超声引导下腓肠肌平面阻滞对足踝部手术患者术后镇痛的影响

Effect of ultrasound-guided gastrocnemius plane block on postoperative analgesia in patients undergoing foot and ankle surgery

目的评价单次腓肠肌平面阻滞(GPB)用于择期全身麻醉下足踝部手术患者术后镇痛的有效性。方法选择全身麻醉下足踝部手术患者60例,男34例,女26例,年龄18~64岁,BMI 18~28 kg/m^(2),ASAⅠ—Ⅲ级。将患者随机分为两组:GPB组和对照组,每组30例。GPB组术前进行GPB,于腓肠肌表面共注入0.375%罗哌卡因30 ml,对照组不予GPB。两组麻醉诱导和麻醉维持方法一致。术后均行无背景剂量羟考酮静脉镇痛。记录术后4、8、12、16、24、48 h静息和活动(足踝部背曲与跖曲)时NRS评分,术后0~16、16~24、24~48、0~48 h疼痛-时间曲线下面积(AUC),术中瑞芬太尼的用量,术后48 h内地佐辛补救情况,术后0、4、8、12、16、24、48 h的羟考酮滴定量,术后48 h有效按压次数、总按压次数和首次按压时间,术后住院时间、首次下床活动时间,以及头晕、发热、恶心呕吐、皮肤瘙痒和神经并发症等不良反应发生情况。结果与对照组比较,GPB组术后4、8、12、16 h静息和活动时NRS评分明显降低(P<0.01),静息时和活动时0~16、0~48 h AUC,地佐辛补救次数,术后0、4、8、12、16、24、48 h羟考酮滴定量,术后48 h有效按压次数和总按压次数明显减少,首次按压时间明显延长(P<0.01)。两组术后24、48 h静息和活动时NRS评分差异无统计学意义。两组首次下床活动时间、头晕、发热、恶心呕吐、皮肤瘙痒发生率差异无统计学意义。结论超声引导下腓肠肌平面阻滞是一种新型入路,可用于精确阻滞胫神经、腓总神经、腓肠内、外侧皮神经,可以为足踝部手术患者提供有效的术后镇痛。

Objective To evaluate the efficacy of single gastrocnemius plane block for postoperative analgesia in patients undergoing elective foot and ankle surgery under general anesthesia.Methods Sixty patients undergoing foot and ankle surgery were selected,including 34 males and 26 females,aged 18-64 years,BMI 18-28 kg/m^(2),ASA physical statusⅠ-Ⅲ.Patients were randomly divided into two groups:GPB group and control group,30 cases in each group.Preoperative GPB was performed in the GPB group,and a total of 0.375%ropivacaine 30 ml was injected into the gastrocnemius surface,without GPB in the control group.The methods of induction and maintenance of anesthesia were the same in the two groups.All patients were given oxycodone analgesia pump without background dose after operation.The NRS score at rest and during activity(dorsal curvature and metatarsal curvature of foot and ankle)at 4,8,12,16,24,48 hours after operation,the area under the pain-time curve at 0-16,16-24,24-48,0-48 hours after operation(AUC)were recorded.The intraoperative dosage of remifentanil,the rescue of inland dezocine 48 hours after operation,and oxycodone drops 0,4,8,12,16,24,48 hours after operation were recorded.The effective pressing times,the total pressing times and the first pressing time were recorded 48 hours after operation,and the postoperative hospital stay and the first time to get out of bed were recorded.The adverse reactions such as dizziness,fever,nausea and vomiting,skin pruritus and neurological complications were recorded.Results Compared with the control group,0-16,0-48 hours AUC at rest,0-16,0-48 hours AUC during activity,dizoxin rescue times,oxycodone titration 0,4,8,12,16,24,48 hours after operation,effective pressing times and total pressing times decreased significantly in the GPB group 4,8,12,16,24,48 hours after operation,the first pressing time was significantly prolonged(P<0.01).There was no significant difference in NRS score at rest and activity between the two groups 24 and 48 hours after operation.There was no significant difference in the time of getting out of bed for the first time,the incidence of dizziness,fever,nausea and vomiting,and skin pruritus between the two groups.Conclusion Ultrasound-guided gastrocnemius plane block is a new approach for precise block of tibial nerve,common peroneal nerve,medial sural cutaneous nerve and lateral sural cutaneous nerve.This method can provide effective postoperative analgesia for patients undergoing foot and ankle surgery.