连续外周神经阻滞用于骨科手术的并发症和不良反应

背景连续外周神经阻滞（CPNBs）的快速普及使研究者可以对其不良反应和并发症做进一步研究。方法在全麻或腰麻前，对骨科手术患者采用标准置管技术实施前路坐骨神经、股神经或肌间沟臂丛神经连续阻滞，观察与CPNBs有关的并发症和不良反应。结果我们连续观察了2002年至2004年间849例患者（平均年龄65±13岁）的1398次CPNBs，其中有221例患者接受肌间沟臂丛神经阻滞，628例患者接受股神经阻滞，549例坐骨神经阻滞。后者同时实施股神经和坐骨神经阻滞：总体来看，有9例（0．6％）患者出现穿刺点局部炎症，3例（0．2％，均为连续股神经阻滞）出现局部感染（脓疱）。1例实施股神经阻滞者发生腹膜后血肿导致股神经压迫性损伤。使用神经肌肉电刺激仪确认股四头肌完全去神经支配。未发现其他严重的神经系统并发症。有1例肌间沟臂丛神经阻滞者发生高铁血红蛋白血症。约有6％的股神经和腰丛阻滞患者有血管损伤。1例患者发生导管断裂。结论我们的结果进一步证实CPNBs的严重并发症很罕见，而轻度不良反应可能更常见。

BACKGROUND： The increasing popularity of continuous peripheral nerve blocks （CPNBs） warrants further study of their adverse effects and complications. METHODS： Anterior sciatic, femoral, and interscalene brachial plexus CPNBs were performed preoperatively using standardized catheter techniques in orthopedic patients prior to general or spinal anesthesia. Complications and adverse effects related to CPNBs were prospectively evaluated. RESULTS： We analyzed 1398 CPNBs in 849 consecutive patients （mean age 65 ± 13 yr） between 2002 and 2004. Two-hundred-twenty-one patients received interscalene, 628 patients femoral, and 549 sciatic CPNBs, respectively. In all the latter patients, we performed both femoral and sciatic CPNBs. Overall, there were 9 cases of local inflammation at the insertion site （0. 6%）, and 3 local infec- tions （pustule） （0.2%, all femoral CPNBs）. In one patient undergoing a femoral technique, a retroperitoneal hero.aroma led to compression injury of the femoral nerve. Complete denervation of the quadriceps femoris muscle was confirmed by electro- neuromyography. No other major neurological complications were noted. There was one case of methemoglobinemia associated with an interscalene CPNB. Vascular puncture occurred in approximately 6% of patients undergoing femoral and sciatic CPNBs. Catheter rupture was noted in one patient. CONCLUSIONS： Our results add to the evidence that major complications from CPNBs are rare. However. minor adverse effects associated with CPNBs may be more common.