【原】股骨近端骨折术后髂筋膜室阻滞与前路腰方肌阻滞术后镇痛的比较研究

股骨近端骨折术后髂筋膜室阻滞与前路腰方肌阻滞术后镇痛的比较研究

贵州医科大学     麻醉与心脏电生理课题组

翻译：邓举  编辑：张中伟  审核：曹莹

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背景：本研究的目的是比较超声引导下经（前路）腰方肌阻滞(QLB)与腹股沟下髂筋膜室阻滞(FICB)治疗股骨近端骨折术后镇痛的疗效。患者报告的视觉模拟评分(VAS)疼痛、镇痛需求和下床活动是关键因素。

方法：这项前瞻性随机试验是在获得研究机构伦理委员会批准后进行的。在这项研究中，超声引导下的腹股沟下髂筋膜室阻滞与超声引导下的前路腰方肌阻滞进行比较，使用50ml 0.25%的布比卡因，最大剂量为2.5mg/kg，128名患者（每组64名患者）在脊髓麻醉后进行手术，在手术结束时实施。如果VAS>3，给予纳布啡作为补救性镇痛。我们的主要结果是在第一个24小时内的第一次补救性镇痛和总镇痛药消耗量；次要结果是患者开始行走的时间。

结果：FICB组的术后疼痛感从30分钟开始（P值0.022）至24小时（P值<0.001），他们接受的麻醉剂总剂量（14.1±3.5）远远高于QLB组（7.9±3.4），P值（<0.001∗）。与QLB组（14.1±4.5），P值（<0.001∗）相比，FICB组实施首次补救性镇痛所需的时间要少得多。与QLB组（20.1±4.6）相比，FICB组需要更长的时间开始走动（22.3±4.8），P值（0.011∗）。低血压（1.6%）主要在QLB组发现，而筋膜分离不良（1.6%）仅在FICB组观察到。FICB组和QLB组之间的并发症没有明显差异。

结论：接受股骨近端骨折术后QL前阻滞的患者与接受FICB的患者相比显示出延迟的首次补救性镇痛和早期行走较低的纳布啡总消耗量。

原始文献来源： O. S. M. Abd Elmaksoud , S. E. M. Elansary , N. G. Fahmy,et al. A Comparative Study between Postoperative Analgesia of Fascia Iliaca Compartment Block and Anterior Quadratus Lumborum Block in Proximal Femur Fracture.［J］Anesthesiology Research and Practice 2022：1-7.

英文原文

A Comparative Study between Postoperative Analgesia of Fascia Iliaca Compartment Block and Anterior Quadratus Lumborum Block in Proximal Femur Fracture

Abstract

Elderly patients with various comorbidities are more likely to suffer from proximal femur fractures. It is also a painful fracture, and poor pain management can have serious physiological and psychological consequences, such as acute delirium.

Purpose：The aim of this study is to compare the efficacy of ultrasound-guided transmuscular (anterior) quadratus lumborum block (QLB) versus infrainguinal fascia iliaca compartment block (FICB) in proximal femur fractures for postoperative analgesia. Patient-reported pain on the visual analogue scale (VAS), analgesic demand, and ambulation were the key factors.

Patients and Methods:This prospective, randomised trial was done after

receiving approval from the institute’ study ethical committee. In this study, ultrasound-guided infrainguinal fascia iliaca compartment block was compared to ultrasound-guided anterior quadratus lumborum block using 50ml of bupivacaine 0.25%, with a maximum dose of 2.5 mg/kg at the end of surgery after spinal anaesthesia in 128 patients (64 patients in each group).Nalbuphine was given as rescue analgesia if VAS >3. Our 1st outcome was the first rescue analgesia and total analgesic consumption in the 1st 24 hours; the 2nd outcome was the time patients started to ambulate.

Results: Postoperative pain perception was substantially greater in the FICB group starting from 30min (P value 0.022) till 24 hours (P value <0.001), and they received a considerably larger total narcotic dose (14.1±3.5) than patients in the QLB group (7.9±3.4), P value (<0.001∗). ,e time required to achieve fifirst rescue analgesia was much less in the FICB group (8.5±2.2)

compared to the QLB group (14.1±4.5), P value (<0.001∗), and they took much longer to ambulate (22.3±4.8) when compared to the QLB group (20.1±4.6), P value (0.011∗). Hypotension (1.6%) was detected mainly in the QLB group, whereas poor fascial separation (1.6%) was observed only in the FICB group. ,ere were no significant differences in complications between both the FICB and QLB groups.

Conclusion: Patients receiving postoperative anterior QL block for proximal femur fracture demonstrated delayed first rescue analgesia and lower total nalbuphine consumption with early ambulation than patients who received FICB.

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