Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Medicine (Baltimore). 2023 May 5;102(18):e33690. doi: 10.1097/MD.0000000000033690.
To assess the rate of conversion to general anesthesia, sedative and analgesic drug-sparing effects, and complications of popliteal sciatic nerve block (PSNB) compared with a sham block during lower limb angioplasty.
A randomized, controlled, double-blinded trial of patients with chronic limb-threatening ischemia (CLTI) who receive PSNB with 0.25% levobupivacaine 20 mL compared with a sham block (control) during lower limb angioplasty. Pain scores, conversion rate to general anesthesia, amount of sedoanalgesia drug usage, complications, and satisfaction with the anesthesia technique by surgeons and patients were assessed.
Forty patients were enrolled in this study. Two of 20 (10%) control group patients were converted to general anesthesia, while none of the patients in the intervention group required general anesthesia (P = .487). Pain scores before PSNB did not differ between the groups (P = .771). After the block, pain scores in the block group were lower than those in the control group: 0 (0, 1.5) (median, interquartile range) and 2.5 (0.5, 3.5), respectively (P = .024). The analgesic effect persisted until immediately after the surgery (P = .035). There was no difference in pain scores at the 24-hours follow-up visit (P = .270). The total propofol and fentanyl dosage requirements, a number of patients who required propofol and fentanyl, side effects, and satisfaction were not different between the groups. No major complications were noted.
PSNB provided effective pain relief during and immediately after lower limb angioplasty, but did not statistically affect the rate of conversion to general anesthesia, sedoanalgesia drug usage, or complications.
评估腘窝坐骨神经阻滞（PSNB）与假阻滞相比，在下肢血管成形术中转为全身麻醉的比率、镇静和镇痛药物节省效果以及并发症。
一项随机、对照、双盲试验，纳入慢性肢体威胁性缺血（CLTI）患者，在下肢血管成形术中接受 0.25%左旋布比卡因 20mL 的 PSNB 与假阻滞（对照）相比。评估疼痛评分、转为全身麻醉的比率、镇静镇痛药物使用量、并发症以及外科医生和患者对麻醉技术的满意度。
本研究纳入了 40 名患者。对照组中有 2 名（10%）患者转为全身麻醉，而干预组中无患者需要全身麻醉（P=.487）。PSNB 前两组的疼痛评分无差异（P=.771）。阻滞后，阻滞组的疼痛评分低于对照组：分别为 0（0，1.5）（中位数，四分位距）和 2.5（0.5，3.5）（P=.024）。镇痛效果持续到手术结束后（P=.035）。24 小时随访时疼痛评分无差异（P=.270）。两组间总丙泊酚和芬太尼用量、需要丙泊酚和芬太尼的患者数量、副作用和满意度无差异。未出现主要并发症。
PSNB 可在下肢血管成形术中及术后立即提供有效镇痛，但在转为全身麻醉的比率、镇静镇痛药物使用量或并发症方面无统计学影响。
