Giorgi P, Bornet P, Giuge M, Blanchard J C, Ksouri S
Service d'Anesthésie-Réanimation, CHG de Grasse-Clavary.
Ann Fr Anesth Reanim. 1991;10(3):248-50. doi: 10.1016/s0750-7658(05)80829-9.
This retrospective study of the 46 operations, carried out over a one year period for lower limb varicose veins using peripheral nerve blocks, included 45 patients (35 women and 10 men, mean age 49.3 years), all ASA 1 or 2, except for 4 elderly patients with a varicose ulcer (ASA 2 or 3). In 40 procedures, a sciatic nerve block combined with a "3 in 1" lumbar plexus block at the level of the groin (as described by Winnie) were used. In the remaining six, either a sciatic nerve block (short saphenous vein crossectomy; n = 3), or a "3 in 1" lumbar plexus block alone (short stripping of the long saphenous vein; n = 3) were required. A peripheral nerve stimulator to locate accurately each nerve was used. For each nerve block, the anaesthetic mixture consisted of 20 ml lidocaine 1.5% with 1:200,000 adrenaline, and 10 ml of bupivacaine 0.375% with 1:200,000 adrenaline. Surgery was only performed on one limb at a time, as the required dose of local anaesthetic was too high to safely carry out bilateral nerve blocks. In 71.7% of patients surgery was made on an day-case basis. Of those patients who had to remain in hospital overnight or longer, the peripheral nerve block was never responsible for this. During the same period, nine similar procedures were carried out under general anaesthesia, and two under epidural anaesthesia. They included seven bilateral varicose veins, three patient refusals for peripheral nerve blocks, and one allergy to lidocaine. Already used for some procedures in orthopaedic and casualty surgery, peripheral nerve blocks seem to be well suited for surgery of unilateral varicose veins.
这项回顾性研究涵盖了在一年时间内使用周围神经阻滞进行的46例下肢静脉曲张手术，涉及45名患者（35名女性和10名男性，平均年龄49.3岁），除4名患有静脉曲张溃疡的老年患者（ASA 2或3级）外，其余均为ASA 1或2级。在40例手术中，采用了坐骨神经阻滞联合腹股沟水平的“三合一”腰丛阻滞（如Winnie所述）。其余6例中，3例进行了坐骨神经阻滞（小隐静脉横断术），3例仅进行了“三合一”腰丛阻滞（大隐静脉短段剥脱术）。使用了周围神经刺激器来精确定位每条神经。每次神经阻滞时，麻醉混合液由20毫升1.5%利多卡因加1:200,000肾上腺素以及10毫升0.375%布比卡因加1:200,000肾上腺素组成。由于所需局部麻醉剂剂量过高，无法安全地进行双侧神经阻滞，所以手术每次仅在一个肢体上进行。71.7%的患者接受日间手术。在那些需要住院过夜或更长时间的患者中，这绝不是由周围神经阻滞导致的。同期，9例类似手术采用全身麻醉进行，2例采用硬膜外麻醉进行。这些病例包括7例双侧静脉曲张、3例患者拒绝接受周围神经阻滞以及1例对利多卡因过敏。周围神经阻滞已在骨科和急诊手术的一些操作中使用，似乎非常适合单侧静脉曲张手术。
