Department of Orthopedic Surgery, Busan Medical Center, 62, Yangjeong-ro, Busan, Republic of Korea.
BMC Surg. 2023 Aug 10;23(1):227. doi: 10.1186/s12893-023-02138-9.
Below knee amputation (BKA) is a common surgical procedure for diabetic foot ulcers and necrotizing lower limb fasciitis patients. However, it is a painful procedure and inadequate postoperative analgesia impedes rehabilitation and prolongs hospitalization. An ideal pain management regimen should provide superior analgesia while minimizing opioid consumption and improving rehabilitation.
We retrospectively reviewed medical charts of 218 patients who underwent BKA for diabetic foot ulcer or necrotizing lower limb fasciitis at a single center between January 2017 and September 2020. Two groups were analyzed: patients who received dual nerve block (DNB) before surgery (Group I; n = 104), and patients who did not (Group II; n = 93). By the exclusion criteria, 21 patients were excluded. The femoral and sciatic nerves were each blocked separately under ultrasound guidance. This procedure was performed immediately before the operation.
Group I patients' subjective pain scores were significantly lower than that of Group II at 6, 12, and 24 h after BKA (P < 0.05). Group I's morphine milligram equivalent (MME) was significantly lower than those of Group II at 72 h after BKA (P < 0.05). Moreover, the rate of postoperative nausea and vomiting (PONV) and delirium was significantly lower in Group I patients than that in Group II patients.
Ultrasound-guided lower extremity nerve block surgery is excellent for early postoperative pain control, could be used as an accurate and effective pain control method, and can reduce the side effects of opioid consumption after BKA.
膝下截肢（BKA）是治疗糖尿病足溃疡和下肢坏死性筋膜炎患者的常见手术。然而，这是一个痛苦的过程，术后镇痛不足会阻碍康复并延长住院时间。理想的疼痛管理方案应提供卓越的镇痛效果，同时最大限度地减少阿片类药物的消耗并改善康复。
我们回顾性分析了 2017 年 1 月至 2020 年 9 月在一家中心接受 BKA 治疗糖尿病足溃疡或下肢坏死性筋膜炎的 218 名患者的病历。我们分析了两组患者：术前接受双神经阻滞（DNB）的患者（I 组，n=104）和未接受 DNB 的患者（II 组，n=93）。通过排除标准，排除了 21 名患者。在超声引导下分别对股神经和坐骨神经进行单独阻滞。该程序在手术前立即进行。
BKA 后 6、12 和 24 小时，I 组患者的主观疼痛评分明显低于 II 组（P<0.05）。BKA 后 72 小时，I 组的吗啡毫克当量（MME）明显低于 II 组（P<0.05）。此外，I 组患者术后恶心和呕吐（PONV）及谵妄的发生率明显低于 II 组患者。
超声引导下下肢神经阻滞术对术后早期疼痛控制效果极佳，可作为一种准确有效的疼痛控制方法，减少 BKA 后阿片类药物消耗的副作用。
