神经刺激器定位神经阻滞在下肢手术中的应用

目的观察神经刺激器定位腰丛神经阻滞对下肢手术患者MAP、HR及SpO2的影响。方法45例股骨中段以下手术患者随机均分为三组:A组,神经刺激器定位下行神经阻滞;B组,行连续硬膜外麻醉;C组,单侧腰麻。A组在神经刺激器定位下行腰丛及坐骨神经阻滞,以2mA强度刺激,出现相应区域肌群收缩后渐减至0.3mA仍有收缩,回抽无血无液,给试验量3～5ml确定位置正确,一次注入0.5%罗比卡因20～25ml,记录术中MAP、HR、SpO2,并与B、C组相比较。结果A组MAP、HR在手术过程中较B、C组平稳(P<0.05,P<0.01)。三组间SpO2变化的差异无显著意义。结论神经刺激器定位下肢神经阻滞应用于下肢手术中定位准确,生理干扰小,镇痛效果好。     

腰丛神经阻滞与硬膜外阻滞在老年股骨粗隆骨折手术中比较

目的比较老年患者股骨粗隆骨折手术中神经刺激器定位下的腰丛-坐骨神经阻滞与硬膜外麻醉效果。方法 60例ASA2～3级拟行老年股骨粗隆骨折患者,随机分为腰丛-坐骨神经阻滞组（A组,n=30）和硬膜外麻醉组（B组,n=30）。A组采用神经刺激器定位下的腰丛-坐骨神经阻滞。腰丛：0.5%罗哌卡因25ml和1%利多卡因15ml;坐骨神经：0.5%罗哌卡因10ml和1%利多卡因10ml。B组行硬膜外麻醉,给予0.5%罗哌卡因和1%利多卡因混合液10～18ml。观察两组患者血流动力学变化、阻滞起效,持续时间及穿刺操作时间、麻醉费用、效果。结果 A组在手术过程中的收缩压、舒张压、心率较B组平稳,两组感觉阻滞起效有显著差异（P〈0.05）,A组感觉阻滞维持时问明显长于B组（P〈0.05）;两组穿刺时间、麻醉费用、药物剂量有显著差异（P〈0.05）。结论腰丛-坐骨神经阻滞用于老年患者单侧股骨粗隆骨折不仅可满足手术需要,而且对血流动力学影响小,阻滞维持时间长,麻醉费用低。     

外周神经阻滞在血管外科重症患者下肢手术中的应用

目的采用外周神经刺激器引导行腰丛联合坐骨神经阻滞,评价其在血管外科重症患者(ASA分级为Ⅲ、Ⅳ级)下肢手术中的临床应用价值。方法2006年4月~2007年5月,接受下肢外周神经阻滞的血管外科病人,根据ASA分级分为2组,Ⅰ、Ⅱ级为普通组(C组,n=22),作为对照,Ⅲ、Ⅳ级为重症组(S组,n=25)。2组都在神经刺激器引导下行腰丛联合坐骨神经阻滞,分析两组的麻醉效果,感觉和运动阻滞的起效时间,恢复时间,术中和术后并发症发生情况。结果组间比较,两组的麻醉效果无统计学差异(C组麻醉效果好15例,中4例,差3例;S组麻醉效果好18例,中5例,差2例;U=261.000,P=0.710)。C组68.2%(15/22)的病例,S组72.0%(18/25)的病例都可以很好地满足外科手术对麻醉的要求。组间比较,2组的感觉运动阻滞起效时间无差异(P>0.1),S组腰丛、坐骨神经的感觉和运动恢复时间长于C组(P<0.01)。C组1例术中双侧阻滞,1例术后大腿前面感觉麻木;S组1例术后腹膜后血肿。这些患者经保守治疗均痊愈出院。结论血管外科下肢手术中,ASA分级为Ⅲ、Ⅳ级的重症患者应用外周神经阻滞,可以取得和普通患者同样的麻醉效果...     

