Diwan Sandeep, Nair Abhijit, Adhye Bharati, Sancheti Parag K
Anaesthesiology, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, IND.
Anaesthesiology, Ibra Hospital, Ibra, OMN.
Cureus. 2022 Jan 9;14(1):e21041. doi: 10.7759/cureus.21041. eCollection 2022 Jan.
Background Neurostimulation-guided sacral plexus blocks (SPBs) are primarily indicated for surgeries of the foot and ankle and secondarily for supplementing a lumbar plexus block for hip surgeries. Although ultrasound has largely replaced neurostimulation-guided SPB, it may not be available at all facilities. Hence, it is prudent to understand the intricacies of neurostimulation-guided SPB. Methodology In this study, 10 American Society of Anesthesiologists-physical status I and II patients undergoing an intramedullary femoral nail procedure for femoral fractures of the shaft femur received a combined lumbar and sacral plexus block for operative surgery and postoperative pain relief. Neurostimulation-guided SPB was administered in all patients after the lumbar plexus block. Results In all patients, gluteal contractions were observed as the stimulating needle advanced during neurostimulation-guided SPB, which was either a dorsal or plantar flexion. The end-point of neurostimulation-guided SPB was obtained at 1-1.5 mm beyond the gluteal contractions. Conclusions It is important to understand that gluteal contractions are evident as the needle is advanced and can be considered a gateway during a neurostimulation-guided SPB.
神经刺激引导下的骶丛阻滞（SPB）主要用于足踝手术，其次用于补充腰丛阻滞以进行髋关节手术。尽管超声已在很大程度上取代了神经刺激引导下的SPB，但并非所有医疗机构都能使用。因此，了解神经刺激引导下SPB的复杂性是明智的。方法：在本研究中，10例美国麻醉医师协会身体状况I级和II级、因股骨干骨折接受股骨髓内钉手术的患者接受了腰丛和骶丛联合阻滞，用于手术及术后镇痛。在所有患者的腰丛阻滞后进行神经刺激引导下的SPB。结果：在所有患者中，神经刺激引导下的SPB过程中，当刺激针推进时均观察到臀肌收缩，表现为背屈或跖屈。神经刺激引导下的SPB终点在臀肌收缩后1 - 1.5毫米处获得。结论：必须明白，在神经刺激引导下的SPB过程中，随着针的推进，臀肌收缩明显，可将其视为一个关键标志。
