新型神经阻滞针行连续股神经阻滞定位方法的研究

目的 探讨新型神经阻滞针在老年下肢关节置换术行连续股神经阻滞麻醉及术后镇痛中不同定位方法的优势。方法 选择择期行膝和髋关节置换的老年患者(≥65岁)共60例,ASA分级Ⅰ～Ⅲ级,随机分成3组,应用新型神经阻滞针,分别使用鞘膜突破定位、B超引导定位和二者结合的定位方法行患肢连续股神经阻滞并留置导管术后镇痛。观察3组患者一次操作置管成功率、平均操作时间,术后安静/活动时镇痛效果、恶心呕吐发生率、穿刺置管部位有否感染、神经损伤、局麻药物毒性反应、其他镇痛药物使用量、导管平均留置时间及患者满意度等。结果 鞘膜突破定位组一次操作成功置管为75%,置管平均操作时间(3.1±0.4)min；超声引导组一次操作置管成功率90%,置管平均操作时间(4.9±0.7)min；鞘膜突破结合B超定位组一次操作置管成功率90%,置管平均操作时间(3.5±0.5)min,置管平均操作时间每两组之间互相比较差异有统计学意义(P<0.01),一次操作成功率鞘膜突破定位组与其他两组比较差异有统计学意义(P<0.05)。3组患者术毕6、12、24、48h静止/活动时VAS镇痛评分、镇静评分、恶心呕吐发生率、患者满意度均无显著区别；3组患者均未出现穿刺置管部位感染、局麻药物毒性反应及呼吸抑制等并发症,也均未使用其他止痛药物。3组导管平均留置时间(4.27±6.6)h；镇痛结束拔除留置导管后仅超声引导组有1例患者大腿前部及膝关节内侧皮肤略感麻木,余患者均异常症状。结论 使用新型神经阻滞针在老年下肢关节置换术后行连续股神经阻滞麻醉及术后镇痛,采用鞘膜突破定位、超声引导定位及两者结合定位镇痛效果相似。鞘膜突破定位与超声引导定位相结合的定位方法可缩短置管操作时间,一次操作成功率高,可供临床借鉴。
Objective To investigate the positioning in continuous femoral nerve block(CFNB) with a novel cannula-over-needle in geriatric lower extremity joint arthroplasty. Methods Sixty patients aged≥65 years, ASA status Ⅰ-Ⅲ undergoing knee or hip replacement were recruited. Patients were randomly assigned in 3 different positioning methods:fascial pop(group 1), positioning guided by ultrasound(group 2) or fascial pop combined with B ultrasound(group 3) for continuous femoral nerve block and postoperative analgesia with indwelling cannula. All the patients received a specially designed needle-over-cannula and patient-controlled analgesia(PCA) through the indwelling external cannula for postoperative analgesia. The outcome measurements included success rate of single placement with the external indwelling cannula, time to place the external indwelling cannula on average, postoperative analgesic effect, incidence of nausea and vomiting, infection at the puncture site, nerve injury, local anesthetics related toxicity, dosage of other analgesics, average indwelling time of the cannula and patient's satisfaction. Results The success of single attempt indwelling cannula was 75% in group 1,0% in group 2 and 90% in group 3. The performing time of external indwelling cannula was(3.1±0.4) min in group 1,(4.9±0.7)min in group 2 and(3.5±0.5) min in group 3 on average(P<0.01). There were no significant differences in visual analogue scale(VAS) score at 6,2,24 and 48 h, Ramsay sedation score(RSS), incidence of nausea and vomiting, patient's satisfaction among 3 groups. Infection at the puncture site, local anesthetics related toxicity and respiratory depression were not found during the cannula indwelling. All patients didn't receive any other analgesics and the indwelling time of external indwelling cannula was(42.7±6.6) h on