硬膜外麻醉与腰丛坐骨神经阻滞在膝关节手术中的比较。
A comparison of epidural anesthesia and lumbar plexus-sciatic nerve blocks for knee surgery.
机构信息
Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital - Ankara, Turkey.
出版信息
Clinics (Sao Paulo). 2010;65(1):29-34. doi: 10.1590/S1807-59322010000100006.
OBJECTIVES
The efficacy of combined lumbar plexus-sciatic nerve blocks was compared to epidural anesthesia in patients undergoing total knee surgery.
PATIENTS AND METHODS
The study included 80 American Society of Anesthesiologists (ASA) Physical Status I-III patients (age range 18 to 65) undergoing knee surgery. The patients were randomly divided into one of two groups. Epidural anesthesia was performed in the epidural anesthesia (EA) group (n=40), and the lumbar plexus and sciatic nerves were blockedin the lumbar plexus-sciatic nerve blocks (LPSB) group (n=40). For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the lumbar plexus-sciatic nerve blocks group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request, and patient and surgeon satisfaction with the anesthetic technique were recorded.
RESULTS
One patient in the epidural anesthesia group and three patients in the lumbar plexus-sciatic nerve blocks group required general anesthesia due to failed block. There were no significant differences between the two groups regarding the success of providing adequate anesthesia. Eight patients in the lumbar plexus-sciatic nerve blocks group developed contralateral spread. The onset of sensory-motor block and the time of the first analgesic request were significantly later in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. Although there were no significant differences regarding patient satisfaction with the anesthetic technique between the two groups, surgeon satisfaction was significantly higher in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group.
CONCLUSION
The lumbar plexus -sciatic nerve blocks provide effective unilateral anesthesia and may offer a beneficial alternative to epidural anesthesia in patients undergoing total knee surgery.
目的
比较联合腰丛-坐骨神经阻滞与硬膜外麻醉用于全膝关节手术患者的效果。
患者与方法
本研究纳入了 80 例美国麻醉医师协会（ASA）身体状况 I-III 级（年龄 18-65 岁）行膝关节手术的患者。患者随机分为两组。硬膜外麻醉组（n=40）行硬膜外麻醉，腰丛-坐骨神经阻滞组（n=40）行腰丛-坐骨神经阻滞。记录每位患者的感觉和运动阻滞的起始时间、运动阻滞的程度、对侧下肢的腰丛-坐骨神经阻滞的感觉阻滞迹象、提供充分麻醉的成功率、血流动力学变化、首次镇痛请求的时间以及患者和外科医生对麻醉技术的满意度。
结果
硬膜外麻醉组有 1 例患者和腰丛-坐骨神经阻滞组有 3 例患者因阻滞失败而需要全身麻醉。两组提供充分麻醉的成功率无显著差异。腰丛-坐骨神经阻滞组有 8 例患者出现对侧扩散。感觉-运动阻滞的起始时间和首次镇痛请求的时间在腰丛-坐骨神经阻滞组明显晚于硬膜外麻醉组。虽然两组患者对麻醉技术的满意度无显著差异，但腰丛-坐骨神经阻滞组的外科医生满意度明显高于硬膜外麻醉组。
结论
腰丛-坐骨神经阻滞可为全膝关节手术患者提供有效的单侧麻醉，可能是硬膜外麻醉的有益替代方法。
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