Capdevila X, Biboulet P, Bouregba M, Barthelet Y, Rubenovitch J, d'Athis F
Department of Anesthesiology, Lapeyronie University Hospital, Montpellier, France.
Anesth Analg. 1998 May;86(5):1039-44. doi: 10.1097/00000539-199805000-00025.
The 3-in-1 (Group 1) and fascia iliaca compartment (Group 2) blocks, two single-injection, anterior approach procedures used to simultaneously block the femoral, obturator, and lateral femoral cutaneous (LFC) nerves, were compared in 100 adults after lower limb surgery. Pain control, sensory and motor blockades, and radiographically visualized spread of local anesthetic solution were studied prospectively. Both approaches provided efficient pain control using 30 mL of 2% lidocaine with 1:200,000 epinephrine and 0.5% bupivacaine and 5 mL of contrast media (iopamidol). Complete lumbar plexus blockade was achieved in 18 (38%) Group 1 and 17 (34%) Group 2 patients (n = 50 patients per group). Sensory block of the femoral, obturator, genitofemoral, and LFC nerves was obtained in 90% and 88%, 52% and 38%, 38% and 34%, and 62% and 90% of the patients in Groups 1 and 2, respectively (P < 0.05). Sensory LFC blockade was obtained more rapidly for the patients in Group 2 (P < 0.05). Concurrent internal and external spread of the local anesthetic solution under the fascia iliaca and between the iliacus and psoas muscles was noted in 62 of the 92 block procedures analyzed radiographically. Isolated external spreads under the fascia iliaca and over the iliacus muscle were noted in 10% and 36% of the patients in Groups 1 and 2, respectively (P < 0.05). The local anesthetic solution reached the lumbar plexus in only five radiographs. We conclude that the fascia iliaca compartment block is more effective than the 3-in-1 block in producing simultaneous blockade of the LFC and femoral nerves in adults. After both procedures, blockade was obtained primarily by the spread of local anesthetic under the fascia iliaca and only rarely by contact with the lumbar plexus.
In adults, the two anterior approaches, 3-in-1 and fascia iliaca compartment blocks, provide effective postoperative analgesia. The fascia iliaca compartment technique provides faster and more consistent simultaneous blockade of the lateral femoral cutaneous and femoral nerves. Sensory block is caused by the spread of local anesthetic solution under the fascia iliaca and only rarely to the lumbar plexus.
在100例接受下肢手术的成人患者中，比较了用于同时阻滞股神经、闭孔神经和股外侧皮神经（LFC）的两种单次注射前路手术——三合一阻滞（第1组）和髂筋膜间隙阻滞（第2组）。前瞻性地研究了疼痛控制、感觉和运动阻滞以及局部麻醉溶液在影像学上显示的扩散情况。两种方法均使用30 mL含1:200,000肾上腺素的2%利多卡因、0.5%布比卡因和5 mL造影剂（碘帕醇）实现了有效的疼痛控制。第1组18例（38%）和第2组17例（34%）患者（每组50例患者）实现了完全腰丛阻滞。第1组和第2组患者中，分别有90%和88%、52%和38%、38%和34%以及62%和90%的患者获得了股神经、闭孔神经、生殖股神经和LFC神经的感觉阻滞（P<0.05）。第2组患者获得LFC感觉阻滞的速度更快（P<0.05）。在92例接受影像学分析的阻滞操作中，62例观察到局部麻醉溶液在髂筋膜下以及髂肌和腰大肌之间同时向内侧和外侧扩散。第1组和第2组分别有10%和36%的患者观察到局部麻醉溶液仅在髂筋膜下向外侧扩散（P<0.05）。仅在5张X线片上观察到局部麻醉溶液到达腰丛。我们得出结论，在成人中，髂筋膜间隙阻滞在同时阻滞LFC神经和股神经方面比三合一阻滞更有效。两种操作后，阻滞主要是通过局部麻醉溶液在髂筋膜下扩散实现的，很少通过与腰丛接触实现。
在成人中，两种前路手术——三合一阻滞和髂筋膜间隙阻滞，均能提供有效的术后镇痛。髂筋膜间隙技术能更快、更一致地同时阻滞股外侧皮神经和股神经。感觉阻滞是由局部麻醉溶液在髂筋膜下扩散引起的，很少涉及腰丛。
Zotero 插件