术前髂筋膜阻滞不会改善关节镜下髋关节手术后的镇痛效果，而导致股四头肌肌无力：随机双盲试验
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Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness: A Randomized, Double-blind Trial
背景与目的
动态髋关节镜检查术后常规需要阿片类药物镇痛。外周神经阻滞用于髋关节镜术后镇痛的效果仍有争议。本试验探讨了术前髂筋膜阻滞是否可改善术后镇痛。
方 法
本研究为前瞻性双盲试验，纳入80例择期髋关节镜术患者，随机分别给予0.2%罗哌卡因40ml术前髂筋膜阻滞或生理盐水。患者手术结束时均关节内注射0.2%罗哌卡因10ml。主要研究终点是恢复室报告的最高疼痛评分; 其他研究终点是术后24小时疼痛评分和阿片类药物的使用。此外，测量股四头肌肌力确定腿部无力情况。
结 果
纳入78例患者数据分析。试验组（6±2）和安慰剂组（7±2）的恢复室内最高疼痛评分无差异[-0.2（95%CI，-1.1-0.7）]，阿片类药物的剂量相似（静脉注射吗啡剂量：15±7mg（试验组）vs16±9mg（安慰剂组））。出院后，患者手术后24小时疼痛程度和阿片类需要量无差异（13±7mg（试验组）vs.12±8mg（安慰剂组）。髂筋膜阻滞导致显著地股四头肌无力。试验组术后有4人跌倒，安慰剂组术后有1人跌倒。
结 论
术前髂筋膜阻滞除了给予关节腔内局部麻药注射外并未改善髋关节镜术后疼痛，但导致了股四头肌无力，增加了跌倒风险。因此，不推荐该类手术患者常规应用术前髂筋膜阻滞。
原始文献摘要
Abstract
Background: Ambulatory hip arthroscopy is associated with postoperative pain routinely requiring opioid analgesia. The potential role of peripheral nerve blocks for pain control after hip arthroscopy is controversial. This trial investigated whether a preoperative fascia iliaca block improves postoperative analgesia.
Methods: In a prospective, double-blinded trial, 80 patients scheduled for hip arthroscopy were randomized to receive a preoperative fascia iliaca block with 40 ml ropivacaine 0.2% orsaline. Patients also received an intraarticular injection of 10-ml ropivacaine 0.2% at procedure end. Primary study endpoint was highest pain score reported in the recovery room; other study endpoints were pain scores and opioid use 24 h after surgery. Additionally, quadriceps strength was measured to identify leg weakness.
Results: The analysis included 78 patients. Highest pain scores in the recovery room were similar in the block group (6 ± 2) versus placebo group (7 ± 2), difference: −0.2 (95% CI, −1.1 to 0.7), as was opioid use (intravenous morphine equivalent dose: 15 ± 7mg [block] vs. 16 ± 9 mg [placebo]). Once discharged home, patients experienced similar pain and opioid use (13 ± 7 mg [block] vs. 12 ± 8 mg [placebo]) in the 24 h after surgery. The fascia iliaca block resulted in noticeable quadriceps weakness. There were four postoperative falls in the block group versus one fall in the placebo group.
Conclusions: Preoperative fascia iliaca blockade in addition to intraarticular local anesthetic injection did not improve pain control after hip arthroscopy but did result in quadriceps weakness, which may contribute to an increased fall risk. Routine use of this block cannot be recommended in this patient population.
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贵州医科大学高鸿教授课题组
编辑：符校魁 审校：余晓旭