Department of Orthopaedic Surgery, Unnan City Hospital, Shimane, Japan.
Department of Anaesthesiology, Shimane University Faculty of Medicine, Shimane, Japan.
Injury. 2019 Oct;50(10):1689-1693. doi: 10.1016/j.injury.2019.03.008. Epub 2019 Mar 16.
Managing pain during movement after hip fracture surgery is important for achieving earlier hip mobilisation and for preventing postoperative complications. In the present study, we tested the hypothesis that the fascia iliaca compartment block (FICB) would improve postoperative pain on movement compared with intravenous acetaminophen.
In this prospective, randomised, controlled, parallel trial, patients were assigned to either the intravenous acetaminophen or the ultrasound-guided FICB group. Visual analog scale (VAS) pain scores were evaluated at 6, 9, 12, 18, 24 h, 2 days, and 7 days postoperatively. The primary outcome was VAS scores on movement at 24 h after surgery. The secondary outcomes were VAS scores on movement at the other time points, VAS scores at rest, the total number of rescue analgesics required and incidence of delirium during the first 24 h postoperatively, potential drug or block-related complications, and the time to first standing.
VAS scores on movement at 24 h after surgery were significantly lower in the FICB group than in the intravenous acetaminophen group [median (the 25th to 75th percentiles), 20 (10-30) vs 40 (30-53); P < 0.01]. The VAS scores on movement at any other time point and the scores at rest at 12 h after surgery were also significantly lower in the FICB group than in the intravenous acetaminophen group. The two groups did not differ in terms of the total number of rescue analgesics required or the incidence of delirium during the first 24 h postoperatively; complications; or the time to first standing.
FICB improved postoperative pain on movement compared with intravenous acetaminophen without increasing the complication rate. However, the total number of rescue analgesics required and the time to first standing were not significantly different between the two groups.
髋部骨折手术后活动时的疼痛管理对于尽早进行髋关节活动和预防术后并发症很重要。在本研究中，我们检验了这样一个假设，即腹横肌筋膜腔隙阻滞（FICB）将比静脉注射对乙酰氨基酚更能改善术后活动时的疼痛。
在这项前瞻性、随机、对照、平行试验中，患者被分配到静脉注射对乙酰氨基酚或超声引导 FICB 组。在术后 6、9、12、18、24 小时、2 天和 7 天评估视觉模拟评分（VAS）疼痛评分。主要结局是术后 24 小时时的运动时 VAS 评分。次要结局是其他时间点的运动时 VAS 评分、休息时的 VAS 评分、所需的总补救性镇痛药数量以及术后 24 小时内发生谵妄的发生率、潜在的药物或阻滞相关并发症以及首次站立的时间。
FICB 组术后 24 小时时的运动时 VAS 评分明显低于静脉注射对乙酰氨基酚组[中位数（25 至 75 百分位数），20（10-30）比 40（30-53）；P<0.01]。FICB 组在任何其他时间点的运动时 VAS 评分和术后 12 小时时的休息时 VAS 评分也明显低于静脉注射对乙酰氨基酚组。两组在术后 24 小时内所需的总补救性镇痛药数量或谵妄发生率、并发症或首次站立时间方面无差异。
与静脉注射对乙酰氨基酚相比，FICB 改善了术后活动时的疼痛，而不增加并发症发生率。然而，两组所需的总补救性镇痛药数量和首次站立时间无显著差异。
