From the *Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Denmark; †Department of Anesthesia, Aarhus University Hospital, Aarhus, Denmark; ‡Department of Radiology, Copenhagen University Hospital, Bispebjerg, Denmark; and §Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Innsbruck Medical University, Innsbruck, Austria.
Reg Anesth Pain Med. 2014 Jan-Feb;39(1):18-25. doi: 10.1097/AAP.0000000000000030.
We describe a new approach to blocking the sciatic and saphenous nerves in the proximal thigh (level of the lesser trochanter or immediately below) using a single-penetration dual-injection (SPEDI) technique. The popliteal-sciatic approach necessitates repositioning of the leg exposing the popliteal fossa and an extra injection for the saphenous nerve (SAN) block at the midthigh level. We introduce an alternative, effective, and possibly faster method.
Sixty patients undergoing leg and foot surgery under general anesthesia were included. We deposited 15 mL of ropivacaine 0.75% around the sciatic nerve (SCN) and 5 mL of ropivacaine 0.75% at the SAN. Patients were randomized to the popliteal-sciatic/saphenous technique or the SPEDI technique. The primary outcome measure was performance time. Positioning time, pain assessment, nausea in the postanesthesia care unit, sufentanil demand, dermatomal anesthesia, and degree of motor blockade were also recorded.
Performance time was significantly faster with the SPEDI technique (median time, 110 seconds [range, 57-315 seconds] vs 246 seconds [range, 163-472 seconds]; P < 0.0001). Positioning time was significantly shorter with the SPEDI technique (P < 0.0001). No other statistically significant differences were recorded.
The SPEDI block resulted in significantly faster performance time and reduced positioning time with statistically equal efficacy in relation to pain assessment, nausea, sufentanil demand, dermatomal anesthesia, and motor blockade. The SPEDI block is statistically an equally effective alternative to the traditional popliteal-sciatic/saphenous block combination for leg and foot surgery, but it is faster, requires only 1 skin penetration, and does not require repositioning of the leg.
我们描述了一种在大腿近端（小转子水平或稍下方）阻断坐骨神经和隐神经的新方法，即单次穿刺双重注射（SPEDI）技术。腘窝-坐骨神经入路需要重新定位腿部以暴露腘窝，并在大腿中段额外注射隐神经（SAN）阻滞。我们介绍了一种替代方法，该方法更有效，并且可能更快。
纳入 60 例行全身麻醉下腿部和足部手术的患者。我们在坐骨神经（SCN）周围注入 15 mL 0.75%罗哌卡因，在 SAN 注入 5 mL 0.75%罗哌卡因。患者随机分为腘窝-坐骨神经/隐神经技术组或 SPEDI 技术组。主要观察指标为操作时间。还记录了定位时间、疼痛评估、麻醉后恢复室恶心、舒芬太尼需求、皮区麻醉和运动阻滞程度。
SPEDI 技术的操作时间明显更快（中位数时间 110 秒[范围 57-315 秒] vs 246 秒[范围 163-472 秒]；P<0.0001）。SPEDI 技术的定位时间明显更短（P<0.0001）。未记录到其他具有统计学意义的差异。
SPEDI 阻滞在疼痛评估、恶心、舒芬太尼需求、皮区麻醉和运动阻滞方面与传统腘窝-坐骨神经/隐神经阻滞组合具有同等疗效，但操作时间更快，仅需 1 次皮肤穿刺，且不需要重新定位腿部。
