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与股神经垂直或平行放置的神经周围导管脱位率：随机对照试验
翻译：牛振瑛 编辑：冯玉蓉 审校：曹莹
背景：超声虽然提高了股神经置管的成功率，但术后导管脱位仍是常见问题。虽然与神经平行放置似乎可以降低其他神经和神经丛的导管脱位率，但股神经导管平行放置是否具有优势仍不清楚。
目的：比较与股神经垂直或平行放置时股神经导管的脱位率。
设计：随机对照研究
地点：大学骨科医院。研究时间为2018年10月至2019年6月。
研究对象：80例计划置入股神经导管并接受膝关节手术的患者，随机分为两组。最终对78名患者的数据进行了分析。
干预措施：第1组患者股神经导管与神经垂直放置(40根)，第2组与神经平行放置(38根)。第1组采用神经短轴切面，平面内穿刺法。第2组采用神经短轴切面和平面外穿刺技术，同时将换能器旋转至与所述针在同一平面上的长轴视图。
主要结果指标：主要结果是术后前48小时的导管脱位率。次要结果是疼痛评分和感觉阻滞效果。
结果：两种方法在24、48h时导管脱位的发生率差异无统计学意义(48h时，第1组为15%，第2组为26%，P=0.109)。此外，疼痛评分、感觉阻滞效果和罗哌卡因追加剂量在两组之间也没有差异。然而，在第二组，这项技术需要更长的时间。
结论：将超声探头旋转到长轴平面视图，可以在导管与神经平行放置时检查导管位置。平行放置导管需要更多的时间，但不能显著改善脱位率、疼痛评分或感觉阻滞。
原始文献来源：Kalimeris K, et al.Dislocation rates of perineural catheters placed either perpendicular or parallel to the femoral nerve：A randomised controlled trial[J].Eur J Anaesthesiol 2020 Sep;37(9) DOI：10.1097/EJA.0000000000001237
Dislocation rates of perineural catheters placed either perpendicular or parallel to the femoral nerve：A randomised controlled trial
BACKGROUND Ultrasound has increased the efficacy of femoral nerve catheters but their postoperative dislocation still remains a common problem. Although catheter place-ment parallel to the nerve seems to reduce dislocation rates in other nerves and plexuses, the possible advantage for femoral nerve catheter placement remains unclear.
OBJECTIVE To compare the dislocation rates of femoral catheters when placed perpendicular or parallel to the femoral nerve.
DESIGN Randomised controlled study.
SETTING University orthopaedic hospital. Duration of study:October 2018 to June 2019.
PATIENTS Eighty patients scheduled for major knee surgery with femoral catheter were enrolled and randomly allocated in two groups. Data from 78 patients could be analysed.
INTERVENTIONS The femoral nerve catheters was placed perpendicular to the nerve in Group 1 (n=40), whereas in Group 2 (n=38) parallel to it. For Group 1 the short-axis view of the nerve and an in-plane puncture was used. For Group 2 we used the short-axis view of the nerve and an out-of-plane puncture technique combined with rotation of the transducer to the long-axis view with the needle in-plane.
MAIN OUTCOME MEASURES Primary outcome was the catheter dislocation rate in the first 48h. Secondary outcomes were pain scores and sensory blockade.
RESULTS There was no statistically significant difference between the two techniques regarding dislocation of the catheters at 24 or 48 h (at 48 h, Group 1: 15%, Group 2:2.6%, P=0.109). Also pain scores, sensory blockade and rescue doses of ropivacaine did not differ between the groups. However, in Group 2 the technique took longer.
CONCLUSION Rotating the ultrasound probe to the long-axis in-plane view enabled examination of the catheter position when it was placed parallel to the nerve. The parallel placement of the catheter required more time, but did not significantly improve dislocation rate, pain scores or sensory blockade.
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