Applications of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery

Peng Jie; Zhang Wenqi; Wang Xinhui; Wu Youping; Jia Ji; Qie Wenbin; Xu Bo

doi:10.13406/j.cnki.cyxb.003224

您当前的位置：

首页 >

文章列表页 >

Applications of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery

Clinical research | 更新时间：2025-10-21

- Applications of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery
- Journal of Chongqing Medical University Vol. 48, Issue 5, Pages: 554-558(2023)
- 作者机构：
  
  南部战区总医院麻醉科，广州 510010
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.003224
  CLC： R614.4
- Received：19 July 2022，
  
  Revised：2022-12-29，
  
  Accepted：06 January 2023，
  
  Published：28 May 2023
- 稿件说明：
移动端阅览
彭捷,张雯琪,王昕辉,等.收肌管及腘窝坐骨神经阻滞联合踝部止血带在老年足部手术的应用[J].重庆医科大学学报,2023,48(5):554-558.

Peng Jie,Zhang Wenqi,Wang Xinhui,et al.Applications of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery[J].Journal of Chongqing Medical University,2023,48(5):554-558.
彭捷,张雯琪,王昕辉,等.收肌管及腘窝坐骨神经阻滞联合踝部止血带在老年足部手术的应用[J].重庆医科大学学报,2023,48(5):554-558. DOI： 10.13406/j.cnki.cyxb.003224.

Peng Jie,Zhang Wenqi,Wang Xinhui,et al.Applications of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery[J].Journal of Chongqing Medical University,2023,48(5):554-558. DOI： 10.13406/j.cnki.cyxb.003224.

摘要

目的

探讨收肌管及腘窝坐骨神经阻滞联合踝部止血带在老年足部手术应用的效果。

方法

择期行足部手术的老年患者69例，以随机数字表法分为3组：蛛网膜下腔阻滞联合大腿止血带组（C组）、蛛网膜下腔阻滞联合踝部止血带组（SA组）及收肌管及腘窝坐骨神经阻滞联合踝部止血带组（NA组）。比较3组麻醉后30 min内平均动脉压（mean arterial pressure，MAP）、心率（heart rate，HR）变化峰值，松止血带后1、3、5、10、15 min时MAP及HR变化；术后排尿、排气时间及24 h恢复质量（quality of recovery，QoR）-15评分；麻醉及术野止血效果、间羟胺用量、首次自控镇痛（patient-controlled analgesia，PCA）时间、术后48 h内舒芬太尼用量及不良反应等情况。

结果

纳入患者69例，64例完成研究。与C组及SA组比较，NA组麻醉后30 min内MAP及HR变化峰值明显减小，术后排尿、排气时间显著缩短，24 h QoR-15评分更高；麻醉起效较慢、阻滞范围小，间羟胺用量更少，首次PCA时间显著延长，术后12、24及48 h舒芬太尼累积用量减少，差异有统计学意义（

0.05）。与C组比较，SA组及NA组松止血带后MAP、HR波动幅度明显减小，间羟胺用量更少；术后止血带区域皮肤水泡和疼痛发生率更低，差异有统计学意义（

0.05）。3组其余指标差异无统计学意义（

0.05）。

结论

收肌管及腘窝坐骨神经阻滞联合踝部止血带应用于老年足部手术，血流动力学稳定，恢复速度快，效果良好，不良反应少。

Abstract

Objective

To investigate the effects of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery.

Methods

Sixty-nine elderly patients，scheduled for elective foot surgery，were randomized into 3 groups：subarachnoid block combined with thigh tourniquet group（group C），subarachnoid block combined with ankle tourniquet group（group SA），adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet group（group NA）. The peak changes of mean arterial pressure（MAP） and heart rate（HR） during 30 min after anesthesia，and changes of MAP and HR at 1 min，3 min，5 min，10 min and 15 min after tourniquet deflation；postoperative micturition and flatus passage time，quality of recovery-15（QoR-15） score 24 h after operation；effects of anesthesia and surgical field hemostasis，dose of metaraminol，time of patient-controlled analgesia（PCA） initiation and consumption of sufentanil within 48 h after operation and adverse reactions were compared among the three groups.

