ABSTRACT
Objective@#To observe the application of ultrasound-guided femoral nerve block(FNB) and popliteal sciatic nerve block(PSNB) in patients undergoing foot and ankle surgery.@*Methods@#From August 2015 to August 2017, 60 patients scheduled for foot and ankle surgery undergoing laryngeal mask airway (LMA) general anesthesia in the People′s Hospital of Langfang were randomly divided into 3 groups by the random number table, with 20 cases in each group.Before transfer patients from bed to operating table, A group received dezocine 5 mg iv, B group received FNB combined with PSNB(distal to the sciatic nerve bifurcation), C group received FNB combined with PSNB(proximal to the sciatic nerve bifurcation). A total of 40 mL of 0.375% ropivacaine were injected guided by ultrasound in B group and C group.The time of sufficient sensory block and awake, the dosage of remifentanil and propofol were recorded.Pain was assessed using visual analogue scale (VAS) pre- and post block.The incidence of sleepiness, postoperative nausea and vomiting (PONV), agitation, pain and adverse reaction were also recorded.@*Results@#The time of sufficient sensory block and awake, the dosage of remifentanil and propofol in A, B and C group: A group(not measured), (21.6±1.6)min, (1183±17)μg, (665.0±6.7)mg; B group (25.5±2.5)min, (15.3±1.4)min, (635±16)μg, (455.0±6.5)mg; C group (19.6±2.3)min, (14.9±1.5)min, (598±14)μg, (438.0±9.9)mg.The time of awake, the dosage of remifentanil and propofol in B group and C group were significantly lower than those in A group (F=44.07, 52.41, 62.45, all P<0.05). The time of sufficient sensory block in C group was lower than that in B group(t=15.69, P<0.05). The VAS scores at T2, T3 and T4 in A, B and C group: A group (4.5±0.6)point, (8.4±0.5)point, (6.1±0.9)point; B group (2.6±0.5)point, (3.9±0.3)point, (2.4±0.6)point; C group (2.5±0.4)point, (2.3±0.5)point, (1.1±0.5)point.The VAS scores in B group or C group were significantly lower than those in A group (F=52.36, 72.82, 75.41, all P<0.05). The VAS scores at T3 and T4 in C group were significantly lower than those in B group (t=18.42, q=14.55, all P<0.05). The incidence rates of sleepiness, PONV, agitation and incision pain in A, B and C group: A group (25%, 25%, 15%, 15%, 50%); B group(0%, 5%, 0%, 0%, 10%); C group(0%, 5%, 0%, 0%, 0%). The number of patients who had adverse reactions in B or C group were significantly lower than those in A group (χ2=8.51, 8.73, 10.11, 10.11, 9.69, all P<0.05). The incidence rate of incision pain at sober in C group was lower than that in B group(χ2=10.89, P<0.05).@*Conclusion@#The ultrasound-guided FNB and PSNB(proximal to the sciatic nerve bifurcation) can obviously shorten the onset time, reduce the dosage of general anaesthetic.It has effective analgesia during transfer of patients from bed to operating table and sober.
ABSTRACT
Objective To observe the application of ultrasound-guided femoral nerve block (FNB) and popliteal sciatic nerve block(PSNB) in patients undergoing foot and ankle surgery.Methods From August 2015 to August 2017,60 patients scheduled for foot and ankle surgery undergoing laryngeal mask airway (LMA) general anesthesia in the People's Hospital of Langfang were randomly divided into 3 groups by the random number table,with 20 cases in each group.Before transfer patients from bed to operating table,A group received dezocine 5 mg iv,B group received FNB combined with PSNB (distal to the sciatic nerve bifurcation),C group received FNB combined with PSNB(proximal to the sciatic nerve bifurcation).A total of 40 mL of 0.375％ ropivacaine were injected guided by ultrasound in B group and C group.The time of sufficient sensory block and awake,the dosage of remifentanil and propofol were recorded.Pain was assessed using visual analogue scale (VAS) pre-and post block.The incidence of sleepiness,postoperative nausea and vomiting (PONV),agitation,pain and adverse reaction were also recorded.Results The time of sufficient sensory block and awake,the dosage of remifentanil and propofol in A,B and C group:A group (not measured),(21.6 ± 1.6) min,(1183 ± 17) μg,(665.0 ± 6.7) mg;B group (25.5 ± 2.5) min,(15.3 ± 1.4) min,(635 ± 16) μg,(455.0 ±6.5)mg;C group (19.6 ±2.3)min,(14.9 ± 1.5)min,(598 ± 14) μg,(438.0±9.9) mg.The time of awake,the dosage of remifentanil and propofol in B group and C group were significantly lower than those in A group (F =44.07,52.41,62.45,all P ＜0.05).The time of sufficient sensory block in C group was lower than that in B group(t =15.69,P ＜ 0.05).The VAS scores at T2,T3 and T4 in A,B and C group:A group (4.5 ± 0.6) point,(8.4 ± 0.5) point,(6.1 ± 0.9) point;B group (2.6 ± 0.5) point,(3.9 ± 0.3) point,(2.4 ± 0.6) point;C group (2.5 ± 0.4) point,(2.3 ± 0.5) point,(1.1 ± 0.5) point.The VAS scores in B group or C group were significantly lower than those in A group (F =52.36,72.82,75.41,all P ＜ 0.05).The VAS scores at T3 and T4 in C group were significantly lower than those in B group (t =18.42,q =14.55,all P ＜ 0.05).The incidence rates of sleepiness,PONV,agitation and incision pain in A,B and C group:A group (25％,25％,15 ％,15 ％,50％);B group(0％,5％,0％,0％,10％);C group (0％,5％,0％,0％,0％).The number of patients who had adverse reactions in B or C group were significantly lower than those in A group (x2 =8.51,8.73,10.11,10.11,9.69,all P ＜0.05).The incidence rate of incision pain at sober in C group was lower than that in B group(x2 =10.89,P ＜0.05).Conclusion The ultrasound-guided FNB and PSNB (proximal to the sciatic nerve bifurcation) can obviously shorten the onset time,reduce the dosage of general anaesthetic.It has effective analgesia during transfer of patients from bed to operating table and sober.
ABSTRACT
The article focuses on the recent progress in foot and ankle surgery, including the diagnosis of disease, treatment protocols, outcomes, and evaluation tools as well as other innovations. New and accurate diagnostic modalities and measurements have undergone a breakthrough. Diagnostic modalities tend to be simpler and less expensive. Measurement tools also change to simpler and more accurate. The accuracy and efficacy of surgery and the minimally invasive method have become more popular and important. New treatments and basic research have also made breakthroughs.
ABSTRACT
Postoperative pain is an important factor which affects patients'postoperative rehabilitation training.With the application of ultrasound guided nerve block and multimodal analgesia,the quality of postoperative pain management has improved obviously among patients after foot and ankle surgery.The study has reviewed the related research.