神经刺激器定位腰丛-坐骨神经联合阻滞在老年人下肢手术的应用

目的探讨神经刺激器定位下行腰丛-坐骨神经联合阻滞在老年人下肢手术中的应用,以硬膜外麻醉作对照,观察其对老年病人血流动力学的影响和术后的不良反应。方法60例拟行单侧下肢手术的老年病人,随机分为腰丛-坐骨神经联合阻滞（NER）和硬膜外麻醉（EPI）。记录麻醉前,麻醉开始后15、30、45、60min,术后1h的收缩压（SBP）、舒张压（DBP）和心率（HR）,以及感觉、运动神经阻滞起效及恢复时间、镇痛维持时间、效果。结果麻醉开始后15min。EPI组病人DBP降低明显,随后30、45、60min及术后1hEPI组病人的SBP、DBP均明显低于NER组;NER组感觉、运动神经阻滞起效时间均小于EPI组,恢复时间明显长于EPI组。结论神经刺激器定位下行腰丛-坐骨神经联合阻滞,成功率高,血流动力学平稳,并发症少,起效迅速,镇痛时间长,是老年病人进行单侧下肢手术较好的麻醉方法。     

下肢手术病人左旋布比卡因与罗哌卡因腰丛-坐骨神经联合阻滞的效果

目的 下肢手术病人左旋布比卡因与罗哌卡因腰丛-坐骨神经联合阻滞的效果。方法 择期行单侧下肢手术病人50例,随机分为2组,罗哌卡因组(R组)和左旋布比卡因组(L组),每组 25例。坐骨神经穿刺点为髂后上棘与股骨大转子连线中点垂直线和股骨大转子与骶裂孔连线交点; 腰丛穿刺点为髂嵴连线,腰椎棘突旁开4 cm。选用Stimuplex HNS 11刺激器,采用Stimuplex D 22 G 刺激针。刺激起始电流强度1 mA,在观察到下肢肌肉收缩后,逐渐降低刺激电流强度到≤0．3 mA,相 应的肌群仍有收缩。R组:坐骨神经及腰丛分别注入0．5％罗哌卡因20 ml共200 mg;L组:分别注入 0．375％左旋布比卡因20 ml共150 mg。药物注射完毕后每5 min测定感觉和运动神经阻滞程度,并记 录麻醉起效时间。术中观察病人对止血带的耐受程度及神经阻滞程度分级。记录运动、感觉恢复时 间和首次按压镇痛泵时间。术后24 h评估病人对腰丛-坐骨神经联合阻滞的接受程度及麻醉相关并 发症。结果 R组1例病人阻滞失败,7例(R组5例,L组3例)阻滞尚完全。5例病人(R组3例,L 组2例)手术进行至约50 min时(40～70 min)感到止血带不适。两组间感觉和运动功能恢复时间及术 后首次需要镇痛药物时间比较差异无统计学意义(P>0．05)。49例病人对腰丛-坐骨神经联合阻滞 的接受程度评分均为1分,且未见麻醉相关并发症。结论0．375％左旋布比卡因腰丛-坐骨神经联 合阻滞的起效时间、持续时间和麻醉效果方面与0．5％罗哌卡因相似。     

膝关节镜手术采用神经刺激器定位神经阻滞的体会

目的：探讨膝关节镜手术采用神经刺激器定位腰丛和坐骨神经阻滞的效果。方法：选择2003年9月～2004年4月自愿要求行单侧下肢阻滞的膝关节镜手术患者100例，男68例，女32例，年龄15～76岁，采用德国贝朗公司Stimuplex HNS11神经刺激器行腰丛和坐骨神经阻滞，并使用新型长效局麻药罗哌卡因。手术主要包括半月板切除、韧带重建、关节清理、滑膜切除等。结果：神经阻滞成功率高，麻醉效果佳；阻滞范围局限，对机体影响小，血液动力学状态稳定；术后镇痛好，恢复快。结沦：膝关节镜手术采用神经刺激器定位腰从和坐骨神经阻滞是一种安全和效果良好的麻醉方法。更适合老年人和椎管内麻醉穿刺困难者。     

