Wang Liwei, Qu Yinyin, Deng Ying, Li Jun, Liu Yanqing, Wu Changyi
Department of Anesthesiology, Peking University Third Hospital, Peking University, Beijing, 100191, People's Republic of China.
Department of Orthopaedics, Peking University Third Hospital, Peking University, Beijing, 100191, People's Republic of China.
J Pain Res. 2023 Jun 16;16:2091-2099. doi: 10.2147/JPR.S404489. eCollection 2023.
The location of the sciatic nerve deep within the thigh tissue makes it challenging to locate while the patient is in a supine position. The posterior intermuscular septum of the thigh, which encircles the posterior surface of the adductor magnus muscle (AMM), is where the sciatic nerve is located. Our hypothesis was that administering local anesthetic injections into this area could block the sciatic nerve. Therefore, our aim was to evaluate the effectiveness of sciatic nerve block achieved by injecting local anesthetic into the posterior intermuscular septum of the thigh, named the AMM approach.
Twenty-six patients undergoing total knee arthroplasty were included in the study. We performed an ultrasound-guided sciatic nerve block by injecting 20 mL of 0.25% ropivacaine into the posterior surface of the adductor magnus muscle, using the AMM approach. Additionally, we administered a femoral nerve block with 20 mL of 0.4% ropivacaine. We assessed the sensory and motor effects of the blockade in the operated lower limb and recorded postoperative pain scores at 0, 4, 8, 12, 24, and 48 hours after the operation.
The AMM approach successfully block the sciatic nerve in all 26 patients. The onset of the sensory and motor blockades was achieved within 5.4 ± 1.9 min and 8.7 ± 3.5 min, respectively. We achieved a satisfactory position with the first puncture in 19 of 26 patients (73.1%). The muscle strength of the tibialis anterior immediately after surgery was 4 (ranging from 2 to 5). Additional rescue analgesics were required in 5 of the 26 patients (19.2%) during the first 24 hours postoperatively.
The AMM approach is an innovative and effective method for sciatic nerve block. When combined with simultaneous femoral nerve block in patients undergoing total knee arthroplasty, it provides a useful analgesic treatment option.
坐骨神经位于大腿组织深处，患者仰卧时定位困难。坐骨神经位于大腿后肌间隔内，该肌间隔环绕着大收肌（AMM）的后表面。我们的假设是在此区域进行局部麻醉注射可阻滞坐骨神经。因此，我们的目的是评估通过向大腿后肌间隔注射局部麻醉剂（即AMM法）实现坐骨神经阻滞的有效性。
本研究纳入26例行全膝关节置换术的患者。我们采用AMM法，将20 mL 0.25%的罗哌卡因注入大收肌后表面，进行超声引导下坐骨神经阻滞。此外，我们还用20 mL 0.4%的罗哌卡因进行了股神经阻滞。我们评估了手术下肢阻滞的感觉和运动效果，并记录了术后0、4、8、12、24和48小时的疼痛评分。
AMM法在所有26例患者中均成功阻滞了坐骨神经。感觉和运动阻滞的起效时间分别为5.4±1.9分钟和8.7±3.5分钟。26例患者中有19例（73.1%）首次穿刺即获得满意位置。术后即刻胫前肌肌力为4级（范围为2至5级）。26例患者中有5例（19.2%）在术后24小时内需要额外的补救性镇痛药。
AMM法是一种创新且有效的坐骨神经阻滞方法。在全膝关节置换术患者中与同时进行的股神经阻滞相结合时，它提供了一种有用的镇痛治疗选择。
