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髋部骨折手术患者的髂筋膜室阻滞与镇痛药物消耗

Iliac Fascia Compartment Block and Analgesic Consumption in Patients Operated on for Hip Fracture.

作者信息

Klukowski Mateusz, Kowalczyk Rafał, Górniewski Grzegorz, Łęgosz Paweł, Janiak Marek, Trzebicki Janusz

机构信息

Warszawski Uniwersytet Medyczny I Klinika Anestezjologii i Intensywnej Terapii.

Warszawski Uniwersytet Medyczny Zakład Nauczania Anestezjologii i Intensywnej Terapii, Wydział Nauki o Zdrowiu.

出版信息

Ortop Traumatol Rehabil. 2017 Oct 31;19(5):451-459. doi: 10.5604/01.3001.0010.5825.

Abstract

BACKGROUND

Fractures of the proximal femur in elderly patients are a challenge for orthopedics, anesthe-sio-logy and geriatrics. Early mobilization reduces postoperative mortality among these patients. Effective anal-gesia is necessary to achieve this goal.

MATERIAL AND METHODS

A retrospective analysis of perioperative medical records of 78. patients undergoing surgical treatment of proximal femur fractures was performed. Group 1 (n=35)consisted of patients who were treated with pharmacologic analgesia only (systemic analgesics) and Group 2 (n=43) involved patients who re-ceived a preoperative fascia iliaca compartment block (FICB) and pharmacologic analgesia. FICB was per-formed under ultrasound guidance, and systemic analgesics were administered according to a standardized pro-to-col. Demographics, anesthesia and operation data as well as the dosage of analgesics used on postoperative day 0 were collected for the study.

RESULTS

Patients with antecedent iliac fascia blockade required fewer analgesic interventions (3 vs. 11, p <0.0001) and showed significantly less need for analgesics than non-block patients. No complications were observed after performing FICB.

CONCLUSION

The iliac fascia compartment block produces effective postoperative analgesia and reduces postoperative opioid consumption.

摘要

背景

老年患者股骨近端骨折对骨科、麻醉学和老年医学来说都是一项挑战。早期活动可降低这些患者的术后死亡率。实现这一目标需要有效的镇痛。

材料与方法

对78例接受股骨近端骨折手术治疗患者的围手术期病历进行回顾性分析。第1组(n = 35)仅采用药物镇痛(全身镇痛药)治疗,第2组(n = 43)包括接受术前髂筋膜间隙阻滞(FICB)和药物镇痛的患者。FICB在超声引导下进行,全身镇痛药根据标准化方案给药。收集研究对象的人口统计学、麻醉和手术数据以及术后第0天使用的镇痛药剂量。

结果

先行髂筋膜阻滞的患者需要的镇痛干预较少(3次对11次,p < 0.0001),且与未阻滞患者相比,对镇痛药的需求明显更少。进行FICB后未观察到并发症。

结论

髂筋膜间隙阻滞可产生有效的术后镇痛效果,并减少术后阿片类药物的消耗量。

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