腘窝坐骨神经阻滞对急性足踝骨折术后疼痛的影响  

Effect of Ultrasound-guided Popliteal Sciatic Nerve Block on Postoperative Analgesia in Patients Undergoing Acute Ankle Fracture Surgery

作　　者：张娟[1] 孙艳[1] ZHANG Juan;SUN Yan(Department of Anesthesiology,the First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China)

机构地区：[1]苏州大学附属第一医院麻醉科,江苏苏州215006

出　　处：《中国血液流变学杂志》2019年第2期158-161,共4页Chinese Journal of Hemorheology

基　　金：国家自然科学基金资助项目(81601666)。

摘　　要：目的观察超声引导下腘窝坐骨神经阻滞用于急性足踝骨折术后疼痛的影响.方法选择急性跟骨或外踝骨折患者50例随机分为两组,每组25例.A组喉罩全身麻醉,B组超声引导下腘窝入路坐骨神经阻滞后行喉罩全身麻醉.两组患者按需自控给予静脉吗啡泵入.记录两组术后2、4、6、9、12、15、18、21、24 h时静息和运动时的VAS评分、不同时段吗啡用量以及不良反应的发生等指标.结果术后2、4、6、9 h,B组VAS评分均显著低于A组(P<0.01);在术后12 h,两组VAS评分差异无统计学意义(P>0.05);术后15、18、21、24 h,A组VAS评分均显著低于B组(P<0.01);在术后12 h内每个时间段A组吗啡消耗量高于B组(P<0.01),但在12~24 h时间段内,B组吗啡消耗量高于A组(P<0.01).两组患者术后恶心呕吐例数差异无统计学意义(P>0.05).结论超声引导下坐骨神经阻滞在术后12 h内能有效缓解足部、踝部手术术后疼痛,减少阿片类镇痛药物使用量.但是在术后12~24 h,坐骨神经阻滞组出现暴发痛,阿片类镇痛药物使用量也大大增加,这大大削弱了其优势.Objective To investigate the effect of ultrasound-guided popliteal sciatic nerve block on postoperative analgesia in patients undergoing acute ankle fracture surgery. Methods 50 patients with acute malleolus, calcaneal and lateral foot fractures scheduled for open reduction and internal fixation were enrolled into this study. They were randomly assigned to receive general anesthesia only (group A) or receive ultrasound-guided popliteal sciatic nerve block combined with general anesthesia (group B). All patients received PCIA after operations. The resting and exercise visual analogue scale (VAS) scores, opioid requirements and adverse reactions were recorded at 2, 4, 6, 9, 12, 15, 18, 21 and 24 h after operation. Results The resting and exercise VAS scores at 2, 4, 6 and 9 h were lower in group B than those in group A (P<0.01). At 12 h, there was no significant difference between the two groups (P>0.05), but at 15, 18, 21 and 24 h the resting and exercise VAS scores were lower in group A than those in group B (P<0.01). However, when analyzing the total opioid use by time, postoperative opioid consumption at the first 12 h was lower in group B than that in group A (P<0.01). Postoperative opioid consumption during the 12-hour interval (from 12 to 24 h) was lower in group A than that in group B (P<0.01). There was no significant difference between the two groups in adverse reactions. Conclusion Ultrasound-guided popliteal sciatic nerve blockade combined with general anesthesia in acute ankle fracture surgery can provide good anesthesia status with reduced postoperative pain. However, rebound pain upon cessation of the blocks is a clinically relevant and potentially very problematic issue with the potential to outweigh the benefits.

关 键 词：坐骨神经阻滞 术后镇痛 超声 

分 类 号：R614.4[医药卫生—麻醉学]