对搅拌溶液进行彩色多普勒超声检查可预测连续腘窝坐骨神经阻滞时导管放置的准确性。

Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block.

作者信息

Bowens Clifford, Badiola Ignacio J, Allen Brian Frazer Scott, Canlas Christopher Loredo, Gupta Rajnish Kumar, Jaeger Lisa Michelle, Briggs Eric Russell, Corey John Matthew, Shi Yaping, Schildcrout Jonathan Scott, Malchow Randall John

机构信息

Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.

Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

出版信息

Perioper Med (Lond). 2021 Dec 15;10(1):59. doi: 10.1186/s13741-021-00229-w.

DOI:10.1186/s13741-021-00229-w

PMID:34906248

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8672631/

Abstract

BACKGROUND

Continuous peripheral nerve catheters (PNCs) have been shown to provide superior postoperative analgesia, decrease opioid consumption, and improve patient satisfaction compared with single injection techniques. In order to achieve success and reliability, accurate catheter positioning is an essential element of PNC placement. An agitated solution of normal saline, D5W, or a local anesthetic solution can be produced by the introduction of air to the injectate, creating air bubbles that can enhance ultrasonographic visualization and possibly improve block success.

METHODS

Eighty-three patients were enrolled. Ultrasound-guided continuous popliteal sciatic nerve blocks were performed by positioning the tip of a Tuohy needle between the tibial and common peroneal branches of the sciatic nerve and threading a catheter. An agitated local anesthetic solution was injected through the catheter, viewed with color Doppler ultrasound and video recorded. A peripheral block score (lower score = greater blockade, range 0-14) was calculated based upon the motor and sensory testing at 10, 20, and 30 min after block completion. The color Doppler agitation coverage pattern for the branches of the sciatic nerve was graded as follows: complete (> 50%), partial (> 0%, ≤ 50%), or none (0%).

RESULTS

The degree of nerve blockade at 30 min as judged by median (10th, 90th percentile) peripheral block score was significant for partial or complete color Doppler coverage of the sciatic nerve injectate compared to no coverage [3 (0, 7) vs 8 (4, 14); p < 0.01] and block onset was faster (p = 0.03). The block success was higher in groups with partial or complete coverage of the branches of the sciatic nerve vs no coverage (96% vs 70%; p = 0.02).

CONCLUSIONS

Injection of an agitated solution through a popliteal sciatic perineural catheter is predictive of accurate catheter placement when partial or complete coverage of the sciatic nerve branches is visualized with color Doppler ultrasound.

TRIAL REGISTRATION

NCT01591603.

摘要

背景

与单次注射技术相比，连续外周神经导管（PNC）已被证明能提供更优的术后镇痛效果，减少阿片类药物的使用，并提高患者满意度。为了确保成功与可靠性，准确的导管定位是PNC放置的关键要素。向注射液中注入空气可产生生理盐水、5%葡萄糖水溶液（D5W）或局部麻醉溶液的搅拌溶液，形成气泡，增强超声可视化效果，并可能提高阻滞成功率。

方法

纳入83例患者。通过将Tuohy针尖端置于坐骨神经的胫神经和腓总神经分支之间并置入导管，进行超声引导下连续腘窝坐骨神经阻滞。通过导管注入搅拌后的局部麻醉溶液，用彩色多普勒超声观察并录像。根据阻滞完成后10、20和30分钟时的运动和感觉测试计算外周阻滞评分（分数越低 = 阻滞效果越好，范围0 - 14）。坐骨神经分支的彩色多普勒搅拌覆盖模式分级如下：完全覆盖（> 50%）、部分覆盖（> 0%，≤ 50%）或无覆盖（0%）。

结果

与无覆盖相比，坐骨神经注射液彩色多普勒部分或完全覆盖时，30分钟时根据中位数（第10、90百分位数）外周阻滞评分判断的神经阻滞程度显著更高[3（0，7）对8（4，14）；p < 0.01]，且阻滞起效更快（p = 0.03）。坐骨神经分支部分或完全覆盖组的阻滞成功率高于无覆盖组（96%对70%；p = 0.02）。