下肢骨折患者常因体位变化而出现急性疼痛和不适,这种疼痛会影响术后早期恢复。本研究旨在比较超声联合神经刺激器引导腰骶丛阻滞(LSPB)在仰卧位和侧卧位下肢骨折手术中的适用性和有效性。
我们纳入126例择期行下肢骨折内固定的患者,按随机数字表法分为S组和L组,在仰卧位和侧卧位超声引导下联合神经刺激器行LSPB,分别。主要结果是手术中舒芬太尼的剂量。次要结果是LSPB放置位置时的最大VAS(视觉模拟评分)疼痛评分,位置放置的时间,神经阻滞的时间,尝试穿刺的次数,血液动力学指标,术后1、12和24小时的VAS评分,术后镇痛满意度及与神经阻滞相关的不良事件。
两组使用舒芬太尼的剂量差异无统计学意义(P=0.142)。置位时最大VAS疼痛评分(P<0.01),位置放置时间(P<0.01),S组腰丛阻滞时间和穿刺次数明显低于L组(P<0.01)。然而,S组骶丛阻滞时间高于L组(P=0.029)。血流动力学指标无显著差异,骶丛的穿刺次数,术后VAS评分,两组患者术后镇痛满意度及与神经阻滞相关的不良事件(均P>0.05)。
我们的研究为接受下肢骨折手术的患者提供了一种更舒适,更好接受的麻醉方案。仰卧位的LSPB易于应用,并具有明确的麻醉效果。此外,具有较高的术后镇痛效果,值得推广应用。
该试验在中国临床试验注册登记之前注册(日期:11/03/2021编号:ChiCTR2100044117)。
Patients with lower limb fracture often have acute pain and discomfort from changes in position, and such pain affects early postoperative recovery. This study aimed to compare the applicability and effectiveness of ultrasound combined with nerve stimulator-guided lumbosacral plexus block (LSPB) in the supine versus lateral position during lower limb fracture surgery.
We included 126 patients who underwent elective internal fixation for lower limb fracture who were divided into the S group and the L group by the random number table method and underwent LSPB guided by ultrasound combined with a nerve stimulator in the supine and lateral positions, respectively. The primary outcome was the dose of sufentanil used in surgery. The secondary outcomes were the maximum VAS (visual analogue scale) pain score at position placing for LSPB, the time of position placing, the time for nerve block,the number of puncture attempts,the haemodynamic indicators, the VAS score at 1, 12, and 24 h following surgery, postoperative satisfactory degree to analgesia and adverse events related to nerve block.
There was no statistically significant difference in dose of sufentanil used between the two groups(P = 0.142). The maximum VAS pain score at position placing(P < 0.01), the time of position placement(P < 0.01), the time for lumbar plexus block and the time of puncture attempts were significantly lower in the S group than in the L group (P < 0.01). However, the time for sacral plexus block was higher in the S group than in the L group (P = 0.029). There was no significant difference in haemodynamic indicators,number of puncture attempts for the sacral plexus, postoperative VAS scores, postoperative satisfactory degree to analgesia or adverse events related to nerve block between the two groups (all P > 0.05).
Our study provides a more comfortable and better accepted anaesthetic regimen for patients undergoing lower limb fracture surgery. LSPB in the supine position is simple to apply and has definite anaesthetic effects. Additionally, it has a high level of postoperative analgesia and therefore should be widely applied.
The trial was registered prior to patient enrolment at the Chinese Clinical Trail Registry (Date:11/03/2021 Number: ChiCTR2100044117 ).