摘要
目的探讨超声引导下单次股神经阻滞联合连续胭窝入路坐骨神经阻滞在快速康复足踝部外科中的应用。方法择期拟行单侧足踝部手术的成年患者60例，按随机数字表法分为A、B两组（n=30）。A组行超声引导下单次股神经阻滞和连续胭窝入路坐骨神经阻滞，放置坐骨神经周围导管，术后经神经周围导管采用0．2％罗哌卡因实施患者自控镇痛；B组行L2-3硬膜外穿刺并置管，术后行患者硬膜外自控镇痛。记录麻醉前后的血流动力学变化、麻醉效果、术中输液量及麻黄碱使用情况。记录术后48h内静息／运动疼痛数字评分（NRS）、患肢运动阻滞改良Bromage评分、镇痛泵有效按压次数和补救镇痛率。记录术后首次下床活动时间、住院时间及相关并发症。结果A组麻醉后各时点的收缩压和舒张压明显高于B组（P〈0．05），术中输液量及麻黄碱使用率明显低于B组（P〈0．05）。两组术后静息和运动NRS评分、镇痛泵有效按压次数和补救镇痛率等比较差异无统计学意义（P〉0．05），但B组恶心呕吐、尿潴留等并发症明显多于A组（P〈0．05）。A组术后24h内的患肢运动阻滞改良Bromage评分明显低于B组（P〈0．05），术后首次下床活动时间及住院时间明显短于B组（P〈0．05）。结论超声引导下单次股神经联合连续胭窝入路坐骨神经阻滞对血流动力学干扰小，麻醉效果确切，术后镇痛效果良好且患肢运动阻滞轻微，有利于足踝部外科患者的快速康复。
Objective To explore the feasibility of continuous sciatic nerve block via lateral popliteal approach with single shot femoral nerve block for enhanced recovery after surgery in ankle and foot surgery. Methods Sixty adult patients scheduled for elective ankle and foot surgery were randomly assigned into 2 group （n = 30 each） ： Group A received sciatic nerve block via lateral popliteal approach with a cath- eter placed and a single shot femoral nerve block under ultrasound guidance followed by patient-controlled postoperative analgesia with 0. 2% ropivacaine through the perineural catheter; Group B received the routine epidural puncture and a catheter placement at L2-3 level followed by postoperative analgesia with 0. 2% ropivacaine through the catheter. Systolic blood pressure （ SBP）, diastolic blood pressure （DBP） and heart beat （HR） were recorded before and after anesthesia. The block efficacy, the volume of fluid influsion during operation and the usage of ephedrine were recorded. The pain severity at rest and upon movement with a 0 - 10 numeric rating scale （NRS, 0 = no pain and l0 = worst possible pain） , the modified Bromage score of the motor block of the affected extremity, the number of effective patient-controlled bolus of ropivacaine and the number of need for opioid rescue within 48 h after surgery were assessed. The first time of leaving bed after operation, the length of hospital stay and the occurring of complication related to puncture and an-algelsia were also recorded. Results SBP and DBP at each time point after anesthesia were higher in group A than those in group B （ P 〈 0. 05 ）. The volume of fluid infusion during operation and the occurence of ephedrine use were less in group A than those in group B （ P 〈 0.05 ）. There was no indifference in terms of the NRS scores at rest and upon movement, the number of effective patient-controlled bolus of ropivacaine and the number of need for opioids rescue （ P 〉 0. 05 ） , but the complications such as nausea and vomiting, urinary retention occurred more in group B （P 〈 O. 05 ）. The modified Bromage score of the motor block at each time point within 24 h after surgery was lower in group B than that in group B （ P 〈 O. 05 ）. The first time of leaving bed after operation and the length of hospital stay were shorter in group A than those in group B （ P 〈 0. 05 ）. Conclusions Ultrasound-guided continuous sciatic nerve block via lateral popliteal ap- proach with single shot femoral nerve block can provide exact anesthetic effect with minimal interference on haemodynamics and excelent postoperative analgesia with less influence on movement. It＇s helpful in the an-kle and foot surgery to improve the recovery after surgery.
作者
孔宪刚
李海鸥
王昆
侯代亮
李成文
Kong Xiangang Li Haiou Wang Kun Hou Dailiang Li Chengwen(Department of Anesthesiology, Jining No. 1 People＇s Hospital, Jining 272011, China)
出处
《中国医师杂志》
CAS
2017年第6期855-858,863,共5页
Journal of Chinese Physician
基金
济宁市科技发展计划医药卫生项目（2015-57-07）
