坐骨神经阻滞在踇外翻截骨矫形术后多模式镇痛中的效果评价

The value of popliteal sciatic nerve block in multi-modal analgesia after Hallux Valgus surgery

目的评价经腘窝坐骨神经阻滞(PSNB)在踇外翻截骨矫形术后多模式镇痛管理中的有效性和安全性。方法回顾性分析本院2014年9月至2020年3月在椎管内麻醉下行单侧或双侧踇外翻截骨矫形术患者49例,根据手术结束后是否予以超声引导下PSNB分为PSNB组和Oral组。PSNB组(14例)术毕行超声引导下PSNB,以0.5%罗哌卡因15 ml单次阻滞,并应用联合口服止痛药(对乙酰氨基酚、曲马多、塞来昔布)镇痛;Oral组(35例)术后仅使用口服止痛药。观察术后6 h静息时和第1 d静息/运动疼痛数字评分法(NRS)评分、24 h内中重度疼痛的发生率、阿片类药物补救率、不良反应和麻醉满意度。结果PSNB组和Oral组术后6 h静息NRS评分中位数分别为2.0分和3.0分(P<0.05);第1 d的静息、运动NRS评分中位数分别为0.0分、1.5分和1.0分、3.0分,24 h内中重度疼痛发生率分别为14.3%(2/14)和22.9%(8/35),需要阿片类药物补救镇痛的患者分别占7.1%(1/14)和2.9%(1/35),以上指标两组间比较差异均无统计学意义(均P>0.05);PSNB组未出现不良反应,Oral组1例腰麻后头痛,两组患者的麻醉满意度均为100%。结论加入PSNB作为腰麻下踇外翻截骨矫形术后多模式镇痛的一环,能提高术后6 h的镇痛效果,但并未明显减少术后使用止痛药。

Objective To evaluate the efficacy and safety of popliteal sciatic nerve block(PSNB)in multi-modal analgesia after Hallux Valgus surgery.Methods Forty-nine patients who underwent unilateral or bilateral Hallux Valgus surgery under intraspinal anesthesia from September 2014 to March 2020 were retrospective analyzed.The PSNB group(n=14)underwent postoperative ultrasound guided PSNB with 15 ml of 0.5%ropivacaine,and oral analgesics(paracetamol,tramadol,and celecoxib);the Oral group(n=35)only received aforementioned oral analgesics for pain control.The postoperative 6 h and 24 h rest/active pain NRS scores,the incidence of moderate to severe pain within postoperative 24 h,the requirement of rescue opioid analgesics,side effects,and patients'subjective satisfaction rating were observed and compared between the two groups.Results The median of postoperative 6 h rest NRS score in the PSNB group and the Oral group were 2.0 and 3.0(P<0.05);the median of postoperative 24 h rest/active pain NRS scores were 0.0/1.5 and 1.0/3.0,the incidences of moderate to severe pain within postoperative 24 h were 14.3%(2/14)and 22.9%(8/35),the incidences of remedial opioid analgesics were 7.1%(1/14)and 2.9%(1/35),there were no statistically significant differences in the above mentioned indices(all P>0.05).No side effect was found in the PSNB group,there was a case of post-dural puncture headache in the Oral group,and the subjective satisfaction rate was 100%in both groups.Conclusion Adding PSNB to multi-modal analgesia management strategy for Hallux Valgus surgery may improve short term postoperative pain control,but has no impact on the need of rescue analgesics after surgery.