Comparison of fascia iliaca compartment block versus femoral nerve three-in-one block for postoperative analgesia in elderly patients undergoing hip surgery
10.3760/cma.j.issn.0254-1416.2018.02.015
- VernacularTitle:连续髂筋膜间隙阻滞和股神经三合一阻滞用于髋部手术老年病人术后镇痛效果的比较
- Author:
Wenzhi WU
1
;
Lan ZHANG
;
Guanglei LEI
;
Peiyu LI
;
Guang YANG
Author Information
1. 四川省骨科医院麻醉科
- Keywords:
Nerve Block;
Fascia iliaca compartment;
Femoral nerve;
Analgesia;
Aged
- From:
Chinese Journal of Anesthesiology
2018;38(2):188-191
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the fascia iliaca compartment block versus femoral nerve 3-in-1 block for postoperative analgesia in elderly patients undergoing hip surgery.Methods A total of 160 patients with hip fracture,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 70-101 yr,weighing 30-93 kg,scheduled for elective total hip replacement or artificial femoral head replacement under general anesthesia,were divided into 2 groups (n =80 each) using a random number table:fascia iliaca compartment block group (FIB group) and femoral nerve 3-in-1 block group (FNB group).Ultrasound-guided fascia iliaca compartment and 3-in-1 blocks were performed with 0.2％ ropivacaine 40 ml in FIB and FNB groups,respectively.Patient-controlled analgesia (PCA) with 0.2％ ropivacaine 275 ml was used for postoperative analgesia until 72 h after operation in both groups.The PCA pump was set up with a 5 ml bolus dose,a 60 min lockout interval and background infusion at a rate of 5 ml/h,and the visual analog scale score was maintained≤4.When the visual analog scale score＞4,tramadol 50-100 mg was taken orally or injected intramuscularly for rescue analgesia.Before implanting the catheter,at 15 min after the initial administration and at 12 h after operation,temperature sensation and light touch sensation tests were performed in the anterior regions of thigh (innervated by femoral nerve),lateral region of thigh (innervated by lateral femoral cutaneous nerve) and superior part of the anterior region of thigh (innervated by obturator nerve).Successful sensory block was defined as the occurrence of a decline in temperature sensation or in light touch sensation in any area,and the successful sensory block was recorded.The requirement for rescue analgesia and patient's satisfaction with analgesia were recorded within 72 h after operation.The development of adverse reactions such as nerve damage,nausea and vomiting,dizziness and palpitation was also recorded within 48 h after operation.Results Compared with group FIB,the rate of successful analgesia in lateral thigh area was significantly decreased at 15 min after the initial adminstration and 12 h after operation,the requirement for rescue analgesia after operation was increased,the rate of satisfactory analgesia after operation was decreased (P＜0.05),and no significant change was found in the incidence of postoperative nausea and vomiting or dizziness in group FNB (P＞0.05).Conclusion Ultrasound-guided continuous fascia iliaca compartment block provides better efficacy for postoperative analgesia than 3-in-1 block in elderly patients undergoing hip surgery.
