目的观察髂筋膜腔隙阻滞在老年股骨颈骨折患者腰硬联合麻醉前摆放体位时的镇痛作用。方法将50例老年患者按随机数字表法分成两组，其中观察组为髂筋膜腔隙阻滞（FIC）组25例，对照组为静脉镇痛（IVA）组25例。FIC组在腰硬联合麻醉20min前予0.375%盐酸罗哌卡因行髂筋膜腔隙阻滞，IVA组在腰硬联合麻醉2min前予以1滋g/kg枸橼酸芬太尼注射。观察两组患者入手术室后、摆放体位时、术后6、24、48h的VAS疼痛评分；腰硬联合麻醉操作时间；围术期芬太尼总耗量；患者对操作前干预手段的接受度和不良事件发生率等指标。结果 FIC组比IVA组在摆放体位时和术后6h的VAS疼痛评分降低，分别为2.4±0.9、4.1±1.1及2.2±0.5、3.5±0.8（均P＜0.01）；腰硬联合麻醉操作时间缩短，分别为8.1±2.9、12.9±5.1（P＜0.01）；术后恶心、呕吐发生率下降，分别为10％、23％（P＜0.01）；患者接受度提高，分别为23/25、11/25（P＜0.01）；芬太尼用量增加，分别为（460＋88）、（550＋126）滋g（P＜0.01）。结论相比静脉芬太尼镇痛，超声引导下髂筋膜腔隙阻滞提供了更好的镇痛和更少的麻醉并发症。% [Objective]To evaluate the analgesic effect of fascia iliaca compartment block during patient positioning be-fore combined spinal-epidural anesthesia (CSEA) in elderly patients undergoing surgery for femoral neck fracture. Methods Fifty elderly patients undergoing surgery for femoral neck fracture were randomly assigned to FIC group (fascia iliaca compart-ment block, n=25) and the IVA group (intravenous analgesia with fentanyl, n=25). Patients in IVA group received a i.v. bolus dose of 1μg/kg fentanil 2 min before CSEA and patients in FIC group received a FIC block with 40-50 ml of ropivacaine 3.75 mg/ml (112.5 mg) 20 min before CSEA. Visual analogue pain scale(VAS) scores during positioning, 6h, 24h and 48h after operation, time of achieving CSEA, postoperative fentanyl consumptions, the incidence of side effects, patient acceptance were compared be-tween two groups. Results VAS scores during positioning and 6h after operation in FIC group were lower than those in IVA group (2.4±0.9 vs 4.1±1.1;2.2±0.5 vs 3.5±0.8, respectively;both P<0.01). Time for achieving CSEA in FIC group was shorter than that in IVA group(P<0.01). The incidence of postoperative nausea and vomiting (PONV) was lower in FIC group than that in IVA group (10.0%vs 23.0%, P<0.01). The patient acceptance (yes/no) was also better in the FIC group (23/2) than that in IVA group(11/14)(P<0.01). Perioperative fenanyl consumptions was lower in FIC group than that in IVA group[(460+88)μg vs (550+126)μg](P<0.01). Conclusion The ultrasound-guided FIC block is of more analgesic effect than intravenous fentanyl in facilitat-ing the lateral position for CSE anesthesia in elderly patients undergoing surgery for femoral neck fractures.
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