesth. 2017 Nov;27(11):1120-1124. doi: 10.1111/pan.13227.
BACKGROUND
Hip arthroscopic surgery is performed on older pediatric patients. Fascia iliaca compartment block has proven efficacy in providing analgesia following hip surgery and can be performed with target location of local anesthetic below or above the inguinal ligament. The reported success of ultrasound-guided infra-inguinal fascia iliaca compartment block is lower when compared to traditional landmark technique, while the reliability of supra-inguinal fascia iliaca compartment block is unreported.
AIM
The primary aim was to report the results in obtaining sensory changes in the distribution of the femoral and lateral femoral cutaneous nerves following supra-inguinal fascia iliaca compartment block in patients undergoing arthroscopic hip surgery. Secondary outcomes are the ability to find echogenic landmarks and to report pain scores and opioid consumption.
METHODS
We reviewed the electronic medical record and regional anesthesia database of patients receiving ultrasound-guided fascia iliaca compartment block for arthroscopic hip surgery. Sensory changes to the femoral and lateral femoral cutaneous nerves were determined. Identification of echogenic landmarks was quantified. Pain scores and opioid consumption were determined.
RESULTS
Seventeen patients of mean age 15.4 years old (SD 1.3; range 13-17 years) were included. Sensory changes to both the femoral and lateral femoral cutaneous nerves occurred in 94% of patients (95% CI: 82%-100%). The average volume of ropivacaine 0.2% was 0.53 mL/Kg (SD 0.11 mL/Kg). Echogenic landmarks were identified in all patients. Pain scores and opioid consumption were generally low.
CONCLUSION
A supra-inguinal location for the deposition of local anesthetic when performing fascia iliaca nerve block for hip surgery is reliable in anesthetizing the femoral and lateral femoral cutaneous nerves and should encourage investigation into the clinical efficacy.
背景
髋关节镜手术应用于年龄较大的儿科患者。髂筋膜间隙阻滞已被证明在髋关节手术后提供镇痛方面有效，并且可以在腹股沟韧带下方或上方进行局部麻醉药的靶向定位。与传统的体表标志技术相比，超声引导下腹股沟下髂筋膜间隙阻滞的成功率较低，而腹股沟上髂筋膜间隙阻滞的可靠性尚未见报道。
目的
主要目的是报告在接受髋关节镜手术的患者中，腹股沟上髂筋膜间隙阻滞后股神经和股外侧皮神经分布区域感觉变化的结果。次要结果是找到强回声标志的能力以及报告疼痛评分和阿片类药物消耗量。
方法
我们回顾了接受超声引导下髂筋膜间隙阻滞进行髋关节镜手术患者的电子病历和区域麻醉数据库。确定股神经和股外侧皮神经的感觉变化。对强回声标志的识别进行量化。确定疼痛评分和阿片类药物消耗量。
结果
纳入17例平均年龄15.4岁（标准差1.3；范围13 - 17岁）的患者。94%的患者（95%可信区间：82% - 100%）股神经和股外侧皮神经均出现感觉变化。0.2%罗哌卡因的平均用量为0.53 mL/kg（标准差0.11 mL/kg）。所有患者均识别出强回声标志。疼痛评分和阿片类药物消耗量总体较低。
结论
在进行髋关节手术的髂筋膜神经阻滞时，将局部麻醉药注射于腹股沟上位置，在麻醉股神经和股外侧皮神经方面是可靠的，应鼓励对其临床疗效进行研究。
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