神经刺激器与超声引导连续股神经阻滞用于患者膝关节术后镇痛临床价值的比较

Clinical value of nerve stimulator-versus ultrasound-guided continuous femoral nerve block for analgesia after laparoscopic surgery

目的 比较神经刺激器与超声引导连续股神经阻滞用于患者膝关节术后镇痛的临床价值.方法 择期行膝关节镜手术患者40例,年龄18～60岁,体重指数18 ～ 30 kg/m2,性别不限,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为2组（n=20）：神经刺激器组（S组）和超声组（U组）.2组均行连续硬膜外麻醉,用药为1.73％碳酸利多卡因.2组术后持续输注0.2％罗哌卡因5ml/h行股神经阻滞进行镇痛.分别于术后2、6、24和48 h时行静态VAS评分,于术后24和48 h时行主动运动及被动运动VSA评分,记录股神经旁置管时间、穿刺点皮下血肿及局麻药中毒、恶心和呕吐等发生情况,记录术后补救镇痛情况.结果 2组术后VAS评分、股神经阻滞穿刺和局麻药的相关不良事件发生率差异无统计学意义（P＞0.05）.S组和U组股神经旁置管时间分别为8.0± 1.4和（6.7±0.9）min,S组长于U组（P＜0.01）.2组术后均未进行补救镇痛.结论 神经刺激器引导连续股神经阻滞用于患者膝关节术后镇痛的临床价值高于超声引导,更适合临床推广应用.

Objective To compare the clinical value of nerve stimulator-versus ultrasound-guided continuous femoral nerve block for analgesia after laparoscopic surgery.Methods Forty patients,aged 18-60 yr,with body mass index of 18-30 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic surgery,were randomly assigned into 2 groups （n =20 each） using a random number table：nerve stimulator group （group S） and ultrasound group （group U）.Epidural anesthesia was performed with 1.73 % carbonated lidocaine in both groups.0.2% ropivacaine 5 ml/h was infused continuously after surgery to perform femoral nerve block for analgesia.VAS score at rest was assessed at 2,6,24 and 48 h after surgery.At 24 and 48 h after surgery,VAS scores during active and passive movement were assessed.The time for catheter placement near the femoral nerve and development of subcutaneous hematoma at the puncture site,local anesthetic intoxication and nausea and vomiting were recorded.The postoperative requirement for analgesics was also recorded.Results There was no significant difference in the VAS scores and puncture for femoral nerve block-and local anesthetics-related adverse events between the two groups.The time for catheter placement near the femoral nerve was 8.0 ± 1.4 and （6.7 ± 0.9） min in S and U groups,respectively,and the time was significantly longer in group S than in group U.No patients required rescue analgesic after surgery in both groups.Conclusion Nerve stimulator-guided continuous femoral nerve block provides higher clinical value than ultrasound-guided continuous femoral nerve block for analgesia after laparoscopic surgery and it is more suitable for clinical application.