Wu Hai-Yin, Wang Xiao-Dong, Xiong Guo-Li, Yang Xu-Dong, Wang Li-Kuan
Department of Anesthesiology, Peking University School and Hospital of Stomatology, #22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China.
BMC Anesthesiol. 2025 Jun 7;25(1):290. doi: 10.1186/s12871-025-03151-6.
We investigated the efficacy and safety of preoperative popliteal sciatic nerve block (PSNB) using liposomal bupivacaine (LB) to reduce perioperative opioid consumption and improve recovery quality in patients undergoing maxillofacial reconstruction with a free fibular flap.
A total of 74 patients were randomly allocated into two groups. The PSNB group received ultrasound guided PSNB using 133 mg of LB after anesthesia induction. In the control group, patients underwent nerve block preparation procedures without puncture or drug injection. The primary endpoint was cumulative opioid consumption during the perioperative period (from anesthesia induction to 48 h post-surgery). The secondary endpoints were the total incidence of moderate to severe pain during the 48 h postoperative period; the incidence of moderate to severe pain during different time periods after surgery; the incidence of PONV within 48 h after surgery; subjective sleep quality within 2 days after surgery; the length of post-surgical hospital stay; all-cause in-hospital mortality; and the incidence of other complications during hospitalization.
There was no significant difference in cumulative opioid consumption between the control group (3020.0 [2163.0, 3569.5] µg of remifentanil equivalents) and the PSNB group (2856.0 [2204.0, 3771.0] µg; = 0.863). The incidence of moderate to severe pain at the donor site within 48 h after surgery was significantly lower in the PSNB group (3 [8.1%] of 37 patients) than in the control group (18 [48.6%] of 37 patients; < 0.001). The consumption of rescue opioids was significantly reduced in the PSNB group (0 [0, 50]) compared with that in the control group (50 [0, 100]; = 0.007). The subjective sleep quality numeric rating scale score was significantly lower in the PSNB group than in the control group (day of surgery: 6.0 [5.0, 8.0] vs. 8.0 [6.0, 9.0], = 0.029; postoperative day 1: 5.0 [4.0, 5.0] vs. 7.0 [5.5, 7.5], < 0.001; postoperative day 2: 5.0 [4.0, 5.5] vs. 6.0 [5.0, 7.5], = 0.001). The incidence of postoperative nausea and vomiting was significantly lower in the PSNB group (0 [0.0%]) compared with that in the control group (5 [13.5%]; = 0.021). There was no significant difference in the incidence of adverse events between the two groups.
Preoperative administration of PSNB by LB did not spare opioids during the intraoperative period, but significantly relieved postoperative pain at the donor site, reduced rescue opioid consumption, and improved postoperative sleep quality, without additional adverse events.
Clinicaltrials.gov. Identifier ChiCTR2400080944, 19 February 2024.
我们研究了使用脂质体布比卡因（LB）进行术前腘部坐骨神经阻滞（PSNB）以减少接受游离腓骨瓣颌面重建患者围手术期阿片类药物消耗并改善恢复质量的有效性和安全性。
总共74例患者被随机分为两组。PSNB组在麻醉诱导后接受超声引导下使用133mg LB的PSNB。在对照组中，患者接受神经阻滞准备程序，但不进行穿刺或药物注射。主要终点是围手术期（从麻醉诱导至术后48小时）累积阿片类药物消耗量。次要终点包括术后48小时内中度至重度疼痛的总发生率；术后不同时间段中度至重度疼痛的发生率；术后48小时内恶心呕吐的发生率；术后2天内的主观睡眠质量；术后住院时间；全因住院死亡率；以及住院期间其他并发症的发生率。
对照组（瑞芬太尼等效剂量3020.0[2163.0,3569.5]μg）与PSNB组（2856.0[2204.0,3771.0]μg；P = 0.863）之间的累积阿片类药物消耗量无显著差异。PSNB组术后48小时内供区中度至重度疼痛的发生率（37例患者中的3例[8.1%]）显著低于对照组（37例患者中的18例[48.6%]；P < 0.001）。与对照组（50[0,100]；P = 0.007）相比，PSNB组抢救性阿片类药物的消耗量显著降低（0[0,50]）。PSNB组的主观睡眠质量数字评分量表得分显著低于对照组（手术日：6.0[5.0,8.0]对8.0[6.0,9.0]，P = 0.029；术后第1天：5.0[4.0,5.0]对7.0[5.5,7.5]，P < 0.001；术后第2天：5.0[4.0,5.5]对6.0[5.0,7.5]，P = 0.001）。PSNB组术后恶心呕吐的发生率（0[0.0%]）显著低于对照组（5例[13.5%]；P = 0.021）。两组不良事件发生率无显著差异。
术前使用LB进行PSNB在术中并未节省阿片类药物，但显著减轻了术后供区疼痛，减少了抢救性阿片类药物的消耗，并改善了术后睡眠质量，且无额外不良事件。
Clinicaltrials.gov。标识符ChiCTR2400080944，2024年2月19日。
