超声引导下罗哌卡因复合地塞米松神经阻滞在老年胫腓骨远端骨折手术中的应用

Application of ultrasound-guided ropivacaine combined with dexamethasone nerve block in elderly patients with distal tibiofibular fracture

目的探讨超声引导下罗哌卡因复合地塞米松神经阻滞在老年胫腓骨远端骨折手术中的应用效果。方法选取2020年1月至2021年7月南通市海门区人民医院行锁定加压钢板(locking compression plate,LCP)内固定术的老年单侧胫腓骨远端骨折患者60例,所有患者接受超声引导下股神经联合坐骨神经阻滞麻醉。将60例患者随机分为2组:单纯罗哌卡因组(R组,n=30),给予0.4%罗哌卡因40 mL;罗哌卡因联合地塞米松组(RD组,n=30),给予0.4%罗哌卡因40 mL和地塞米松10 mg。比较2组患者的麻醉效果,术中、术后麻醉相关并发症发生率及术后6 h、12 h、24 h、48 h镇痛泵使用总量。结果R组和RD组的麻醉阻滞完全率分别达到90.0%和93.3%(P>0.05)。两组患者麻醉前和麻醉后30 min搬动患肢时的VAS评分,术中、术后麻醉相关并发症发生率差异无统计学意义。R组患者麻醉后15 min搬动患肢时的VAS评分显著大于RD组[(4.8±0.6)分vs(2.8±0.5)分,P<0.001],RD组患者术后12 h、24 h、48 h镇痛泵药液的使用量显著少于R组(P<0.001)。两组患者均无局麻药毒性反应或呼吸抑制,R组出现术中恶心1例,术后呕吐1例;RD组发生术后恶心1例。结论超声引导下罗哌卡因复合地塞米松神经阻滞用于老年胫腓骨远端骨折手术,与单纯使用罗哌卡因相比,局麻药起效更快,术后镇痛药物的使用量更少,并发症发生率无显著增加,可以安全应用于临床麻醉中。

Objective To explore the application effects of ultrasound-guided ropivacaine combined with dexamethasone femoral nerve and sciatic nerve block anesthesia in the operation of distal tibiofibular fracture in the elderly.Methods From January 2020 to July 2021,60 elderly patients with unilateral distal tibiofibular fracture who underwent locking compression plate(LCP)internal fixation were selected in Nantong Haimen People’s Hospital and randomly divided into two groups,30 patients in each group.All patients received ultrasound-guided femoral nerve combined with sciatic nerve block anesthesia.Group R was treated with 0.4%ropivacaine 40 mL,and group RD was treated with 0.4%ropivacaine 40 mL plus dexamethasone 10 mg.The anesthetic effect,the incidence of anesthesia related complications during and after operation,and the amount of analgesic pump solution used at 6 h,12 h,24 h and 48 h after operation were compared between the two groups.Results The rate of complete block in group R and RD was 90.0%and 93.3%respectively(P>0.05).There was no significant difference between the two groups in VAS score before anesthesia and when the affected limb was moved at 30 min after anesthesia,and in the incidence of anesthesia related complications during and after surgery.The VAS score(4.8±0.6)of group R was significantly higher than that of group RD(2.8±0.5)when the affected limb was moved at 15 min after anesthesia(P<0.001).The dosage of analgesic pump solution in group RD was significantly less than that in group R at 12 h,24 h and 48 h after surgery(P<0.001).There was no local anesthetic toxicity or respiratory depression occurred in both groups.One case of intraoperative nausea and one case of postoperative vomiting occurred in group R,and one case of postoperative nausea occurred in group RD.Conclusions Ultrasound-guided ropivacaine combined with dexamethasone nerve block can be effectively and safely used in the operation of distal tibiofibular fracture in the elderly,compared with ropivacaine alone.The onset effect of local anesthesia is faster,the amount of postoperative analgesic drugs can be reduced,and there is no significant increase in the incidence of complicaitons.