布比卡因脂质体腘窝坐骨神经-隐神经阻滞对足踝手术后镇痛的影响  

Effect of liposomal bupivacaine popliteal sciatic-saphenous nerve block on postoperative analgesia following foot and ankle surgery

作　　者：张绍刚[1] 孙振全[1] 李陆军[1] 童建华 樊迪 ZHANG Shaogang;SUN Zhenquan;LI Lujun;TONG Jianhua;FAN Di(Department of Anesthesiology,Nanjing Integrated Traditional Chinese and Western Medicine Hospital,Nanjing 210014,China)

机构地区：[1]南京市中西医结合医院麻醉科,210014 [2]南京医科大学第二附属医院麻醉科

出　　处：《临床麻醉学杂志》2025年第4期376-381,共6页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金(82172131)。

摘　　要：目的探讨布比卡因脂质体用于腘窝坐骨神经-隐神经阻滞对足踝手术患者术后镇痛效果的影响。方法选择行足踝骨折切开复位内固定术的患者88例,男50例,女38例,年龄18~80岁,BMI 18.5~30.0 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分两组:布比卡因脂质体复合布比卡因组(LB组)和地塞米松复合布比卡因组(BD组),每组44例。LB组给予布比卡因脂质体199.5 mg与布比卡因50 mg,BD组给予布比卡因112.5 mg与地塞米松6 mg,均用生理盐水稀释至30 ml。两组均行腘窝坐骨神经-隐神经阻滞,腘窝坐骨神经阻滞注射20 ml,隐神经阻滞注射10 ml。记录首次镇痛时间,术后6、12、24、48和72 h静息和活动时(踝关节屈伸活动)数字评定量表(NRS)疼痛评分和曲线下面积(AUC)。记录术后0~12 h、>12~24 h、>24~48 h和>48~72 h羟考酮累积消耗量、镇痛泵总按压次数和有效按压次数,术后72 h内恶心、呕吐、头晕、嗜睡和皮肤瘙痒等不良反应发生情况。结果与BD组比较,LB组首次镇痛时间明显延长(P<0.05),术后24 h和48 h静息和活动时NRS疼痛评分明显降低(P<0.05),术后72 h静息和活动时NRS疼痛评分AUC明显减小(P<0.05),术后>24~48 h和>48~72 h羟考酮累积消耗量、镇痛泵总按压次数和有效按压次数明显减少(P<0.05)。两组术后恶心、呕吐、头晕、嗜睡和皮肤瘙痒等不良反应差异无统计学意义。结论布比卡因脂质体可有效延长布比卡因行腘窝坐骨神经-隐神经阻滞的镇痛持续时间,减轻术后疼痛,并减少阿片类药物的使用量。Objective To evaluate the effect of liposomal bupivacaine on postoperative analgesia in patients undergoing foot and ankle surgery under combined popliteal sciatic-saphenous nerve block.Methods Eighty-eight patients,50 males and 38 females,aged 18-80 years,BMI 18.5-30.0 kg/m^(2),ASA physical statusⅠ-Ⅲ,scheduled for open reduction and internal fixation of foot/ankle fractures were enrolled.Patients were randomized into two groups using a random number table:liposomal bupivacaine combined with bupivacaine(group LB)and dexamethasone combined with bupivacaine(group BD),44 patients in each group.Group LB received liposomal bupivacaine 199.5 mg and bupivacaine 50 mg,while group BD received bupivacaine 112.5 mg and dexamethasone 6 mg,both diluted with normal saline to 30 ml.All patients underwent popliteal sciatic nerve block and saphenous nerve block,with 20 ml injected for the popliteal block and 10 ml for the saphenous block.Outcomes included time to first analgesic request,numerical rating scale(NRS)pain scores at rest and during activity(ankle dorsiflexion and plantar flexion)at 6,12,24,48,and 72 hours postoperatively,and the area under the curve(AUC)for pain scores.Cumulative oxycodone consumption,total patient-controlled analgesia(PCA)button presses,and effective PCA button presses during the intervals of 0-12 hours,>12-24 hours,>24-48 hours,and>48-72 hours postoperatively were recorded.The incidence of adverse effects,including nausea,vomiting,dizziness,somnolence,and pruritus was also recorded within 72 hours postoperatively.Results Compared with group BD,group LB had a significantly prolonged time to first analgesic request(P<0.05),significantly lower NRS pain scores at rest and during activity at 24 and 48 hours postoperatively(P<0.05),as well as a significantly lower AUC for NRS pain scores at rest and during activity at 72 hours postoperatively(P<0.05).The cumulative oxycodone consumption,total PCA button presses,and effective PCA button presses were significantly reduced during the intervals of>24-48 h

关 键 词：坐骨神经阻滞 隐神经阻滞 布比卡因 脂质体 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]