超声引导下踝管阻滞在跟骨内固定术后镇痛中的应用

摘要

Objective:To observe the short-term analgesic effect after operation in calcaneus fixation of malleolar canal block guided by ultrasound.Methods:Sixty patients underwent calcaneus fixation surgery in our hospital from Jan.2015 to Dec.2016 were selected and randomly divided into two groups(n=30):group Ⅰ in which the patients received intravenous analgesia,and group N in which the patients received ultrasound-guided nerve block.All patients received subarachnoid anesthesia during operation using different analgesic regimen at 1 hour after the operation.HR,MAP and VAS score were detected at 1,3 and 6 hours post-operation and the next morning.Postoperative nausea and vomiting (PONV)and limb activity were observed and recorded.Results:The vital signs of patients in group N were more stable than those in group Ⅰ (P＜0.05).Patients in group N had lower incidence of POVN and VSA scores at 3 and 6 hours post-operation(P＜ 0.05).No significant difference was found in VAS scores at 1 hour and next morning after surgery between the two groups (P＞0.05).Conclusion:Ultrasound-guided malleolar canal block had a good analgesic effect after calcaneus fixation surgery.%目的:观察超声引导踝管阻滞在跟骨内固定手术后的短期镇痛效果.方法:选取2015年1月至2016年12月在上海市浦东医院行单足跟骨经外侧L型切口切开复位内固定手术的患者60例,按照随机数字表法分为静脉注射镇痛组(Ⅰ组)和超声引导神经阻滞组(N组),每组30例.两组患者术中均采用蛛网膜下腔麻醉,在手术结束后1h分别采用上述两种镇痛方案,并在手术后1h、3h、6h及次日清晨分别监测患者生命体征[平均动脉压(MAP)和心率(HR)]、视觉模拟量表(VAS)评分,并记录两组患者术后恶心呕吐(PONV)发生情况及患肢活动情况.结果:N组患者较Ⅰ组患者术后当天生命体征更加平稳(P＜0.05),PONV发生率更低(P＜0.05),术后1h和次日清晨VAS评分无明显差异(P＞0.05),但术后3h和6 hVAS评分明显降低(P＜0.05).结论:超声引导下踝管神经阻滞能够充分满足跟骨内固定手术的术后镇痛要求,且术后镇痛效果更加完善.