神经鞘膜下注射与鞘外注射对超声引导下腘窝坐骨神经阻滞效果的影响  

Effect of Injection Inside vs Outside Paraneural Sheath on Ultrasound-Guided Popliteal Sciatic Block

作　　者：冯磊[1] 周雁[1] 白岚[1] 种皓[1] 郗扬 赵旸[1] 王庚[1] 郭鸿飞 FENG Lei;ZHOU Yan;BAI Lan;CHONG Hao;XI Yang;ZHAO Yang;WANG Geng;GUO Hongfei(Department of Anesthesio-logy,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Anesthesiology,Beijing Dongzhimen Hospital of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京积水潭医院麻醉科,北京100035 [2]北京市东直门中医院麻醉科,北京100700

出　　处：《医学综述》2019年第23期4593-4599,4606,共8页Medical Recapitulate

基　　金：首都卫生发展科研专项(首发2018-1-2072)

摘　　要：目的比较超声引导下腘窝坐骨神经阻滞时,神经鞘膜下注射(IPS)及鞘外注射(OPS)的阻滞效果及阻滞相关并发症发生情况,为超声引导下腘窝坐骨神经阻滞最佳路径的选择提供理论基础。方法选取2018年1—6月北京积水潭医院择期或急诊行踝关节骨折手术患者60例(骨折部位均不累及内踝),采用随机数字法分为IPS组及OPS组,每组30例。所有患者均采用超声引导侧入路腘窝坐骨神经阻滞,使用0.5%罗哌卡因20 mL,所有手术均在蛛网膜下腔阻滞下完成。比较两组患者操作相关情况、阻滞完全时间、感觉运动阻滞持续时间、术后数字评分法(NRS)评分、术后首次觅求阿片类药物时间及各时间段内舒芬太尼消耗量以及两组患者阻滞及镇痛相关并发症发生情况的差异。结果IPS组操作时间及进针次数少于OPS组[(3.6±1.0)min比(4.5±1.1)min,(2.9±1.1)次比(4.3±1.0)次](P<0.01),而两组操作引起的NRS评分及患者对麻醉操作的满意度比较差异无统计学意义(P>0.05)。OPS组有2例患者阻滞后30 min未达到阻滞完全指标,IPS组阻滞完全时间快于OPS组[(19.3±3.9)min比(28.6±3.0)min](P<0.01)。IPS组患者感觉及运动阻滞持续时间长于OPS组[(21.3±5.3)h比(18.3±3.7)h,(16.2±4.2)h比(13.9±2.9)h],术后虚弱感评分高于OPS组[2.0(1.0,3.0)分比1.0(0.8,2.0)分](P<0.01)。两组患者在术后12 h内均未使用阿片类药物,IPS组术后阿片类药物使用总量低于OPS组(P<0.05)。两组患者均未见阻滞相关并发症的发生。结论与神经OPS相比,超声引导下腘窝处坐骨神经阻滞神经IPS起效更快,感觉及运动阻滞维持时间更长,两者可提供相似的术后镇痛效果,避免了术后12 h内阿片类药物的使用。Objective To compare the blockage effects and complications between the inside paraneural sheath injection(IPS)and outside paraneural sheath injection(OPS)for ultrasound-guided popliteal sciatic block,providing theoretical evidence for the selection of the best approach in clinical practice.Methods Sixty patients undergoing selective or emergency ankle fracture(no medial malleolus was involved in the fracture site)surgery in Beijing Jishuitan Hospital from Jan.to Jun.2018 included in the study and randomized to either the injection inside the paraneural sheath of sciatic nerve group(group IPS)or the injection outside the paraneural sheath group(group OPS),30 cases each.Ultrasound-guided popliteal sciatic block was performed using 0.5%ropivacaine 20 mL through a lateral approach,and all surgeries were finished under subarachnoid anesthesia.The related indexes were compared between two groups:operation related information,time to complete block,duration of sensory and motor block,and postoperative analgesic effects(numeric rating scale,NRS),the time of first time for seeking opioids postoperatively and the total usage of sulfentanyl in different time intervals,as well as the occurrence of related complications.Results Duration and number of injection were significantly decreased in group IPS as compared with group OPS[(3.6±1.0)min vs(4.5±1.1)min,(2.9±1.1)times vs(4.3±1.0)times](P<0.01),but NRS score and patient′s satisfaction of the two methods did not significantly differ(P>0.05).block complete time of the IPS group was shorter than OPS group[(19.3±3.9)min vs(28.6±3.0)min](P<0.01),in OPS group 2 cases had not obtained complete block within 30 min after injection.Group IPS sensory and locomotor block lasts longer than group OPS[(21.3±5.3)h vs(18.3±3.7)h,(16.2±4.2)h vs(13.9±2.9)h]and lower postoperative weakness score[2.0(1.0,3.0)point vs 1.0(0.8,2.0)point](P<0.01).Opioids were used in neither group in 12 hours following the surgery.The total amount of opioids used in the IPS group was lower than that in

关 键 词：麻醉 阻滞 坐骨神经 超声 神经外膜 神经鞘膜 

分 类 号：R614.4[医药卫生—麻醉学]