Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey.
Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey.
Braz J Anesthesiol. 2023 Nov-Dec;73(6):711-717. doi: 10.1016/j.bjane.2021.08.008. Epub 2021 Sep 25.
Pain management in hip fracture patients is of great importance for reducing postoperative morbidity and mortality. Multimodal techniques, including peripheral nerve blocks, are preferred for postoperative analgesia. Older-old hip fracture patients with high ASA scores are highly sensitive to the side effects of NSAIDs and opioids. Our aim was to investigate the effectiveness of the recently popularized Supra-Inguinal Fascia Iliaca Block (SIFIB) in this population.
Forty-one ASA III...IV patients who underwent SIFIB...+...PCA (G-SIFIB) or PCA alone (Group Control: GC) after general anesthesia were evaluated retrospectively. In addition to 24-hour opioid consumption, Visual Analog Scale (VAS) scores, opioid-related side effects, block-related complications, and length of hospital stay were compared.
Twenty-two patients in G-SIFIB and 19 patients in GC were evaluated. The postoperative 24-hour opioid consumption was lower in G-SIFIB than in GC (p...<...0.001). There was a statistically significant reduction in VAS scores at the postoperative 1, 3, and 6 hours at rest (p...<...0.001) and during movement (p...<...0.001 for the 1 and 3 hours, and p...=...0.02 for the 6 hour) in G-SIFIB compared to GC. There was no difference in pain scores at the 12 and 24 hours postoperatively. While there was no difference between the groups in terms of other side effects, respiratory depression was significantly higher in GC than in G-SIFIB (p...=...0.01).
The SIFIB technique has a significant opioid-sparing effect and thus reduces opioid-related side effects in the first 24 hours after hip fracture surgery in older-old patients.
髋部骨折患者的疼痛管理对于降低术后发病率和死亡率非常重要。多模式技术，包括外周神经阻滞，是术后镇痛的首选。高 ASA 评分的老年髋部骨折患者对 NSAIDs 和阿片类药物的副作用非常敏感。我们的目的是研究最近流行的股神经上支筋膜间隙阻滞（Supra-Inguinal Fascia Iliaca Block，SIFIB）在这一人群中的效果。
回顾性评估了 41 例接受全身麻醉后行 SIFIB+PCA（G-SIFIB 组）或单纯 PCA（GC 组）的 ASA III-IV 级患者。除了 24 小时阿片类药物消耗量外，还比较了视觉模拟评分（VAS）评分、阿片类药物相关副作用、阻滞相关并发症和住院时间。
G-SIFIB 组 22 例，GC 组 19 例。G-SIFIB 组术后 24 小时阿片类药物消耗量低于 GC 组（p<0.001）。与 GC 组相比，G-SIFIB 组在术后 1、3 和 6 小时静息时（p<0.001）和运动时（1 和 3 小时时 p<0.001，6 小时时 p=0.02）的 VAS 评分均有统计学显著降低。术后 12 和 24 小时的疼痛评分无差异。虽然两组在其他副作用方面无差异，但 GC 组的呼吸抑制发生率明显高于 G-SIFIB 组（p=0.01）。
SIFIB 技术具有显著的阿片类药物节约效应，因此可减少老年髋部骨折患者术后 24 小时内与阿片类药物相关的副作用。
