超声引导联合区域阻滞用于下肢静脉功能不全手术的临床效果

Clinical effect of ultrasound-guided combined peripheral nerve blocks for surgical and postoperative analgesia management in patients with lower extremity venous insufficiency under phlebectomy

目的:比较超声引导联合区域阻滞和硬膜外神经阻滞用于下肢静脉功能不全患者手术麻醉及术后镇痛的临床效果。方法:择期行下肢静脉功能不全手术患者100例,随机分为超声引导联合区域阻滞(NB)组和硬膜外神经阻滞(EA)组,每组50例。NB组在超声引导下分别行股神经、闭孔神经及臀肌下坐骨神经阻滞和高位结扎局麻;EA组采用腰L2-3椎间隙硬膜外阻滞。记录麻醉操作时间、麻醉起效时间、感觉阻滞的维持时间、运动阻滞的起效和维持时间、局麻药总量、麻醉优良率、术后疼痛视觉模拟评分(VAS)、术后首次需镇痛时间、24 h内吗啡使用量和术后24 h麻醉总体满意度。结果:NB组的麻醉操作时间、麻醉起效时间、感觉和运动阻滞持续时间均长于EA组(P<0.05);2组局麻药利多卡因总量差异无统计学意义(P>0.05),NB组罗哌卡因总用量显著高于EA组(P<0.05);2组麻醉优良率差异无统计学意义(P>0.05);NB组术后VAS评分显著低于EA组(P<0.05);NB组术后首次需镇痛时间长于EA组(P<0.05),术后24 h内吗啡使用量少于EA组(P<0.05);NB组总体满意度高于EA组(P<0.05)。结论:超声引导联合神经阻滞能很好地满足下肢静脉功能不全患者手术,术中麻醉效果及术后镇痛确切。

Objective: To investigate the efficacy of femoral and sciatic combined with obturator nerve blocks for analgesia in patients with lower extremity venous insufficiency compared with epidural anesthesia.Methods: One hundred ASA physical status I-III patients who were scheduled for lower extremity venous insufficiency were randomly divided into two groups: group NB (n=50) and group EA (n=50). Ultrasound-guided femoral nerve block and sciatic nerve block combined with obturator nerve blocks were performed in patients of group NB. Patients in group EA were performed with epidural anesthesia at the level of L 2/3. The procedure time for anesthesia time, the anesthesia onset time, onset time of motor block, duration of sensory and motor block, the operation time, intraoperative medications, successful rate, visual analog scale at 6 hours, 12 hours,18 hours and 24 hours after operation were recorded. At the same time, the first time needed for analgesia after surgery, the satisfaction of patients at postoperative 24 hours and perioperative side effects were also recorded.Results: The anesthesia onset time, the operation time and the duration of sensory and motor block in group NB were obviously longer than those in group EA (P<0.05). The total amount of ropivacaine in group NB was significantly higher than that in group EA (P<0.05), while there was no significant difference in the total amount of lidocaine (P>0.05). There was no difference in successful rate between the two group (P>0.05). Lower VAS pain scores, lower morphine consumption and higher satisfaction in group NB were significantly higher than those in group EA (P<0.05). And the first time that needed for analgesia after surgery in group NB was longer than group EA (P<0.05). Conclusion: Femoral and sciatic combined with obturator nerve blocks can provide an effective anesthesia and analgesia for patients undergoing lower extremity venous insufficiency phlebectomy.