Tangkittithaworn Chonruethai, Kampitak Wirinaree, Benjamungkalarak Tanawat, Apinun Jirun
Department of Anesthesiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Orthopaedics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Indian J Anaesth. 2024 Dec;68(12):1035-1042. doi: 10.4103/ija.ija_968_24. Epub 2024 Dec 3.
Tourniquet-induced hypertension (TH) remains an unresolved issue. Various techniques, such as peripheral nerve blocks, peri-femoral artery blocks, and subcutaneous infiltration, have been explored to address this. The primary objective was to compare the incidence of TH during lower-limb surgery under general anaesthesia between peri-femoral artery block and subcutaneous infiltration, combined with femoral and sciatic nerve blocks. Secondary objectives included intraoperative intravenous fentanyl and antihypertensive uses, as well as postoperative pain scores.
This single-centre, double-blind, randomised controlled trial involved 58 patients scheduled for elective lower-limb surgery. Participants were assigned to the peri-femoral artery block (P-FAB) or subcutaneous infiltration (SI) groups. All patients received general anaesthesia alongside femoral and sciatic nerve blocks. TH was defined as a 30% increase in systolic blood pressure from baseline. Pain was assessed using a numerical rating scale in the post-anaesthetic care unit and at 4, 8, 12, and 24 h post-surgery. Unpaired -test, Chi-square, and Mann-Whitney U test were used for analysis. A value less than 0.05 was considered to be statistically significant.
There were no significant differences in the incidence of TH between the P-FAB and SI groups ( = 1.00). Similarly, no significant differences were observed in intraoperative fentanyl ( = 0.459) or antihypertensive use ( = 0.992). Pain scores across all measured aspects, including thigh and incision sites, were also not significantly different between groups ( > 0.05).
In lower-limb surgery, adding a peri-femoral artery block to general anaesthesia with femoral and sciatic nerve blocks did not reduce the incidence of TH compared to subcutaneous infiltration.
止血带引起的高血压（TH）仍是一个未解决的问题。人们已经探索了各种技术，如外周神经阻滞、股动脉周围阻滞和皮下浸润来解决这一问题。主要目的是比较在全身麻醉下行下肢手术时，股动脉周围阻滞与皮下浸润联合股神经和坐骨神经阻滞时TH的发生率。次要目的包括术中静脉注射芬太尼和抗高血压药物的使用情况以及术后疼痛评分。
这项单中心、双盲、随机对照试验纳入了58例计划进行择期下肢手术的患者。参与者被分配到股动脉周围阻滞（P-FAB）组或皮下浸润（SI）组。所有患者均接受全身麻醉并联合股神经和坐骨神经阻滞。TH定义为收缩压较基线升高30%。在麻醉后护理单元以及术后4、8、12和24小时使用数字评分量表评估疼痛。采用非配对t检验、卡方检验和曼-惠特尼U检验进行分析。P值小于0.05被认为具有统计学意义。
P-FAB组和SI组之间TH的发生率无显著差异（P = 1.00）。同样，术中芬太尼的使用（P = 0.459）或抗高血压药物的使用（P = 0.992）也没有显著差异。两组在所有测量方面的疼痛评分，包括大腿和切口部位，也没有显著差异（P > 0.05）。
在下肢手术中，与皮下浸润相比，在全身麻醉联合股神经和坐骨神经阻滞的基础上加用股动脉周围阻滞并不能降低TH的发生率。
