髂腰肌平面阻滞与髋关节囊周围神经阻滞对老年髋部骨折患者术后运动功能的影响比较OA

Objective To compare the effects of ultrasound-guided single-shot iliopsoas plane block(IPB)and single-shot pericapsular nerve group block(PENGB)on postoperative lower limb motor function in elderly patients with hip fracture.Methods A retrospective analysis was performed on the clinical data of 60 elderly patients with hip fractures admitted to the Department of Orthopedics,Hainan Hospital of Chinese PLA General Hospital from May 2023 to March 2024.According to different block regimens,the patients were divided into IPB group and PENGB group,with 30 cases in each group.IPB group received ultrasound-guided single-shot IPB combined with lateral femoral cutaneous nerve block(LFCNB),and PENGB group received ultrasound-guided single-shot PENGB combined with LFCNB,followed by general anesthesia in both groups.After surgery,both groups were given intravenous infusion of flurbiprofen axetil injection at a dose of 100 mg/d for analgesia.If the visual analogue scale(VAS)score was≥4,dezocine 5 mg was intravenously injected for rescue analgesia per time.The two groups were compared regarding the quadriceps manual muscle test(MMT)grade at 3,6,12,24,and 48 h postoperatively,the time to first ambulation after surgery,VAS scores at rest and during activity(passive straight leg raising to 45°)at 3,6,12,24,and 48 h postoperatively,the intraoperative dosage of sufentanil,and the number of rescue analgesia administration required within 48 h postoperatively.Additionally,the incidences of perioperative complications such as delirium,nausea and vomiting,deep vein thrombosis,neurovascular injury,local anesthetic toxicity,and puncture site infection were compared between the two groups.Results Compared with PENGB group,IPB group had significantly higher MMT grades of quadriceps at 3,6 and 12 h after surgery(P<0.001,P<0.001,P=0.021),a significantly shorter time to first ambulation after surgery(P<0.001),and significantly higher active VAS scores at 3,6 and 12 h after surgery(P=0.011,P=0.016,P=0.028).There was no statistically significant difference in resting VAS scores after surgery,intraoperative sufentanil dosage,frequency of rescue analgesia administration within 48 h after surgery,and incidences of various perioperative complications between the two groups(P>0.05).Conclusion Ultrasound-guided single-shot IPB has a less impact on lower limb muscle strength,and can ensure a good perioperative analgesia effect and safety,making it a more preferable nerve block technique for the early postoperative rehabilitation program of elderly patients with hip fractures.