Song Jae-Hwang, Kang Chan, Hwang Deuk-Soo, Hwang Jung-Mo, Shin Byung-Kon
Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea.
Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea.
J Foot Ankle Surg. 2016 Jan-Feb;55(1):121-4. doi: 10.1053/j.jfas.2015.08.009. Epub 2015 Sep 28.
The analgesic effects of preoperative ultrasound-guided nerve blocks wear off after about 12 hours, leaving some patients in substantial pain. Transdermal fentanyl concentrations peak at 12 to 24 hours after application and maintain this concentration for approximately 72 hours. We sought to determine whether combining the use of a transdermal fentanyl patch with either a sciatic or femoral-sciatic nerve block would improve pain control in patients undergoing foot and/or ankle surgery. Consecutive patients in the no-patch control group (n = 104) were enrolled from July 2011 to October 2011, and those in the treatment group (n = 232) were enrolled from November 2011 to May 2012 and received a transdermal patch (4.125 mg/7.5 cm(2) releasing 25 μg of fentanyl per hour) applied to their chest postoperatively. Pain was assessed using a visual analog scale at 6, 12, 24, and 48 hours after surgery. The primary outcome measure was the number of requests for additional postoperative pain medication. Additional postoperative analgesia was requested by 49 of the 104 control patients (47.1%) and 63 of the 232 treated patients (27.1%; p = .002). The mean pain scores were also lower in the treatment group, with a statistically significant difference (p < .05) at 12, 24, and 48 hours. Thus, patients receiving a fentanyl patch combined with an ultrasound-guided nerve block required less supplemental analgesia to maintain adequate pain control than did those receiving a nerve block alone. In conclusion, a fentanyl patch is a useful adjunct to an ultrasound-guided nerve block in foot and ankle surgery.
术前超声引导下神经阻滞的镇痛效果在约12小时后逐渐消失，导致一些患者仍处于剧痛之中。透皮芬太尼浓度在用药后12至24小时达到峰值，并维持该浓度约72小时。我们试图确定，将透皮芬太尼贴剂与坐骨神经或股-坐骨神经阻滞联合使用，是否能改善足和/或踝关节手术患者的疼痛控制情况。无贴剂对照组（n = 104）的连续患者于2011年7月至2011年10月入组，治疗组（n = 232）的患者于2011年11月至2012年5月入组，并在术后将透皮贴剂（4.125 mg/7.5 cm²，每小时释放25 μg芬太尼）贴于胸部。术后6、12、24和48小时，使用视觉模拟评分法评估疼痛程度。主要观察指标为术后额外镇痛药物的需求次数。104名对照患者中有49名（47.1%）需要额外的术后镇痛，232名治疗患者中有63名（27.1%）需要额外镇痛（p = .002）。治疗组的平均疼痛评分也较低，在12、24和48小时有统计学显著差异（p < .05）。因此，与仅接受神经阻滞的患者相比，接受芬太尼贴剂联合超声引导下神经阻滞的患者维持充分疼痛控制所需的补充镇痛较少。总之，在足踝手术中，芬太尼贴剂是超声引导下神经阻滞的有用辅助手段。
