Evaluation of analgesic effect of iliac fascia space block and low concentration epidural administration in elderly patients with hip fracture after operation
Objective To evaluate the effects of low concentration iliac fascia space block and low concentration epidural block on postoperative rehabilitation of elderly patients with hip fractures,respectively.Methods A prospective randomized controlled study was conducted on 60 patients who were scheduled to undergo hip fracture surgery,aged 65～85 years,regardless of gender,with a BMI of 18～28 kg/m2 and an ASA grade of Ⅱ～Ⅲ.They were randomly divided into group A with low concentration of epidural administration and group B with low concentration of iliac fascial space block.Both groups received combined spinal epidural anesthesia.Both groups received postoperative analgesia with 0.2％ropivacaine.After the surgery in group A,10 ml of low concentration 0.2％ropivacaine was administered for epidural analgesia before removing the epidural catheter,the patients in group B underwent iliac fascia compartment block with a loading dose of 30 ml of the same concentration.Changes in C-reactive protein levels in T0,T2,and T4 were recorded at various time points including preoperative(T0),postoperative 6 hours(T1),postoperative 12 hours(T2),postoperative 24 hours(T3),and postoperative 48 hours(T4),Passive VAS score,active VAS score,quadriceps muscle strength score,maximum hip flexion range of motion,maximum hip abduction range of motion were recorded at various time points T1,T2,T3,and T4.The occurrence of sleep disorders within 48 hours after surgery(evaluated using the PSQI)and the number of times of relief pain were recorded.Results There was no significant difference in sex,age,body mass index and operation duration between the two groups(P＞0.05).On the first day and the third day after operation,the stress response laboratory index CRP of the two groups showed a downward trend compared with that before operation,but there was no significant difference between the two groups(P＞0.05).Compared with Group A,Group B had a decrease in resting and exercise VAS scores at time points T,and T2 after surgery,while Group B had an increase in maximum hip flexion and abduction activity at time points T2,T3,and T4 after surgery(P＜0.05).There was no statistically significant difference in resting and exercise VAS scores between the two groups at time points T3 and T4 after surgery(P＞0.05).There was no statistically significant difference in quadriceps muscle strength scores between the two groups(P＞0.05).The incidence of postoperative complications in Group B was significantly lower than that in Group A(16.7％vs.40.0％),and the time of getting out of bed[(4.7±0.8)d vs(14.5±2.4)d]and hospital stay[(3.3±0.7)d vs(10.6±1.6)d]were significantly shorter than those in Group A.The number of times of relief analgesia within 48 hours after surgery was also significantly less than that in Group A[(1.2±0.6)times vs(2.04±0.8)times](P＜0.05).Conclusion Low concentration iliac fascia space block can effectively relieve postoperative pain in elderly patients with hip fractures,facilitate early postoperative rehabilitation training and ambulatory activities,effectively reduce the incidence of postoperative complications,shorten hospital stay,and provide more advantages for postoperative analgesia in elderly patients undergoing hip arthroplasty.
The elderlyHip joint surgeryLow concentrationIliac fascia space blockEpidural blockPostoperative analgesia
万方数据
维普
