Abstract：【Objective】 To compare the effects of different sciatic nerve block approaches guided by ultrasound on knee replacement (TKA). 【Methods】 A total of 108 patients with TKA who were admitted to our hospital were enrolled in the study. According to the different sciatic nerve block approaches,the patients were divided into four groups,with 27 cases in each group. The four groups were group A (inferior gluteal space approach),group B (anterior mid-thigh approach),group C (inferior lateral greater trochanter approach) and group D (upper lateral popliteal fossa approach). The related indexes of sciatic nerve block,hemodynamic indexes [mean arterial pressure (MAP),diastolic blood pressure (DBP),heart rate (HR)] at different time points,visual analog score (VAS) of resting and active pain at different time points after surgery,and the incidence of complications in the four groups were observed and compared. 【Results】 In terms of operation time,the procedure length was in the order of group B < group D < group C < group A,and there were statistically significant differences among all groups (P<0.05). The number of puncture times in groups B and D were less than those in groups A and C,and the difference was statistically significant (P<0.05). The puncture depth of group D was less than that of group A,C,and B,while the puncture depth of group A and C was less than that of group B (P<0.05). There were no significant differences in the onset time and duration among the four groups (P>0.05). The success rate of nerve block in group D was higher than that in groups A,B and C (P<0.05),however,there was no statistical significance among groups A,B and C (P>0.05). There were no significant differences in hemodynamic indexes at different time points and VAS scores at both resting and active time points among the four groups (P>0.05). There was no significant difference in the total incidence of postoperative complications among the four groups (P>0.05). 【Conclusion】 In TKA,the sciatic nerve block effects under the middle thigh anterior approach and the upper lateral approach of popliteal fossa guided by ultrasound are better approaches,which can be used as an optimization scheme for clinical anesthesia.
[1] HUNT L P,MATHARU G S,BLOM A W,et al. Patellar resurfacing during primary total knee replacement is associated with a lower risk of revision surgery[J].Bone Joint J,2021,103-B(5):864-871.
[2] MARASHI-POUR S,WATSON D E,HARRIS I A. Association between number of replacements and readmissions following total knee and total hip replacements in New South Wales' public hospitals.[J].ANZ J Sur,2021,91(6):1277-1283.
[3] CAPPELLERI G,AMBROSOLI A L,GEMMA M,et al. Intraneural ultrasound-guided sciatic nerve block:minimum effective volume and electrophysiologic effects[J].Anesthesiology,2018,129(2):241-248.
[4] 赵建宁,周利武,陆维举,等.人工全膝关节置换术的适应证选择及疗效分析[J].中国矫形外科杂志,2002,9(2):140-142.
[5] STREET B D,ADKIN A,GAGE W.Reported balance confidence and movement reinvestment of younger knee replacement patients are more like younger healthy individuals,than older patients[J].Gait Posture,2018,61(1):130-134.
[6] MUSSO D,KLAASTAD I,YTREB L M.A combination of infraclavicular and suprascapular nerve blocks for total shoulder arthroplasty:A case series[J].Acta Anaesthesiol Scand,2021,65(5):674-680.
[7] 王美容,柳垂亮,何妹仪,等.超声引导下收肌管入路一针四点法神经阻滞用于全膝关节置换术后镇痛的效果[J].中华麻醉学杂志,2020,40(6):728-731.
[8] 苏文婷,蔡秀免,林群,等.超声引导下股-腘窝坐骨神经阻滞在老年高血压患者单侧大隐静脉曲张手术中对血压和心率的影响[J].中华高血压杂志,2020,28(3):276-279.
[9] HIROSHI U,HIROYUKI N,JUN N,et al. Involvement of lysophosphatidic acid-induced astrocyte activation underlying the maintenance of partial sciatic nerve injury-induced neuropathic pain[J].Pain,2018,159(11):2170-2178.
[10] 王美容,李志鹏,何妹仪,等.超声引导下大转子下与腘窝上外侧入路坐骨神经阻滞在全膝关节置换术后的镇痛效果[J].临床麻醉学杂志,2019,35(8):742-746.
[11] 谢振玮,姚军.超声引导下两种入路坐骨神经阻滞对于踝部骨折患者麻醉效果的比较[J].上海医学,2018,41(9):537-540.
[12] 王春光,刘蕊,李艳军,等.收肌管阻滞联合腘动脉-膝关节囊后间隙阻滞或胫神经阻滞在全膝关节置换术中的应用[J].临床麻醉学杂志,2021,37(3):229-232.
2023, Vol. 40 
