Li Chun-Xiu, Ge Wen-Chao, Yang Kang-Ning, Zheng Hua-Yong, Wang Xiao-Wei, Wang Ye-Lai, Gao Jie, Guo Wen-Zhi
Department of Anesthesiology, Shanxi Medical University, Taiyuan 030000, Shanxi, China.
Graduate School of North China University of Science and Technology, Tangshan 063210, Hebei, China; Department of Anesthesiology, the 7th Medical Center of PLA General Hospital, Beijing 100700, China.
Zhongguo Gu Shang. 2023 Nov 25;36(11):1046-51. doi: 10.12200/j.issn.1003-0034.2023.11.008.
To study the effect of ultrasound-guided fascia iliaca compartment block on perioperative analgesia and postoperative complications in geriatric patients with hip fractures.
A total of 127 elderly patients undergoing hip fracture surgery from January 2021 to September 2021 were randomized to receive ultrasound-guided continuous fascia iliaca compartment block(group F) either intravenous analgesia control group(group C). There were 62 cases in group F, including 19 males and 43 females with an average age of (82.4±7.2) years old ranging from 66 to 95 years old, involving 25 femoral neck fractures and 37 femoral intertrochanteric fractures. There were 65 cases in control group, including 18 males and 47 females, with an average age of (81.4±8.7) years old ranging from 65 to 94 years old, involving 29 femoral neck fractures and 36 femoral intertrochanteric fractures. The visual analogue scale(VAS), minimental state examination (MMSE), observer's assessment of alertness/sedation(OAA/S) scale, modified Bromage score, postoperative complications and general conditions during hospitalization in two groups were observed.
The resting and exercise VAS at 30 min after block, anesthesia placement and 6, 24 and 48 h after surgery were lower than those in group C(<0.05). In group F, MMSE scores at 12 h before surgery, and 1, 3 d after surgery and OAA/S scores at 3 d after surgery were higher than those in group C(<0.05). The incidence of adverse effects and the number requiring additional analgesia were lower than those in group C(<0.05). Group F had better perioperative analgesia satisfaction and hospital stay than group C(<0.05). But there was no significant difference regarding Bromage score and 30-day mortality between two group(>0.05).
Ultrasound-guided continuous fascia iliacus space block was safe and effective for elderly patients with hip fracture, and could significantly reduce perioperative pain, improve postoperative cognitive function, and reduce postoperative complications, thereby shortening hospital stay and improving the quality of life during hospitalization.
探讨超声引导下髂筋膜间隙阻滞对老年髋部骨折患者围手术期镇痛及术后并发症的影响。
选取2021年1月至2021年9月行髋部骨折手术的127例老年患者，随机分为超声引导下连续髂筋膜间隙阻滞组（F组）和静脉镇痛对照组（C组）。F组62例，男19例，女43例，平均年龄（82.4±7.2）岁，年龄范围66～95岁，其中股骨颈骨折25例，股骨转子间骨折37例。C组65例，男18例，女47例，平均年龄（81.4±8.7）岁，年龄范围65～94岁，其中股骨颈骨折29例，股骨转子间骨折36例。观察两组患者阻滞30分钟、麻醉摆放时、术后6、24及48小时静息和运动时视觉模拟评分（VAS）、简易精神状态检查表（MMSE）、观察者警觉/镇静评分（OAA/S）、改良Bromage评分、术后并发症及住院期间一般情况。
F组阻滞30分钟、麻醉摆放时、术后6、24及48小时静息和运动时VAS评分低于C组（<0.05）。F组术前12小时、术后1、3天MMSE评分及术后3天OAA/S评分高于C组（<0.05）。F组不良反应发生率及追加镇痛例数低于C组（<0.05）。F组围手术期镇痛满意度及住院时间优于C组（<0.05）。但两组间Bromage评分及30天死亡率差异无统计学意义（>0.05）。
超声引导下连续髂筋膜间隙阻滞用于老年髋部骨折患者安全有效，可显著减轻围手术期疼痛，改善术后认知功能，并减少术后并发症，从而缩短住院时间，提高住院期间生活质量。
