Capdevila Xavier, Pirat Philippe, Bringuier Sophie, Gaertner Elisabeth, Singelyn François, Bernard Nathalie, Choquet Olivier, Bouaziz Hervé, Bonnet Francis
Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France.
Anesthesiology. 2005 Nov;103(5):1035-45. doi: 10.1097/00000542-200511000-00018.
Continuous peripheral nerve block (CPNB) is the technique of choice for postoperative analgesia after painful orthopedic surgery. However, the incidence of neurologic and infectious adverse events in the postoperative period are not well established. This issue was the aim of the study.
Patients scheduled to undergo orthopedic surgery performed with a CPNB were prospectively included during 1 yr in a multicenter study. Efficacy of postoperative analgesia, bacteriologic cultures of the catheter, and acute neurologic and infectious adverse events were evaluated after surgery in 1,416 patients at arrival in the postanesthesia care unit, at hour 1, and every 24 h up to day 5. Risk factors for adverse events were determined using logistic regression.
The median duration of CPNB was 56 h. Both general anesthesia and CPNB were performed in 73.6% of the patients. Postoperative analgesia was effective in 96.3%, but an increase in pain scores was noted at hour 24 (P = 0.01). Hypoesthesia or numbness occurred in 3% and 2.2%, respectively, and paresthesia occurred in 1.5%. Three neural lesions (0.21%) were noted after continuous femoral nerve block. Two of these patients were anesthetized during block procedure. Nerve damage completely resolved 36 h to 10 weeks later. Cultures from 28.7% of the catheters were positive. Three percent of patients had local inflammatory signs. The bacterial species most frequently found were coagulase-negative staphylococcus (61%) and gram-negative bacillus (21.6%). A Staphylococcus aureus psoas abscess (0.07%) was reported in one diabetic woman. Independent risk factors for paresthesia/dysesthesia were postoperative monitoring in intensive care, age less than 40 yr, and use of bupivacaine. Risk factors for local inflammation/infection were postoperative monitoring in intensive care, catheter duration greater than 48 h, male sex, and absence of antibiotic prophylaxis.
CPNB is an effective technique for postoperative analgesia. Minor incidents and bacterial colonization of catheters are frequent, with no adverse clinical consequences in the large majority of cases. Major neurologic and infectious adverse events are rare.
连续外周神经阻滞（CPNB）是骨科疼痛手术后术后镇痛的首选技术。然而，术后神经和感染性不良事件的发生率尚未完全明确。本研究旨在解决这一问题。
在1年时间内，前瞻性纳入多中心研究中计划接受CPNB骨科手术的患者。对1416例患者术后在麻醉后恢复室、术后1小时以及术后第5天内每24小时评估术后镇痛效果、导管细菌培养以及急性神经和感染性不良事件。采用逻辑回归确定不良事件的危险因素。
CPNB的中位持续时间为56小时。73.6%的患者同时接受了全身麻醉和CPNB。术后镇痛有效率为96.3%，但在术后24小时疼痛评分有所增加（P = 0.01）。感觉减退或麻木的发生率分别为3%和2.2%，感觉异常的发生率为1.5%。连续股神经阻滞后发现3例神经损伤（0.21%）。其中2例患者在阻滞过程中接受了麻醉。神经损伤在36小时至10周后完全恢复。28.7%的导管培养结果为阳性。3%的患者有局部炎症体征。最常见的细菌种类是凝固酶阴性葡萄球菌（61%）和革兰氏阴性杆菌（21.6%）。1例糖尿病女性患者报告发生金黄色葡萄球菌腰大肌脓肿（0.07%）。感觉异常/感觉障碍的独立危险因素包括重症监护病房术后监测、年龄小于40岁以及使用布比卡因。局部炎症/感染的危险因素包括重症监护病房术后监测、导管留置时间大于48小时、男性以及未使用抗生素预防。
CPNB是一种有效的术后镇痛技术。轻微事件和导管细菌定植较为常见，在大多数情况下无不良临床后果。严重的神经和感染性不良事件罕见。
