Nag Kusha, Ravishankar M, Parthasarathy S, Thomas Tina M
Department of Anesthesiology, University Medical Centre, King Abdullah Medical City, Kingdom of Bahrain.
Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Pondicherry, India.
Indian J Anaesth. 2023 Sep;67(9):802-808. doi: 10.4103/ija.ija_140_23. Epub 2023 Sep 6.
Sciatic nerve block at the popliteal level for lower limb procedures provides unpredictable success rates even with ultrasonographic (USG) guidance. This study aimed to compare USG-guided single-point versus two-point injection techniques
Sixty patients posted for foot surgeries under USG-guided sciatic nerve block were randomised into Group Single Point, receiving a single injection of 20 mL of 1.5% lignocaine with adrenaline just proximal to the sciatic nerve bifurcation, and Group Double Point, receiving two injections of 10 mL of 1.5% lignocaine with adrenaline, one at the point similar to the first group and a second injection 6 cm above the first point. Sensory blockade onset, time to complete sensory blockade, time to complete motor blockade, length of the nerve exposed and analgesia duration were evaluated. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) statistics version 20 software.
Double-point injection technique showed a significantly faster time to complete motor blockade [14.46 (9.93) min], increased length of nerve exposed to local anaesthetic [23.23 (7.209) cm] and extended duration of analgesia [420.40 (99.34) min] compared to the single-point injection technique [20.89 (12.62) min, 18.78 (5.95) cm and 344.28 (125.97) min, respectively]. The onset of sensory blockade and the time to complete sensory blockade were comparable between the two groups.
USG-guided popliteal sciatic nerve block with a double-point injection technique does not significantly shorten the time to complete the sensory block. However, the time to complete motor nerve block and duration of analgesia are prolonged significantly, which may be clinically beneficial for postoperative analgesia.
即使在超声（USG）引导下，腘窝水平的坐骨神经阻滞用于下肢手术时成功率仍难以预测。本研究旨在比较超声引导下单点与两点注射技术。
60例计划在超声引导下进行坐骨神经阻滞的足部手术患者被随机分为单点组，在坐骨神经分叉近端单次注射20 mL含肾上腺素的1.5%利多卡因；两点组，在与第一组相同位置注射10 mL含肾上腺素的1.5%利多卡因，在第一点上方6 cm处再注射10 mL。评估感觉阻滞起效时间、完成感觉阻滞时间、完成运动阻滞时间、暴露神经长度和镇痛持续时间。使用社会科学统计软件包（SPSS）统计版本20软件进行统计分析。
与单点注射技术相比，两点注射技术显示完成运动阻滞的时间明显更快[14.46（9.93）分钟]，暴露于局部麻醉剂的神经长度增加[23.23（7.209）厘米]，镇痛持续时间延长[420.40（99.34）分钟]，单点注射技术分别为[20.89（12.62）分钟、18.78（5.95）厘米和344.28（125.97）分钟]。两组之间感觉阻滞的起效时间和完成感觉阻滞的时间相当。
超声引导下腘窝坐骨神经阻滞采用两点注射技术并不能显著缩短完成感觉阻滞的时间。然而，完成运动神经阻滞的时间和镇痛持续时间显著延长，这在临床上可能有利于术后镇痛。
