Casati Andrea, Fanelli Guido, Koscielniak-Nielsen Zbigniew, Cappelleri Gianluca, Aldegheri Giorgio, Danelli Giorgio, Fuzier Régis, Singelyn François
*Department of Anesthesiology and Pain Therapy, University of Parma; †Vita-Salute University of Milano, IRCCS San Raffaele Hospital, Milano, Italy; ‡Department of Anesthesiology, Université Catholique de Louvain School of Medicine, St. Luc Hospital, Brussels, Belgium; and §Department of Anesthesia and Operative Services, Copenhagen University Hospital, Rigshospitalet, Denmark.
Anesth Analg. 2005 Oct;101(4):1192-1197. doi: 10.1213/01.ane.0000167232.10305.cd.
We prospectively tested the hypothesis that the use of a stimulating catheter improves the efficacy of continuous posterior popliteal sciatic nerve block in 100 randomized patients scheduled for elective orthopedic foot surgery. After eliciting a sciatic mediated muscular twitch at < or = 0.5 mA nerve stimulation output, the perineural catheter was advanced 2-4 cm beyond the tip of the introducer either blindly (Group C; n = 50) or stimulating via the catheter (Group S; n = 50). A bolus dose of 25 mL of 1.5% mepivacaine was followed by a postoperative patient-controlled infusion of 0.2% ropivacaine (basal infusion: 3 mL/h; incremental dose: 5 mL; lockout time: 30 min). Propacetamol 2 g IV was administered every 8 h, and opioid rescue analgesia was available if required. Catheter placement required 7 +/- 2 min in Group S and 5 +/- 2 min in Group C (P = 0.056). A significantly shorter onset time of both sensory and motor blocks was noted in Group S. No difference in quality of pain relief at rest and during motion was reported between the groups. Median (range) local anesthetic consumption during the first 48 h after surgery was 239 mL (175-519 mL) and 322 mL (184-508 mL) in Groups S and C, respectively (P = 0.002). Rescue opioid analgesia was required by 12 (25%) and 28 (58%) patients in Groups S and C, respectively (P = 0.002). We conclude that the use of a stimulating catheter results in shorter onset time of posterior popliteal sciatic nerve block, similar pain relief with reduced postoperative consumption of local anesthetic solution, and less rescue opioid consumption.
This prospective, randomized, blind investigation demonstrated that the use of a stimulating catheter for continuous posterior popliteal sciatic nerve block resulted in shorter onset time of sensory and motor blocks and less local anesthetic consumption and need for rescue pain medication after elective orthopedic foot surgery compared with blind catheter advancement.
我们前瞻性地检验了以下假设：对于100例计划接受择期足部骨科手术的患者，使用刺激导管可提高腘后坐骨神经连续阻滞的效果。在神经刺激输出≤0.5 mA时引出坐骨神经介导的肌肉抽搐后，将神经周围导管在穿刺针尖端后方盲目推进2 - 4 cm（C组；n = 50）或通过导管进行刺激（S组；n = 50）。给予25 mL 1.5%甲哌卡因推注剂量后，术后患者自控输注0.2%罗哌卡因（基础输注速度：3 mL/h；追加剂量：5 mL；锁定时间：30分钟）。静脉注射对乙酰氨基酚2 g，每8小时一次，必要时可使用阿片类药物进行补救镇痛。S组导管置入需要7±2分钟，C组需要5±2分钟（P = 0.056）。S组感觉和运动阻滞的起效时间明显更短。两组在静息和运动时的疼痛缓解质量方面无差异。术后48小时内，S组和C组局部麻醉药的中位（范围）用量分别为239 mL（175 - 519 mL）和322 mL（184 - 508 mL）（P = 0.002）。S组和C组分别有12例（25%）和28例（58%）患者需要补救性阿片类镇痛（P = 0.002）。我们得出结论，使用刺激导管可使腘后坐骨神经阻滞的起效时间缩短，疼痛缓解效果相似，同时减少术后局部麻醉药的用量以及补救性阿片类药物的使用量。
这项前瞻性、随机、盲法研究表明，与盲目推进导管相比，在择期足部骨科手术后，使用刺激导管进行腘后坐骨神经连续阻滞可使感觉和运动阻滞的起效时间缩短，减少局部麻醉药的用量，并减少对补救性镇痛药物的需求。
