Effects of fascia iliaca compartment block by different approaches on obturator nerve block and perioperative analgesia in total hip replacement
Objective To investigate the effects of different fascia iliaca compartment blocks on obturator nerve block and perioperative analgesia in total hip replacement.Methods Sixty elderly patients undergoing total hip replacement surgery who were admitted to Jinhua Central Hospital from May 2020 to May 2021 were selected and divided into inguinal fascia iliaca compartment block(group Ⅰ)and supra-inguinal fascia iliaca compartment block(group S)according to random number table method,30 cases in each group.After the completion of block,alcohol swab was used to test the onset time of blocks on the femoral nerve,obturator nerve and lateral femoral cutaneous nerve,and the muscle strength of the adductor muscle of the thigh was measured 10,20 and 30 min after block.Visual analogue scale(VAS)was used to evaluate the postoperative pain degree of patients in the two groups:entry(T0),6 h(T1),12 h(T2),24 h(T3)and 48 h(T4).The intraoperative doses of sufentanil and remifentanil used,the accumulative number of effective compressions for patient-controlled intravenous analgesia(PCIA)within 48 h after surgery,the first time to walk out of bed,patients'pain satisfaction and postoperative complications were recorded.Results Compared with group Ⅰ,the onset time of obturator nerve block in group S was significantly shortened(P＜0.05).The muscle strength reduction rate of thigh adductor muscle in group S was larger than that of group Ⅰ at 20 and 30 min after block(all P＜0.05).The decrease of static and dynamic VAS scores in group S was significantly greater than that of group Ⅰ at T,and T2(all P＜0.05).The intraoperative usage of sufentanil and remifentanil,the accumulative number of effective compressions for PCIA,and the first time to get out of bed in group S were significantly reduced compared with group Ⅰ(all P＜0.05).Conclusion Ultrasound-guided supra-inguinal fascia iliaca compartment block has a significant effect on obturator nerve block in elderly patients with total hip replacement,which can reduce pain and facilitate patients to get out of bed earlier.It is a safe and effective method.
Total hip replacementFascia iliacaOld ageObturator nerveAnalgesic effect
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