连续腘窝上坐骨神经联合隐神经阻滞镇痛对足踝皮瓣移植后皮瓣成活和局部血运的影响

doi:10.3969/j.issn.2095-9400.2020.03.016

Abstract
Figure/Table
References (0)
Related Citation (8)

Download: PDF (1651 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective: To evaluate the effects of continuous popliteal sciatic nerve combined with saphenous nerve block on the local blood supply and survival of circulation skin flap in patients after free flap transplantation for the foot and ankle. Methods: A prospective study was made on 60 patients with ASA I-II who underwent anterolateral thigh flap transplantation for skin and soft tissue defects of the feet and ankles treated in Ningbo NO.6 Hospital from March 2018 to April 2019. All the patients were randomly assigned to receive either continuous popliteal sciatic nerve combined saphenous nerve block (S group) or controlled intravenous analgesia (C group), with 30 cases in each group. The blood circulation and survival of free flap were compared between two groups, VAS score was recorded at 6 h, 12 h, 24 h, 2 d, 3 d after operation, and adverse reactions occur were analyzed. Results: The scores of flap elasticity, capillary refill time and flap survival rate in S group were higher than those in the C group. The incidence of vascular crisis in the S group was lower than that in the C group, with statistical difference (P<0.05). VAS of 6 h, 12 h, 24 h, 2 d, 3 d and the incidence of adverse reactions after operation in S group were lower than the C group. Conclusion: Continuous popliteal sciatic nerve combined saphenous nerve block could improve the local flap of patients with free flap transplantation for the foot and ankle, and improve the survival rate of flap.

Key words： popliteal sciatic nerve saphenous nerve postoperative analgesia free flap transplantation survival rate

	Service
	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	WANG Jue
	ZHANG Yiwei
	WANG Xiuzhen
	CHEN Jie
	YUAN Na
	GE Yeying

URL:

https://xb.wmu.edu.cn/EN/10.3969/j.issn.2095-9400.2020.03.016 OR https://xb.wmu.edu.cn/EN/Y2020/V50/I3/245

[1] 俞学子, 张龙, 王殷红, 等. 游离穿支皮瓣修复足背软组织缺损[J]. 中华整形外科杂志, 2019, 35(4): 376-380.
[2] 王冬冬, 马婷婷, 黄凯, 等. 右美托咪啶复合舒芬太尼对游离皮瓣移植术后镇痛效果及血管危象的影响[J]. 中国医师进修杂志, 2017, 40(1): 59-62.
[3] QING L, WU P, LIANG J, et al. Use of flow-through anterolateral thigh perforator flaps in reconstruction of complex extremity defects[J]. J Reconstr Microsurg, 2015, 31(8): 571-578.
[4] 赵子松, 陈晓梅, 陈广福. 连续股神经联合坐骨神经阻滞在膝关节置换术后镇痛效果观察[J]. 中国临床医生杂志, 2015, 7(5): 69-71.
[5] KARINJA S J, LEE B T. Advances in flap monitoring and impact of enhanced recovery protocols[J]. J Surg Oncol, 2018, 118(5): 758-767.
[6] 刘明明, 彭伶丽. 皮瓣移植术后非侵入性微循环监测方法的进展[J]. 中华显微外科志, 2019, 42(2): 208-211.
[7] ZHENG X, ZHENG C, WANG B, et al. Reconstruction of complex soft-tissue defects in the extremities with chimeric anterolateral thigh perforator flap[J]. Int J Surg, 2016, 26(5): 25-31.
[8] 夏成德, 狄海萍, 邢培朋, 等. 游离股前外侧皮瓣修复烧伤后小腿环形大面积软组织缺损的临床效果[J]. 中华烧伤杂志, 2019, 35(4): 248-252.
[9] 熊胜, 蒯英英, 张广亮, 等.芬太尼透皮贴超前镇痛对减少断指再植术后血管危象的临床观察[J]. 中华手外科杂志, 2017, 33(1): 62-63.
[10] GOPLEN C M, VERBEEK W, KANG S H, et al. Preoperative opioid use is associated with worse patient outcomes after Total joint arthroplasty: a systematic review and meta-analysis[J]. BMC Musculoskelet Disord, 2019, 20(1): 234-240.
[11] PUJIC B, HOLO-DJILVESI N, DJILVESI D, et al. Epidural hematoma following low molecular weight heparin prophylaxis and spinal anesthesia for cesarean delivery[J]. Int J Obstet Anesth, 2019, 37(2): 118-121.
[12] ILFELD B M, GABRIEL R A, TRESCOT A M, et al. Ultrasound-guided percutaneous cryoneurolysis providing postoperative analgesia lasting many weeks following a single administration: a replacement for continuous peripheral nerve blocks?A case report[J]. Korean J Anesthesiol, 2017, 70(5): 567-570.
[13] 王权光, 陈丽梅, 刘乐, 等. 超声引导下连续股神经阻滞联合单次前路坐骨神经阻滞用于膝关节置换术后镇痛[J]. 温州医学院学报, 2013, 43(12): 792-795.
[14] AMBROSOLI A L, GUZZETTI L, CHIARANDA M, et al. A randomised controlled trial comparing two popliteal nerve catheter tip positions for postoperative analgesia after day-case hallux valgus repair[J]. Anaesthesia, 2016, 1(11): 1317-1323.
[15] PATEL U A, HERNANDEZ D, SHNAYDER Y, et a1. Free flap reconstruction monitoring techniques and frequency in the era of restricted resident work hours[J]. JAMA Otolaryngol Head Neck Surg, 2017, 143(8): 803-809.
[16] 杨涛, 周日永, 鲍娜娜, 等. 超声引导联合区域阻滞用于下肢静脉功能不全手术的临床效果[J]. 温州医科大学学报, 2017, 47(3): 218-221.
[17] 马永兵, 刘海洲. 连续臂丛神经阻滞镇痛对断指再植血流动力学影响的研究[J]. 浙江医学, 2013, 18(1): 1668-1670.
[18] 张明东, 韩磊. 持续周围神经阻滞镇痛在上下肢皮瓣移植术中的应用效果评价[J]. 影像研究与医学应用, 2018, 2(10): 26-27.
[19] 陶涛, 周全. 超声引导下腰交感神经阻滞在下肢皮瓣修复手术中的应用[J]. 中华创伤骨科杂志, 2019, 21(7): 632-635.
[20] JAYARAM K, RAO P, GURAJALA I, et al. Evaluation of the effect of regional anaesthesia on microvascular free flaps [J]. Turk J Anaesthesiol Reanim, 2018, 46(6): 441-446.