不同浓度布比卡因脂质体髂筋膜间隙阻滞用于老年患者全髋置换术镇痛效果的比较
Comparison of analgesic effects of fascia iliaca compartment block with different concentrations of li-posomal bupivacaine for total hip replacement in elderly patients
周准 1孙韧 1钮铮 1谢杰 1杜宪 1谭和莲 1徐振华1
作者信息
- 1. 苏州大学附属张家港医院麻醉科,张家港 215600
- 折叠
摘要
目的 比较不同浓度布比卡因脂质体髂筋膜间隙阻滞用于老年患者全髋置换术的镇痛效果.方法 本研究为前瞻性研究.选择苏州大学附属张家港医院2023年9月至12月拟行全髋关节置换术的髋部骨折老年患者64例,性别不限,年龄65～85岁,BMI 20～30 kg/m2,ASA分级Ⅰ-Ⅲ级,采用随机数字表法分为4组(n=16):麻醉诱导前在超声引导下行髂筋膜间隙阻滞,LB1组、LB2组、LB3组和LB4组分别给予布比卡因脂质体66.5、133.0、199.5和266.0 mg,均用生理盐水稀释至30 ml.记录术中舒芬太尼、瑞芬太尼用量和气管拔管时间.分别于术后4、8、12、24和48 h时,记录静态和动态疼痛数字量表评分(NRS).NRS≥4分时静脉注射帕瑞昔布钠,并记录帕瑞昔布钠使用情况.分别于术后4、8、12、24和48 h时,采用改良Bromage评分法评估患侧下肢运动神经阻滞效果.记录术后首次下床时间及住院时间.记录术后48 h时患者对镇痛效果满意度评分及术后48 h内不良反应发生情况.结果 与LB1组相比,LB2组、LB3组和LB4组术中舒芬太尼和瑞芬太尼用量减少,气管拔管时间缩短,术后12、24和48 h时静态NRS评分及术后8、12、24和48 h时动态NRS评分降低,镇痛满意度评分升高,LB2组术后4和8 h时改良Bromage评分升高,术后首次下床时间及住院时间缩短,LB3组和LB4组术后4、8、12、24和48 h时改良Bromage评分升高(P＜0.05).与LB2组相比,LB3组和LB4组术后12、24和48 h时改良Bromage评分升高,术后首次下床时间及住院时间延长(P＜0.05).4组术后不良反应发生率比较差异无统计学意义(P＞0.05).结论 布比卡因脂质体髂筋膜间隙阻滞用于老年患者全髋置换术镇痛的适宜浓度为133 mg/30 ml.
Abstract
Objective To compare the analgesic effects of fascia iliaca compartment block with dif-ferent concentrations of liposomal bupivacaine for total hip replacement in elderly patients.Methods This was a prospective study.Sixty-four elderly patients of either sex with hip fracture,aged 65-85 yr,with body mass index of 20-30 kg/m2 and American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ,undergoing elective total hip arthroplasty from September to December 2023 in Zhangjiagang Hospital affilia-ted to Soochow University,were divided into LB1,LB2,LB3 and LB4 groups(n=16 each)using the ran-dom number table method.The fascia iliaca compartment block was performed under ultrasound guidance be-fore anesthesia induction.Liposomal bupivacaine 66.5,133.0,199.5 and 266.0 mg diluted to 30 ml in nor-mal saline were given in LB1,LB2,LB3 and LB4 groups,respectively.The consumption of intraoperative sufentanil and remifentanil and tracheal extubation time were recorded.The pain numeric rating scale(NRS)scores at rest and during activity were recorded at 4,8,12,24 and 48 h postoperatively.Parecoxib sodium was intravenously injected when the NRS score ≥4,and the use of parecoxib sodium was recorded.The effect of motor nerve block in the affected lower extremity was evaluated using the modified Bromage scale score at 4,8,12,24 and 48 h postoperatively.The first ambulation time and duration of hospitalization were recorded.The scores for patients'satisfaction with analgesic effects at 48 h after operation and the occurrence of adverse reactions within 48 h after operation were recorded.Results Compared with LB1 group,the consumption of intraoperative sufentanil and remifentanil was significantly reduced,the tracheal extubation time was short-ened,NRS scores at rest at 12,24 and 48 h after operation and NRS scores during activity at 8,12,24 and 48 h after operation were significantly decreased,and the scores for patients'satisfaction with analgesic effects were increased in LB2,LB3 and LB4 groups,the modified Bromage scale scores were significantly increased at 4 and 8 h after operation,and the first ambulation time and duration of hospitalization were shortened in LB2 group,and the modified Bromage scale scores were significantly increased at 4,8,12,24 and 48 h af-ter operation in LB3 and LB4 groups(P＜0.05).Compared with LB2 group,the modified Bromage scale scores were significantly increased at 12,24 and 48 h after operation,and the first ambulation time and du-ration of hospitalization were prolonged in LB3 and LB4 groups(P＜0.05).There was no significant differ-ence in the incidence of postoperative adverse reactions among the four groups(P＞0.05).Conclusions The optimal concentration of liposomal bupivacaine for fascia iliaca compartment block is 133 mg/30 ml when used for analgesia in elderly patients undergoing total hip replacement.
关键词
布比卡因/脂质体/髂骨/筋膜/神经传导阻滞/镇痛/关节成形术,置换,髋Key words
Bupivacaine/Liposomes/Ilium/Fascia/Nerve block/Analgesia/Arthro-plasty,replacement,hip引用本文复制引用
基金项目
国家自然科学基金(81901137)
国家自然科学基金(82002108)
出版年
2024
NETL
NSTL
万方数据