膝关节镜手术采用神经刺激器定位神经阻滞的体会

目的:探讨膝关节镜手术采用神经刺激器定位腰丛和坐骨神经阻滞的效果.方法:选择2003年9月～2004年4月自愿要求行单侧下肢阻滞的膝关节镜手术患者100例,男68例,女32例,年龄15～76岁,采用德国贝朗公司StimuplexR HNS11神经刺激器行腰丛和坐骨神经阻滞,并使用新型长效局麻药罗哌卡因.手术主要包括半月板切除、韧带重建、关节清理、滑膜切除等.结果:神经阻滞成功率高,麻醉效果佳;阻滞范围局限,对机体影响小,血液动力学状态稳定;术后镇痛好,恢复快.结论:膝关节镜手术采用神经刺激器定位腰丛和坐骨神经阻滞是一种安全和效果良好的麻醉方法.更适合老年人和椎管内麻醉穿刺困难者.     

上肢手术病人超声引导锁骨上臂丛神经阻滞的效果

目的探讨上肢手术病人超声引导锁骨上臂丛神经阻滞的效果。方法拟在锁骨上臂丛神经阻滞下行上肢手术病人120例,ASA Ⅰ-Ⅲ级,随机分为3组(n=40):超声引导组(U组)、神经刺激器组(N组)、传统方法组(T组)。局麻药为0．75％罗哌卡因与2％利多卡因等容量混合液,剂量为0．4ml·kg-1。记录肌皮神经、桡神经、正中神经、尺神经阻滞的起效时间,并评价其阻滞完善率; 评定手术全程的麻醉效果(优、良、差),记录并发症。结果 U组4根神经阻滞完善率均接近100％ (P>0．05),N组和T组尺神经的阻滞完善率均低于肌皮神经和桡神经(P<0．05)。与T组比较,U 组和N组正中神经阻滞完善率均较高,麻醉优良率较高,起效时间均较短(P<0．05或0．01)。与N组比较,U组尺神经阻滞完善率和麻醉优等率较高,起效时间较短(P<0．01)。T组穿刺过程中有3例误入血管,3组均无严重并发症。结论上肢手术病人超声引导锁骨上臂丛神经阻滞较神经刺激器辅助和传统方法下的阻滞效果更好,起效时间更短,在临床上具有推广应用价值。     

三角肌运动反应用于小儿经肌间沟臂丛神经阻滞的临床观察

目的为三角肌运动反应作为在外周神经刺激器定位下小儿经肌间沟臂丛神经阻滞终点的临床应用提供参考。方法60例拟行上肢手术患儿,在外周神经刺激器定位下行经肌间沟臂丛神经阻滞,随机分为3组:A组(20例),三角肌运动反应终点组;B组(20例),肱二头肌运动反应终点组;C组(20例),三角肌和肱二头肌运动反应终点组。比较各组在刺激域电流、获得终点时间、合作患儿运动阻滞起效时间及神经阻滞效果的差异。结果组间刺激域电流、运动阻滞起效时间、神经阻滞效果差异无统计学意义(P>0.05);A、B组获得终点时间大于C组(P<0.05)。结论三角肌运动反应终点可以作为小儿经肌间沟臂丛神经阻滞穿刺针正确定位的标志。     

超声引导肌间沟臂丛神经阻滞的临床应用

目的 比较超声引导联合神经刺激器(US)定位与单纯神经刺激器(NS)定位行肌间沟臂丛神经阻滞的效果及安全性.方法 选择拟行上肢手术的患者40例,ASA Ⅰ或Ⅱ级,随机均分为US组和NS组.两组均给予0.5%的罗哌卡因30ml.记录寻找目标神经所需时间和完成操作所需时间、感觉神经阻滞起效和持续时间;评价各神经支配区域的感觉阻滞程度、手术区域麻醉效果(优、良、失败);观察并记录并发症.结果 US组完成操作所需时间(3.7±1.1)min,明显短于NS组的(7.2±3.5)min(P<0.01).US组感觉阻滞起效时间(12.0±2.4)min,明显快于NS组(15.2±3.0)min(P<0.05).麻醉效果优等率US组为85%,NS组为70%,差异无统计学意义.US组未出现并发症;NS组有3例患者出现与神经阻滞相关的并发症.结论 超声引导下行肌间沟臂丛神经阻滞操作时间短,阻滞起效快,效果好,并发症少.     

