Kim Ha-Jung, Chin Ki Jinn, Kim Hyungtae, Jang Hwa-Young, Bin Seong-Il, Ro Young-Jin, Koh Won Uk
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
J Ultrasound Med. 2020 Aug;39(8):1641-1647. doi: 10.1002/jum.15258. Epub 2020 Mar 3.
We aimed to identify the optimal lower limb position for an ultrasound (US)-guided anterior approach to a sciatic nerve block.
We included 45 patients who met the following criteria: American Society of Anesthesiologists physical status of 1 to 3, age between 18 and 80 years, and scheduled to undergo knee surgery that required a sciatic nerve block. The lower limbs of each patient were placed in the following 4 positions: N, neutral; ER, external rotation of the hip (angle, 45°); ER/F15, ER (angle, 45°) and flexion (angle, 15°) of the hip; and ER/F45, ER (angle, 45°) and F (angle, 45°) of the hip. An investigator acquired US scans of the sciatic nerve in each position, and the visibility score and depth of the sciatic nerve from the skin were analyzed.
The visibility scores were significantly higher in positions ER/F15 and ER/F45 than in positions ER and N (P < .0001). However, there was no difference between the visibility scores in positions ER/F15 and ER/F45 (P = .0959). The depth of the sciatic nerve from the skin decreased with ER and an increase in the F angle of the hip (overall P < .0001).
Based on the visibility score and depth from the skin, ER of the hip to 45° with a greater F angle (45° versus 15°) of the hip appears to be the optimal position for an US-guided anterior approach to a sciatic nerve block.
我们旨在确定超声（US）引导下坐骨神经阻滞前路的最佳下肢位置。
我们纳入了45例符合以下标准的患者：美国麻醉医师协会身体状况分级为1至3级，年龄在18至80岁之间，计划接受需要坐骨神经阻滞的膝关节手术。每位患者的下肢被置于以下4种位置：N，中立位；ER，髋关节外旋（角度，45°）；ER/F15，髋关节外旋（角度，45°）且屈曲（角度，15°）；以及ER/F45，髋关节外旋（角度，45°）且屈曲（角度，45°）。一名研究者获取了每个位置坐骨神经的超声扫描图像，并分析了坐骨神经的可视性评分和从皮肤到坐骨神经的深度。
ER/F15和ER/F45位置的可视性评分显著高于ER和N位置（P <.0001）。然而，ER/F15和ER/F45位置的可视性评分之间没有差异（P = 0.0959）。从皮肤到坐骨神经的深度随着髋关节外旋以及髋关节屈曲角度增加而减小（总体P <.0001）。
基于可视性评分和从皮肤到坐骨神经的深度来看，髋关节外旋至45°且更大的髋关节屈曲角度（45°对比15°）似乎是超声引导下坐骨神经阻滞前路的最佳位置。
