神经刺激器定位行腰丛-坐骨神经联合阻滞在老年人下肢手术的应用

目的评估使用罗哌卡因或左旋布比卡因对择期下肢手术的老年人在神经刺激器定位下行腰丛-坐骨神经联合阻滞的临床价值。方法60例拟行择期单侧下肢手术的老年病人,ASAII-IV级,随机分成罗哌卡因组(R组,n=30)和左旋布比卡因组(L组,n=30),均在神经刺激器定位下行腰丛-坐骨神经联合阻滞,正确定位后两点分别给予0.375%的罗哌卡因(R组)或左旋布比卡因(L组)。记录麻醉前、切皮时、手术结束时的平均动脉压(MAP)和心率(HR),以及感觉/运动阻滞起效时间、镇痛维持时间及效果(术中及术后1、3小时VAS评分)、运动阻滞维持时间、术中辅助用药量、术中及术后不良反应或并发症等指标。结果L组运动阻滞起效时间短于R组(P<0.05),L组镇痛持续时间、运动阻滞维持时间长于R组(P<0.05),R组术后3h疼痛评分高于L组(P<0.05)。MAP或HR在二组各时间点的总体变化无明显差异(P>0.05)。结论对老年人下肢手术,使用罗哌卡因或左旋布比卡因在神经刺激器定位下行腰丛-坐骨神经联合阻滞,不仅成功率高,麻醉效果好,而且保持循环稳定对全身影响小,术后并发症发生率低。

A clinical study on combined lumbar plexus-sciatic nerve block by nerve stimulator in the elderly undergoing lower-extremity surgery

Objective To evaluate the values of com bined lum bar plexus-sciatic nerve block with ropivacaineor levobupivacaine by nerve stim ulator in the elderly undergoing lower-extrem ity surgery. M ethods Sixty oldpatients,ASA physical status of II-IV,were random ly allocated into two groups:Ropivacaine group (R group,n=30)and Levobupivacaine group (L group,n=30). Combined lum bar plexus-sciatic nerve block was perform ed by anerve stim ulator in both groups and 0.375%ropivacaine or levobupivacaine of 20m l was injected in devideddoses. The m ean artory pressure and heart rate were m easured before anesthesia,at the beginning and end ofsurgery.The onset tim e,duration of sensory and m otor block,the quality of analgesia(VAS scores of the operation,1and 3h postoperatively), and side effects were recorded and analysed. R esults There were no significantchanges on the m ean artory pressure or heart rate at each tim epoints in both groups (P>0.05). The onset timeof motor block in L group was lower than that in R group(P<0.05).The duration of analgesia and m otor block inL group were longer than that in R group(P<0.05).The VAS scores at 3h postoperatively in R group was higherthan that in L group (P<0.05). C onclusions Com bined lum bar plexus-sciatic nerve block with ropivacaine orlevobupivacaine by nerve stim ulator is a good choice of the elderly undergoing lower-extrem ity surgery whichhas the advantages of high success,good analgesia and a stable hemodynam ics.