Department of Anesthesiology, Chaohu Hospital of Anhui Medical University, Chaohu, Anhui, China.
Department of Anesthesiology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China.
BMC Anesthesiol. 2022 Jun 3;22(1):174. doi: 10.1186/s12871-022-01710-9.
Patients with lower limb fracture often have acute pain and discomfort from changes in position, and such pain affects early postoperative recovery. This study aimed to compare the applicability and effectiveness of ultrasound combined with nerve stimulator-guided lumbosacral plexus block (LSPB) in the supine versus lateral position during lower limb fracture surgery.
We included 126 patients who underwent elective internal fixation for lower limb fracture who were divided into the S group and the L group by the random number table method and underwent LSPB guided by ultrasound combined with a nerve stimulator in the supine and lateral positions, respectively. The primary outcome was the dose of sufentanil used in surgery. The secondary outcomes were the maximum VAS (visual analogue scale) pain score at position placing for LSPB, the time of position placing, the time for nerve block,the number of puncture attempts,the haemodynamic indicators, the VAS score at 1, 12, and 24 h following surgery, postoperative satisfactory degree to analgesia and adverse events related to nerve block.
There was no statistically significant difference in dose of sufentanil used between the two groups(P = 0.142). The maximum VAS pain score at position placing(P < 0.01), the time of position placement(P < 0.01), the time for lumbar plexus block and the time of puncture attempts were significantly lower in the S group than in the L group (P < 0.01). However, the time for sacral plexus block was higher in the S group than in the L group (P = 0.029). There was no significant difference in haemodynamic indicators,number of puncture attempts for the sacral plexus, postoperative VAS scores, postoperative satisfactory degree to analgesia or adverse events related to nerve block between the two groups (all P > 0.05).
Our study provides a more comfortable and better accepted anaesthetic regimen for patients undergoing lower limb fracture surgery. LSPB in the supine position is simple to apply and has definite anaesthetic effects. Additionally, it has a high level of postoperative analgesia and therefore should be widely applied.
The trial was registered prior to patient enrolment at the Chinese Clinical Trail Registry (Date:11/03/2021 Number: ChiCTR2100044117 ).
下肢骨折患者常因体位改变而出现急性疼痛和不适，这种疼痛会影响术后早期恢复。本研究旨在比较超声联合神经刺激器引导下的腰骶丛阻滞（LSPB）在仰卧位与侧卧位应用于下肢骨折手术的适用性和效果。
我们纳入了 126 例行择期下肢骨折内固定术的患者，采用随机数字表法将其分为 S 组和 L 组，分别在超声联合神经刺激器引导下于仰卧位和侧卧位行 LSPB。主要结局是手术中舒芬太尼的用量。次要结局是 LSPB 置管时的最大视觉模拟评分（VAS）、置管时间、神经阻滞时间、穿刺尝试次数、血流动力学指标、术后 1、12 和 24 小时的 VAS 评分、术后对镇痛的满意度以及与神经阻滞相关的不良事件。
两组患者舒芬太尼用量无统计学差异（P=0.142）。S 组患者 LSPB 置管时的最大 VAS 疼痛评分（P<0.01）、置管时间（P<0.01）、腰丛阻滞时间和穿刺尝试次数均显著低于 L 组（P<0.01）。然而，S 组患者骶丛阻滞时间长于 L 组（P=0.029）。两组患者血流动力学指标、骶丛穿刺尝试次数、术后 VAS 评分、术后对镇痛的满意度以及与神经阻滞相关的不良事件均无统计学差异（均 P>0.05）。
本研究为下肢骨折手术患者提供了一种更舒适、更易接受的麻醉方案。仰卧位 LSPB 操作简单，麻醉效果确切，且术后镇痛效果较高，因此应广泛应用。
该试验于患者入组前在中国临床试验注册中心注册（日期：2021 年 11 月 3 日，注册号：ChiCTR2100044117）。
