神經阻斷術配合鎮靜應用於接受姆指外翻手術之病患

The perioperative effectiveness of popliteal sciatic block for patients undergoing bunion surgery

背景：接受踝及足關節手術的病患常在術後感到中度到嚴重的疼痛，膕窩坐骨神經阻斷術兼具術中麻醉與術後止痛。此研究之目的在於比較兩種不同的麻醉方法在拇指外翻手術的效果。方法：病患被隨機分配到神經阻斷組以及全身麻醉組。神經阻斷組(n=32)接受超音波導引膕窩坐骨神經阻斷以及propofol標靶輸注。全身麻醉組(n=37)放置喉頭面罩使用sevoflurane麻醉。術中視病患需求給予麻啡類藥物。我們將病患基本資料，麻醉參數及術後恢復紀錄（疼痛，術後合併症，止痛藥使用以及病患滿意度）做紀錄並比較。結果：比起全身麻醉，神經阻斷術能夠給予接受拇指外翻手術的病患更好的術後恢復。神經阻斷術組的病患術中需要的鴉片類止痛藥人數較全身麻醉組少(15/32，47%與37/37，100%，p <0.001)。在恢復室的疼痛程度，神經阻斷術組也比全身麻醉組低(2.0±1.8與3.3±1.4, p<0.01)。神經阻斷術組在恢復室需要鴉片類止痛藥的人數也比全身麻醉組少(9/31，29%與27/37，73%，p<0.001)。此外，神經阻斷術組發生數後噁心嘔吐的機率也比全身麻醉組低(5/31，16% 與 15/37，41%，p=0.03)。結論：對於接受拇指外翻手術的病患，超音波導引之膕窩坐骨神經阻斷術比全身麻醉更能有效減少術後疼痛以及不良反應。

Background: Patients usually experience moderate to severe postoperative pain and require multiple doses of parenteral analgesics after foot and ankle surgery. Popliteal sciatic block (PSB) could provide sufficient anesthesia and reduces postoperative pain. The purpose of this study is to compare the effectiveness of two anesthetic techniques in bunion surgery.　Methods: Patients were randomly allocated into PSB group (popliteal sciatic block with propofol sedation) and a GA group (general anesthesia). The PSB group (n=32) received ultrasound guided PSB and propofol target-controlled infusion (TCI). The GA group (n=37) received laryngeal mask airway with sevoflurane. Intraoperative opioids (morphine or fentanyl) were given for both groups when necessary. The demographic data, anesthetic and postoperative recovery parameters (pain intensity, adverse events, analgesics use and satisfaction) were all recorded.　Results: Patients in the PSB group depicted better postoperative recovery profile than those in the GA group. In the PSB group, less patients required intra-operative opioids when compared with the GA group (15/32, 47% vs. 37/37, 1000/o, p<0.001). Postoperative pain intensity was significantly lower in the PSB group than in the GA group at post-anesthesia care unit (2.0 1.8 vs. 3.3 1.4, p <0.01). In postoperative anesthesia care unit (PACU), fewer patients required postoperative opioids in the PSB group than in the GA group (9/31, 29% vs. 27/37, 73%, p<0.001). Less postoperative nausea vomiting was noted in the PSB group when compared with the GA group (5/31, 16% vs. 15/37, 41%, p=0.03).　Conclusion: Ultrasound-guided popliteal sciatic block reduced postoperative pain and adverse events in patients undergoing bunion surgery than did general anesthesia.