Clinical study on ultrasound-guided femoral nerve combined with popliteal sciatic nerve block for postoperative analgesia in patients with lower limb arterial occlusive disease after bypass grafting
10.3760/cma.j.cn341190-20240815-01051
- VernacularTitle:超声引导下股神经联合腘窝坐骨神经阻滞用于下肢动脉硬化闭塞症旁路移植术后镇痛的临床研究
- Author:
Yongjun HE
1
;
Jie ZHANG
Author Information
1. 浙江中医药大学附属金华市中医医院麻醉科，金华 321000
- Publication Type:Journal Article
- Keywords:
Ultrasonography;
Nerve block;
Femoral nerve;
Sciatic nerve;
Arteriosclerosis obliterans;
Lower extremity;
Pain, postoperative;
Analgesia
- From:
Chinese Journal of Primary Medicine and Pharmacy
2025;32(4):517-522
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical efficacy of ultrasound-guided femoral nerve combined with popliteal sciatic nerve block for postoperative analgesia in lower limb arterial occlusive disease after bypass grafting and the underlying mechanisms.Methods:This prospective study included 120 patients with grade C and D lower limb arterial occlusive disease who were treated at Jinhua Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University from March 2021 to January 2024. The patients were randomly assigned to either the control group or the observation group using a computer-generated randomization method, with 60 patients in each group. Both groups underwent lower limb arterial bypass grafting under combined spinal-epidural anesthesia and received intravenous patient-controlled analgesia after surgery. The observation group received ultrasound-guided femoral nerve combined with popliteal sciatic nerve block 15 minutes before surgery. The changes in pain response at 48 hours post-surgery were evaluated in each group. Serum levels of stress response factors (including serum norepinephrine, cortisol, angiotensin II, and malondialdehyde) at 12 and 48 hours post-surgery were measured in each group. The duration of the first press of the patient-controlled analgesia pump and the number of effective presses within 48 hours after surgery were recorded in each group. The incidences of adverse reactions and complications related to postoperative analgesic medications were calculated.Results:The Visual Analog Scale scores at 6, 12, 24, and 48 hours post-surgery in the observation group were significantly lower than those in the control group ( t = 5.52-24.68, all P < 0.001). The duration of the first press of the patient-controlled analgesia pump in the observation group [(9.25 ± 1.16) hours] was significantly longer compared to the control group [(4.46 ± 0.72) hours, t = 16.84, P < 0.001]. The number of effective presses within 48 hours after surgery in the observation group [(3.84 ± 0.62) times] was significantly lower than in the control group [(7.21 ± 0.87) times, t = 12.53, P < 0.001]. The serum levels of norepinephrine, cortisol, angiotensin II, and malondialdehyde at 12 and 48 hours post-surgery in the observation group were also significantly lower than those in the control group ( t = 10.44-21.64, all P < 0.001). The overall incidences of adverse drug reactions and complications in the observation group [5.00% (3/60), 6.67% (4/60)] were significantly lower compared to the control group [16.67% (10/60), 21.67% (13/60), χ2 = 4.22, 5.55, both P < 0.05]. Conclusions:Ultrasound-guided femoral nerve combined with popliteal sciatic nerve block can alleviate pain responses after bypass grafting in patients with lower limb arterial occlusive disease by downregulating the synthesis and secretion levels of stress response factors. This technique can delay the timing of postoperative analgesic administration, reduce the frequency of postoperative analgesic medication, and lower the risk of adverse drug reactions and postoperative complications.
