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| 超声引导下大转子下与腘窝上外侧入路坐骨神经阻滞在全膝关节置换术后的镇痛效果 |
| Effect of ultrasound-guided lateral approach under the greater trochanter and lateral approach above popliteal fossa sciatic nerve blockade on postoperative analgesia following total knee arthroplasty |
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| DOI：10.12089/jca.2019.08.003 |
| 中文关键词: 超声引导 外侧入路 坐骨神经阻滞 全膝关节置换术 |
| 英文关键词: Ultrasound-guided Lateral approach Sciatic nerve block Total knee arthroplasty |
| 基金项目:佛山市卫生局研究计划课题（2014178）；佛山市科技创新项目（FS0AA-KJ218-1301-0041） |
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| 中文摘要: |
目的 比较超声引导下大转子下与腘窝上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效果。
方法 选择气管内全麻下行单侧TKA手术的患者60例，男20例，女40例，年龄>60岁，ASA Ⅱ或Ⅲ级，术毕待清醒拔管后在超声联合神经刺激仪引导下行单次股神经及坐骨神经阻滞镇痛，根据坐骨神经阻滞入路的不同将患者随机分为两组：大转子下外侧入路坐骨神经阻滞组（LG组）和腘窝上外侧入路坐骨神经阻滞组（LP组），每组30例。记录坐骨神经阻滞操作完成时间、尝试穿刺次数、穿刺针深度、感觉及运动阻滞起效时间、持续时间；记录穿刺及阻滞成功例数、患者满意度评分等；记录术后2、4、8、12、24、36 h静息及活动时VAS评分。
结果 LP组坐骨神经阻滞操作完成时间明显短于LG组（P＜0.05），尝试穿刺次数明显少于LG组（P＜0.05），穿刺针深度明显浅于LG组（P＜0.05），穿刺及阻滞成功率、患者满意度评分明显高于LG组（P＜0.05）。两组感觉及运动阻滞起效时间、持续时间、术后不同时点静息及活动时VAS评分差异无统计学意义。
结论 超声联合神经刺激仪引导下腘窝上外侧入路坐骨神经阻滞较大转子下外侧入路进针深度更浅，穿刺、阻滞成功率及患者满意度更高，为一种优化后外侧入路坐骨神经阻滞穿刺技术。 |
| 英文摘要: |
Objective To compare efficacy of ultrasound-guided lateral under the greater trochanter and lateral above popliteal fossa sciatic nerve blockade on postoperative analgesia following total knee arthroplasty (TKA).
Methods Sixty patients, 20 males and 40 females, aged > 60 years, ASA physical status Ⅱ or Ⅲ, undergoing general anesthesia experienced unilateral TKA were selected. After extubation, single femoral nerve block combined with sciatic nerve blockwere performed. All the patients were randomly allocated into two groups according to different approaches of sciatic nerve blockade (30 cases in each): group LG (lateral approach under the greater trochanter) and group LP (lateral approach above popliteal fossa). The data of sciatic nerve blockade were collected included the performance time, the number of attempts, the depth of needle, the presence and duration time of motor and sensory block. The success rate of blockade and puncture and the patients' satisfaction ratings scale were measured. Rest and movement visual analogue score (VAS) were collected 2, 4, 8, 12, 24 and 36 h after surgery.
Results Compared with group LG, the performance time and the depth of needle were significantly shorter and the number of attempts was less in group LP (P < 0.05). The success rate of the block and puncture and the patients' satisfaction were higher in group LP than in group LG (P < 0.05). There was no significant difference in the presence and duration time and VAS scores in different time at rest and movement between two groups.
Conclusion The ultrasound combined with neurostimulator guided lateral approach above popliteal fossa sciatic nerve blockade can reduce the performance time and the depth of needle compared with lateral approach under the greater trochanter. Moreover, the success rate of the blockade and puncture, the patients' satisfaction were higher above popliteal fossa approach. It's a new optimization technique for sciatic nerve block. |
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