足踝手术后连续腓肠肌平面阻滞的镇痛效果

Analgesic effect of continuous gastrocnemius plane block after foot and ankle surgery

目的 探索连续腓肠肌平面阻滞镇痛用于足踝部手术患者术后镇痛效果。方法选择全麻下行足踝部择期手术患者42例,男19例,女23例,年龄18~64岁,BMI 18~28 kg/m^(2),ASAⅠ—Ⅲ级。将患者随机分为两组:连续腓肠肌平面阻滞镇痛组(CN组)和患者自控静脉镇痛(PCIA)组(Ⅰ组),每组21例。CN组术毕行连续腓肠肌平面阻滞镇痛,配方为0.125%罗哌卡因300 ml,背景剂量为3 ml/h,单次给药剂量为8 ml,锁定时间为25 min。Ⅰ组术毕使用羟考酮PCIA,配方为羟考酮30 mg、托烷司琼6 mg加生理盐水至150 ml,输注速度0.5 ml/h,单次追加剂量5 ml。观察两组术后0~16、16~24、24~48、0~48 h时段静息和活动时NRS评分曲线下面积(AUC),1、8、16、24、32、48 h静息和活动时NRS评分,CN组术后胫神经和腓总神经运动功能恢复时间、羟考酮滴定量、术后48 h内补救镇痛药物的吗啡当量累计使用量、补救镇痛次数、补救镇痛率、首次下床活动时间、术后恶心呕吐的发生情况和患者满意度评分。结果 与Ⅰ组比较,CN组0~16、16~24、24~48、0~48 h静息和活动时NRS评分AUC明显降低(P<0.01),术后1、8、16、24、32、48 h NRS评分明显降低(P<0.01),CN组16 h有10例(50%)患者腓总神经运动功能恢复,24 h有17例(85%)患者腓总神经运动功能恢复,32~48 h所有患者腓总神经运动功能恢复,48 h内所有患者胫神经运动功能正常。与Ⅰ组比较,CN组吗啡当量累计使用量和补救镇痛次数明显减少(P<0.01),补救镇痛率明显降低(P<0.01),患者满意度评分明显升高(P<0.01)。两组羟考酮滴定量、首次下床活动时间,恶心呕吐发生率差异无统计学意义。结论 超声引导下连续腓肠肌平面阻滞可以实现胫神经运动和感觉阻滞分离,可在足踝手术后提供良好且持续的镇痛效果。

Objective To explore the analgesic effect of continuous gastrocnemius plane block for postoperative pain management in foot and ankle surgery.Methods Forty-two patients undergoing foot and ankle surgery under general anesthesia were enrolled,including 19 males and 23 females,aged 18-64 years,BMI 18-28 kg/m^(2),ASA physical status Ⅰ-Ⅲ.Patients were randomly divided into two groups:the continuous gastrocnemius plane block group(group CN) and the patient controlled intravenous analgesia(PCIA) group(group Ⅰ),21 patients in each group.In group CN,continuous gastrocnemius plane block was performed with a 0.125% ropivacaine solution,totaling 300 ml.The background infusion rate was set at 3 ml/h,with a bolus dose of 8 ml and a lockout time of 25 minutes for analgesia,while in group Ⅰ,patients received PCIA with oxycodone,utilizing a formulation comprising oxycodone 30 mg and tropisetron 6 mg in a total volume of 150 ml.The infusion rate was set at 0.5 ml/h,with a single additional dose of 5 ml.The area under the curve(AUC) of numeric rating scale(NRS) scores was calculated during the postoperative periods of 0-16,16-24,24-48,and 0-48 hours for both rest and activity states in both groups.NRS scores were evaluated at 1,8,16,24,32,and 48 hours postoperatively during both rest and activity in the two groups.Postoperative recovery time for the tibial nerve and common peroneal nerve was assessed in group CN,titration of oxycodone,cumulative morphine-equivalent usage of rescue analgesics within 48 hours postoperatively,number of rescue analgesia administrations,rescue analgesia rate,the time of the first ambulation,the incidence of postoperative nausea and vomiting,and patient satisfaction score in both groups.Results Compared with group Ⅰ,group CN exhibited a significant reduction in AUC of NRS scores during the periods of 0-16,16-24,24-48,and 0-48 hours for both rest and activity(P < 0.01).Compared with group Ⅰ,group CN showed significantly lower NRS scores at rest and during activity 1,8,16,24,32,and 48 hours postoperatively(P < 0.01).In group CN,10 patients(50%) had recovery of common peroneal nerve motor function at 16 hours,17 patients(85%) at 24 hours,and all patients had recovery at 32-48 hours for the common peroneal nerve,and within 48 hours,all patients had normal tibial nerve motor function.Compared with group Ⅰ,group CN showed significantly reduced cumulative morphine-equivalent consumption and rescue analgesia times(P < 0.01),with a significantly lower rescue analgesia rate(P < 0.01),and significantly increased patient satisfaction scores(P < 0.01).There were no statistically significant differences between the two groups in oxycodone titration,time of first ambulation,and incidence of nausea and vomiting.Conclusion Ultrasound-guided continuous gastrocnemius plane block can achieve the separation of tibial nerve motor and sensory blockade,providing effective and sustained analgesia for postoperative pain management after foot and ankle surgery.