超声引导下仰卧位与侧卧位腰丛神经阻滞的临床效果分析

The investigation of two different position approaches for ultrasound-guided lumbar plexus block

目的观察仰卧位和侧卧位下超声引导腰丛神经阻滞的临床效果。方法选取2018年1～10月在中山大学附属第八医院择期行股骨近端骨折内固定术患者60例,随机数字表法分为仰卧位组(S组,n=30)和侧卧位组(L组,n=30),在超声引导下行侧路骶旁坐骨神经联合腰丛神经阻滞。观察局麻药向硬膜外腔扩散发生率、超声识别腰丛时间、穿刺时间、操作完成时间、超声下腰丛可见度、感觉和运动阻滞持续时间、患者的满意度评分、术后24 h视觉模拟评分法(VAS)评分及其他不良事件。结果 S组局麻药向硬膜外腔扩散率低于L组(P<0.05)。S组超声识别腰丛时间、操作完成时间均短于L组(P<0.05)。S组腰丛可见度和患者满意度评分均高于L组(P<0.05)。两组阻滞持续时间和术后12 h VAS评分差异无统计学意义。结论仰卧位腰丛神经阻滞时局麻药向硬膜外腔扩散的发生率更低,耗时更短,提高了患者的满意度。因此,仰卧位腰丛神经阻滞可安全便捷应用于临床。

Objective To observe the effects of supine position and lateral decubitus position on the outcomes of ultrasound-guided lumbar plexus blocks for patients. Methods Sixty patients undergoing lower limb surgery in the Eighth Affilated Hospital. Sun Yat-Sen University from January to October2018 were selected for the study, and after lateral approach of ultrasound-guided parascral sciatic nerve block in the supine position, were randomly divided into two groups according to different approaches of ultrasound-guided lumbar plexus block: in supine position(group S, n =30) or lateral decubitus position(group L, n =30). The incidence of epidural spread after lumbar plexus block, ultrasound landmark and needle s identification, and performance time of lumbar plexus, the duration time of lumbar plexus nerve sensory and motor blockade, the ultrasound visibility score, also embraced patients satisfaction ratings scale were recorded. Visual analogue score(VAS) and the occurrence of complications until24 h after operation were analyzed. Results Compared with group L, the incidence of epidural spread was significantly lower in group S ( P <0.05), ultrasound landmark and needle s identification, and performance time were markedly shorter in group S ( P <0.05), the ultrasound visibility score and the patients satisfaction ratings scale of the group S were higher( P <0.05). There was no statistically difference in duration of nerve block and VAS score at12 h after surgery between two groups. Conclusion The lumbar plexus block in the supine position is a more appropriate approach considering its lower incidence of epidural spread than that of the lateral decubitus position approach. It is a safe, simple and effective technique for lumbar plexus block.