Department of Anesthesiology and Critical Care, Montpellier University Hospital, Montpellier, France.
Reg Anesth Pain Med. 2010 Nov-Dec;35(6):559-64. doi: 10.1097/AAP.0b013e3181fa6b60.
The ideal spread of local anesthetic (LA) solution around the sciatic nerve during a popliteal block remains unclear. We tested the hypothesis that a circumferential spread of LA and/or intraneural injection could lead to rapid surgical block.
Patients (n = 100) scheduled for foot or ankle surgery underwent popliteal sciatic nerve block using nerve stimulation according to Borgeat's technique and injection of ropivacaine (0.5 mL/kg). Sensory and motor blockades were assessed on the tibial nerve (TN) and common peroneal nerve (CPN) at 5, 15, and 30 mins after completion of the block and in the recovery room. A successful block was defined as a complete sensory block in TN and CPN. Changes in cross-sectional and longitudinal surfaces and diameters and the characteristics of LA spread around the nerve were noted using ultrasound. A suspected intraneural injection was defined as a 15% increase in the surface area or anteroposterior diameter of the nerve. Patients were followed up on days 1 and 7 after surgery.
Successful block was noted in 57% of patients at 30 mins and in 88% of patients in the recovery room. A circumferential spread of LA occurred in 47% of patients and 53% had noncircumferential spread. Complete sensory block was significantly higher in the group that had a circumferential spread (73% vs 43%, P = 0.035) only at 30 mins. In the postoperative care unit, there was no difference among the groups. Separated circumferential spreads around TN and CPN were noted in 12% of patients. All of these patients had a complete sensory and motor blockade at 15 mins. Concerning intraneural injection, only the change in the anteroposterior diameter on a 6-cm length of nerve was associated with a higher success and faster onset block at 5 (P = 0.008), 15 (P = 0.02), and 30 (P = 0.05) mins. There were no clinically detectable nerve injuries at follow-up.
For popliteal sciatic nerve block, circumferential spread of LA, and separation of the nerve into its 2 components are associated with rapid surgical block.
在腘窝坐骨神经阻滞中，局麻药（LA）在坐骨神经周围的理想扩散范围尚不清楚。我们假设 LA 的环形扩散和/或神经内注射可能导致快速手术阻滞。
根据 Borgeat 的技术，接受足部或踝关节手术的患者（n = 100）接受神经刺激下的腘窝坐骨神经阻滞，并注射罗哌卡因（0.5 mL/kg）。在阻滞完成后 5、15 和 30 分钟以及在恢复室评估胫神经（TN）和腓总神经（CPN）的感觉和运动阻滞。成功的阻滞定义为 TN 和 CPN 完全感觉阻滞。使用超声观察神经周围 LA 扩散的横截面积和纵截面积、直径变化及特征。神经内注射定义为神经表面积或前后直径增加 15%。术后第 1 天和第 7 天对患者进行随访。
30 分钟时，57%的患者阻滞成功，恢复室时 88%的患者阻滞成功。LA 呈环形扩散的患者占 47%，非环形扩散的患者占 53%。仅在 30 分钟时，环形扩散组的完全感觉阻滞明显更高（73%比 43%，P = 0.035）。在术后护理病房，各组之间无差异。在 12%的患者中，可见 TN 和 CPN 周围的分隔环形扩散。所有这些患者在 15 分钟时均有完全的感觉和运动阻滞。关于神经内注射，只有神经 6cm 长度上前后直径的变化与更高的成功率和更快的阻滞起效相关，在 5、15 和 30 分钟时（P = 0.008、P = 0.02 和 P = 0.05）。随访时无临床可检测到的神经损伤。
对于腘窝坐骨神经阻滞，LA 的环形扩散和神经的 2 个分支的分离与快速手术阻滞相关。
