Breebaart Margaretha B, Branders Jordi, Sermeus Luc, Termurziev Sultan, Camerlynck Helene, Van Putte Lennert, Van Putte Minelli Marnik, De Hert Stefan
Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium.
Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium.
Local Reg Anesth. 2021 Mar 25;14:43-50. doi: 10.2147/LRA.S299870. eCollection 2021.
Continuous sciatic nerve blocks have proven benefits for postoperative analgesia after foot surgery. However, the optimal mode of administration remains a point of debate. Ultrasound guided subparaneural injection accelerates onset time and increases duration after a single shot sciatic nerve block. This double blind prospective randomized trial compares the 48-hour local anesthetic (LA) dose consumption of an automated intermittent bolus technique to a continuous infusion regimen in a subparaneural sciatic nerve catheter after hallux valgus surgery.
Patients scheduled for hallux valgus surgery were randomized to receive either a continuous infusion of levobupivacaine 0.125% at 5mL/h (group A) or an intermittent automated bolus of 9.8 mL every 2 hours with a background of 0.1 mL/h (group B), both with a PCA bolus of 6 mL and lockout of 30 minutes. The 48 hour LA consumption, PCA boluses, Numeric Rating Scale (NRS), satisfaction and return of normal sensation were recorded.
Sixteen patients were excluded because of protocol violation or technical problems and 42 patients remained for analysis. The 48 hour ropivacaine consumption was higher in group A (293 ±60 mL) than group B (257±33 mL). The median and highest NRS scores and patient satisfaction were not statistically different between groups. Normal sensation returned after 75 ± 22 hours (group A) and 70 ± 17 hours (group B).
Programmed bolus administration in subparaneural sciatic nerve catheters reduces LA consumption 48 hours after surgery with equal analgesia and patient satisfaction. Return of sensation is variable and can last more than 75 hours.
连续坐骨神经阻滞已被证明对足部手术后的镇痛有益。然而，最佳给药方式仍是一个有争议的问题。超声引导下神经旁注射可加速单次坐骨神经阻滞后的起效时间并延长持续时间。这项双盲前瞻性随机试验比较了拇外翻手术后神经旁坐骨神经导管采用自动间歇性推注技术与持续输注方案在48小时内局部麻醉药（LA）的剂量消耗情况。
计划进行拇外翻手术的患者被随机分为两组，A组接受0.125%左旋布比卡因以5mL/h的速度持续输注，B组每2小时接受9.8 mL的间歇性自动推注并伴有0.1 mL/h的背景输注，两组均有6 mL的PCA推注且锁定时间为30分钟。记录48小时内的LA消耗量、PCA推注次数、数字评分量表（NRS）、满意度以及正常感觉的恢复情况。
16名患者因违反方案或技术问题被排除，42名患者留作分析。A组4�小时罗哌卡因消耗量（293±60 mL）高于B组（257±33 mL）。两组之间的NRS中位数和最高分以及患者满意度无统计学差异。正常感觉在A组75±22小时、B组70±17小时后恢复。
神经旁坐骨神经导管采用程序化推注给药可降低术后48小时的LA消耗量，镇痛效果和患者满意度相当。感觉恢复情况因人而异，可能持续超过75小时。
