The Incidence of Complications Is Low Following Foot and Ankle Surgery for Which Peripheral Nerve Blocks Are Used for Postoperative Pain Management
The Incidence of Complications Is Low Following Foot and Ankle Surgery for Which Peripheral Nerve Blocks Are Used for Postoperative Pain Management
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使用周围神经阻滞进行术后疼痛管理的足踝手术后并发症的发生率较低
DOI：
10.1007/s11420-017-9588-y
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
J. Yadeau
中科院分区：
文献类型：
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作者：
R. Kahn;S. Ellis;Jennifer Cheng;Jodie Curren;K. Fields;Matthew M. Roberts;J. Yadeau
背景：应用区域麻醉的足部和踝关节手术的神经系统并发症的发生率尚未得到很好的确定。问题/目的本研究的目的是前瞻性地确定在使用踝关节阻滞（ABs）和腘窝阻滞（pop）的繁忙足和踝关节服务中神经和周围神经阻滞（PNB）部位并发症的发生率。患者和方法本前瞻性观察研究纳入了接受足部和踝关节手术的ABs或pop患者。手术块的选择取决于外科医生的偏好。在术后第2周、第6周和第12周对患者进行并发症评估。每个并发症与阻滞的关系由外科医生和麻醉师评分。结果2012年10月至2014年10月共2516例患者行2704例手术。有195例并发症（7.2%）被认为是神经或PNB部位的并发症。严重并发症发生率为0.7%。持久性有机污染物的并发症发生率（8.8%）高于ABs（2.5%）。然而，当分析仅限于前足手术时，这种差异并不显著。地塞米松的使用与持久性有机污染物的并发症增加有关。195例总并发症中只有5例，20例严重并发症中有2例被外科医生和麻醉师审稿人认为可能是由阻塞引起的。结论神经或神经阻滞相关并发症和严重并发症的发生率分别为7.2和0.7%，大多数没有明确的手术与神经阻滞病因。使用神经周围地塞米松的持久性有机污染物较高的并发症发生率应谨慎解释，因为缺乏随机化和可能的混杂因素。
BackgroundThe incidence of neurologic complications from foot and ankle surgery utilizing regional anesthesia is not well established.Questions/PurposesThe purpose of this study was to prospectively determine the incidence of neurologic and peripheral nerve block (PNB) site complications on a busy foot and ankle service that utilizes ankle blocks (ABs) and popliteal blocks (POPs).Patients and MethodsThis prospective observational study included patients undergoing foot and ankle surgery with ABs or POPs. Block choice was determined by surgeon's preference. Patients were assessed for complications during postoperative visits at 2, 6, and 12 weeks. The relation of each complication to the block was scored by a surgeon and anesthesiologist.ResultsFrom October 2012 to October 2014, 2516 patients underwent 2704 surgeries. There were 195 complications (7.2%) considered neurologic or at the PNB site. The incidence of serious complications was 0.7%. A higher complication rate was reported for POPs (8.8%) than for ABs (2.5%). However, when analysis was limited to forefoot surgery, this difference was not significant. Dexamethasone use was associated with increased complications for POPs. Only 5 of the 195 total complications, and 2 of 20 serious complications, were deemed to have been likely caused by the block by both the surgeon and anesthesiologist reviewer.ConclusionsThe incidences of neurologic or block-related complications and serious complications were 7.2 and 0.7%, respectively, most without a clear surgical vs. nerve block etiology. The higher complication rate for POPs using perineural dexamethasone should be interpreted cautiously in light of the lack of randomization and likely confounders.