Ultrasound-guided Multiple Nerve Blocks A Safe and Effective Anesthetic Modality in Geriatric Hip Fracture Patients
Ultrasound-guided Multiple Nerve Blocks A Safe and Effective Anesthetic Modality in Geriatric Hip Fracture Patients
复制标题
超声引导多神经阻滞
DOI：
10.1097/ajp.0000000000000988
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发表时间：
2021-12-01
影响因子：
2.9
通讯作者：
He，Xingying
中科院分区：
文献类型：
--
作者：
Gu，Jue;Wang，Eerdun;He，Xingying
目的：比较超声引导下复合神经阻滞(筋膜间室阻滞+骶丛阻滞+臀上神经阻滞)在老年髋部骨折患者中应用的可行性。方法：94例患者随机分为两组，N组采用超声引导下复合神经阻滞，G组采用全麻术。主要结果包括围手术期疼痛阈值指数(PTI)和数字评分。次要观察指标包括：(1)围手术期妄想指数和简易精神状态问卷；(2)围手术期舒适度指数；(3)围手术期阿片类药物用量(术后72小时内)；(4)术后副作用(术后72 小时内)。结果：87例患者完成研究。基线PTI在两组之间具有可比性。然而，N组术中PTI明显低于G组，术前和术后舒适度指数评分在两组之间具有可比性。G组术后24~72 h的中度妄想明显高于术前水平，术后24 h的早期中度妄想明显高于N组。术中高PTI与高阿片类药物消耗相关。G组静脉注射舒芬太尼的剂量是N组的两倍，恶心呕吐发生率两组相似。讨论：超声引导多神经阻滞可能是老年髋部骨折患者常用麻醉方法的一种替代方法。它提供了令人满意的术中疼痛管理，并减少了术后早期的认知障碍。
Objectives: The aim was to compare the feasibility of ultrasound-guided multiple nerve blocks (fascia iliaca compartment block+sacral plexus block+superior cluneal nerve block) with general anesthesia in geriatric hip fracture patients. Methods: Ninety-four patients were randomly divided into 2 groups: group N received ultrasound-guided multiple nerve blocks and group G received general anesthesia. Primary outcome measures included perioperative Pain Threshold Index (PTI) and Numerical Rating Scale. Secondary outcome measures comprised the following: (1) perioperative Delirium Index and Short Portable Mental Status Questionnaire; (2) perioperative Comfort Index; (3) perioperative opioid consumption (within 72 hours postoperatively); and (4) postoperative side effects (within 72 h postoperatively). Results: Eighty-seven patients completed the study. Baseline PTI was comparable between the groups. However, intraoperative PTI was significantly lower in group N than in group G. Preoperative and postoperative Comfort Index scores were comparable between the groups. Moderate delirium (24 to 72 h postoperatively) was significantly higher than the baseline in group G. Early moderate delirium (24 h postoperatively) was significantly higher in group G than in group N. Severe delirium was comparable between the groups and within each group. High intraoperative PTI was associated with high opioid consumption. The intravenous sufentanil dose in group G was twice of that in group N. Incidence of nausea and vomiting was similar between the groups. Discussion: Ultrasound-guided multiple nerve blockade may be an alternative to the common anesthetic procedures used for geriatric hip fracture patients. It provided satisfactory intraoperative pain management and reduced early postoperative cognitive disorders.