Results

Sixty-nine patients were enrolled in the study，and sixty-four completed the study. Compared with group C and group SA，the peak changes of MAP and HR during 30 min after anesthesia of group NA were significantly lower. In addition， the postoperative micturition and flatus passage time were sh

ortened，and QoR-15 score 24 h after operation was higher. The onset of anesthesia was slower，region of blockade was smaller，less metaraminol was used，time of PCA initiation was longer，and cumulative consumptions of sufentanil were less at 12 h，24 h and 48 h after operation in group NA. All the differences were statistically significant（

0.05）. Compared with group C，the amplitudes of MAP and HR changes in group SA and group NA after tourniquet deflation were significantly smaller with less metaraminol. Moreover，the incidences of skin blisters and pain in tourniquet area were significantly lower after operation（

0.05）. There were no significant differences in other indexes among the three groups（

0.05）.

Conclusion

Applications of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery could bring stable hemodynamics，enhanced recovery， favorable effects and few adverse reactions.

关键词

Keywords

references

Kumar K ， Railton C ， Tawfic Q . Tourniquet application during anesthesia：what we need to know? [J ] . J Anaesthesiol Clin Pharmacol ， 2016 ， 32 （ 4 ）： 424 - 430 .

气压止血带在四肢手术中应用的专家共识 [J ] . 中华麻醉学杂志， 2020 ， 40 （ 10 ）： 1160 - 1166 .

Expert consensus on application of pneumatic tourniquet in patients undergoing limb operation [J ] . Chin J Anesthesiol ， 2020 ， 40 （ 10 ）： 1160 - 1166 .

Roberts RK ， Cleave ES ， Rambani R . Surgical efficacy of the ankle tourniquet for forefoot surgery [J ] . J Perioper Pract ， 2014 ， 24 （ 12 ）： 279 - 282 .

Noordin S ， McEwen JA ， Jr Kragh JF ， et al . Surgical tourniquets in orthopaedics [J ] . J Bone Joint Surg Am ， 2009 ， 91 （ 12 ）： 2958 - 2967 .

Leurcharusmee P ， Sawaddiruk P ， Punjasawadwong Y ， et al . The possible pathophysiological outcomes and mechanisms of tourniquet-induced ischemia-reperfusion injury during total knee arthroplasty [J ] . Oxid Med Cell Longev ， 2018 ， 2018 ： 8087598 .

Rudkin AK ， Rudkin GE ， Dracopoulos GC . Acceptability of ankle tourniquet use in midfoot and forefoot surgery：audit of 1 000 cases [J ] . Foot Ankle Int ， 2004 ， 25 （ 11 ）： 788 - 794 .

Gwosdz J ， Bilbrew L ， Jupiter D ， et al . The effects of timing of ankle blocks in forefoot，midfoot，or hindfoot reconstruction with the use of an ankle tourniquet [J ] . Foot Ankle Spec ， 2018 ， 11 （ 6 ）： 527 - 533 .

Martins LES ， Ferraro LHC ， Takeda A ， et al . Ultrasound-guided peripheral nerve blocks in anticoagulated patients - case series [J ] . Braz J Anesthesiol Engl Ed ， 2017 ， 67 （ 1 ）： 100 - 106 .

Kleif J ， Gögenur I . Severity classification of the quality of recovery-15 score：an observational study [J ] . J Surg Res ， 2018 ， 225 ： 101 - 107 .

Wall PL ， Buising CM ， Hingtgen E ， et al . Limb position change affects tourniquet pressure [J ] . J Spec Oper Med ， 2021 ， 21 （ 1 ）： 11 - 17 .

宋达玮，程　宇，倪莉，等 . 踝部止血带与大腿止血带在足部手术中的应用比较 [J ] . 中国矫形外科杂志， 2013 ， 21 （ 17 ）： 1708 - 1712 .

Song DW ， Cheng Y ， Ni L ， et al . Comparison of the effect and the security between ankle tourniquet and thigh tourniquet [J ] . Orthop J China ， 2013 ， 21 （ 17 ）： 1708 - 1712 .

Pinsornsak P ， Pinitchanon P ， Boontanapibul K . Effect of different tourniquet pressure on postoperative pain and complications after total knee arthroplasty：a prospective，randomized controlled trial [J ] . J Arthroplasty ， 2021 ， 36 （ 5 ）： 1638 - 1644 .

Farhan-Alanie MM ， Trompeter AJ ， Wall PDH ， et al . Tourniquet use in lower limb trauma and fracture surgery [J ] . Bone Joint J ， 2021 ， 103 -B（ 5 ）： 809 - 812 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

General anesthesia combined scalp nerve block used in craniotomy for patients with hypertension

Parecoxib sodium combined scalp nerve block for postoperative analgesia in craniotomy

Related Author

Huang Fusen

Wu Chaoran

Related Institution

Department of Anesthesia，The First Affiliated Hospital of Chongqing Medical University

Department of Anesthesia，West China Hospital，Sichuan University

⁰