腰丛神经阻滞与腹股沟髂筋膜阻滞用于全髋关节置换术的比较：单盲随机试验
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腰丛神经阻滞与腹股沟髂筋膜阻滞用于全髋关节置换术的比较：单盲随机试验
翻译：吴学艳 编辑：冯玉蓉 审校：曹莹
研究目的：比较超声引导下腰丛神经阻滞(LPB)与腹股沟髂筋膜阻滞(SIFIB)在全髋关节置换术(THA)中的应用。
设计：随机等效试验。
单位：大学医院。
患者：60例首次接受全髋置换术的患者。
干预措施：患者随机分为超声引导下LPB组(n=30)和SIFIB组(n=30)。局麻药为(0.25%左旋布比卡因40 ml＋肾上腺素5μg/ml)，所有受试者均静脉注射4mg地塞米松作为阻滞辅助用药。术后48小时内，所有患者均接受自控静脉镇痛(吗啡)以及对乙酰氨基酚和酮洛芬。
测量方法：单盲法研究者记录了吗啡在24和48小时的使用量，以及第一次使用吗啡的时间，3、6、12、24和48小时的疼痛评分，不良事件的发生率，出院准备时间和住院时长。单盲法研究者还在3、6和24小时使用10分的感觉运动综合量表进行了感觉运动阻滞评估。
主要结果：24小时（95％CI -4.0 mg～2.0 mg）和48小时（95％CI，-5.0～2.0 mg）吗啡总使用量或首次使用吗啡的时间，组间无差异；此外，在3小时后的所有时间间隔的疼痛评分均相似。在3和6 h的复合感觉运动评分方面，组间没有差异。但是，SIFIB的作用持续时间长于LPB，并在24小时的综合评分更高。在并发症方面未发现组间差异。与LPB相比，SIFIB的出院准备时间(3[1-4]天与2[1-3]天；P=0.042)和住院时间(3[2-5]天与3[2-4]天；P=0.048)更短。
结论：对于全髋关节置换术，LPB和SIFIB在减少吗啡使用和疼痛管理方面并无差异。然而，SIFIB阻滞时间更长，与缩短出院准备时间和住院时间有关。
原始文献来源: Bravo D, Layera S, Aliste J,et al.Lumbar plexus block versus suprainguinal fascia iliaca block for total hip arthroplasty: A single-blinded, randomized trial.[J].J Clin Anesth 2020 Jun 02;66.
Lumbar plexus block versus suprainguinal fascia iliaca block for total hip arthroplasty: A single-blinded, randomized trial
Abstract
Study objective: Comparison of ultrasound-guided lumbar plexus block (LPB) and suprainguinal fascia iliaca block (SIFIB) in patients undergoing total hip arthroplasty (THA).
Design: Randomized equivalence trial.
Setting: University Hospital.
Patients: Sixty patients undergoing primary THA.
Interventions: Patients were randomly allocated to receive ultrasound-guided LPB (n = 30) or SIFIB (n = 30).The local anesthetic agent (40 mL of levobupivacaine 0.25% with epinephrine 5 μg/mL) and block adjuvant(4 mg of intravenous dexamethasone) were identical in all subjects. Postoperatively, all patients received patient-controlled intravenous analgesia (morphine) as well as acetaminophen and ketoprofen during 48h.
Measurements: A blinded investigator recorded morphine consumption at 24 and 48 h as well as time to first morphine request, pain scores at 3, 6, 12, 24 and 48 h, incidence of adverse events, time to readiness for discharge, and length of hospital stay. The blinded investigator also carried out sensorimotor block assessment at 3, 6 and 24 h using a 10-point sensorimotor composite scale.
Main results: No intergroup differences were found in terms of cumulative morphine consumption at 24 h (95%CI: −4.0 mg to 2.0 mg) and 48 h (95% CI, −5.0 mg to 2.0 mg) or time to first morphine request. Furthermore,pain scores were similar at all time intervals after 3 h. There were no intergroup differences in terms of composite sensorimotor scores at 3 and 6 h. However, SIFIB lasted longer than lumbar plexus block as evidenced by a higher composite score at 24 h. No intergroup differences were found in terms of complications. Compared with LPB, SIFIB was associated with shorter time to readiness for discharge (3 [1-4] vs. 2 [1-3] days; P = 0.042) and
length of hospital stay (3 [2-5] vs. 3 [2-4] days; P = 0.048).
Conclusions: For THA, no differences were found between LPB and SIFIB in terms of breakthrough morphine requirement and pain control. However, SIFIB resulted in a longer block and was associated with shorter time to readiness for discharge as well as decreased hospital stay
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