腰丛-坐骨神经联合阻滞用于老年患者下肢手术的临床研究

目的探讨腰丛-坐骨神经联合阻滞在老年患者下肢手术应用的可行性。方法40例60岁以上拟行单侧下肢手术的患者随机均分为两组。A组采用神经刺激器定位技术,正确定位腰丛和坐骨神经后分别给予0.375%罗哌卡因20～25ml和0.5%罗哌卡因15～20ml;B组选择L2～3或L3～4间隙行硬膜外麻醉,给予0.75%罗哌卡因10～15ml。观察两组血流动力学变化、阻滞效果及其不良反应。结果B组麻醉15min后各时点的SBP、DBP均明显低于麻醉前及A组(P<0.05或P<0.01);A组镇痛持续时间长于B组(P<0.05),但运动阻滞持续时间短于B组(P<0.05);B组术中使用麻黄碱的例数及输液量高于A组(P<0.05);B组患者围术期恶心、呕吐、尿潴留等不良反应的发生率明显高于A组(P<0.01)。结论腰丛-坐骨神经联合阻滞对血流动力学影响小,术后镇痛时间长,并发症少,适用于老年患者下肢手术。     

The pharmacodynamics of ropivacaine and bupivacaine in combined sciatic and femoral nerve blocks for total knee arthroplasty

The potency of ropivacaine compared with bupivacaine in regional anesthesia remains controversial. Therefore, we compared the pharmacodynamics of equal concentrations of bupivacaine and ropivacaine in combined sciatic and femoral nerve blocks for patients undergoing knee arthroplasty. Fifty patients received 40 mL of either 0.5% bupivacaine (n = 25) or 0.5% ropivacaine (n = 25) divided between the sciatic (15 mL) and the femoral (25 mL) nerves before induction of anesthesia. Loss and recovery of sensory (% of cold sensation compared to opposite side) and motor (no contraction or normal muscle force) functions were recorded in the distribution of the femoral, saphenous, common peroneal, and tibial nerves. Pain scores and morphine consumption over 48 h were also evaluated. There were no difference between bupivacaine and ropivacaine in terms of onset of sensory and motor blockade. However, resolution of sensory and motor function was faster in the ropivacaine group but only significantly so for the sciatic nerve and between 24 to 28 h for sensory resolution and 12 to 20 h for motor function. Overall, pain scores and morphine consumption were similar. In conclusion, we showed that block resolution is different between bupivacaine and ropivacaine when administered for combined sciatic and femoral nerve blocks. A new systematic method to assess sciatic and femoral nerve blockade is proposed.     

Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block

BACKGROUND: Femoral and sciatic nerve block may not provide complete post-operative analgesia following total knee replacement. This study was designed to evaluate whether the addition of an obturator nerve block to combined femoral and sciatic nerve block improves the quality of post-operative analgesia following primary total knee replacement. METHODS: Sixty patients were randomised into one of two groups: combined femoral and sciatic nerve block with 15 ml 0.75% ropivacaine to each nerve or combined femoral and sciatic nerve block with 15 ml 0.75% ropivacaine to each nerve and an obturator nerve block with 5 ml 0.75% ropivacaine. RESULTS: Peripheral nerve blocks were successful in 85% of patients. The group which received the obturator nerve block showed a significant increase in the time until their first request for analgesia (mean 257.0 vs. 433.6 min) and a significant reduction in the total requirements for morphine throughout the study period (mean 83.8 vs. 63.0 mg) (P<0.05). There were no systemic or neurological sequelae in any of the groups. CONCLUSIONS: The addition of an obturator nerve block to femoral and sciatic blockade improved post-operative analgesia following total knee replacement.     

