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| 超声引导下外侧入路坐骨神经阻滞在全膝关节置换术后镇痛中的应用 |
| Ultrasound-guided lateral approach to the sciatic nerve block in postoperative analgesia after total knee arthroplasty |
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| DOI：10.12089/jca.2018.11.002 |
| 中文关键词: 超声引导 坐骨神经阻滞 全膝关节置换术 术后镇痛 |
| 英文关键词: Ultrasound-guided Sciatic nerve block Total knee arthroplasty Postoperative |
| 基金项目:佛山市卫生局研究计划课题(2014178) |
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| 中文摘要: |
目的 研究超声引导下外侧入路坐骨神经阻滞在全膝关节置换术(TKA)术后镇痛中的应用情况,并与传统的后入路法比较,评价其临床应用价值。
方法 选择气管插管全麻下行单侧TKA手术患者60例,男22例,女38例,年龄60～85岁,ASA Ⅱ或Ⅲ级,所有患者术毕拔管送麻醉恢复室,在超声引导下行单次股神经联合坐骨神经阻滞镇痛,根据坐骨神经入路不同,随机分为2组(n=30):外侧入路组(L组),仰卧位下于转子下股骨干中上段外侧行坐骨神经阻滞镇痛;后入路组(P组),侧卧位下于坐骨结节和股骨大转子间行坐骨神经阻滞镇痛。记录坐骨神经阻滞操作完成时间、穿刺针深度、最低平均电流刺激的强度、穿刺成功率、坐骨神经感觉阻滞起效时间、持续时间和患者对操作满意度评分;收集术后36 h内不同时点静息和活动时VAS评分及并发症的发生情况。
结果 L组操作完成时间明显短于P组(P<0.05),进针深度明显浅于P组(P<0.05),穿刺的成功率和患者满意度均明显高于P组(P<0.05);两组术后不同时点静息和活动时VAS评分、术后镇痛药物使用情况和肌力差异无统计学意义。两组术后36 h内均未见局部红肿、感染和神经损伤等麻醉相关并发症。
结论 与传统的转子间水平后入路法比较,超声联合神经电刺激针引导坐骨神经阻滞镇痛的外侧入路是一种更简单而安全有效的穿刺入路技术。 |
| 英文摘要: |
Objective To evaluate the clinical applicationof ultrasound-guidedlateral approachsingle sciatic nerve block in postoperative analgesia following total knee arthroplasty (TKA).
Methods Sixty patients, 22 males and 38 females, aged 60 - 85 years, ASA physical status Ⅱ or Ⅲ, who underwent general anesthesia experienced unilateral TKA were sent to recovery room after extubation and the single femoral nerve block combined with sciatic nerve block were performed by ultrasound-guidaned. All patients were randomly allocated into two groups according to different approaches of sciatic nerve block (30 cases in each): lateral approach (group L), sciatic nerve block was performed at the upper middle segment of the femoral shaft under the supine position; posterior approach (group P), sciatic nerve block was performed between ischial tuberosity and the greater trochanter of the femur under lateral position. The date were collected included the performance time, depth of needle, the lowest averagemean current, the success rate, the onset and duration time of sciatic nerve sensory blockade, also embraced patients’ satisfaction ratings scale. Rest and movement visual analogue score (VAS),the occurrence of complications at different points of 36 h after operation were recorded.
Results Compared with group P, the performance time,and the depth of needle were significantly shorter in group L (P < 0.05), the success rate and the patients’ satisfaction were higher in group L (P < 0.05). There was no statistically significant difference in VAS score, the using of postoperative analgesic and the muscle strength between two groups. The anesthetic complications such as local red and swollen, infection, nerve injury and other relatives were no observed within 36 h in the two groups.
Conclusion Compared with intertrochanteric posterior approach, ultrasound guided lateral approachsciatic nerve block can provide an ideal effect in early postoperative analgesia after TKA. It is a simple, safe and effective technology for sciatic nerve block. |
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