Van de Velde Stijn, Kalmar Alain F, Raes Matthias, Poelaert Jan, Lootens Tom, Vanoverschelde Henk
Department of Anesthesia and Critical Care Medicine, Maria Middelares Hospital, Ghent, Belgium.
Department of Anesthesiology and Perioperative Medicine, Acute and Chronic Pain Therapy, University Hospital, Brussels, Belgium.
Open Orthop J. 2016 Jul 20;10:258-63. doi: 10.2174/1874325001610010258. eCollection 2016.
Noninvasive measurement of cutaneous tissue oxygenation using near-infrared spectroscopy (NIRS) has become common in peri-operative care. Following institution of peripheral nerve blocks, neurovascular alterations in the blocked region have been described.
The primary aim of this study encompassed the assessment of the influence of a popliteal block on changes in regional oxygen saturation (SrO2), and the location of most prominent changes.
We conducted a prospective randomised controlled trial. Hundred twenty patients who received a popliteal block for foot surgery were included. Popliteal block was performed under echographic guidance. The patients were randomized in 3 groups according to the location of the SrO2 electrodes on the legs. Bilateral SrO2 measurements were performed simultaneously. SrO2 in the operated leg and in the control leg was measured at baseline and 1, 5, 10, 15, and 30 minutes after the perineural injection. We quantified the evolution in SrO2 by calculating over time the differences in SrO2 values between the operated and control leg (=ΔSrO2).
At 30 minutes, ΔSrO2 increased significantly (p<0.05) at the plantar side of the foot (11.3% ± 2.9%), above the ankle (4.9% ± 1.3%) and the popliteal fossa (3.6% ± 1.2%).
At 30 minutes after institution of the popliteal block, ΔSrO2 was most prominent at the plantar side of the foot as compared with measurement performed above the ankle or under the knee.
使用近红外光谱法（NIRS）对皮肤组织氧合进行无创测量在围手术期护理中已变得很常见。在实施外周神经阻滞后，已描述了阻滞区域的神经血管改变。
本研究的主要目的包括评估腘窝阻滞对局部氧饱和度（SrO2）变化的影响以及最显著变化的位置。
我们进行了一项前瞻性随机对照试验。纳入了120例因足部手术接受腘窝阻滞的患者。腘窝阻滞在超声引导下进行。根据腿部SrO2电极的位置将患者随机分为3组。同时进行双侧SrO2测量。在神经周围注射前及注射后1、5、10、15和30分钟测量手术侧腿和对照侧腿的SrO2。我们通过计算手术侧腿和对照侧腿SrO2值随时间的差异（=ΔSrO2）来量化SrO2的变化。
30分钟时，足部跖侧（11.3%±2.9%）、踝关节上方（4.9%±1.3%）和腘窝（3.6%±1.2%）的ΔSrO2显著增加（p<0.05）。
在腘窝阻滞实施30分钟后，与踝关节上方或膝关节下方的测量相比，足部跖侧的ΔSrO2最为显著。
