Lauf Jason A, Huggins Pearson, Long Joseph, Al-Issa Mohammed, Byrne Brian, Large Bryan P, Whitehead Brent, Cheney Nicholas A, Law Timothy D
Orthopedic Surgery, Ohio University Heritage College of Osteopathic Medicine, Dublin, USA.
Medicine, Ohio State University College of Medicine, Columbus, USA.
Cureus. 2020 Jul 28;12(7):e9434. doi: 10.7759/cureus.9434.
Background Foot and ankle surgeries are frequently accompanied by a peripheral nerve block in order to reduce postoperative pain. Higher than expected complication rates with peripheral nerve blocks have led to increased concern among surgeons and patients. To our knowledge, no study conducted by the treating surgeon has identified risk factors that may predispose a patient to complications. Our goal was to attempt to identify those risk factors. Methods We reviewed patient charts of those who underwent an orthopedic foot and ankle procedure between 2013 and 2018, as performed by the senior author. This yielded 992 procedures performed across four surgical locations. Of these procedures, 137 procedures were removed because no block was used. The remaining cases were analyzed for nerve complications, defined as sensory or motor deficits along the distribution of a nerve. The patients were divided into those with and without complications and were evaluated for differences. Statistical analysis was performed using the SAS software (SAS Institute Inc., Cary, North Carolina, USA). Results The overall short-term complication rate was 10.1% and the long-term complication rate was 4.3%, with a total of 855 blocks given. Electromyographies (EMGs) were performed on 24.4% of the patients with a complication. Of the EMGs, 95.2% confirmed nerve complications in the distribution of the blocked nerve. The significant factors associated with complications were age, BMI, location, and smoking status. A regression analysis was performed to determine the odds ratio for individual factors. Those with significantly higher odds ratio were between 40 and 65 years of age, had normal or underweight BMI, underwent surgery at an outpatient surgery center, and were current smokers. Conclusions Our study suggests that there are significant epidemiological factors in predicting postoperative complications related to a peripheral nerve block. The study also shows a similar short-term complication rate but a higher long-term complication rate than other studies. This data are important because it allows for an informed decision to be made between a surgeon, anesthesiologist, and the patient regarding the safety and necessity of delivering a preoperative peripheral nerve block based on patient risk factors.
足踝手术常伴有外周神经阻滞以减轻术后疼痛。外周神经阻滞的并发症发生率高于预期，这引起了外科医生和患者的更多关注。据我们所知，尚无主刀医生进行的研究确定可能使患者易发生并发症的危险因素。我们的目标是试图找出这些危险因素。方法：我们回顾了2013年至2018年间由资深作者实施的骨科足踝手术患者的病历。这产生了在四个手术部位进行的992例手术。在这些手术中，137例因未使用阻滞而被排除。对其余病例分析神经并发症，定义为沿神经分布的感觉或运动功能障碍。将患者分为有并发症和无并发症两组，并评估差异。使用SAS软件（SAS Institute Inc.，美国北卡罗来纳州卡里）进行统计分析。结果：在总共855次阻滞中，总体短期并发症发生率为10.1%，长期并发症发生率为4.3%。24.4%有并发症的患者进行了肌电图（EMG）检查。在这些肌电图检查中，95.2%证实了阻滞神经分布区域的神经并发症。与并发症相关的显著因素为年龄、体重指数、手术部位和吸烟状况。进行回归分析以确定各因素的比值比。比值比显著较高的患者年龄在40至65岁之间，体重指数正常或体重过轻，在门诊手术中心接受手术，且为现吸烟者。结论：我们的研究表明，在预测与外周神经阻滞相关的术后并发症方面存在显著的流行病学因素。该研究还显示短期并发症发生率与其他研究相似，但长期并发症发生率更高。这些数据很重要，因为它能让外科医生、麻醉医生和患者根据患者风险因素，就是否进行术前外周神经阻滞的安全性和必要性做出明智的决定。
