翻譯：吳學(xué)艷  編輯：馮玉蓉  審校：曹瑩

研究目的：比較超聲引導(dǎo)下腰叢神經(jīng)阻滯(LPB)與腹股溝髂筋膜阻滯(SIFIB)在全髖關(guān)節(jié)置換術(shù)(THA)中的應(yīng)用。

設(shè)計(jì)：隨機(jī)等效試驗(yàn)。

單位：大學(xué)醫(yī)院。

患者：60例首次接受全髖置換術(shù)的患者。

干預(yù)措施：患者隨機(jī)分為超聲引導(dǎo)下LPB組(n=30)和SIFIB組(n=30)。局麻藥為(0.25%左旋布比卡因40 ml＋腎上腺素5μg/ml)，所有受試者均靜脈注射4mg地塞米松作為阻滯輔助用藥。術(shù)后48小時(shí)內(nèi)，所有患者均接受自控靜脈鎮(zhèn)痛(嗎啡)以及對(duì)乙酰氨基酚和酮洛芬。

測(cè)量方法：單盲法研究者記錄了嗎啡在24和48小時(shí)的使用量，以及第一次使用嗎啡的時(shí)間，3、6、12、24和48小時(shí)的疼痛評(píng)分，不良事件的發(fā)生率，出院準(zhǔn)備時(shí)間和住院時(shí)長(zhǎng)。單盲法研究者還在3、6和24小時(shí)使用10分的感覺運(yùn)動(dòng)綜合量表進(jìn)行了感覺運(yùn)動(dòng)阻滯評(píng)估。

主要結(jié)果：24小時(shí)（95％CI -4.0 mg～2.0 mg）和48小時(shí)（95％CI，-5.0～2.0 mg）嗎啡總使用量或首次使用嗎啡的時(shí)間，組間無(wú)差異；此外，在3小時(shí)后的所有時(shí)間間隔的疼痛評(píng)分均相似。在3和6 h的復(fù)合感覺運(yùn)動(dòng)評(píng)分方面，組間沒有差異。但是，SIFIB的作用持續(xù)時(shí)間長(zhǎng)于LPB，并在24小時(shí)的綜合評(píng)分更高。在并發(fā)癥方面未發(fā)現(xiàn)組間差異。與LPB相比，SIFIB的出院準(zhǔn)備時(shí)間(3[1-4]天與2[1-3]天；P=0.042)和住院時(shí)間(3[2-5]天與3[2-4]天；P=0.048)更短。

結(jié)論：對(duì)于全髖關(guān)節(jié)置換術(shù)，LPB和SIFIB在減少嗎啡使用和疼痛管理方面并無(wú)差異。然而，SIFIB阻滯時(shí)間更長(zhǎng)，與縮短出院準(zhǔn)備時(shí)間和住院時(shí)間有關(guān)。

原始文獻(xiàn)來(lái)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