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一种用于闭孔神经阻滞的新型腹股沟入路:解剖学和随机临床研究。

A new inguinal approach for the obturator nerve block: anatomical and randomized clinical studies.

作者信息

Choquet Olivier, Capdevila Xavier, Bennourine Khaled, Feugeas Jean-Louis, Bringuier-Branchereau Sophie, Manelli Jean-Claude

机构信息

Department of Anesthesiology and Critical Care Medicine, La Conception University Hospital, Marseille, France.

出版信息

Anesthesiology. 2005 Dec;103(6):1238-45. doi: 10.1097/00000542-200512000-00020.

Abstract

BACKGROUND

Obturator nerve block is highly recommended for knee surgery in addition to a femoral nerve block. The main disadvantage of the classic approach at the pubic tubercle is low patient acceptance due to pain and discomfort. The authors hypothesized that the use of a new inguinal obturator nerve block technique would reduce pain and discomfort in patients.

METHODS

The inguinal approach was simulated in five fresh cadavers. Injection of latex was performed in two cadavers. The location of the needle and the extent of latex solution were analyzed. Fifty patients scheduled to undergo arthroscopic knee surgery were randomly assigned to receive obturator nerve block using either the inguinal (n = 25) or the pubic tubercle approach (n = 25).

RESULTS

In all cadavers, the needle was close to the obturator nerve branches, which were surrounded by the latex solution. In the clinical study, visual analog scale pain scores and discomfort of block placement were significantly lower in the inguinal group compared with the pubic tubercle group (P < 0.01). In the inguinal group, there was a significant decrease in block performance time (P < 0.05) and in bolus of propofol and fentanyl used for the procedure (P < 0.01). Twenty minutes after application of the block, adductor strength decrease, occurrence, and location of cutaneous distribution of the obturator nerve were not significantly different between the groups. The incidence of minor complications was significantly increased in the pubic tubercle group (P < 0.05). No major complications were observed.

CONCLUSIONS

The new inguinal approach decreases patient discomfort and pain of block placement as well as the time and sedation and analgesics required for a similar quality of sensory and motor block compared with the pubic tubercle approach.

摘要

背景

除股神经阻滞外,闭孔神经阻滞在膝关节手术中也备受推荐。经典的耻骨结节入路的主要缺点是患者因疼痛和不适而接受度较低。作者推测,使用一种新的腹股沟闭孔神经阻滞技术会减轻患者的疼痛和不适。

方法

在5具新鲜尸体上模拟腹股沟入路。对2具尸体进行乳胶注射。分析针的位置和乳胶溶液的分布范围。50例计划接受关节镜膝关节手术的患者被随机分为两组,分别采用腹股沟入路(n = 25)或耻骨结节入路(n = 25)进行闭孔神经阻滞。

结果

在所有尸体中,针均靠近闭孔神经分支,且这些分支被乳胶溶液包围。在临床研究中,腹股沟组的视觉模拟评分疼痛得分和阻滞放置时的不适感均显著低于耻骨结节组(P < 0.01)。腹股沟组的阻滞操作时间显著缩短(P < 0.05),且用于该操作的丙泊酚和芬太尼推注量也显著减少(P < 0.01)。阻滞应用20分钟后,两组间内收肌力量减弱、闭孔神经皮肤分布的出现及位置无显著差异。耻骨结节组的轻微并发症发生率显著增加(P < 0.05)。未观察到严重并发症。

结论

与耻骨结节入路相比,新的腹股沟入路可减轻患者的不适和阻滞放置时的疼痛,同时在获得相似质量的感觉和运动阻滞的情况下,减少所需的时间以及镇静和镇痛药用量。

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