Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, CA, USA.
Reg Anesth Pain Med. 2009 Sep-Oct;34(5):480-5. doi: 10.1097/AAP.0b013e3181ada57a.
Sciatic perineural catheters via a popliteal fossa approach and subsequent local anesthetic infusion provide potent analgesia and other benefits after foot and ankle surgery. Electrical stimulation (ES) and, more recently, ultrasound (US)-guided placement techniques have been described. However, because these techniques have not been compared in a randomized fashion, the optimal method remains undetermined. Therefore, we tested the hypotheses that popliteal-sciatic perineural catheters placed via US guidance require less time for placement and produce equivalent results, as compared with catheters placed using ES.
Preoperatively, subjects receiving a popliteal-sciatic perineural catheter for foot and/or ankle surgery were randomly assigned to either the ES with a stimulating catheter or US-guided technique with a nonstimulating catheter. The primary end point was catheter insertion duration (in minutes) starting when the US transducer (US group) or catheter-placement needle (ES group) first touched the patient and ending when the catheter-placement needle was removed after catheter insertion.
All US-guided catheters were placed per protocol (n = 20), whereas only 80% of stimulation-guided catheters could be placed per protocol (n = 20, P = 0.106). All catheters placed per protocol in both groups resulted in a successful surgical block. Perineural catheters placed by US took a median (10th-90th percentile) of 5.0 min (3.9-11.1 min) compared with 10.0 min (2.0-15.0 min) for stimulation (P = 0.034). Subjects in the US group experienced less pain during catheter placement, scoring discomfort a median of 0 (0.0-2.1) compared with 2.0 (0.0-5.0) for the stimulation group (P = 0.005) on a numeric rating scale of 0 to 10.
Placement of popliteal-sciatic perineural catheters takes less time and produces less procedure-related discomfort when using US guidance compared with ES.
经腘窝入路的坐骨神经周围导管和随后的局部麻醉剂输注可为足部和踝关节手术后提供有效的镇痛和其他益处。已经描述了电刺激 (ES) 和最近的超声 (US) 引导放置技术。然而，由于这些技术尚未以随机方式进行比较，因此最佳方法仍未确定。因此，我们测试了以下假设：与使用 ES 放置的导管相比，使用 US 引导放置的坐骨神经周围导管需要更少的时间并且产生等效的结果。
接受腘窝-坐骨神经周围导管用于足部和/或踝关节手术的患者在术前随机分配到 ES 加刺激导管或 US 引导技术加非刺激导管。主要终点是从 US 换能器 (US 组) 或导管放置针 (ES 组) 首次接触患者开始到导管插入后取出导管放置针结束时的导管插入持续时间 (以分钟计)。
所有 US 引导的导管均按方案放置 (n = 20)，而只有 80%的刺激引导导管可按方案放置 (n = 20，P = 0.106)。两组中所有按方案放置的导管均导致手术阻滞成功。US 放置的周围神经导管中位时间 (第 10-90 百分位数) 为 5.0 分钟 (3.9-11.1 分钟)，而刺激组为 10.0 分钟 (2.0-15.0 分钟) (P = 0.034)。US 组的患者在导管放置过程中疼痛程度较低，疼痛评分中位数为 0 (0.0-2.1)，而刺激组为 2.0 (0.0-5.0) (P = 0.005)，疼痛程度为 0 至 10 的数字评分量表。
与 ES 相比，使用 US 引导放置腘窝-坐骨神经周围导管需要更少的时间并且产生的与程序相关的不适更少。
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