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首页> 外文期刊>The Internet Journal of Anesthesiology >Comparison Between 0.125% And 0.25% Bupivacaine Administrated Through Continuous Three In One Block With Fluoroscopic Catheter Tip Confirmation For Postoperative Pain After Total Knee Arthroplasty
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Comparison Between 0.125% And 0.25% Bupivacaine Administrated Through Continuous Three In One Block With Fluoroscopic Catheter Tip Confirmation For Postoperative Pain After Total Knee Arthroplasty

机译：连续三合一并经荧光镜下导管末端确认在全膝关节置换术后疼痛的比较，布比卡因0.125％和0.25％的比较

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Background:The three - in - one technique of simultaneously blocking the femoral, the lateral femoral cutaneous (LFC) and the obturator nerves by a single injection of a local anesthetic was first described in 1973, and it was suggested that the underlying mechanism was one of cephalad spread resulting in a blockade of the lumber plexus. Many subsequent studies have, however, reported sub optimal analgesia levels, particularly in the obturator nerve distribution. Aims & Objective:The aim of this prospective study was to compare 0.125% Bupivacaine and 0.25% Bupivacaine administered by continuous infusion in obtaining effective postoperative analgesia and sensory blockade in the area of distribution of the femoral, obturator and lateral cutaneous nerves. Materials & Methods:86 patients were randomly allocated to either group A (0.125%) or group B (0.25%). All patients received a standard anesthetic; postoperatively 19 to 20 cm of a catheter was placed in the femoral sheath after femoral nerve location with a nerve locator. Contrast media (3ml Iohexol USP) was injected, and the catheter tip was located by means of an anteroposterior pelvic radiograph. A 20 ml equal volume mixture of 0.5% bupivacaine and 2% lidocaine was injected through the catheter. Thirty minutes after injection pain scores and sensory blockade was evaluated in the cutaneous distribution of the lateral femoral cutaneous, femoral and obturator nerves. In ten patients (8.6%) the catheter could not be threaded, eight patients (6.8%) drug could not be injected, two patients (1.72%) had vascular punctures and in six patients (5.16%) there was catheter dislodgement before the 48-hour period, these patients were withdrawn from the study.Results & Conclusion: Comparing group A and B patients, sensory block was achieved in 100% for the femoral nerve in both the groups, 90% and 96% for the lateral femoral cutaneous nerve and 54% and 96% for the obturator nerve (p<0.05). Visual analog scale pain scores on movement were significantly lower in-group B than group A (P<0.05). We conclude continuous three-in-one block with 0.25% bupivacaine infused at 2ml/h, with fluoroscopy confirmation of the catheter tip near the lumbar plexus provides a more efficient pain relief after total knee arthroplasty than a continuous of 0.125% bupivacaine at 2ml/h. Of the two concentrations, superior analgesic effect of 0.25% bupivacaine can be attributed to the motor blockade of the mixed nerves (femoral and obturator) compared to the differential blocking of these nerves by the 0.125% bupivacaine. Introduction The use of peripheral nerve blocks is recommended after orthopedic surgery. Continuous peripheral nerve blocks have improved postoperative pain relief, rehabilitation, and patient satisfaction compared with IV narcotics for both upper and lower extremity procedures (1,2,3,4, 5). The continuous three in one block first described by Winnie et, al (6) is as effective as epidural analgesia with lower side effects (urinary retention, nausea & risk of spinal subarachoid hemorrhage in anticoagulated patients) (3,4).Whilst the three in one block described by Winnie provides anaesthesia in the distribution of the femoral, obturator and lateral cutaneous nerve, subsequent studies have indicated an inconsistency in the degree of obturator nerve block with this technique (7,8).The aim of this study was to compare 0.125% Bupivacaine and 0.25% Bupivacaine administered by continuous infusion in obtaining effective post operative analgesia and sensory blockade in the area of distribution of the femoral, obturator and lateral cutaneous nerves. Materials & Methods After informed consent and with institutional approval, 86 ASA physical status I – II patients Scheduled for elective Unilateral TKA under general anesthesia were included in this study. Patients were excluded if they had coagulation abnormalities, age 80 yrs, preexisting neurological deficit, severe cardio respiratory disease or hepatic or renal
机译：背景：1973年首次描述了通过单次局部麻醉剂同时阻断股骨，股外侧皮（LFC）和闭孔神经的三合一技术，这表明其潜在机制是一种的头颅扩散，导致木材神经丛受阻。但是，随后的许多研究均报告了次优镇痛水平，尤其是在闭孔神经分布方面。目的与目的：本项前瞻性研究的目的是比较连续输注给予0.125％布比卡因和0.25％布比卡因在股骨，闭孔和外侧皮肤神经分布区域获得有效的术后镇痛和感觉阻滞作用。材料与方法：将86例患者随机分为A组（0.125％）或B组（0.25％）。所有患者均接受标准麻醉。术后用神经定位器在股神经定位后将19至20 cm的导管置入股鞘中。注入造影剂（3ml Iohexol USP），并通过骨盆前后位片定位导管尖端。通过导管注射20 ml等体积的0.5％布比卡因和2％利多卡因的混合物。注射后30分钟，评估股外侧皮，股骨和闭孔神经的皮肤分布的疼痛评分和感觉阻滞。在10例患者（8.6％）中无法穿刺导管，8例患者（6.8％）无法注射药物，2例患者（1.72％）进行了血管穿刺，而6例患者（5.16％）的患者在48岁之前发生了导管移位结果与结论：比较A组和B组，两组的股神经感觉阻滞分别达到100％，股外侧皮神经达到90％和96％闭孔神经分别为54％和96％（p <0.05）。视觉模拟评分运动疼痛评分在B组明显低于A组（P <0.05）。我们得出结论，以2ml / h的速度输注0.25％布比卡因的连续三合一阻滞，并通过荧光镜检查证实，在全膝关节置换术后腰椎丛附近的导管尖端比连续使用0.125％的布比卡因以2ml / h的方式提供更有效的止痛效果H。在这两种浓度中，与0.125％布比卡因对神经的不同阻滞作用相比，0.25％布比卡因具有较高的镇痛作用可归因于混合神经（股骨和闭孔）的运动阻滞。简介骨科手术后建议使用周围神经阻滞。与上肢和下肢手术的静脉麻醉药相比，连续性周围神经阻滞改善了术后疼痛缓解，康复和患者满意度（1、2、3、4、5）。 Winnie等人（6）首先描述的连续三合一阻滞与硬膜外镇痛一样有效，且副作用较低（抗凝患者的尿retention留，恶心和脊髓蛛网膜下腔出血的风险）（3,4）。在Winnie所描述的一个阻滞提供了股骨，闭孔和外侧皮神经分布的麻醉中，随后的研究表明该技术闭孔神经阻滞的程度是不一致的（7,8）。比较通过连续输注施用0.125％布比卡因和0.25％布比卡因在股骨，闭孔和外侧皮肤神经分布区域获得有效的术后镇痛和感觉阻滞作用。材料与方法经知情同意并获得机构批准后，本研究纳入了86名计划在全身麻醉下进行择期单侧TKA的ASA I – II型身体状况患者。如果患者患有凝血功能异常，年龄80岁，既往存在神经功能缺损，严重的心脏呼吸系统疾病或肝，肾疾病，则将其排除在外

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