Popliteal fossa block: Lateral approach to the sciatic nerve

Regional anesthesia for foot and ankle surgery in children is usually provided using a caudal blockade. However, there are certain conditions that preclude the use of a caudal block. The use of a sciatic nerve block in addition to a femoral nerve block can provide good analgesia for these procedures. In a sedated or anesthetized child, it may be easier to perform this nerve block with the patient in a supine position. The use of a nerve stimulator and a sheathed needle can assist in locating the nerve. This nerve block may offer the additional advantage of a longer duration of pain relief. Copyright 2002, Elsevier Science (USA). All rights reserved.     

Lateral approach to the sciatic nerve in the popliteal fossa: a comparison between 1.5% mepivacaine and 0.75% ropivacaine

BACKGROUND AND OBJECTIVES: Ropivacaine and mepivacaine are commonly used local anesthetics for peripheral nerve blockade. The purpose of the present study was to compare onset time, quality of anesthesia, and duration of analgesia with ropivacaine 0.75% and mepivacaine 1.5% for lateral popliteal nerve block. METHODS: Fifty American Society of Anesthesiologists (ASA) physical status I or II patients scheduled for foot and ankle surgery with calf tourniquet under lateral popliteal sciatic nerve block were randomly assigned to receive 30 mL of either ropivacaine 0.75% or mepivacaine 1.5%. Time required for onset of sensory and motor block, resolution of motor blockade, onset of postsurgical pain, and time of first analgesic medication were recorded. RESULTS: The 2 groups were similar with regard to demographic variables and duration of surgery. Onset of sensory and motor block was significantly shorter in the mepivacaine group (9.9 +/- 3.3 min and 14.7 +/- 3.6 min, respectively) than in the ropivacaine group (18.1 +/- 6.1 min and 23.6 +/- 5.5 min, respectively) (P < 0.001). Resolution of motor block occurred later in the ropivacaine group than in the mepivacaine group (P < 0.001), and duration of postoperative analgesia was significantly longer in the ropivacaine group (19 +/- 3.4 h) compared with the mepivacaine group (5.9 +/- 1.1 h) (P < 0.001). Analgesic requirements were higher in mepivacaine group than in the ropivacaine group (P < 0.001). There were 2 failed blocks, one in each group. CONCLUSIONS: Both ropivacaine and mepivacaine provided effective sciatic nerve blockade. Mepivacaine 1.5% displayed a significantly shorter onset time than ropivacaine 0.75%. Postoperatively, ropivacaine 0.75% resulted in longer-lasting analgesia and less need for oral pain medication.     

神经刺激器定位下行腰丛复合坐骨神经阻滞对老年髋关节置换术患者免疫功能的影响

目的 探究神经刺激器定位下行腰丛复合坐骨神经阻滞对老年髋关节置换术患者术后免疫功能的影响.方法 前瞻性收集本院2016年2月至2018年10月收治的86例接受髋关节置换术治疗的老年患者为研究对象,依据随机数字表的方式分组,每组43例.其中,对照组进行硬膜外麻醉,观察组进行神经刺激器定位下腰丛复合坐骨神经阻滞麻醉.观察对...     

The effects of three different approaches on the onset time of sciatic nerve blocks with 0.75% ropivacaine

We studied three different injection techniques of sciatic nerve block in terms of block onset time and efficacy with 0.75% ropivacaine. A total of 75 patients undergoing foot surgery were randomly allocated to receive sciatic nerve blockade by means of the classic posterior approach (group classic; n = 25), a modified subgluteus posterior approach (group subgluteus; n = 25), or a lateral popliteal approach (group popliteal; n = 25). All blocks were performed with the use of a nerve stimulator (stimulation frequency, 2 Hz; intensity, 2-0.5 mA) and 30 mL of 0.75% ropivacaine. Onset of nerve block was defined as complete loss of pinprick sensation in the sciatic nerve distribution with concomitant inability to perform plantar or dorsal flexion of the foot. In the three groups, an appropriate sciatic stimulation was elicited at <0.5 mA. The failure rate was similar in the three groups (group popliteal: 4% versus group classic: 4% versus group subgluteus: 8%). The onset of nerve block was slower in group popliteal (25 +/- 5 min) compared with group classic (16 +/- 4 min) and group subgluteus (17 +/- 4 min; P < 0.001). There was no significant difference in the onset of nerve block between group classic and group subgluteus. No differences in the degree of pain measured at the first postoperative administration of pain medication were observed among the three groups. We conclude that the three approaches resulted in clinically acceptable anesthesia in the distribution of the sciatic nerve. The subgluteus and classic posterior approaches generated a significantly faster onset of anesthesia than the lateral popliteal approach. IMPLICATIONS: Comparing three different approaches to the sciatic nerve with 0.75% ropivacaine, the classic and subgluteal approaches exhibited a faster onset time of sensory and motor blockade than the lateral popliteal approach.     

