Ultrasound-guided lumbar sympathetic block for flap repair of lower limb defects / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the efficacy of ultrasound-guided lumbar sympathetic block (LSB) used for flap repair of lower limb defects.Methods A retrospective study was conducted of the 27 patients who had received flap repair of lower limb defects at Department of Anesthesiology,Central People's Hospital of Zhanjiang surgery from June 2017 to December 2018.Of them,14 had conventional flap repair (conventional group) and 13 additional ultrasound-guided LSB (LSB group).The 2 groups were compared at 12,24,48 and 72 hours after operation in terms of color,texture,skin temperature and survival of the flaps and visual analogue scale (VAS) pain scores.Functional recovery of flap sensation after one month follow-up was also observed and compared.Results The 2 groups were comparable because there were no significant differences between them in the preoperative general data(P ＞ 0.05).All the patients were followed up for an average of 3.1 months (from 2 to 6 months).At 12 and 24 hours after operation,the LSB group had significantly more patients with normal flap color (84.6％ and 92.3％) than the conventional group (35.7％ and 50.0％) (P ＜ 0.05).At 12,24,48 and 72 hours after operation,the LSB group had significantly higher skin temperature (36.7 ± 0.2 ℃,36.8±0.3 ℃,36.9±0.2 ℃ and 36.9±0.1 ℃) than the conventional group(35.4±0.4 ℃,35.7 ± 0.6 ℃,35.9 ± 0.3 ℃ and 36.2 ± 0.2 ℃) (P ＜ 0.05).At 12 and 24 hours after operation,the LSB group had significantly lower VAS pain scores (2.1 ± 1.0 and 2.3 ± 0.9) than the conventional group(4.6 ± 0.9 and 4.4 ±0.8) (P ＜0.05).All the flaps in the LSB group obtained primary survival after operation while infection occurred in one case in the conventional group.One month follow-up showed that 12 patients in the LSB group (92.3％) obtained sensory recovery of flaps while 6 ones (42.9％) did in the conventional group,showing a significant difference (P ＜ 0.05).Conclusion As an auxiliary treatment for flap repair of lower limb defects,SLB can improve the blood supply to the transplanted flap and facilitate the recovery of nerve function in the graft flap.