Clinical application of ultrasound-guided femoral nerve and popliteal sciatic nerve block in patients undergoing foot and ankle surgery / 中国基层医药

ABSTRACT

Objective To observe the application of ultrasound-guided femoral nerve block (FNB) and popliteal sciatic nerve block(PSNB) in patients undergoing foot and ankle surgery.Methods From August 2015 to August 2017,60 patients scheduled for foot and ankle surgery undergoing laryngeal mask airway (LMA) general anesthesia in the People's Hospital of Langfang were randomly divided into 3 groups by the random number table,with 20 cases in each group.Before transfer patients from bed to operating table,A group received dezocine 5 mg iv,B group received FNB combined with PSNB (distal to the sciatic nerve bifurcation),C group received FNB combined with PSNB(proximal to the sciatic nerve bifurcation).A total of 40 mL of 0.375％ ropivacaine were injected guided by ultrasound in B group and C group.The time of sufficient sensory block and awake,the dosage of remifentanil and propofol were recorded.Pain was assessed using visual analogue scale (VAS) pre-and post block.The incidence of sleepiness,postoperative nausea and vomiting (PONV),agitation,pain and adverse reaction were also recorded.Results The time of sufficient sensory block and awake,the dosage of remifentanil and propofol in A,B and C groupA group (not measured),(21.6 ± 1.6) min,(1183 ± 17) μg,(665.0 ± 6.7) mg;B group (25.5 ± 2.5) min,(15.3 ± 1.4) min,(635 ± 16) μg,(455.0 ±6.5)mg;C group (19.6 ±2.3)min,(14.9 ± 1.5)min,(598 ± 14) μg,(438.0±9.9) mg.The time of awake,the dosage of remifentanil and propofol in B group and C group were significantly lower than those in A group (F =44.07,52.41,62.45,all P ＜0.05).The time of sufficient sensory block in C group was lower than that in B group(t =15.69,P ＜ 0.05).The VAS scores at T2,T3 and T4 in A,B and C groupA group (4.5 ± 0.6) point,(8.4 ± 0.5) point,(6.1 ± 0.9) point;B group (2.6 ± 0.5) point,(3.9 ± 0.3) point,(2.4 ± 0.6) point;C group (2.5 ± 0.4) point,(2.3 ± 0.5) point,(1.1 ± 0.5) point.The VAS scores in B group or C group were significantly lower than those in A group (F =52.36,72.82,75.41,all P ＜ 0.05).The VAS scores at T3 and T4 in C group were significantly lower than those in B group (t =18.42,q =14.55,all P ＜ 0.05).The incidence rates of sleepiness,PONV,agitation and incision pain in A,B and C groupA group (25％,25％,15 ％,15 ％,50％);B group(0％,5％,0％,0％,10％);C group (0％,5％,0％,0％,0％).The number of patients who had adverse reactions in B or C group were significantly lower than those in A group (x2 =8.51,8.73,10.11,10.11,9.69,all P ＜0.05).The incidence rate of incision pain at sober in C group was lower than that in B group(x2 =10.89,P ＜0.05).Conclusion The ultrasound-guided FNB and PSNB (proximal to the sciatic nerve bifurcation) can obviously shorten the onset time,reduce the dosage of general anaesthetic.It has effective analgesia during transfer of patients from bed to operating table and sober.