Redborg Kirsten E, Sites Brian D, Chinn Christopher D, Gallagher John D, Ball Perry A, Antonakakis John G, Beach Michael L
Departments of Anesthesiology, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Reg Anesth Pain Med. 2009 Jan-Feb;34(1):24-8. doi: 10.1097/AAP.0b013e3181933f09.
: During ankle block performance, anesthetizing the sural nerve is important for generating complete anesthesia of the lateral aspect of the foot. We hypothesized that an ultrasound-guided perivascular approach, utilizing the lesser saphenous vein as a reference, would prove more successful than a conventional approach based on surface landmarks.
: Eighteen healthy volunteers were prospectively randomized into this controlled and blinded study. Each subject was placed prone and the right ankle was randomized to receive either an ultrasound-guided perivascular sural nerve block (group US) or a traditional landmark-based sural nerve block (group TRAD). The subject's left ankle then received the alternate approach. The ultrasound technique relied on injecting local anesthetic circumferentially around the lesser saphenous vein. All blocks were performed with 5 mL of 3% chloroprocaine. We evaluated sensory block to ice and pinprick. Secondary outcome variables included performance times, number of needle passes, participant satisfaction, and presence of any complications.
: At the midfoot position, testing at 10 minutes after block placement revealed a loss of sensation to ice in 94% (complete in 78% and partial in 16%) in the US group versus 56% in the TRAD group (complete in 28%, partial in 28%) (P <.01). Complete loss of sensation to ice persisted in 33% of the US group as compared with 6% in the TRAD group at 60 minutes (P <.05). A similar pattern was observed when the blocks were tested with pinprick. Ultrasound-guided blocks took longer to perform on average than the traditional blocks (mean difference of 102 seconds, P <.001). The ultrasound block was subjectively felt to be denser by 88% of the subjects (P =.001).
: Ultrasound guidance using the lesser saphenous vein as a reference point results in a more complete and longer lasting sural nerve block than does a traditional approach using surface landmarks.
在进行踝部阻滞时，麻醉腓肠神经对于实现足部外侧的完全麻醉很重要。我们推测，以小隐静脉为参照的超声引导血管周围入路比基于体表标志的传统入路更成功。
18名健康志愿者被前瞻性随机纳入这项对照双盲研究。每位受试者俯卧位，右脚踝随机接受超声引导血管周围腓肠神经阻滞（超声组）或传统体表标志法腓肠神经阻滞（传统组）。然后受试者的左脚踝接受另一种方法。超声技术是在小隐静脉周围环形注射局部麻醉药。所有阻滞均使用5毫升3%的氯普鲁卡因。我们评估了对冰敷和针刺的感觉阻滞。次要结局变量包括操作时间、进针次数、受试者满意度以及有无任何并发症。
在足中部位置，阻滞放置后10分钟进行测试，超声组94%的受试者对冰敷感觉丧失（完全丧失78%，部分丧失16%），而传统组为56%（完全丧失28%，部分丧失28%）（P<.01）。60分钟时，超声组33%的受试者对冰敷仍持续完全感觉丧失，而传统组为6%（P<.05）。用针刺测试阻滞时观察到类似模式。超声引导阻滞平均操作时间比传统阻滞长（平均差异102秒，P<.001）。88%的受试者主观感觉超声阻滞更浓密（P =.001）。
以小隐静脉为参照点的超声引导比使用体表标志的传统方法能产生更完全、更持久的腓肠神经阻滞。
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