经臀下入路连续坐骨神经阻滞在跟骨骨折患者术后镇痛中的应用

目的探讨0．2％罗哌卡因经臀下入路连续坐骨神经阻滞用于跟骨骨折术后镇痛的效果及安全性。方法纳入2012年5月-2013年1月40例择期行跟骨骨折切开复位内固定术患者,随机分为连续坐骨神经阻滞组（CSB组）和静脉自控镇痛组（PCIA组）,每组20例。CSB组行经臀下入路的连续坐骨神经阻滞置管,术后连接镇痛泵持续泵注0．2％罗哌卡因进行连续镇痛。PCIA组术后采用镇痛泵进行静脉自控镇痛。观察术后2、8、24、48h静止和运动时疼痛评分和镇静评分,记录患者术后其他镇痛药物使用情况、患者及医生满意度和不良反应发生情况。结果CSB组术后各时点视觉模拟评分（VAS）（静止和运动）均明显低于PCIA组,差异有统计学意义（P〈0．005）;术后镇痛药物的使用量均明显低于PCIA组,差异具有统计学意义（P〈0．05）;患者及医生满意度明显高于PCIA组,差异具有统计学意义（P〈0．05）。结论与静脉自控镇痛相比,0．2％罗哌卡因经臀下入路连续坐骨神经阻滞可为跟骨骨折术后提供更加满意的镇痛效果,安全性高,值得临床推广。

Subgluteal Approach Continuous Sciatic Nerve Block for Postoperative Analgesia in Calcaneal Fracture Patients

Objective To investigate the effect and safety of subgluteal approach continous sciatic nerve block with 0.2% ropivacaine for postoperative analgesia in calcaneal fracture patients. Methods Forty calcaneal fracture patients treated from May 2012 to January 2013 were randomly assigned to two groups： 20 patients in continuous sciatic nerve block group （group CSB） and 20 patients in self-controlled intravenous analgesia group （group PCIA）. Patients in group CSB were given subgluteal approach continuous sciatic nerve block, and PCA pump was connected to give 0.2% ropivacaine via continuous nerve block catheter continuously for analgesia. Patients in group PCIA were given PCA pump directly for self-controlled intravenous analgesia. The movement/rest VAS scores and Ramsay scores at 2, 8, 24, 48 hours after surgery, the dose of other analgesia drugs after surgery, the satisfaction of patients and surgeons, and side effects were recorded. Results The movement and rest visual analogue scale （VSA） scores and the dose of analgesia drugs in group CSB were significantly lower than group PCIA at all time points （P 〈 0.05）. The satisfaction of patients and surgeons in group CSB was higher than group PCIA （P 〈 0.05）. Conclusion Compared with self-controlled intravenous analgesia, subgluteal approach continuous sciatic nerve block with 0.2% ropivacaine can provide better and safer postoperative analgesia for calcaneal fracture patients.