Wang Baiyun, Hu Bingbing, Zhong Huanhui, Zhao Chengda
The Affiliated Nanhua Hospital, Department of Anesthesiology, Hengyang Medical College, University of South China, Hengyang 421001, Hunan, China.
Evid Based Complement Alternat Med. 2021 Oct 14;2021:9691062. doi: 10.1155/2021/9691062. eCollection 2021.
OBJECTIVE: To investigate the effects of different doses of hydromorphone under the guidance of ultrasound on ropivacaine blocking the superior inguinal iliac fascia and postoperative analgesia. METHODS: From January 2020 to June 2021, 90 American Society of Anesthesiologists (ASA) I-II patients undergoing elective total hip arthroplasty (THA) were selected and randomly divided into 3 groups, 30 patients in each one. Ultrasound-guided superior inguinal iliac fascia block was performed in the patients of the 3 groups before operation. The L group: 0.3% ropivacaine 30 ml; the H1 group: 0.3% ropivacaine + 25 g/kg hydromorphone 30 ml; the H2 group: 0.3% ropivacaine + 50 g/kg hydromorphone 30 ml. The time until the occurrence of pain, pain intensity, sufentanil remedial dose, the number of PCIA presses, and effective times were compared among the 3 groups. The VAS and Ramsay scores of 3 groups were recorded at 12 h, 24 h, 36 h, and 48 h after operation. RESULTS: The time from the end of surgery to the appearance of pain in the H2 group was higher than that in the H1 group and the L group, and the time in the H1 group was higher than that in the L group ( < 0.05). The VAS score in the H2 group was lower than that in the H1 group and the L group, and the VAS score in the H1 group was lower than that in the L group ( < 0.05). The VAS scores of 12 h, 24 h, 36 h, and 48 h after operation in the H2 group were lower than those of the H1 group and the L group, and the H1 group was lower than the L group ( < 0.05). The Ramsay scores at 12 h, 24 h, 36 h, and 48 h after operation in the H2 group and the H1 group were higher than those in the L group ( < 0.05), and the difference was not statistically significant in the H2 group and the H1 group ( > 0.05). The remedial dosage of sufentanil, times of PCIA compression, and effective times in the H2 group were lower than those in the H1 group and the L group, and the level in the H1 group was lower than that in the L group ( < 0.05). The incidence rates of adverse reactions in the L group, the H1 group, and the H2 group were 13.33%, 23.33%, and 30.00%, respectively. There was no significant difference in the incidence rate of adverse reactions among the 3 groups ( > 0.05). CONCLUSION: 25 g/kg and 50 g/kg hydromorphone used in the ultrasound-guided superior inguinal iliac fascia block can enhance the time effect of ropivacaine and improve analgesic effects, with good safety. In addition, time effect and analgesic effect of 50 g/kg hydromorphone in enhancing ropivacaine were more obvious.
目的：探讨超声引导下不同剂量氢吗啡酮对罗哌卡因阻滞髂腹股沟上筋膜及术后镇痛的影响。 方法：选取2020年1月至2021年6月择期行全髋关节置换术（THA）的美国麻醉医师协会（ASA）Ⅰ-Ⅱ级患者90例，随机分为3组，每组30例。3组患者均于术前在超声引导下行髂腹股沟上筋膜阻滞。L组：0.3%罗哌卡因30 ml；H1组：0.3%罗哌卡因+25 μg/kg氢吗啡酮30 ml；H2组：0.3%罗哌卡因+50 μg/kg氢吗啡酮30 ml。比较3组患者疼痛出现时间、疼痛强度、舒芬太尼补救剂量、PCIA按压次数及有效次数。记录3组患者术后12 h、24 h、36 h及48 h的VAS和Ramsay评分。 结果：H2组手术结束至疼痛出现时间高于H1组和L组，H1组高于L组（P<0.05）。H2组VAS评分低于H1组和L组，H1组低于L组（P<0.05）。H2组术后12 h、24 h、36 h及48 h的VAS评分低于H1组和L组，H1组低于L组（P<0.05）。H2组和H1组术后12 h、24 h、36 h及48 h的Ramsay评分高于L组（P<0.05），H2组和H1组间差异无统计学意义（P>0.05）。H2组舒芬太尼补救剂量、PCIA按压次数及有效次数低于H1组和L组，H1组低于L组（P<0.05）。L组、H1组、H2组不良反应发生率分别为13.33%、23.33%、30.00%。3组不良反应发生率差异无统计学意义（P>0.05）。 结论：超声引导下髂腹股沟上筋膜阻滞使用25 μg/kg和50 μg/kg氢吗啡酮可增强罗哌卡因的时效，提高镇痛效果，安全性良好。此外，50 μg/kg氢吗啡酮增强罗哌卡因的时效和镇痛效果更明显。
Evid Based Complement Alternat Med. 2021-10-14
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