Department of Anesthesiology and Reanimation, Sakarya Training and Research Hospital, Sakarya, Turkey.
Department of Anesthesiology and Reanimation, Faculty of Medicine, Sakarya University, Sakarya, Turkey.
Medicine (Baltimore). 2024 Nov 1;103(44):e40311. doi: 10.1097/MD.0000000000040311.
Ultrasound-guided peripheral nerve blocks may be a good alternative in patients under antithrombotic drugs. We evaluated the efficacy of ultrasound-guided popliteal sciatic nerve block in patients undergoing lower extremity wound debridement of whom antithrombotic drugs could not be stopped. We focused on hemorrhagic complications related to sciatic nerve block. Wound care patients followed by Cardiovascular Surgery Department scheduled for lower extremity wound surgery were included in this prospective observational study. Data was collected between March 2021 and September 2022. All patient were under antithrombotic therapy and discontinuation of anticoagulant drugs were not possible. Single-insertion and multiple-injection sciatic nerve block at popliteal region was applied to all patients under ultrasound guidance. Primary outcome was the rate of hemorrhage. Secondary outcomes were block onset times, block success and postoperative analgesia times. Data of 105 patients was evaluated, 87 were male and 18 were female. Mean patient age was 61.92 ± 10.06, mean patient body mass index was 25.68 ± 6.33. All patients were under 1 or more antithrombotic drugs. Only one minor hematoma was detected by postoperative ultrasonography control in 1 patient. Hemorrhage complication rate was 1 of 105 (% 0.95, 95% CI, 0.00024-0.051). Overall block success rate was 99.05%. Mean block onset time was 16.27 ± 5.69 minutes. Mean postoperative analgesia time was 19.5 ± 11.22 hours. Sciatic nerve block under ultrasound guidance using in-plane technique was safe and provided sufficient surgical anesthesia and postoperative analgesia for lower extremity wound debridement surgery in patients on antithrombotic drugs.
超声引导下的外周神经阻滞可能是正在使用抗血栓药物的患者的一个较好的替代选择。我们评估了在不能停用抗血栓药物的情况下，接受下肢伤口清创术的患者行超声引导下腘窝坐骨神经阻滞的效果。我们重点关注与坐骨神经阻滞相关的出血并发症。该前瞻性观察研究纳入了心血管外科病房计划行下肢伤口手术的伤口护理患者。数据收集于 2021 年 3 月至 2022 年 9 月期间。所有患者均正在接受抗血栓治疗，且不能停用抗凝药物。所有患者均在超声引导下接受单次插入和多次注射的腘窝坐骨神经阻滞。主要结局为出血发生率。次要结局为阻滞起效时间、阻滞成功率和术后镇痛时间。共评估了 105 例患者的数据，其中 87 例为男性，18 例为女性。患者的平均年龄为 61.92±10.06 岁，平均体重指数为 25.68±6.33。所有患者均正在使用 1 种或多种抗血栓药物。仅 1 例患者术后超声检查发现轻微血肿。出血并发症发生率为 105 例中的 1 例（1%，95%CI，0.00024-0.051）。总体阻滞成功率为 99.05%。平均阻滞起效时间为 16.27±5.69 分钟。平均术后镇痛时间为 19.5±11.22 小时。在使用平面内技术的超声引导下进行坐骨神经阻滞，对于正在使用抗血栓药物的下肢伤口清创术患者，是一种安全且可提供充分手术麻醉和术后镇痛的方法。
