超声引导下纳布啡与罗哌卡因髂筋膜间隙阻滞对老年髋部骨折患者术前疼痛的影响：一项多中心、三盲、随机、对照试验

Effect of Ultrasound-Guided Fascia Iliac Compartment Block with Nalbuphine and Ropivacaine on Preoperative Pain in Older Patients with Hip Fractures: A Multicenter, Triple-Blinded, Randomized, Controlled Trial.

作者信息

Huang Fengyi, Qian Haitao, Gao Fei, Chen Jianghu, Zhang Guopan, Liu Yonglin, Chen Yijia, Lin Xinqiang, Chen Fei, Song Wei, Yang Daihe, Chen Wenbin, Jiang Changcheng, Liu Chuyun, Zheng Ting, Gong Cansheng, Ye Peng, Zheng Xiaochun

机构信息

Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dong Street, Fuzhou, 350001, Fujian, China.

Department of Anesthesiology, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou, China.

出版信息

Pain Ther. 2022 Sep;11(3):923-935. doi: 10.1007/s40122-022-00397-7. Epub 2022 Jun 8.

DOI:10.1007/s40122-022-00397-7

PMID:35674985

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9314510/

Abstract

INTRODUCTION

Pain management for older patients with hip fractures is challenging. This study aimed to investigate the effect of ultrasound-guided fascia iliac compartment block (UGFICB) using different doses of nalbuphine in combination with ropivacaine on preoperative analgesia in older patients with hip fractures.

METHODS

In this multicenter randomized controlled trial, 280 elderly patients with hip fracture were randomly allocated into four UGFICB groups (n = 70 in each group): a ropivacaine group (30 mL 0.1% ropivacaine + 0.9% normal saline) and three ropivacaine plus nalbuphine groups (5, 10, and 20 mg nalbuphine, respectively). The primary outcomes were the duration of analgesia at rest and on passive movement. Secondary outcomes included sensory block area, side effects, and vital signs. The doses of rescue analgesia with parecoxib sodium were also analyzed.

RESULTS

The addition of nalbuphine dose-dependently increased the duration of analgesia at rest and on passive movement (P < 0.05) and expanded the area of sensory block (P < 0.05). Compared with the ropivacaine group, the pain scores at rest and on movement at 6 and 8 h after the block were lower in three ropivacaine plus nalbuphine groups (P < 0.05), without between-group differences at 2, 4, and 12 h. The four groups had comparable side effects (nausea and vomiting) and vital signs (P > 0.05).

CONCLUSIONS

UGFICB with 5, 10, and 20 mg nalbuphine added to ropivacaine prolonged the analgesia duration, increased sensory block area, reduced pain, and decreased the doses of rescue parecoxib sodium for older patients after hip fracture, without obvious side effects. Among these three doses, nalbuphine 20 mg in combination with ropivacaine provided the longest duration of analgesia and the largest sensory block area.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2000029934).

摘要

引言

老年髋部骨折患者的疼痛管理具有挑战性。本研究旨在探讨超声引导下不同剂量纳布啡联合罗哌卡因的髂筋膜室阻滞（UGFICB）对老年髋部骨折患者术前镇痛的效果。

方法

在这项多中心随机对照试验中，280例老年髋部骨折患者被随机分为四组UGFICB组（每组n = 70）：罗哌卡因组（30 mL 0.1%罗哌卡因+0.9%生理盐水）和三组罗哌卡因加纳布啡组（分别为5、10和20 mg纳布啡）。主要结局指标为静息和被动运动时的镇痛持续时间。次要结局指标包括感觉阻滞区域、副作用和生命体征。还分析了帕瑞昔布钠的补救镇痛剂量。

结果

添加纳布啡可剂量依赖性地延长静息和被动运动时的镇痛持续时间（P < 0.05），并扩大感觉阻滞区域（P < 0.05）。与罗哌卡因组相比，三组罗哌卡因加纳布啡组在阻滞6和8小时后的静息和运动时疼痛评分较低（P < 0.05），在2、4和12小时时组间无差异。四组的副作用（恶心和呕吐）和生命体征具有可比性（P > 0.05）。