Study On Ultrasound-guided Popliteal Sciatic Nerve Combined With Saphenous Nerve Block Applied To Postoperative Analgesia Of Tibia And Fibula Fracture

Objective:To compare the effect of ultrasound-guided popliteal sciatic nerve block and popliteal sciatic nerve combined with saphenous nerve block in post operative analgesia following tibiofibular fracture with double incision.Methods:Ninety patients underwent double-incision internal fixation for the treatment of tibiofibular fractures were randomly divided into sciatic nerve block group A,combined block group B and control group C,30 cases each.The sciatic nerve block group A and the combined block group B underwent ultrasound-guided popliteal sciatic nerve block and ultrasound-guided popliteal sciatic nerve + saphenous nerve block.The local anesthetic was treated with ropivacaine at a concentration of 0.33%.20 minutes,after the nerve block was effective,2 ml of bupivacaine and 1 ml of normal saline were mixed into 3 ml of the equal proportion of the liquid in the lateral position.When the patient’s VAS score is ≥ 4 points,the patient is responsible for opening the patient-controlled intravenous analgesia pump(referred to as PCIA pump)as a remedy for poor analgesic effect.The PCIA pump consists of morphine 2 mg/kg plus saline to 100 ml.Rest and movement visual analogue score(VAS),Ramsay,BCS and muscle strength grading were observed at 1h,3h,6h and 12 h after operation.The times of PCIA opening,the number of effective PCIA compressions within 12 h after operation,the patients’ satisfaction with analgesic treatment and adverse reactions after 12 h were observed.Results:The duration of sensorimotor block in group B and group A was higher than that in group C(P<0.05),and group B was greater than group A(P<0.05).However,there was no significant difference in exercise block duration between group A and group B.PCIA pump-assisted analgesia was used in group C at the earliest,followed by group A,and was used in group B at the latest,with statistically significant differences among the three groups(P<0.05),indicating that group B can reduce the consumption of opioids.Within 12 hours after operation,the rest and movement VAS score,BCS score and PCIA effective compression times were significantly better in group A and group B than in group C(P<0.05),and group B was better than group A(P<0.01).There was a difference in the satisfaction rate of analgesia treatment between different postoperative analgesia methods(P<0.05).The analgesic satisfaction of patients in group B was the highest,and group A was better than group C.The incidence of nausea and vomiting was the highest in group C,followed by group A and group B,with statistically significant differences among the three groups(P<0.05).Conclusions:Ultrasound-guided popliteal sciatic nerve block combined with saphenous nerve block for patients with tibiofibular fracture after double-incision internal fixation can provide more satisfactory postoperative analgesia.It can reduce the consumption of opioids and the incidence of adverse events such as nausea and vomiting.