足踝术后连续腘窝坐骨神经阻滞镇痛与静脉镇痛的随机对照研究

目的评价连续腘窝坐骨神经阻滞镇痛与静脉镇痛用于足踝外科手术术后的镇痛优劣。方法选取宁波市第六医院2017年1月至4月蛛网膜下腔麻醉、下行足踝外伤择期手术患者60例，采用随机数字表法将患者分为两组，试验组N组（n=30）术毕使用局部麻醉药物采用连续腘窝坐骨神经阻滞镇痛（patient controlled nerve-block analgesia, PCNA），对照组I组（n=30）术毕使用阿片类药物静脉镇痛（patient controlled intravenous analgesia, PCIA）。观察两组患者术后12h静息和活动状态下的NRS评分、术后6、24、48h静息和活动状态下的NRS评分。观察术后恶性、呕吐发生率；N组导管脱出和渗漏分析；记录患者总体满意度评分及术毕1周手术侧肢体的感觉和运动异常情况。结果与I组比较，N组的12h静息和活动NRS评分明显下降(P<0.05),差异有统计学意义。N组术后恶性呕吐发生率低，N组导管脱出（1例）,渗漏（1例）,后改为PCIA泵镇痛。N组患者总体满意度评分较高(P<0.05)。术毕1周电话随访两组患者均未发生术侧肢体感觉和运动异常。结论连续腘窝神经阻滞术后镇痛改善了足踝术后患者镇痛效果，减少了术后恶性呕吐发生率，患者满意度提高，但对于连续置管引起的导管脱出和渗漏需引起一定的重视。
ObjectiveTo compare the postoperative analgesic effect of continuous popliteal sciatic nerve block analgesia with intravenous analgesia for patients undergoing foot and ankle surgery. MethodsSixty patients for foot and ankle surgery in Ningbo Sixth Hospital from January to April 2017 were enrolled. The operations were performed under spinal anesthesia; and the postoperative analgesia was applied with patient controlled nerve-block analgesi（PCIA). Patients were randomly assigned into two groups： group N (n=30) using local anesthetic with continuous popliteal sciatic nerve postoperative analgesia and group I (n=30) using opioids with intravenous analgesia. The primary outcomes were 12h resting and active NRS scores, the secondary outcomes were 6h, 24h, 48h resting and active NRS scores. The postoperative incidence of malignant vomiting, catheter prolapse and leakage in group N; the overall satisfaction score; the sensory or motor abnormalities of extremity one week after operation was recorded. ResultsCompared with the group I, the 12h resting and active NRS scores of the PCNA group decreased significantly (P<0.05), and the incidences of postoperative nausea and vomiting were lower. There were 1 case of catheter prolapse, and 1 case of leakage in group N. The overall satisfaction score of patients with PCNA was higher. No sensory or motor abnormalities one week after operation were observed. ConclusionThe continuous popliteal nerve block with PCNA pump can reduce postoperative nausea and vomiting, improve the overall satisfaction for postoperative analgesia in patients with ankle and foot surgery; however, attention should be paid for catheter prolapse and leakage