A Comparison of Ultrasound-Guided and Landmark-Based Approaches to Saphenous Nerve Blockade: A Prospective, Controlled, Blinded, Crossover Trial
A Comparison of Ultrasound-Guided and Landmark-Based Approaches to Saphenous Nerve Blockade: A Prospective, Controlled, Blinded, Crossover Trial
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超声引导和基于地标的隐神经阻滞方法的比较：前瞻性、对照、盲法、交叉试验
DOI：
10.1213/ane.0b013e3182908d5d
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发表时间：
2013
影响因子：
5.7
通讯作者：
John M. Corey
中科院分区：
文献类型：
--
作者：
M. Kent;R. Hackworth;R. Riffenburgh;J. Kaesberg;D. Asseff;Eugenio Lujan;John M. Corey
背景：膝关节以下的外科手术常使用隐神经阻滞。根据方法的不同，成功率从33%到88%不等。在这项前瞻性志愿者研究中，我们比较了两种超声引导技术，改良的股内侧隐神经阻滞和股周围隐神经阻滞与膝关节以下的阻滞。方法：在单盲、交叉、前瞻性试验中，20名成年志愿者接受了3种不同的隐神经阻滞。阻断成功的主要终点是隐神经远端三分之二分布的感觉丧失。次要变量包括实施麻醉的时间、感觉消失的时间、麻醉期间的疼痛和运动无力。结果：改良股内侧肌法和股周法的成功率(80%，与可信区间差50%，23%~77%，P=0.009；100%，与可信区间差70%，41%~91%，P<；0.001)均显著高于膝下法(30%，30%)。股周超声与改良股内侧超声比较，差异无统计学意义(与CI相差20%，−为7%~49%，P=0.125)。此外，除了股周围技术显示阻滞时间快于膝下阻滞(P=0.007)外，与其他测量变量相比，差异无统计学意义。结论：在我们的前瞻性研究中，我们发现超声引导下膝上隐神经阻滞较膝下隐神经阻滞具有更高的成功率，且操作简单、时间短。
BACKGROUND:Blockade of the saphenous nerve is often used for surgeries below the knee. Depending on the approach, success rates vary widely ranging from 33% to 88%. In this prospective volunteer study, we compared 2 ultrasound-guided techniques, the modified vastus medialis and perifemoral saphenous nerve block with a below the knee field block. METHODS:Twenty volunteer adults, in a single-blinded, crossover, prospective trial underwent 3 different saphenous nerve blocks. The primary end point of block success was loss of sensation in the distal two-thirds distribution of the saphenous nerve. Secondary variables included time to perform the block, time to sensory loss, pain during block, and motor weakness. RESULTS:Compared with the below the knee field block success rate (30%), both the modified vastus medialis and perifemoral techniques had significantly higher success rates (80%, difference 50% with confidence interval [CI], 23%–77%, P = 0.009, and 100%, difference 70% with CI, 41%–91%, P < 0.001, respectively). However, the difference when comparing the perifemoral ultrasound technique against the modified vastus medialis ultrasound technique did not show significance (difference 20% with CI, −7% to 49%, P = 0.125). Also, no statistical differences were found with the other variables measured, except the perifemoral technique showed faster block performance times than below the knee field block (P = 0.007). CONCLUSION:In our prospective study, we have demonstrated that ultrasound-guided above the knee saphenous nerve blocks have higher success rates than a below the knee field block and are easily performed in a short amount of time.