| Objective At present patients with Lower extremity ischemic diseases becomemore in clinical, to those who can not be treated by surgery and intervention,blocking the lumbar sympathetic nerve reaches a certain therapeutic effect. Epiduralnerve block is the technique that all the nerves of the corresponding segments can beblocked, including sympathetic nerves, there are relatively large reports about it forthe treatment of lower extremity pain diseases in our Country. Lumbar sympatheticblock technique also appeared early, but it is used very little in clinical applicationand research. The purpose of this study was to compare the clinical effects ofcontinuous lumbar sympathetic block technique and continuous epidural nerve blockfor treatment of lower extremity vascular diseases, in order to determine their degreeof sympathetic block are the same or not.Methods According to the screening criteria, a total of49patients were randomlydivided into two groups, there were27patients in EB group, and22patients in LSB group. We did the Lumbar sympathetic block technique under the X-ray guiding. Atdifferent time points of preoperative and postoperative, we reported and comparedthe ipsilateral dorsal foot skin temperature, visual analogue scale (VAS) and SF-36quality of life score of the two groups. Ipsilateral dorsal foot skin temperaturemeasurement was objective indicator, which increased≥2℃1h after operation wasmeaning that the operation was successful and sympathetic nerve was blockedeffectively. VAS score and SF-36quality of life scores for patients were subjectiveevaluation, that the degree of pain relieved more than50%after blocking wasmeaning the treatment effective.Results There was no significant difference between the two groups preoperative,p>0.05. The symptoms of the two groups of patients both have improved comparedwith preoperative, ipsilateral dorsal foot skin temperature rose higher than before,the degree of pain declined. Postoperative one hour, limb dorsal foot mean skintemperature EB group was (32.2±1.0)℃and the LSB group was (34.6±0.5)℃,Compared with the preoperative p<0.05, statistically significant. One hour afteroperation, compared between the two groups, p<0.05.One hour after operation, somepatients of EB group, their dorsal foot skin temperature rose failed to≥2℃, itshowed the sympathetic nerve was not completely blocked. Success rate ofsympathetic block, EB group was48.0%(12/25), the LSB group was78.9%(15/19)(p <0.05).24hours after extubation, skin temperature compared between the twogroups, p<0.05. One hour after operation, the mean score of dynamic VAS, EBgroup was3.7±0.6, the LSB group2.9±0.7, and the mean static VAS score, EBgroup was4.5±1.7，LBS group was3.8±0.6,there was a statistically significant(p<0.05). The efficiency of EB group was72.0%(18/25)，LSB group was89.5%(17/19),p>0.05. The maximum dorsal foot skin temperature and the decreased degree ofresting VAS score had a linear correlation, the postoperative skin temperature washigher, the patients with rest pain to ease more obviously. Postoperative SF-36 quality of life score compared with preoperative rose between the two groups(p<0.05). There were more complications in the patients of EB group, the majorityof the lower extremity numbness and difficulty in urination, the LSB group did notappear these complications.Conclusion The effect of continuous lumbar sympathetic block technique ismuch better than continuous epidural nerve block. A higher degree of sympatheticblock, higher selectivity and somatic nervous complications was significantly lowerthan the epidural nerve block, and there are no great impacts on the quality of life inpatients with lower extremity vascular diseases. |
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