罗哌卡因复合不同浓度亚甲蓝行髂筋膜阻滞对髋关节置换术病人术后镇痛和康复效果的影响

doi:10.3969/j.issn.1003-9198.2025.05.007

摘要/Abstract

摘要： 目的对比罗哌卡因复合不同浓度亚甲蓝行髂筋膜阻滞在髋关节置换术病人术后镇痛效果及对认知水平和髋关节功能恢复的影响。方法选择髋关节置换术病人81例,采用随机数表法分为3组,L组予以0.25%罗哌卡因30 mL,Y₁组予以0.25%罗哌卡因复合20 mg亚甲蓝共30 mL,Y₂组予以0.25%罗哌卡因复合40 mg亚甲蓝共30 mL,3组均在全麻诱导前行超声引导下髂筋膜阻滞。记录3组术后1、3、7 d静息和活动状态下的VAS评分,术前1 d和术后7 d的MMSE评分,术后7 d的Harris评分,术后首次步行距离,术后7 d内下床活动次数,需静脉补救镇痛用药例数,术后7 d内不良反应发生情况。结果 81例病人中,术后失访4例,因要求使用静脉镇痛泵剔除2例,最终纳入75例,每组25例。与L组相比,Y₁组和Y₂组术后1、3、7 d静息和活动状态下的VAS评分明显降低(P＜0.05);与Y₁组相比,Y₂组在术后1 d静息状态和术后1、3、7 d活动状态下的VAS评分明显降低(P＜0.05)。与L组相比,Y₁组和Y₂组术后7 d的Harris评分高,术后首次步行距更长,7 d内下床活动次数更多,术后需静脉补救镇痛例数更少,差异均有统计学意义(P＜0.05)。3组手术前后的MMSE评分和术后恶心呕吐、心律失常、头晕头痛、胸闷腹痛的发生情况差异均无统计学意义(P>0.05)。结论罗哌卡因复合亚甲蓝行髂筋膜阻滞用于髋关节置换的术后镇痛比单纯使用罗哌卡因镇痛效果更好,镇痛时间更长久,更有利于术后髋关节功能的快速康复,同时,亚甲蓝的镇痛效果在一定程度上呈现剂量依赖性。

关键词: 髋关节置换术, 亚甲蓝, 罗哌卡因, 髂筋膜阻滞, 镇痛, 老年人

Abstract: Objective To compare the effects of ropivacaine combined with different concentrations of methylene blue for fascia iliaca block on postoperative analgesia, cognitive function and hip joint function recovery in the patients undergoing hip arthroplasty. Methods A total of 81 patients undergoing hip arthroplasty were enrolled and divided into three groups using a random number table: L group was given 30 mL of 0.25% ropivacaine;Y₁ group was given 30 mL of mixture of 0.25% ropivacaine with 20 mg methylene blue;Y₂ group was given 30 mL of mixture of 0.25% ropivacaine with 40 mg methylene blue.All the groups received ultrasound-guided fascia iliaca block before the induction of general anesthesia.The scores of pain Visual Analogue Scale(VAS) at rest and activity 1, 3 and 7 days after surgery, the scores of Mini-Mental State Examination(MMSE) 1 day before surgery and 7 days after surgery, the Harris score 7 days safter surgery,the distance of the first postoperative walk, the number of activities to get out of bed within 7 days postoperatively, the number of cases requiring intravenous rescue analgesia, and the incidence of adverse reactions within 7 days postoperatively were recorded. Results Among the initial 81 patients, 4 cases were lost to follow-up, and 2 cases were excluded for voluntarily requesting intravenous patient-controlled analgesia. Ultimately, 75 patients were included, with 25 cases in each group.Compared with L group, the scores of VAS at rest and activity 1, 3 and 7 days after surgery were significantly lower in Y₁and Y₂ groups(P<0.05);Compared with Y₁ group, the scores of VAS in Y₂ group were significantly lower at rest 1 day after surgery and at activity 1, 3 and 7 days after surgery (P<0.05).Compared with L group, the Harris scores were significantly higher 7 days after surgery, the first walk distance after surgery was significantly longer, the number of activities to get out of bed within 7 days postoperatively was significantly higher, and the number of patients requiring intravenous rescue analgesia after surgery was less in Y₁ and Y₂ groups(P<0.05).There were no statistically significant differences in preoperative and postoperative MMSE scores,and the incidence rate of postoperative adverse reactions among the three groups. Conclusions Iliofascial block with ropivacaine and methylene blue for postoperative pain relief after hip replacement is more effective than ropivacaine alone, and the analgesic time is longer, which is more conducive to the rapid recovery of postoperative hip joint function, and the analgesic effect of methylene blue shows dose-dependence with a certain extent.

Key words: hip arthroplasty, methylene blue, ropivacaine, fascia iliaca compartment block, analgesia, aged

中图分类号:

R 614.4

张扬, 杨顺, 臧刘雪, 陆咨儒, 于震峰, 刘美玉. 罗哌卡因复合不同浓度亚甲蓝行髂筋膜阻滞对髋关节置换术病人术后镇痛和康复效果的影响[J]. 实用老年医学, 2025, 39(5): 466-471.

ZHANG Yang, YANG Shun, ZANG Liuxue, LU Ziru, YU Zhenfeng, LIU Meiyu. Effects of ropivacaine combined with different concentrations of methylene blue for fascia iliaca block on postoperative analgesia and rehabilitation in patients undergoing hip arthroplasty[J]. Practical Geriatrics, 2025, 39(5): 466-471.

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