两种不同镇痛方式在跟骨骨折患者术后镇痛中的比较

目的 将连续坐骨神经阻滞镇痛与单次坐骨神经阻滞联合静脉自控镇痛用于跟骨骨折患者的术后镇痛,比较两种镇痛方式的有效性和安全性.方法 选择40例ASAⅠ~Ⅱ级,年龄18~65岁,择期行跟骨骨折切开复位内固定术的患者,随机分为两组：连续坐骨神经阻滞组（CSB组）,单次坐骨神经阻滞联合静脉自控镇痛组（SSB组）,每组20例.CSB组采用连续神经阻滞套件,在神经刺激器引导下,进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.SSB组在神经刺激器引导下,进行经臀入路单次坐骨神经阻滞,术后采用静脉自控镇痛泵进行连续镇痛.观察术后2、8、24、48h静止和运动时疼痛评分和镇静评分,记录患者术后其它镇痛药物使用情况、患者及医生满意度和不良反应发生情况.结果 CSB组术后24h和48h的VAS评分（静止和运动）明显低于SSB组,差异具有统计学意义（P=0.003,P=0.048）.CSB组术后杜冷丁的使用量明显低于SSB组,差异具有统计学意义（P=0.003）;两组其余各观察指标差异均无统计学意义.结论 两种镇痛方式均可以提供满意的镇痛效果.与单次坐骨神经阻滞联合静脉自控镇痛相比,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持久有效的镇痛效果,值得临床推广.

Comparison of two different analgesic methods for postoperative analgesia in calcaneal fracture patients

Objective To compare the effect and safety of subgluteal approach continous sciatic nerve block and single injection gluteal approach sciatic nerve block combine with patient controlled intravenous analgesia （PCIA） for postoperative anal- gesia in calcaneal fracture patients. Methods Forty calcaneal fracture patients, 18 -65 years old, ASA I～ II Class were ran- domly divided into two groups： 20 patients in continuous sciatic nerve block group （ Group CSB） and 20 patients in single injection gluteal approach sciatic nerve block combine with patient controlled intravenous analgesia group （Group SSB）. Patients in Group CSB were given subgluteal approach continuous sciatic nerve block by continuous nerve block equipment under the nerve stimulator guidance, and connect PCA pump to give O. 2% ropivacaine via continuous nerve block catheter continuously for analgesia. Pa- tients in Group SSB were given single gluteal approach sciatic nerve block under the nerve stimulator guidance, and connect PCA pump via venous after surgery for 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 effect were coupared were coup- arod. Results The movement and rest VSA scores in Group CSB was lower than Group SSB at 24 and 48 hours after surgery （P = 0. 003, P = 0. 048）. The dose of dolantin in Group CSB was lower than Group SSB （P = 0. 003）. Conclusion Compared with single gluteal approach sciatic nerve block combined with patient Controlled intravenous analgesia, subgluteal approach contin- uous sciatic nerve block with 0. 2% ropivacaine could provide postoperative analgesia for calcaneal fracture patients.