Nader Antoun, Kendall Mark C, Candido Kenneth D, Benzon Hubert, McCarthy Robert J
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Anesth Analg. 2009 Jan;108(1):359-63. doi: 10.1213/ane.0b013e31818c9452.
In this prospective randomized study, we compared a single-injection modified intertendinous (n = 55) with the classic posterior (n = 54) popliteal sciatic nerve block for patients undergoing ankle/foot surgery.
Nerve stimulator-guided blocks were performed 7-8 cm (classic posterior) or 12-14 cm (modified intertendinous) above the popliteal crease. Levobupivacaine 0.625% with epinephrine 1:300,000 (Chirocaine(R), Purdue Pharma, Stamford, CT), was injected in 5 mL aliquots to a total volume of 0.4 mL/kg (range, 25-35 mL). The needle position was considered acceptable if an evoked motor response of plantar flexion, inversion, eversion or a dorsiflexion of the ipsilateral foot was elicited at <or=0.4 mA. Complete block was defined as pinprick anesthesia and motor paralysis of the foot within 60 min.
The median distance from the popliteal crease to the modified intertendinous site was 14.0 cm (interquartile range, 13.5-15 cm) compared to 7.5 cm (interquartile range 7.0-8.0 cm) for the classic posterior site (P < 0.01). Complete block was achieved in 44 of 55 patients (81.5%) in the modified intertendinous compared to 39 of 54 patients (70.9%) in the classic posterior group (P = 0.26). Complete block frequency was greater with an evoked motor response of inversion 49 of 56 patients (87.5%) and plantar flexion 23 of 30 patients (76.7%) compared with dorsiflexion/eversion 11 of 23 patients (47.8%) (P = 0.001). The median (95% CI) time (min) to complete block with an evoked motor response of inversion was 10 (0-22 min) for the modified intertendinous compared to 30 (4-56 min) with the classic posterior approach (P = 0.04).
Potential advantages of the modified intertendinous approach include more rapid onset of anesthesia with an evoked motor response of inversion compared to a classic posterior popliteal sciatic nerve block.
在这项前瞻性随机研究中，我们比较了单注射改良腱间（n = 55）与经典后路（n = 54）腘坐骨神经阻滞用于接受踝/足手术的患者。
在腘横纹上方7 - 8厘米（经典后路）或12 - 14厘米（改良腱间）处进行神经刺激器引导下的阻滞。将含1:300,000肾上腺素的0.625%左旋布比卡因（耐乐品，普渡制药公司，斯坦福德，康涅狄格州）以5毫升 aliquots 注射，总量为0.4毫升/千克（范围25 - 35毫升）。如果在≤0.4毫安时引出同侧足部跖屈、内翻、外翻或背屈的诱发运动反应，则认为针的位置可接受。完全阻滞定义为在60分钟内足部针刺麻醉和运动麻痹。
与经典后路部位的7.5厘米（四分位间距7.0 - 8.0厘米）相比，从腘横纹到改良腱间部位的中位距离为14.0厘米（四分位间距13.5 - 15厘米）（P < 0.01）。改良腱间组55例患者中有44例（81.5%）实现了完全阻滞，而经典后路组54例患者中有39例（70.9%）实现了完全阻滞（P = 0.26）。与背屈/外翻的23例患者中的11例（47.8%）相比，内翻诱发运动反应的56例患者中有49例（87.5%）和跖屈诱发运动反应的30例患者中有23例（76.7%）完全阻滞频率更高（P = 0.001）。改良腱间组内翻诱发运动反应至完全阻滞的中位（95%可信区间）时间（分钟）为10（0 - 22分钟），而经典后路方法为30（4 - 56分钟）（P = 0.04）。
与经典后路腘坐骨神经阻滞相比，改良腱间方法的潜在优势包括内翻诱发运动反应时麻醉起效更快。
