超声引导下隐神经与坐骨神经联合置管阻滞应用于踝关节骨折术后镇痛  

Ultrasound-guided saphenous nerve and sciatic nerve block with indwelling catheter for postoperative analgesia of ankle fracture surgury

作　　者：喻翔卿[1] 赵以松[1] 陆季娟 陈梅花 沈劼颖 YU Xiang-qing;ZHAO Yi-song;LU Ji-juan;CHEN Mei-hua;SHEN Jie-ying(Department of Anesthesiology,Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine,Suzhou,Jiangsu 215009,China)

机构地区：[1]南京中医药大学附属苏州市中医医院麻醉科

出　　处：《中国临床研究》2019年第10期1389-1392,共4页Chinese Journal of Clinical Research

基　　金：苏州市科技发展计划(应用基础研究-医疗卫生)项目(SYSD2015126)~~

摘　　要：目的观察超声引导下隐神经与坐骨神经置管阻滞在踝关节骨折患者术后镇痛中的应用效果。方法选择2016年1月至2018年12月单侧踝关节骨折患者75例,在腰麻下行内外踝切开复位内固定术,术后随机分为三种术后镇痛组:连续隐神经与坐骨神经置管阻滞组(A组,25例);单次隐神经阻滞+连续坐骨神经置管阻滞组(B组,25例);静脉芬太尼PCIA组(C组,25例)。记录术后48h内各时点的数字疼痛评定量表评分(NPRS)和股四头肌肌力,阿片类药物使用量,患者镇痛满意度和不良反应发生情况。结果A、B组在术后6~12h静息和运动时NPRS评分差异无统计学意义(P均>0.05),并均显著低于C组(P均<0.01);A组在术后18~36h静息和运动时NPRS评分均低于B、C组(P<0.05,P<0.01);A、B组在术后6~36h芬太尼用量及芬太尼总量均少于C组(P均<0.01);三组患者术后各时点股四头肌肌力比较,差异无统计学意义(P均>0.05)。术后阿片类药不良反应发生率以C组最高(P<0.01)。患者镇痛满意度评分以A组最高(P<0.01)。结论超声引导下的连续隐神经与坐骨神经联合阻滞能有效缓解踝部术后疼痛,减少阿片类镇痛药物使用量,提高患者舒适度。Objective To observe the effect of ultrasound-guided saphenous nerve and sciatic nerve block with indwelling catheter on postoperative analgesia in patients with ankle fracture.Methods Seventy-five patients with unilateral ankle fracture were selected,who underwent open reduction and internal fixation of internal and external malleolus under lumbar anesthesia from January 2016 to December 2018.According to the postoperative analgesia methods,the patients were randomly divided into continuous saphenous nerve and sciatic nerve block group(group A,n=25),single saphenous nerve block plus continuous sciatic nerve block group(group B,n=25),patient-controlled intravenous analgesia(PCIA) with fentanyl(group C,n=25).The numerical pain rating scale(NPRS),quadriceps femoris muscle strength,opioid use,patient satisfaction and adverse reactions were recorded within 48 hours after operation.Results NPRS scores were similar at rest and during exercise 6-12 hours after operation between group A and group B(all P>0.05),and were significantly lower than those in group C(all P<0.01).At 18-36 hours postoperatively,NPRS scores at rest and during exercise in group A were statistically lower than those in group B and C(P<0.05,P<0.01).The dosage of fentanyl and the total amount of fentanyl used in group A and B were significantly less than those in group C at 6-36 hours after operation(all P<0.01).There was no significant difference in quadriceps femoris muscle strength among three groups at different time points after operation(all P>0.05).The incidence of adverse reactions of opioids was the highest in group C(P<0.01),and analgesic satisfaction of patients was the best in group A(P<0.01).Conclusion Ultrasound-guided continuous saphenous nerve and sciatic nerve block can effectively relieve postoperative pain of ankle fracture surgery,reduce the dosage of opioid analgesics and improve the patients′ comfort.

关 键 词：连续隐神经阻滞 连续坐骨神经阻滞 踝关节骨折 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]