Bonet A, Koo M, Sabaté A, Otero I, Bocos J, Pi A
Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
Rev Esp Anestesiol Reanim. 2015 Oct;62(8):428-35. doi: 10.1016/j.redar.2014.10.009. Epub 2015 Jan 2.
Arthroscopic knee surgery is a minimally invasive technique with moderate pain during the first 24h. Our main objective was to evaluate the efficacy of ultrasound guided saphenous nerve block as a method of pain control intraoperatively and postoperatively for this surgery.
A prospective and observational study. All patients received general anesthesia with laryngeal mask in the saphenous group, nerve block was performed with 10 ml ropivacaine 0.475%. Location of the surgery (external compartment group/internal compartment group), morphine consumption, VAS for pain at 5, 30, 60 and 120 min and 24 h after surgery, need for rescue medication, onset of nausea and vomiting, length of stay in PACU, delayed discharge and satisfaction were evaluated.
The study included 73 patients. Of these, 46 received saphenous nerve block and 27 didn't receive it. Consumption of intraoperative, postoperative and total morphine was significantly lower in the saphenous group as well as VAS at 24h. In the subgroup of internal compartment surgery differences in VAS 24 h, morphine consume and lenght of stay in PACU were mantained.
The ultrasound-guided block of saphenous nerve, particularly in the internal compartment arthroscopic knee surgery, decreases analgesic requirements, obtaining more effective pain control in the first 24 h postoperatively and without any known side effects.
关节镜下膝关节手术是一种微创手术,术后24小时内疼痛程度中等。我们的主要目的是评估超声引导下隐神经阻滞作为该手术术中及术后疼痛控制方法的疗效。
一项前瞻性观察研究。隐神经阻滞组所有患者均采用喉罩全身麻醉,使用0.475%的10毫升罗哌卡因进行神经阻滞。评估手术部位(外侧间室组/内侧间室组)、吗啡用量、术后5分钟、30分钟、60分钟、120分钟及24小时的疼痛视觉模拟评分(VAS)、是否需要急救药物、恶心呕吐的发生情况、在麻醉后恢复室(PACU)的停留时间、延迟出院情况及满意度。
该研究纳入73例患者。其中,46例接受隐神经阻滞,27例未接受。隐神经阻滞组术中、术后及吗啡总用量以及24小时时的VAS评分均显著更低。在内侧间室手术亚组中,24小时时的VAS评分、吗啡用量及在PACU的停留时间差异依然存在。
超声引导下隐神经阻滞,尤其是在内侧间室关节镜下膝关节手术中,可降低镇痛需求,在术后24小时内获得更有效的疼痛控制,且无任何已知副作用。