股神经联合坐骨神经阻滞应用在踝关节镜手术中的效果评价

目的 比较两种不同的麻醉方式在踝关节镜手术中的应用效果。方法 选择2018年1月至2019年12月在中山大学孙逸仙纪念医院行踝关节镜手术的患者60例,随机分为股神经组和腰丛组,每组各30例,股神经组实施股神经联合坐骨神经阻滞,腰丛组实施腰丛联合坐骨神经阻滞。比较两组患者术中和术后的麻醉和镇痛效果、麻醉操作时间、不同时间的心率及平均血压和麻醉并发症及不良反应。结果 两组患者术中额外使用局麻药和麻醉性镇痛药人数、术后24小时内静息或运动的VAS评分及额外使用镇痛药的人数和使用时间差异均无统计学意义;股神经组麻醉操作时间显著少于腰丛组;股神经组在麻醉操作过程中的心率和平均血压显著低于腰丛组;两组患者术后不良反应比较差异无统计学意义。结论 股神经联合坐骨神经阻滞与腰丛联合坐骨神经阻滞在踝关节镜手术中的麻醉和术后镇痛效果无显著差别,但前者麻醉操作时间更短,围术期生命体征更平稳。     

改良髂筋膜间隙联合腘窝坐骨神经阻滞在单侧大隐静脉曲张手术中的应用

目的观察改良髂筋膜间隙联合腘窝坐骨神经阻滞在单侧大隐静脉曲张手术中的麻醉效果。方法选择择期行单侧大隐静脉高位结扎加抽剥术患者60例,男32例,女28例,年龄42~76岁,ASAⅠ或Ⅱ级,采用随机数字表法将其分为改良髂筋膜间隙联合腘窝坐骨神经阻滞组(N组)和硬膜外阻滞组(E组),每组30例。N组先行腘窝坐骨神经阻滞,再在超声图像上确认髂筋膜和股神经位置,先行股神经阻滞,再在同一穿刺点从缝匠肌内侧缘开始,由外向内沿髂筋膜下给1%利多卡因10ml和0.5%罗哌卡因10ml,同时超声探头在腹股沟韧带水平向内移动,内侧达股动脉上方;E组采用L2~3间隙行硬膜外阻滞。记录两组阻滞前(T0)、阻滞后10min(T1)、30min(T2)、60min(T3)的SBP、DBP及HR;记录两组阻滞完成时间、感觉阻滞起效时间、术中麻黄碱使用情况、麻醉效果及术后48h恶心呕吐、头痛及尿潴留发生情况。结果与T0时比较,T2时E组的SBP和DBP明显降低(P0.05),T2时N组SBP和DBP明显高于E组(P0.05);N组感觉阻滞起效时间明显短于E组、术中麻黄碱使用率明显低于E组(P0.05);E组整体麻醉效果优于N组(P0.05),但两组麻醉效果优良率差异无统计学意义;术后48hN组尿潴留发生率明显低于E组(P0.05)。结论改良髂筋膜间隙联合腘窝坐骨神经阻滞用于单侧大隐静脉高位结扎加抽剥术中,麻醉效果良好,较硬膜外阻滞具有血流动力学影响小、术后并发症少及适应证更广等优点。