股骨外侧旁入路连续坐骨神经阻滞用于足踝手术后自控镇痛的效果  

Efficacy of lateral femoral approach to continuous sciatic nerve block for patient-controlled analgesia after foot and ankle surgery

作　　者：殷臣竹 张兰[1] 吴文知[1] 杨光[1] 张进[1] 李培玉[1] 向芮 

机构地区：[1]四川省骨科医院麻醉科,成都市610041

出　　处：《中华麻醉学杂志》2017年第6期678-680,共3页Chinese Journal of Anesthesiology

基　　金：四川省医学会科研课题

摘　　要：目的评价股骨外侧旁入路连续坐骨神经阻滞用于足踝手术后fj控镇痛的效果。方法择期足踝于_术病人100例，ASA分级I-Ⅲ级，年龄18～60岁，体重50～100kg，身高145～190cm，性别小限，采用随机数宁表法分为2组（n=50）：病人自控坐骨神经阻滞镇痛组（PCNA组）和病人自控静脉镇痛组（PCIA组）。PCNA组在超声联合神经刺激器引导下实施股骨外侧入路坐骨神经阻滞，定位成功后注入0．2％罗哌卡因20ml，置入神经丛导管，再注入0．2％罗哌卞因10ml。PCIA组坐骨神经定位成功后注入0．2％罗哌卡冈30ml。均采用喉罩全身麻醉，术毕PCNA组采用0．2％罗哌#因（用生理盐水稀释至200m1）行PCNA，背景输汪速率5ml／h，PCA剂量0．5ml，锁定时州15min；PCIA组采用舒芬太尼100斗g＋曲马多500mg＋托烷司琼10mg（用生理盐水稀释至200m1）行PCIA，背景输注速率2ml／h，PCA剂撼0．5m1，锁定时间15rain，维持VAS评分≤3分，均镇痛至术后72h。当VAS评分≥4分时，肌肉注射曲马多100mg进行镇痛补救。记录术后72h内镇痛补救悄况和恶心、呕叶、失眠、穿刺郎位感染、出血等不良反应的发生情况。结果与PCIA组比较，PCNA组镇痛补救率和恶心、呕吐发牛率降低（P〈0．05）。结论股骨外侧旁入路连续坐骨神经阻滞可安全有效地用于足踝手术病人术后自控镇痛。Objective To evaluate the efficacy of lateral femoral approactl to continuous sciatic nerve block for patient-controlled analgesia after loot and ankle surgery. Methods One hundred American Society of Anesthesiologists physical status Ⅰ -Ⅲ patients of both sexes, aged 18-60 yr, weighing 50-100 kg, with body height of 145-190 cm, scheduled for elective foot and ankle surgery, were divided into 2 groups （n= 50 each ） using a randonl number table： patient-controlled nerve block analgesia （PCNA） group anti patient-controlled intravenous analgesia （PCIA） group. In group PCNA, the lateral femoral ap- proach to sciatic nerve block was perfi^rmed under the guidanee of ultrasound and a neurostimulator, 0.2% ropivacaine 20 ml was injected after successful location, the catheter was inserted, anti 0.2% rnpivacaiue 10 nd was injected again. In group PCIA, 0.2% ropivacaine 30 ml was injected after successful locatiou of the sciatic nerve. General anesthesia was performed using laryngeal mask airway in both groups. In group PCNA, PCNA was performed with 0. 2% ropivacaine （diluted to 200 ml in normal saline） at the end of surgery, and the PCNA pump was set up with a 0.5 ml bolus dnse, a 15-nfin lockout interval and back- ground infusion at a rate of 5 ml/h. In group PCIA, PCIA was performed with sufentanil 100 p,g, tramadol 500 mg and tropisetron 10 mg （diluted to 200 ml in normal saline） at the end of surgery, and the PC1A pump was set up with a 0. 5 ml bolus dose, a 15-min lockout interval and background infusion at a rate of 2 ml/h. The visual analog seale seore was maintained≤ 3, and postoperative analgesia lasted until postopera- tive 72 h. When visual analog scale seores ≥ 4, tramadol 100 mg was intramuseularly injeeted as rescue analgesic. The requirement for rescue analgesia and development of adverse effects such as nausea and vom- iting, insomnia, puncture site infection and bleeding were recorded within 72 h afler surgery. Results The requirement for reseue analgesia and incidenee of nau

关 键 词：神经传导阻滞 坐骨神经 镇痛 病人控制 

分 类 号：R614[医药卫生—麻醉学]