神经刺激仪引导下腘窝坐骨神经并隐神经阻滞用于拇外翻手术的临床观察

Clinical observation of stimulator guided popliteal sciatic nerve and saphenous nerve block for hallux valgus operation

目的 观察神经刺激仪引导下腘窝坐骨神经并隐神经阻滞用于拇外翻矫正术中穿刺的准确性、并发症情况及麻醉效果,并与硬膜外麻醉进行比较。方法 择期拇外翻矫正术48例,年龄18-70岁,ASAⅠ-Ⅲ级,随机分为腘窝坐骨神经并隐神经阻滞组（P组,n=24）和硬膜外阻滞组（E组,n=24）。P组采用神经刺激仪引导下腘窝坐骨神经并隐神经阻滞,E组采用硬膜外麻醉,选L3-4间隙穿刺,成功后两组均注入1%利多卡因与0.5%罗哌卡因混合液。观察两组血流动力学,感觉、运动阻滞效果,术后镇痛情况,不良反应及舒适满意度。结果 P组血流动力学稳定,感觉和运动阻滞起效时间与E组比较差异无统计学意义[（9±8）min vs.（12±5）min,（14±5）min vs.（16±8）min,P〉0.05];恢复时间长于E组[（562±125）min vs.（346±91）min,（392±85）min vs.（262±95）min,P〈0.05];不良反应少,舒适满意度高于E组。结论 神经刺激仪引导下腘窝坐骨神经并隐神经阻滞用于拇外翻手术麻醉效果满意,术中血流动力学稳定,术后镇痛时间长,不良反应轻微,患者满意度高,是拇外翻矫正术较好的麻醉方法。

Objective To observe the accuracy, effect and complications of the nerve stimulator guided popliteal sciatic nerve and saphenous nerve block for hallux valgus. Methods Forty-eight cases who were electively operated for hallux valgus, aged 18-70 years old, ASA I-Ⅲ grade, were randomly divided into the popliteal sciatic nerve and saphe-nous nerve block group （group P, n=24） and epidural anesthesia group （group E, n=24）. In group P, popliteal sciatic nerve and saphenous nerve block was guided by a nerve stimulator. In group B, epidural anesthesia was performed at L3-4. Pa-tients of these two groups were injected with 1% lidocaine and 0.5% ropivacaine after being successfully punctured. Sub-squently, the mixed liquid of 1%lidocaine and 0.5%bupivacaine was injected. The two groups were observed for hemody-namics, sensory motor block effects, postoperative analgesia, adverse reactions and comfort of patients. Results Compared with group E, hemodynamics of group P was more stable, while sensory and motor block onset time was not significantly different （P〉0.05）, the analgesia maintaining time was significantly longer than that of group E （P〈 0.05）, at the same time, less adverse reactions were observed, and patients were more comfortable. Conclusion The nerve stimulator guided popliteal sciatic nerve and saphenous nerve block for hallux valgus operation is a good choice with satisfactory block ef-fects, stable hemodynamics, longer time of postoperative analgesia, few complication and more patient satisfaction.