Objective To compare the clinical effects of lumbar plexus-sciatic nerve block versus subarachnoid nerve block on unilateral lower limb surgery.Methods A total of 60 patients with ASA I-II who underwent unilateral lower extremity surgery were randomly divided by random number table into lumbar plexus-sciatic nerve block group (group A) and subarachnoid nerve block group (group B), with 30 cases in each group.Group A underwent nerve stimulator-assisted lumbar plexus-sciatic nerve combined block, using 0.5% ropivacaine at 20 mL for lumbar plexus block and 0.5% ropivacaine at 15 mL for sciatic nerve block; while group B received subarachnoid nerve block anesthesia, with 0.5% ropivacaine at 10-15 mL.Heart rate (HR), mean arterial pressure (MAP), respiration rate (RR), and oxygen saturation (SPO2) were recorded at 5 min before anesthesia (T0), 5 min after anesthesia (T1), beginning of surgery (T2), 30 min after the start of surgery (T3), and end of surgery(T4); sensory and motor block onset time, sensory and motor recovery time, sufentanil usage, ephedrin usage, and postoperative adverse events (nausea, pruritus, hypotension, and urinary retention) were also recorded.Results The sensory and motor block onset time in group A was statistically shorter than that in group B (P<0.05).At T0, HR, MAP, RR, and SPO2 were not different between group A and group B (P>0.05); at T1, T2, T3, and T4, HR in group A was significantly lower than that in group B (P<0.05); at T4, MAP in group A was significantly higher than in that in group B (P<0.05).The sufentanil use rate was not different between the two groups, but the ephedrin use rate in group A was significantly lower than that in group B (P<0.05).The rates of adverse reactions in group A (nausea, pruritus, urinary retention, and hypotension) were significantly lower than those in group B (P<0.05).Conclusion Compared with subarachnoid nerve block, lumbar plexus-sciatic nerve block shows more stable hemodynamics and less postoperative complications in unilateral lower limb surgery.
TAN Jian
,
LI Xiuman
. Comparison of lumbar plexus-sciatic nerve block versus subarachnoid nerve block in lower limb sugery[J]. Surgical Research and New Technique, 2019
, 8(1)
: 31
-35
.
DOI: 10.3969/j.issn.2095-378X.2019.01.010
[1] 李春光.下肢神经阻滞用于老年患者全膝关节置换术临床观察[J].山东医药, 2013,53(34):59-61.
[2] 陈敏,施震,胡光俊,等.局麻药高浓度低容量坐骨神经阻滞和低浓度高容量腰丛阻滞的临床研究[J].临床麻醉学杂志, 2014,30(1):52-55.
[3] 于健,单士强,聂宇,等.神经联合阻滞在高龄患者单侧股骨头置换术中的应用[J].河北医科大学学报, 2015,36(2):162-165.
[4] 张晋峰,宋晓媛,王佳,等.超声引导下不同麻醉药物配伍对坐骨神经联合股神经阻滞的效果观察[J].实用医技杂志, 2017,24(8):885-887.
[5] 舒化青,张小沼,姚尚龙,等.不同浓度罗呱卡因用于腰丛-坐骨神经阻滞的药代动力学[J].中华麻醉学杂志, 2006,26(11):1018-1020.
[6] Murray J M, Derbyshire S, Shields M O.Lower limb blocks[J].Anaesthesia, 2010,65(supplll):57-66.
[7] Xiao J, Cai M H, Wang X R, et al.Time course of action and pharmacokinetics of ropivacaine in adult and elderly patients following combined lumbar plexus-sciatic nerve block[J].Int J Clin Pharmacol Ther, 2010,48(9):608-613.
[8] 王世祥.腰丛—坐骨神经阻滞用于老年患者下肢骨科手术200例[J].中国药业, 2015,24(23):151-153.
[9] Vanterpool S, Steele SM, Nielsen KC, et a1.Combined lumbar-plexus and sciatic-nerve blocks: an analysis of plasma ropivacaine concentrations[J].Reg Anesth Pain Med, 2006,31(5):417-421.
[10] 李炯希,吴志云,许培阳.腰丛坐骨神经联合阻滞用于单侧大隐静脉曲张手术的临床效果[J].南昌大学学报(医学版), 2014,54(12):70-74.
[11] 张昊,焦建宝,于青,杨永明,等.超声引导下腰丛-坐骨神经阻滞在老年膝关节镜手术中的效果[J].安徽医药, 2018,22(2):316-319.
[12] Eijebari H, Jebabli N, Salouge I, etal.Population pharmacokinetics of bupivacaine in combined lumbar and sciatic nerve block[J].Indian J Pharmacol, 2014,46(2):201-206.
[13] 瞿巍巍,彭浩,唐官成.腰丛-坐骨神经联合阻滞与硬膜外阻滞对膝关节置换术患者麻醉效果比较[J].浙江创伤外科, 2017,22(2):397-399.
[14] 张毅,郭海芳,杨春.腰丛复合坐骨神经阻滞麻醉对老年人股骨颈骨折患者术中血压和心率的影响[J].山东医药, 2011,51(22):104-105.
