| Background and objective Nerve block anesthesia is widely applied clinically for its advantages of exact effect and little side effect on hemodynamic. Because of the shortcomings of "the invisible target nerve" by nerve stimulator-guided block, ultrasound-guided nerve block is considerd to be “visual” and performed for its precise location. This study aimed to discusse the application values of ultrasound-guided sciatic and femoral nerve block by comparing with nerve stimulator-guided nerve block.Subjects and methods Patients who receive lower limb surgery through nerve block anesthesia were selected. The procedures was performed in anesthesiology department by anesthesiologists together with physicion of ultrasound. This study has been reviewed and approved by the Hospital Ethics Committee. 60 subjects were numbered from 1 to 60 and devided into 2 groups according to the random principle. Group A(n = 30) was operated with ultrasound-guided sciatic and femoral nerve block. Group B(n = 30) operated with stimulator-guided sciatic and femoral nerve block. Among the 60 subjects, 34 subjects would be operated the great saphenous vein ligation endarterectomy, 22 subjects would be operated lower extremity soft tissue masses implement resection, 4 subjects would undergo knee arthroplasty. The median age was 69 years old(47-86). Narcotic drug was 0.5% ropivacaine and injection of a single nerve with 20 ml ropivacaine was proceed. The effect of anesthesia was judged by two anesthesiologists who did not participate in the study. The follow-up and record of anesthesia-related complications were also done by them. 2 ultrasound physicians not involved in the study defined the distribution of the local anesthetic. The four doctors finished the mission in a condition of knowing any information about the objects( following the double blindprinciple).The main measurments included the rate of block success, onset time of sensory block, anesthesia qualityResults: ⑴ The rate of block success of group A was 100 %. In the group B, 3 cases were failed and turned to undergo a general anesthetic block, so the rate of block success was 90%. We compared the rates of the two groups, and P <0.05 was considered statistically significant. ⑵ Onset time of sensory block in group A was 5 minutes to 16 minutes, with an average time of 10 ± 2.4 minutes. Onset time of block of group B was 5 minutes to 16 minutes, with an average time of 13.3 ± 2.9minutes. t test was conducted in the two groups, P <0.05 was considered statistically significant. ⑶ Anesthesia Quality: ①In the group A,3 subjects need assistance analgesic as surgery analgesia,while in the group B,the number was 9. ②No blood was seen when the syringe was withdrawing in all the subjects of the group A. There was visible blood in seven subjects in the group B during the puncture syringe was ithdrawing. ③According to the records on the 60 subjects by the two ultrasound physicians not involved in the study, in the group A the neural stem were covered with local anesthetic aroundly,which was recorded as 4 scores. In the group B, 15 subjects got 4 scores, while 7 subjects got 3 scores,5 subjects got 2 scores. A bit or no visible local anesthetic were found in 3 subjects which were failed,of whom 2 subjects got 1 score and 1 subject got 0 score. ④In the group A, 30 subjects had no postoperative neurological trauma, hematoma formation, local anesthetic toxicity and other complications. Among the successful blockade 27 subjects in the group B, 3 subjects felt swelling in puncture site, which may be considered as nerve trauma.Conclusion: By comparison with nerve stimulator-guided method, ultrasound-guided nerve block could increase success rate, shorten the pre-onset block time and improve the block quality, showing a higher application value in the sciatic and femoral nerve block. |
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