护士引导下的超声引导股神经阻滞：急诊科两种不同患者流系统的随机对照试验

IF 1.5 Q3 NURSING International Journal of Orthopaedic and Trauma Nursing Pub Date : 2023-12-04 DOI:10.1016/j.ijotn.2023.101074

Elin Saga , Ragnhild S. Falk , Pia C. Bing-Jonsson , Kirsti I. Skovdahl , Espen Lindholm

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引用次数: 0

摘要

导言：髋部骨折老人面临着复杂的挑战。有效的疼痛控制对患者的康复和生活质量至关重要。方法我们进行了一项非盲法随机对照试验，调查由受过专门培训的护士（护士组）与麻醉师（麻醉师组）对髋部骨折患者进行超声引导下股神经阻滞的效果。我们的假设是，与麻醉师组相比，护士组患者在入院后 120 分钟内的疼痛强度动态数字评分量表的总和要低于麻醉师组患者在五个时间点的疼痛强度动态数字评分量表的总和。主要结果由急诊科入院后 120 分钟内动态疼痛（髋关节屈曲至与床面呈最大 30°）的累积数字评级量表评分来衡量。结果从 2020 年 2 月至 2021 年 6 月，共筛选了 263 名患者，其中 42 人（16.0%）同意并被随机分配；每组 21 人。各组间的主要结果无差异（P = 0.24），显示受过专门培训的护士与麻醉师相比并无明显优势。两组均未发现并发症或不良反应。两组患者使用全身镇痛药和出现谵妄的情况相似。在护士组中，患者更早地接受了超声引导下的股神经阻滞。结论我们的研究并未证明，在进行超声引导下的股神经阻滞时，受过专门培训的护士比麻醉师对累积疼痛有统计学意义上的显著优势，而两组中均未观察到副作用/并发症或不良反应。该试验于2019年10月31日在Clinicaltrials.gov（NCT04145752）上注册。

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Nurse-led ultrasound-guided femoral nerve block: A randomised controlled trial of two different patient flow systems in an emergency department

Introduction

Elderly with hip fractures present complex challenges. Effective pain management is crucial for recovery and quality of life. However, pain control can be difficult and requires customized care.

Methods

We conducted an unblinded, randomised controlled trial investigating the effects of ultrasound-guided femoral nerve block in patients with hip fracture performed by specially trained nurses (Group Nurse) compared to anaesthesiologists (Group Anaesthesiologist). The hypothesis was that a single shot ultrasound-guided femoral nerve block would result in a total summarized lower dynamic numeric rating scale score for pain intensity during the first 120 min after admission for patients in Group Nurse compared to Group Anaesthesiologist measured in five timepoints. The primary outcome was measured by a cumulative numeric rating scale score for dynamic pain (with flexion of the hip until maximum 30° from bed surface) during the first 120 min after admission to the emergency department.

Results

From February 2020 to June 2021, 263 patients were screened, of which 42 (16.0%) consented and were randomly allocated; 21 in each arm. The primary outcome was not different between groups (p = 0.24), and displayed no substantial superiority of specially trained nurses over anaesthesiologist. No complications or adverse effects were observed in either group. The use of systemic analgesics and the development of delirium was similar between the two groups. In the Nurse Group, patients were administered their ultrasound-guided femoral nerve block earlier.

Conclusion

Our study did not demonstrate a statistically significant beneficial effect of specially trained nurses over anaesthesiologist on cumulative pain in performing ultrasound-guided femoral nerve blocks, while no side-effects/complications or adverse effects were observed in either group.