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Anesthesiology:神经内超声引导下坐骨神经阻滞:最小有效容量和电生理效应

2018-08-12 王子君 罂粟花

无论是坐骨神经内和神经外注射均可导致严重地神经轴突损伤。本研究旨在确定神经内注射1%罗哌卡因对90%的患者达到完全感觉-运动阻滞的最小有效容量以及相关的电生理改变。

背景与目的:无论是坐骨神经内和神经外注射均可导致严重地神经轴突损伤。本研究旨在确定神经内注射1%罗哌卡因对90%的患者达到完全感觉-运动阻滞的最小有效容量以及相关的电生理改变。

方法:47名ASA I-II级患者根据抛硬币法接受超声引导下腘窝坐骨神经阻滞。初始剂量为15ml。完成基础、5周和6个月的电生理检测。评估振幅、潜伏期和速度。随后进行了6个月的电话随访。

结果:对于90%的患者达到完全感觉 - 运动坐骨神经阻滞,1%罗哌卡因的最小有效体积为6.6ml(95%CI,6.4-6.7),起效时间为19±12min。成功率为98%。踝、腓骨、踝和腘窝的动作电位(mV)基线振幅分别为8.4±2.3、 7.1±2.0、 15.4±6.5和11.7±5.1。患者在第五周(4.3±2.1、3.5±1.8、6.9±3.7和5.2±3.0)和第六个月(5.9±2.3、5.1±2.1、10.3±4.0和7.5±2.7)显着减少( P <0.001)。潜伏期和速度与基线没有变化。在6个月的随访中没有患者报告神经系统症状。

结论:神经内超声引导下行腘窝局部麻醉注射显着降低局部麻醉剂量,实现有效的感觉 - 运动阻滞,降低全身毒性的风险。持续的电生理学变化表明可能有轴突损伤,需要进一步研究。

原始出处

Cappelleri G, Ambrosoli A L, Gemma M, et al. Intraneural Ultrasound-guided Sciatic Nerve Block: Minimum Effective Volume and Electrophysiologic Effects.[J]. Anesthesiology, 2018:1.

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    2019-04-30 xiangyuzhou971
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    2018-08-14 skhzy

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