Department of Anesthesiology, Second Affiliated Hospital of Naval Medical University.
Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.
Clin J Pain. 2021 Dec 1;37(12):881-886. doi: 10.1097/AJP.0000000000000988.
The aim was to compare the feasibility of ultrasound-guided multiple nerve blocks (fascia iliaca compartment block+sacral plexus block+superior cluneal nerve block) with general anesthesia in geriatric hip fracture patients.
Ninety-four patients were randomly divided into 2 groups: group N received ultrasound-guided multiple nerve blocks and group G received general anesthesia. Primary outcome measures included perioperative Pain Threshold Index (PTI) and Numerical Rating Scale. Secondary outcome measures comprised the following: (1) perioperative Delirium Index and Short Portable Mental Status Questionnaire; (2) perioperative Comfort Index; (3) perioperative opioid consumption (within 72 hours postoperatively); and (4) postoperative side effects (within 72 h postoperatively).
Eighty-seven patients completed the study. Baseline PTI was comparable between the groups. However, intraoperative PTI was significantly lower in group N than in group G. Preoperative and postoperative Comfort Index scores were comparable between the groups. Moderate delirium (24 to 72 h postoperatively) was significantly higher than the baseline in group G. Early moderate delirium (24 h postoperatively) was significantly higher in group G than in group N. Severe delirium was comparable between the groups and within each group. High intraoperative PTI was associated with high opioid consumption. The intravenous sufentanil dose in group G was twice of that in group N. Incidence of nausea and vomiting was similar between the groups.
Ultrasound-guided multiple nerve blockade may be an alternative to the common anesthetic procedures used for geriatric hip fracture patients. It provided satisfactory intraoperative pain management and reduced early postoperative cognitive disorders.
比较超声引导下多神经阻滞（股神经丛阻滞+腰丛神经阻滞+臀上神经阻滞）与全身麻醉在老年髋部骨折患者中的可行性。
94 例患者随机分为 2 组：N 组接受超声引导下多神经阻滞，G 组接受全身麻醉。主要观察指标包括围术期疼痛阈值指数（PTI）和数字评分量表。次要观察指标包括：（1）围术期谵妄指数和简易精神状态检查量表；（2）围术期舒适度指数；（3）围术期阿片类药物用量（术后 72 小时内）；（4）术后不良反应（术后 72 小时内）。
87 例患者完成了研究。两组患者的基础 PTI 无显著差异，但 N 组术中 PTI 显著低于 G 组。两组患者术前和术后舒适度评分无显著差异。G 组患者术后 24 至 72 小时出现中度谵妄（高于基线），显著高于 N 组。G 组患者术后 24 小时出现早期中度谵妄（高于基线），显著高于 N 组。两组患者严重谵妄发生率相似，且组内比较差异无统计学意义。高术中 PTI 与高阿片类药物用量相关。G 组患者静脉舒芬太尼用量是 N 组的两倍。两组患者恶心呕吐发生率相似。
超声引导下多神经阻滞可为老年髋部骨折患者提供一种替代全身麻醉的方法。它能提供满意的术中疼痛管理，并减少术后早期认知障碍。
