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本公眾號(hào)每天分享一篇最新一期Anesthesia & Analgesia等SCI雜志的摘要翻譯，敬請(qǐng)關(guān)注并提出寶貴意見  Intraneural Ultrasound-guided Sciatic Nerve Block: Minimum Effective Volume and Electrophysiologic Effects  背景與目的：無論是坐骨神經(jīng)內(nèi)和神經(jīng)外注射均可導(dǎo)致嚴(yán)重地神經(jīng)軸突損傷。本研究旨在確定神經(jīng)內(nèi)注射1%羅哌卡因?qū)?0%的患者達(dá)到完全感覺-運(yùn)動(dòng)阻滯的最小有效容量以及相關(guān)的電生理改變。  1方法：47名ASA I-II級(jí)患者根據(jù)拋硬幣法接受超聲引導(dǎo)下腘窩坐骨神經(jīng)阻滯。初始劑量為15ml。完成基礎(chǔ)、5周和6個(gè)月的電生理檢測(cè)。評(píng)估振幅、潛伏期和速度。隨后進(jìn)行了6個(gè)月的電話隨訪。 結(jié)果：對(duì)于90％的患者達(dá)到完全感覺 - 運(yùn)動(dòng)坐骨神經(jīng)阻滯，1％羅哌卡因的最小有效體積為6.6ml（95％CI，6.4-6.7），起效時(shí)間為19±12min。成功率為98％。踝、腓骨、踝和腘窩的動(dòng)作電位（mV）基線振幅分別為8.4±2.3、 7.1±2.0、 15.4±6.5和11.7±5.1?；颊咴诘谖逯埽?.3±2.1、3.5±1.8、6.9±3.7和5.2±3.0）和第六個(gè)月（5.9±2.3、5.1±2.1、10.3±4.0和7.5±2.7）顯著減少（ P <0.001）。潛伏期和速度與基線沒有變化。在6個(gè)月的隨訪中沒有患者報(bào)告神經(jīng)系統(tǒng)癥狀。 結(jié)論：神經(jīng)內(nèi)超聲引導(dǎo)下行腘窩局部麻醉注射顯著降低局部麻醉劑量，實(shí)現(xiàn)有效的感覺 - 運(yùn)動(dòng)阻滯，降低全身毒性的風(fēng)險(xiǎn)。持續(xù)的電生理學(xué)變化表明可能有軸突損傷，需要進(jìn)一步研究。 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. BACKGROUND:Both extra- and intraneural sciatic injection resulted in significant axonal nerve damage. This study aimed to establish the minimum effective volume of intraneural ropivacaine 1% for complete sensory-motor sciatic nerve block in 90% of patients, and related electrophysiologic variations. METHODS:Forty-seven consecutive American Society of Anesthesiologists physical status I-II patients received an ultrasound-guided popliteal intraneural nerve block following the up-and-down biased coin design. The starting volume was 15?ml. Baseline, 5-week, and 6-month electrophysiologic tests were performed. Amplitude, latency, and velocity were evaluated. A follow-up telephone call at 6 months was also performed. RESULTS:The minimum effective volume of ropivacaine 1% in 90% of patients for complete sensory-motor sciatic nerve block resulted in 6.6?ml (95% CI, 6.4 to 6.7) with an onset time of 19?±?12?min. Success rate was 98%. Baseline amplitude of action potential (mV) at ankle, fibula, malleolus, and popliteus were 8.4?±?2.3, 7.1?±?2.0, 15.4?±?6.5, and 11.7?±?5.1 respectively. They were significantly reduced at the fifth week (4.3?±?2.1, 3.5?±?1.8, 6.9?±?3.7, and 5.2?±?3.0) and at the sixth month (5.9?±?2.3, 5.1?±?2.1, 10.3?±?4.0, and 7.5?±?2.7) (P < 0.001 in all cases). Latency and velocity did not change from the baseline. No patient reported neurologic symptoms at 6-month follow-up. CONCLUSIONS:The intraneural ultrasound-guided popliteal local anesthetic injection significantly reduces the local anesthetic dose to achieve an effective sensory-motor block, decreasing the risk of systemic toxicity. Persistent electrophysiologic changes suggest possible axonal damage that will require further investigation. 麻醉學(xué)文獻(xiàn)進(jìn)展分享 |
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