Department of Anesthesiology, Peking University Third Hospital, Beijing, China.
Chin Med J (Engl). 2011 Feb;124(4):519-24.
The adjunction of ultrasound to nerve stimulation has been proven to improve single-injection peripheral nerve block quality. However, few reports have been published determining whether ultrasound can facilitate continuous nerve blocks. In this study, we tested the hypothesis that the addition of ultrasound to nerve stimulation facilitates femoral nerve blocks with a stimulating catheter.
In this prospective randomized study, patients receiving continuous femoral nerve blocks for total knee replacement were randomly assigned to either the ultrasound guidance combined with stimulating catheter group (USNS group; n = 60) or the stimulating catheter alone group (NS group; n = 60). The primary end point was the procedure time (defined as the time from first needle contact with the skin until correct catheter placement). The numbers of needle passes and catheter insertions, onset and quality of femoral nerve blocks, postoperative pain score, and early knee function were also recorded.
The procedure time was significantly less in the USNS group than in the NS group (9.0 (6.0 - 22.8) minutes vs. 13.5 (6.0 - 35.9) minutes, P = 0.024). The numbers of needle passes and catheter insertions were also significantly less in the USNS group. A greater complete block rate was achieved at 30 minutes in the USNS group (63.3% vs. 38.3%; P = 0.010). The postoperative pain score, the number of patients who required bolus local anesthetic and intravenous patient-controlled analgesia, and knee flexion on the second postoperative day were not significantly different between the two groups of patients.
Ultrasound-assisted placement of a stimulating catheter for femoral nerve blocks decreases the time necessary to perform the block compared with just the nerve-stimulating technique. In addition, a more complete blockade is achieved using the ultrasound-assisted technique.
超声联合神经刺激已被证明可提高单次外周神经阻滞的质量。然而，鲜有研究报道超声是否有助于连续神经阻滞。在本研究中，我们通过刺激导管测试了超声联合神经刺激有助于股神经阻滞的假设。
这是一项前瞻性随机研究，接受连续股神经阻滞的全膝关节置换术患者被随机分为超声引导联合刺激导管组（USNS 组；n = 60）或单纯刺激导管组（NS 组；n = 60）。主要终点是操作时间（定义为从第一根针接触皮肤到正确放置导管的时间）。记录针的穿刺次数和导管的插入次数、股神经阻滞的起效和质量、术后疼痛评分以及早期膝关节功能。
USNS 组的操作时间明显短于 NS 组（9.0（6.0 - 22.8）分钟 vs. 13.5（6.0 - 35.9）分钟，P = 0.024）。USNS 组的针穿刺次数和导管插入次数也明显减少。USNS 组在 30 分钟时达到完全阻滞的比例更高（63.3% vs. 38.3%；P = 0.010）。两组患者的术后疼痛评分、需要追加局部麻醉药和静脉自控镇痛的患者数量以及术后第二天膝关节的屈曲度均无显著差异。
与单纯神经刺激技术相比，超声引导下放置刺激导管进行股神经阻滞可减少操作时间。此外，超声辅助技术可实现更完全的阻滞。
