超声引导下踝关节周围神经阻滞在足部清创手术中的应用

Ultrasound-guided peri-ankle nerve block for forefoot debridement

目的探讨B超引导下踝关节周围神经阻滞用于足部清创的可行性及安全性。方法选择本院2012年6月至2013年6月足部急诊清创患者60例,ASAⅠ~Ⅲ级,随机分为超声引导下踝关节周围神经阻滞组(研究组,NB组)和局麻组(对照组,LA组),每组30例:研究组行超声引导下踝关节周围神经阻滞,对照组于手术区域周围行局部浸润麻醉,两组均采用1.0%利多卡因。分别记录麻醉前、手术中及手术后的血压(MBP)、心率(HR)等生命征情况,视觉模拟疼痛评分(VAS)及局麻药用量和局部麻醉药毒性反应等并发症情况。结果 LA组在术中及术后患者血压(waldχ2=15.7,P<0.01)、心率(waldχ2=42.7,P<0.01)、疼痛VAS评分(waldχ2=78.4,P<0.01)均显著高于NB组,两组局麻药用量无明显差别(P>0.05),但LA组局麻药毒性反应发生率高于NB组(P<0.05)。结论 B超引导下踝关节神经阻滞麻醉效果确切、减少局麻药毒性反应,可安全有效地应用于足部清创手术的麻醉。

Objective To investigate the feasibility and security of ultrasound-guided periankle nerve blocks for forefoot debridement. Method 60 ASA Ⅰ~Ⅲ patients who underwent emergency forefoot debridement were enrolled in our hospital from June 2012 to June 2013 and were randomly divided into two groups(n = 30): LA group: 1.0% of lidocaine local anesthesia; NB group: ultrasound-guided peri-ankle nerve blocks with 1.0% lidocaine. MBP, HR, VAS were recorded before anesthesia, during operation and post-operation.The amount of local anesthesia, and the complication were also recorded. Result The intraoperative and postoperative MBP(wald χ2=15.7,P <0.01), HR(wald χ2=42.7,P <0.01) and VAS scores(wald χ2=78.4,P <0.01)in LA group were significantly higher than those of NB group, and there was no significant difference in the amount of local anesthetic(P>0.05)between the two groups, but the rate of local anesthetic toxicity was higher in the LA group(P<0.05). Conclusion Ultrasound-guided peri-ankle nerve block can be safely and effectively used in the anesthesia for the forefoot debridement surgery.