股神经阻滞的技巧

2024 年 3 月 26 日

股神经阻滞是临床应用最广泛、成功率较高的神经阻滞技术之一。超声引导技术允许医生监测局部麻醉剂的扩散和针的放置，进行调整，并降低股动脉穿刺的风险。

与更远端的技术（例如股骨三角阻滞或内收肌管阻滞）相反，股神经阻滞可以为膝关节手术提供完全麻醉。

In contrast to more distal techniques, such as the femoral triangle block or adductor canal block, the femoral nerve block can provide complete anesthesia for various procedures, including knee surgery, making it a crucial tool in surgical and emergency settings. In geriatric patients with hip fractures, the use of ultrasound-guided femoral nerve blocks offers a safer, more effective alternative to opioids for pain management.

Importance of pain management in geriatric hip fractures

Hip fractures are a leading cause of emergency surgeries in elderly patients, often resulting in prolonged recovery times, high morbidity, and significant mortality rates. Managing acute pain effectively in this population is critical yet challenging due to multiple factors, including:

Opioid-related risks: Elderly patients are more susceptible to adverse effects such as sedation, nausea, respiratory depression, and cognitive impairment when opioids are used for pain relief.
合并症： Many geriatric patients have underlying health issues, such as kidney disease or gastrointestinal conditions, which limit the use of NSAIDs.
Opioid misuse: The global opioid crisis has led to increased efforts to minimize opioid use, particularly in vulnerable populations like the elderly.

一项研究 Tsai et al. 2022 published in the Journal of Clinical Medicine focused on the use of lidocaine-based single-shot ultrasound-guided femoral nerve block (USFNB) in geriatric patients with traumatic hip fractures. The researchers found that this technique not only significantly reduced opioid consumption but also led to faster and more effective pain relief compared to standard care.

主要调查结果

Reduced opioid use: Patients who received USFNB required 80% less opioids than those who were treated with systemic analgesics.
Faster pain relief: The time for meaningful pain relief was significantly shorter in the USFNB group (96 minutes) compared to the standard care group (185 minutes).
Safety: The study found no significant complications associated with USFNB, making it a safe option for managing acute pain in elderly patients.

Benefits of ultrasound-guided femoral nerve block in hip fracture management

The benefits of USFNB in the emergency management of geriatric hip fractures are clear. It offers targeted, effective pain relief with minimal systemic side effects. Key advantages include:

Opioid reduction: By providing localized pain relief, USFNB decreases the need for opioids, reducing the risk of adverse effects and potential addiction.
Faster recovery: Improved pain management enables earlier mobilization and rehabilitation, accelerating recovery and reducing complications.
Minimal complications: With ultrasound guidance, practitioners can ensure accurate needle placement, reducing the risk of complications such as vascular puncture or nerve injury.

Best practices for a successful femoral nerve block

Adhering to best practices is crucial for ensuring the success of a femoral nerve block. Below are three essential tips for performing a successful ultrasound-guided femoral nerve block:

Use real-time ultrasound guidance
- Ultrasound allows for precise needle placement and real-time visualization of the femoral nerve and surrounding structures. This minimizes the risk of complications, such as femoral artery puncture, and improves the accuracy of anesthetic delivery.
Optimize patient positioning
- Ensure the patient is supine with the leg slightly abducted to expose the inguinal area. Proper positioning facilitates better access to the femoral nerve and ensures an accurate block.
Monitor the spread of local anesthetic
- Continuous monitoring of the anesthetic’s spread under ultrasound ensures complete coverage of the femoral nerve. If the anesthetic does not fully surround the nerve, adjustments can be made immediately, improving the block’s effectiveness.

Clinical application: femoral nerve block in emergency settings

The ultrasound-guided femoral nerve block is especially beneficial in emergency settings, such as managing acute pain in geriatric hip fractures. The technique can be performed quickly by trained emergency physicians, providing rapid pain relief and reducing the need for systemic analgesics.

By adhering to the above tips, clinicians can ensure the safe and effective administration of the block, improving outcomes for patients while minimizing the risk of opioid-related complications.

结论

Ultrasound-guided femoral nerve blocks offer a highly effective and safe method for managing acute pain in elderly patients with hip fractures. By reducing opioid use and providing faster pain relief, this technique aligns with modern efforts to improve patient care while addressing the challenges associated with opioid overuse. Incorporating Ultrasound-guided femoral nerve blocks into clinical practice enhances pain management and contributes to better overall patient outcomes. Following best practices—such as using real-time ultrasound guidance, optimizing patient positioning, and carefully monitoring anesthetic spread—can ensure the success of this technique in both emergency and surgical settings.

有关更多详细信息，请参阅临床医学杂志.

Tsai TY, Cheong KM, Su YC, et al. Ultrasound-Guided Femoral Nerve Block in Geriatric Patients with Hip Fracture in the Emergency Department. J Clin Med. 2022;11(10):2778. Published 2022 May 14.

遵循以下 3 个成功股神经阻滞的基本技巧：