超声联合神经刺激仪引导改良侧入路坐骨神经阻滞术用于足部手术的临床评价

Clinical evaluation of modified lateral approach to sciatic nerve block guided by ultrasound and nerve stimulator for foot surgery

目的 评价超声联合神经刺激仪引导改良侧入路坐骨神经阻滞术用于足部手术的可行性.方法 择期行足部手术患者62例,性别不限,年龄18 ～ 60岁,BMI＜ 30 kg/m2,ASA分级Ⅰ-Ⅲ级.静脉注射异丙酚2～4 mg/kg和舒芬太尼0.2 ～ 0.4 μg/kg麻醉诱导后置入喉罩并行机械通气,持续吸入七氟醚.在超声联合神经刺激仪引导下于改良侧入路（股骨中上1/3附近）实施坐骨神经阻滞术,注入0.3％罗哌卡因30 ml.坐骨神经阻滞完成后,静脉注射罗库溴铵0.6 mg/kg,静脉输注异丙酚1 ～2 mg· kg-1·h-1.切皮即刻追加舒芬太尼0.10～ 0.15 μg/kg,术中间隔1h静脉注射罗库溴铵0.15mg/kg.记录穿刺深度、穿刺时间、穿刺成功情况.术毕患者完全清醒后,评价感觉阻滞情况.记录术后72 h内神经损伤、穿刺部位血肿和感染等的发生情况.结果 穿刺时间为（40±17）s,穿刺深度为（5.8±0.7） cm,一次性穿刺成功率为77％,感觉完全阻滞率为100％.术后随访未见神经损伤、穿刺部位血肿和感染等发生.结论 超声联合神经刺激仪引导下改良侧入路法坐骨神经阻滞术用于足部手术安全有效.

Objective To evaluate the feasibility of modified lateral approach to sciatic nerve block guided by ultrasound and nerve stimulator for foot surgery.Methods Sixty-two patients of both sexes,aged 18-60 yr,with body mass index 〈 30 kg/m2,of ASA physical status Ⅰ-Ⅲ,scheduled for elective foot surgery,were included in the study.Anesthesia was induced with iv propofol 2-4 mg/kg and sufentanil 0.2-0.4 μg/kg.The laryngeal mask airway was inserted and the patients were mechanically ventilated.Sevoflurane was inhaled continuously.Modified lateral approach to sciatic nerve block was performed with 0.3 % ropivacaine 30 ml under the guidance of the ultrasound combined with nerve stimulator.Rocuronium 0.6 mg/kg and propofol 1-2 mg· kg-1 · h-1 were administered after completion of sciatic nerve block.Additional sufentanil 0.10-0.15 μg/kg was intravenously injected immediately after skin incision and rocuronium 0.15 mg/kg was injected intravenously at 1 h intervals.The depth of puncture and time for puncture and success rate of puncture were recorded.Sensory block was assessed after the patients regained consciousness completely.Nerve injury,hematoma at the puncture site and infection within 72 h after surgery were recorded.Results The time for puncture was （40 ± 17） s.The depth of puncture was （5.8 ± 0.7） cm.The success rate of puncture at first attempt was 77 %.The rate of complete sensory block was 100%.The post-operative follow-up showed that no patients developed nerve injury,hematoma or infection.Conclusion Modified lateral approach to sciatic nerve block guided by ultrasound and nerve stimulator is safe and effective for foot surgery.