CAJ | 학술논문

背景：硬膜外持续镇痛曾被认为是下肢术后镇痛的金标准，其效果确切，全身不良反应较少，临床上普遍采用。但此法有低血压及尿潴留等不良反应，且患者在术后常规需应用低分子肝素抗凝，有增加硬膜外血肿的可能性，限制了硬膜外镇痛的临床使用。目前超声引导下连续髂筋膜腔隙阻滞技术的相关研究报道甚少。 　　目的：评价连续髂筋膜间隙阻滞和连续硬膜外阻滞两种不同镇痛方法对全髋关节置换后镇痛效果和关节功能恢复的影响。 　　方法：将60例择期行全髋关节置换患者分为2组：连续髂筋膜间隙阻滞组和连续硬膜外镇痛组(n=30)。两组患者在全身麻醉诱导前均接受预注量，连续髂筋膜间隙阻滞组经髂筋膜间隙注入0.25%罗哌卡因30 mL，连续硬膜外阻滞组经硬膜外导管注入0.20%罗哌卡因10 mL，均留置导管。待镇痛效果明确后，全麻插管。术毕两组分别经髂筋膜间隙、硬膜外连接镇痛泵持续给药，未使用术后自控镇痛单次给药。若疼痛难以忍受时，视其疼痛程度，予补救镇痛(帕瑞昔布20-40 mg/次)。记录目测类比评分、帕瑞昔布补救剂量、麻醉并发症、髋关节Harris评分、下床时间和住院时间。 　　结果与结论：目测类比评分、额外追加的镇痛药量、Harris 评分、住院日两组无明显差别。但是下床时间连续髂筋膜间隙阻滞组早于连续硬膜外阻滞组，而且连续髂筋膜间隙阻滞组并发症明显低于连续硬膜外阻滞组。提示全髋关节置换后，两种镇痛方式均可提供满意的术后镇痛效果，髋关节功能可得到良好的恢复；但连续髂筋膜间隙阻滞并发症少且有利于患者早期下床活动，对于髋关节置换后镇痛是更好的选择。
배경：경막외지속진통증피인위시하지술후진통적금표준，기효과학절，전신불량반응교소，림상상보편채용。단차법유저혈압급뇨저류등불량반응，차환자재술후상규수응용저분자간소항응，유증가경막외혈종적가능성，한제료경막외진통적림상사용。목전초성인도하련속가근막강극조체기술적상관연구보도심소。 　　목적：평개련속가근막간극조체화련속경막외조체량충불동진통방법대전관관절치환후진통효과화관절공능회복적영향。 　　방법：장60례택기행전관관절치환환자분위2조：련속가근막간극조체조화련속경막외진통조(n=30)。량조환자재전신마취유도전균접수예주량，련속가근막간극조체조경가근막간극주입0.25%라고잡인30 mL，련속경막외조체조경경막외도관주입0.20%라고잡인10 mL，균류치도관。대진통효과명학후，전마삽관。술필량조분별경가근막간극、경막외련접진통빙지속급약，미사용술후자공진통단차급약。약동통난이인수시，시기동통정도，여보구진통(파서석포20-40 mg/차)。기록목측류비평분、파서석포보구제량、마취병발증、관관절Harris평분、하상시간화주원시간。 　　결과여결론：목측류비평분、액외추가적진통약량、Harris 평분、주원일량조무명현차별。단시하상시간련속가근막간극조체조조우련속경막외조체조，이차련속가근막간극조체조병발증명현저우련속경막외조체조。제시전관관절치환후，량충진통방식균가제공만의적술후진통효과，관관절공능가득도량호적회복；단련속가근막간극조체병발증소차유리우환자조기하상활동，대우관관절치환후진통시경호적선택。
BACKGROUND:Epidural analgesia has been considered a gold standard for postoperative analgesia in the lower limbs. Its outcomes are accurate and adverse reactions are few, so it can be used in the clinic. However, this method has adverse reactions such as hypotension and urine retention. Low molecular weight heparin should be used after operation, which can increase the possibility of epidural hematoma, and limits its application to epidural analgesia in the clinic. At present, few studies concerned ultrasound guided continuous fascia iliaca compartment block technology. OBJECTIVE:To evaluate the efficacy of postoperative pain relief and the joint rehabilitation between a continuous fascia iliaca compartment block and a continuous epidural analgesia for patients undergoing total hip arthroplasty. METHODS:A total of 60 patients undergoing a selective total hip arthroplasty were assigned to continuous fascia iliaca compartment block group and continuous epidural analgesia group (n=30). Al patients in both groups received a pre-fluence before general anesthesia. Continuous fascia iliaca compartment block group were injected with 0.25%ropivacaine 30 mL via iliac fascia gap. Continuous epidural analgesia group received 0.20%ropivacaine 10 mL via epidural catheter, indwel ing catheter. When the analgesic effect was identified, anesthesia intubation was carried out. After operation, medicine was given via iliac fascia and epidural analgesia pump in both groups respectively. Postoperative analgesia in single dose was not given. If pain could not be endured, analgesia would be rescued (parecoxib 20-40 mg/time) according to pain degree. Visual analogue scale scores, supplemental analgesia of parecoxib, complication of anesthesia, Harris hip joint scores, day of first walk, and duration of hospital stay were recorded. RESULTS AND CONCLUSION:No significant difference in visual analogue scale scores, supplemental analgesia, Harris hip joint scores and duration of hospital stay was detected. Day of first walk was earlier in the continuous fascia iliaca compartment block group than in the continuous epidural analgesia group. The complications were apparently lower in the continuous fascia iliaca compartment block group than in the continuous epidural analgesia group. These data indicated that after total hip arthroplasty, two kinds of analgesia methods could provide satisfactory postoperative outcomes. Hip joint was perfectly recovered. However, the complications of continuous fascia iliaca compartment block were less, and helpful to patients’ early off-bed activities, and could be considered as a good choice for analgesia after total hip arthroplasty.