多模式连续坐骨神经阻滞对胫腓骨骨折患者术后镇痛效果的影响

Effect of multimodal continuous sciatic nerve block on postoperative analgesia of patients with tibiofibular fracture

目的分析多模式连续坐骨神经阻滞对胫腓骨骨折术后镇痛的影响。方法选取2017年1月—2019年1月陕西省铜川市人民医院行胫腓骨骨折手术患者160例,随机分为2组各80例。对照组术后采用自控皮下镇痛,观察组采用超声引导下多模式连续坐骨神经阻滞镇痛。观察2组患者术后12h小腿的肿胀感觉,术后48h时发生恶心、呕吐人数和需要追加镇痛药人数,术后翻身和平躺时疼痛情况,以及术后48h镇痛满意度。结果术后12h,观察组患者小腿肿胀程度显著优于对照组(P<0.05)。观察组术后48h内有8例(10.00%)患者发生恶心、呕吐,对照组为53例(66.25%);观察组追加吗啡镇痛药的有3例(3.75%),对照组有56例(70.00%),差异均有统计学意义(P<0.05)。术后8、16、32h时,观察组患者翻身与平躺VAS评分均显著低于对照组(P<0.05)。观察组患者对镇痛的满意度显著优于对照组(P<0.05)。结论胫腓骨骨折患者术后采用超声引导下多模式连续坐骨神经阻滞的镇痛效果理想,可降低患者不良反应发生率,提高镇痛满意度。

Objective To analyze the effect of multimodal continuous sciatic nerve block on postoperative analgesia of patients with tibiofibular fracture.Methods A total of 160 patients with tibiofibular fractures from January 2017 to January 2019 in Tongchuan People′s Hospital in Shaanxi province were selected and randomly divided into two groups,with 80 cases in each group.The control group underwent self-controlled subcutaneous analgesia,and the observation group was given ultrasound-guided multimode continuous sciatic nerve block analgesia.The swelling sensation of leg at 12 hours after operation,the cases with nausea and vomiting within 48 hours after operation,the cases with additional analgesics,the pain of turning over and lying down after operation,and the satisfaction degree to analgesia within 48 hours after operation were observed in both groups.Results At 12 hours after operation,the degree of leg swelling in the observation group was significantly better than that in the control group(P<0.05).Eight patients(10.00%)had nausea and vomiting within 48 hours after operation in the observation group,53 patients(66.25%)had nausea and vomiting in the control group,3 patients(3.75%)in the observation group and 56 patients(70.00%)were additional morphine analgesics in the control group,and there were significant differences(P<0.05).At 8,16 and 32 hours after operation,the VAS scores of turning over and lying down in the observation group were significantly lower than those in the control group(P<0.05).The satisfaction degree to analgesia in the observation group was significantly better than that in the control group(P<0.05).Conclusion Ultrasound-guided multimodal continuous sciatic nerve block is effective in postoperative analgesia of patients with tibiofibular fracture,which can reduce incidence rate of adverse reactions and increase satisfaction degree to analgesia.