From the Department of Anesthesiology, Affiliated Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai (JD, YZ, XC, WN, HY, WJ, TX), Department of Anesthesiology, Tongzhou People's Hospital, Nantong (TX), Department of Anesthesiology, Shanghai Jiahui International Hospital (DZ) and Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China (YL, HS).
Eur J Anaesthesiol. 2021 Apr 1;38(4):366-373. doi: 10.1097/EJA.0000000000001452.
Ultrasound-guided posterior lumbar plexus block is widely used for hip fracture surgery but it requires a change of position, which may be painful.
Our primary objective was to describe a new technique, the anterior iliopsoas muscle space block, which can be performed in the supine position, and to test the hypothesis that its analgesia for hip surgery was similar to that of the traditional posterior lumbar plexus block.
Randomised, double-blind study.
Shanghai 6th People's Hospital, China, from February to August 2019.
Forty-eight patients scheduled for unilateral hip fracture surgery were included in the study. The exclusion criteria were infection at the puncture site, history of hip surgery, pre-existing neurological deficits of the lower extremity, contraindications for regional anaesthesia, allergy to local anaesthetics, coagulopathy, abuse of medicine or alcohol, or daily consumption of analgesics.
Patients were randomised to receive a lateral sacral plexus block with either an anterior iliopsoas muscle space block or a posterior lumbar plexus block, using 0.33% ropivacaine (30 ml each).
The main outcome was verbal numerical scale (VNS) pain intensity 1 h after surgery in the postanesthesia care unit, and the secondary outcome was the dose of intra-operative fentanyl. The differences in VNS scores and fentanyl use between the groups were analysed.
Based on previous work, we considered a difference (confidence interval [CI]) of 1.6 on the VNS to be significant. The median [IQR] pain scores in postanesthesia care unit were similar in the anterior 0 [0 to 3] and posterior groups 1.5 [0 to 3]. The median scores for intra-operative fentanyl use were similar in the anterior 20 [10 to 42.5] μg and posterior groups 15 [0 to 50] μg (P = 0.34). The difference in the median pain score at-rest was NS: anterior group 0.5 [0 to 5], posterior group 0 [0 to 2], median difference -0.5 (95% CI -2 to 0). The median post to preblock difference in VNS was higher in the anterior -0.5 [-2 to 0] than in the posterior group 0 [-1.25 to 0], median difference 0.5 (95% CI 0 to 1). The median block onset time was longer in the anterior 11 [6 to 14.25] min than in the posterior group 6 [4.75 to 8] min (P = 0.002), median difference -5 (95% CI -7 to -1).
The anterior iliopsoas muscle space block had the same effect as the posterior lumbar plexus block on peri-operative analgesia for hip surgery, but with a longer onset time. Therefore, anterior iliopsoas muscle space block can be recommended as a routine technique for hip and lower limb procedures.
http://www.chictr.org.cn identifier: ChiCTR1900021214.
超声引导下后路腰椎丛阻滞广泛应用于髋部骨折手术，但需要改变体位，可能会引起疼痛。
本研究旨在描述一种新的技术，即前路髂腰肌间隙阻滞，该技术可在仰卧位进行，并验证其用于髋部手术的镇痛效果与传统后路腰椎丛阻滞相似的假设。
随机、双盲研究。
中国上海第六人民医院，2019 年 2 月至 8 月。
48 例拟行单侧髋部骨折手术的患者被纳入研究。排除标准为穿刺部位感染、髋关节手术史、下肢存在神经功能缺损、局部麻醉禁忌证、对局部麻醉剂过敏、凝血功能障碍、滥用药物或酒精、或每日使用镇痛药。
患者随机接受 0.33%罗哌卡因（各 30ml）行外侧骶丛阻滞，分别为前路髂腰肌间隙阻滞或后路腰椎丛阻滞。
术后麻醉恢复室（PACU）中术后 1 小时的视觉模拟评分（VNS）疼痛强度为主要观察指标，次要观察指标为术中芬太尼用量。分析两组间 VNS 评分和芬太尼使用的差异。
基于前期工作，我们认为 VNS 评分差异（置信区间 [CI]）1.6 具有统计学意义。PACU 中中位数[IQR]疼痛评分在前路组为 0 [0 至 3]，后路组为 1.5 [0 至 3]。术中芬太尼用量中位数在前路组为 20 [10 至 42.5]μg，后路组为 15 [0 至 50]μg（P=0.34）。静息时疼痛评分的中位数差异无统计学意义：前路组 0.5 [0 至 5]，后路组 0 [0 至 2]，中位数差异-0.5（95%CI-2 至 0）。前路组 VNS 阻滞前后差值的中位数为-0.5 [-2 至 0]，后路组为-0 [-1.25 至 0]，中位数差异 0.5（95%CI 0 至 1）。前路组阻滞起效时间中位数为 11 [6 至 14.25]min，后路组为 6 [4.75 至 8]min（P=0.002），中位数差异-5（95%CI-7 至-1）。
前路髂腰肌间隙阻滞在髋部手术围术期镇痛方面与后路腰椎丛阻滞效果相同，但起效时间较长。因此，前路髂腰肌间隙阻滞可作为髋部和下肢手术的常规技术推荐。
http://www.chictr.org.cn 标识符：ChiCTR1900021214。
