From the CHU Clermont-Ferrand, Médecine Péri-Opératoire (MC, FL, PJ, A-LC, EF); Université Clermont-Auvergne (EF); CHU Clermont-Ferrand, Unité de Biostatistiques, Direction de la Recherche Clinique et des Innovations (BP); CHU Clermont-Ferrand, Centre de Pharmacologie Clinique (CD); and INSERM, CIC1405 & UMR1107, Clermont-Ferrand, France (CD).
Eur J Anaesthesiol. 2020 Sep;37(9):787-795. doi: 10.1097/EJA.0000000000001263.
Adding a regional block to general anaesthesia can prevent postoperative pain and improve peripheral circulation.
To seek improved postoperative analgesia and care due to a long-acting combined femoral and sciatic nerve block in patients undergoing femoropopliteal bypass surgery.
A randomised, double-blind, controlled trial.
Vascular surgery unit of a French university hospital.
Forty-four adults scheduled for bypass surgery under general anaesthesia.
Patients were allocated to receive either an active nerve block with 20 ml of 0.375% levobupivacaine and clonidine 0.5 μg kg, or a simulated (sham) block only, but with local anaesthesia of the skin, before general anaesthesia. General anaesthesia was standardised with propofol, then sevoflurane and sufentanil adjusted according to clinical need. Postoperative analgesia was standardised with paracetamol 1 g every 6 h, and intravenous morphine, initially titrated in the postanaesthesia care unit and then patient-controlled. Oral analgesics were repeated up to day 3.
The primary outcome was morphine consumption during the first 24 postoperative hours. In a subgroup of postoperative patients distal tissue oxygen saturation was recorded at the lateral side of the blocked calf.
Patients in the active group received less intra-operative sufentanil (median dose 25 vs. 41 μg), needed less morphine during the first 24 h (15 vs. 27 mg) and 72 (20 vs. 35 mg) postoperative hours, than in the control group. They also had less pain on movement, but pain at rest, the tissue oxygen saturation and other rehabilitation outcomes were unaffected by the treatment. Tolerance outcomes were also similar between groups.
Combining the two regional blocks improves the quality of postoperative care in this frail population, probably by reducing the amount of peri-operative opioid.
ClinicalTrials.gov (ref. NCT01785693).
在全身麻醉中加入区域阻滞可以预防术后疼痛并改善外周循环。
由于长效股神经和坐骨神经联合阻滞，为接受股腘旁路手术的患者提供更好的术后镇痛和护理。
随机、双盲、对照试验。
法国一所大学医院的血管外科病房。
44 名接受全身麻醉下旁路手术的成年人。
患者被随机分配接受 20ml 0.375%左旋布比卡因和 0.5μg/kg 可乐定的主动神经阻滞，或仅接受皮肤局部麻醉的模拟（假）阻滞，但在全身麻醉前进行。全身麻醉采用丙泊酚标准化，然后根据临床需要调整七氟醚和舒芬太尼。术后镇痛采用 1g 对乙酰氨基酚每 6 小时标准化，静脉注射吗啡，最初在麻醉后恢复室滴定，然后患者自控。口服镇痛药在第 3 天重复使用。
主要观察指标为术后 24 小时内吗啡的消耗量。在术后患者的亚组中，记录阻滞小腿外侧的组织氧饱和度。
与对照组相比，实验组患者术中接受的舒芬太尼（中位剂量 25 对 41μg）、术后 24 小时内（15 对 27mg）和 72 小时内（20 对 35mg）需要的吗啡更少，运动时疼痛也更少，但休息时疼痛、组织氧饱和度和其他康复结果不受治疗影响。两组之间的不良反应结局也相似。
联合两种区域阻滞可改善此类脆弱人群的术后护理质量，可能通过减少围手术期阿片类药物的用量来实现。
ClinicalTrials.gov（注册号 NCT01785693）。
