di Benedetto Pia, Casati Andrea, Bertini Laura
Department of Anesthesiology, CTO Roma, Rome, Italy.
Reg Anesth Pain Med. 2002 Mar-Apr;27(2):168-72.
To compare continuous infusion or a patient-controlled technique for postoperative analgesia after foot surgery, using a new subgluteus approach for continuous sciatic nerve block.
Fifty healthy patients, undergoing orthopedic foot surgery, received a continuous sciatic nerve block using a new subgluteus approach. All blocks were placed with the aid of a nerve stimulator using a 10-cm, 18-gauge insulated Tuohy needle. After either plantar flexion or dorsiflexion of the operated foot was elicited at < or = 0.5 mA, 20 mL of 0.75% ropivacaine was injected incrementally using repeated aspiration tests, then followed by the introduction of a 20-gauge epidural catheter. Postoperatively, 0.2% ropivacaine was infused with either a 10 mL/h continuous infusion (group Continuous, n = 25) or with a 5 mL/h basal rate with 5 mL bolus every 60 minutes (group patient-controlled analgesia [PCA], n = 25). Intraoperative analgesic supplementation, as well as postoperative pain relief, morphine consumption, incidence of complication, and patient satisfaction were recorded by an observer unaware of group assignment.
The sciatic catheter was successfully placed in all patients. Intravenous fentanyl supplementation (dose range, 50 to 150 microg) was required in 4 patients in each group, but no patient required general anesthesia. Catheter dislocation was reported in 2 patients (4%). The quality of pain relief was good in both groups, and none experienced complications. Nine patients of the Continuous group (37%) and 7 patients of the PCA group (29%) required rescue morphine analgesia because of pain in the femoral dermatomes (P =.76). Ropivacaine consumption was 240 mL in the Continuous group (range, 200 to 240 mL) and 140 mL in the PCA group (range, 120 to 290 mL) (P =.0005). Patient acceptance was good in both groups.
The continuous subgluteus sciatic nerve block represents an easy and reliable option for postoperative analgesia after foot surgery; using a patient controlled rather than a continuous infusion technique reduces the consumption of local anesthetic solution without affecting the quality of pain relief.
采用一种新的臀下途径进行连续坐骨神经阻滞，比较足部手术后连续输注或患者自控技术用于术后镇痛的效果。
50例接受足部骨科手术的健康患者，采用新的臀下途径接受连续坐骨神经阻滞。所有阻滞均在神经刺激器辅助下，使用一根10厘米长、18号绝缘的Tuohy针进行。在手术侧足部在≤0.5毫安电流下引出跖屈或背屈后，使用反复回抽试验逐步注入20毫升0.75%罗哌卡因，然后置入一根20号硬膜外导管。术后，0.2%罗哌卡因以10毫升/小时的速度连续输注（连续输注组，n = 25）或基础速度5毫升/小时，每60分钟追加5毫升推注量（患者自控镇痛组[PCA]，n = 25）。由不了解分组情况的观察者记录术中镇痛补充情况、术后疼痛缓解情况、吗啡用量、并发症发生率及患者满意度。
所有患者坐骨神经导管均成功置入。每组各有4例患者需要静脉补充芬太尼（剂量范围为50至150微克），但无一例患者需要全身麻醉。有2例患者（4%）报告导管移位。两组疼痛缓解质量均良好，且均未发生并发症。连续输注组有9例患者（37%）和PCA组有7例患者（29%）因股部皮节疼痛需要追加吗啡镇痛（P = 0.76）。连续输注组罗哌卡因用量为240毫升（范围为200至240毫升），PCA组为140毫升（范围为120至290毫升）（P = 0.0005）。两组患者接受度均良好。
臀下连续坐骨神经阻滞是足部手术后一种简单可靠的术后镇痛方法；采用患者自控而非连续输注技术可减少局部麻醉药溶液的用量，且不影响疼痛缓解质量。
