Zhang Yang, Yang Shun, Lu Zi-Ru, Zhou Feng, Liu Mei-Yu
Department of Anesthesiology, Taizhou Jiangyan Hospital of TCM, Taizhou, 225500, China.
Department of Orthopedic, Taizhou Jiangyan Hospital of TCM, Taizhou, 225500, China.
BMC Musculoskelet Disord. 2025 Mar 14;26(1):256. doi: 10.1186/s12891-025-08490-6.
The duration of a single fascia iliaca compartment block (FICB) with ropivacaine is limited. This study investigated whether methylene blue as an adjuvant anesthetic in FICB can enhance the postoperative analgesic effect following total hip arthroplasty (THA).
Patients who planned to undergo THA were recruited for this randomized clinical trial from June 2023 to February 2024. Ninety elderly patients undergoing THA were randomly divided into two groups that received ultrasound-guided FICB with either ropivacaine and methylene blue (MB + R group, n = 45) or ropivacaine only (R group, n = 45) before induction of general anesthesia. The primary outcomes were postoperative Visual Analog Scale (VAS) scores. Secondary outcomes included inflammatory factor levels, heart rate (HR), mean arterial pressure (MAP), postoperative analgesic use, postoperative activity, and adverse events.
The MB + R group had significantly lower VAS scores at both rest and with activity at 24 and 48 h postoperatively than the R group (P < 0.001). Additionally, the hypersensitive C-reactive protein, procalcitonin, and neutrophil-to-lymphocyte ratio values were significantly lower in the MB + R group than in the R group on the first and second days after surgery (P < 0.05). The number of patients requiring supplemental analgesia postoperatively was significantly lower in the MB + R group (P = 0.020). Additionally, the MB + R group had a significantly longer walking distance on the first time out of bed and a higher number of out-of-bed activities within 48 h postoperatively (P < 0.001).
Compared to ropivacaine alone, the combination of ropivacaine and methylene blue in FICB provided better analgesic effects over a longer duration. Additionally, the addition of methylene blue reduced the postoperative production of inflammatory markers and promoted patients' functional recovery.
ClinicalTrials.gov, Registration number: NCT06284941, Retrospectively registered, Date of registration: February 04, 2024.
罗哌卡因单次髂筋膜间隙阻滞（FICB）的持续时间有限。本研究调查了在FICB中使用亚甲蓝作为辅助麻醉剂是否能增强全髋关节置换术（THA）后的术后镇痛效果。
2023年6月至2024年2月，本随机临床试验招募了计划接受THA的患者。90例接受THA的老年患者在全身麻醉诱导前被随机分为两组，分别接受超声引导下的FICB，一组使用罗哌卡因加亚甲蓝（MB+R组，n=45），另一组仅使用罗哌卡因（R组，n=45）。主要结局指标为术后视觉模拟评分（VAS）。次要结局指标包括炎症因子水平、心率（HR）、平均动脉压（MAP）、术后镇痛药物使用情况、术后活动情况及不良事件。
术后24小时和48小时，MB+R组静息及活动时的VAS评分均显著低于R组（P<0.001）。此外，术后第一天和第二天，MB+R组的超敏C反应蛋白、降钙素原及中性粒细胞与淋巴细胞比值均显著低于R组（P<0.05）。MB+R组术后需要补充镇痛的患者数量显著更少（P=0.020）。此外，MB+R组术后首次下床行走的距离显著更长，且术后48小时内的下床活动次数更多（P<0.001）。
与单独使用罗哌卡因相比，FICB中罗哌卡因与亚甲蓝联合使用可在更长时间内提供更好的镇痛效果。此外，添加亚甲蓝可减少术后炎症标志物的产生，并促进患者功能恢复。
ClinicalTrials.gov，注册号：NCT06284941，回顾性注册，注册日期：2024年2月4日。
