Clinical Research

Application of ultrasound⁃guided combined femoral nerve and femoral artery block on tourniquet response in lower extremity surgery

  • Xiaoqing FAN ,
  • Xiaojing ZHENG ,
  • Ling HU
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  • Department of Anesthesiology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China

Received date: 2023-11-02

  Online published: 2024-04-08

Abstract

Objective To observe the safety and effectiveness of ultrasound?guided femoral nerve combined with femoral artery block to reduce tourniquet reaction in patients undergoing knee arthroplasty. Methods 100 patients(18 ~ 75 years old, body mass index 18 ~ 30 kg/m2)who were classified as grade Ⅰ?Ⅲ according to ASA standard and received unilateral total knee arthroplasty. The patients were randomly divided into two groups,the ultrasound?guided femoral nerve combined with femoral artery block with general anesthesia was utilized in group NA with 50 cases, and femoral nerve block alone with general anesthesia was used in group N with 50 cases. The target nerve block was guided by ultrasound before induction of anesthesia in both two groups,and anesthesia induction was performed after the block effect was etermined. Patients in two groups underwent surgery under general anesthesia of the laryngeal mask,and all patients under went self?controlled intravenous analgesia(PCIA). If a patient had a visual analogue score(VAS)score > 5 after surgery, flurbiprofenate 50 mg will be given intravenously as a remedy for analgesia. The patients' SBP,DBP and HR were recorded before anesthesia (T1), 1 min before tourniquet inflation (T2), 15 min after tourniquet inflation (T3), 30 min (T4), 45 min (T5), and 60 min (T6),the number of cases of tourniquet hypertension occurring in patients intraoperatively and the amount of nicardipine and esmolol were recorded, and the movement and static VAS scores at 2, 6, 12, and 24 h after surgery were recorded.the postoperative rescue analgesic requirements and the time of getting out of bed were recorded. The incidence of adverse reactions such as nausea,vomiting,deliriumand infection were also recorded. Results Compared with group N,SBP,DBP and HR were significantly lower in group NA at 45 and 60 min after tourniquet inflation, and the incidence of tourniquet hypertension and the amount of nicardipine and esmolol were also significantly lower (P < 0.05), and the time of getting out of bed was advanced (P < 0.05); the movement and static VAS scores,the time of the first remedial analgesia, and number of times of remedial analgesia, as well as the occurrence of nausea,vomiting,delirium and infection were not statistically significant. Conclusion Ultrasound?guided femoral nerve combined with femoral artery block can be safely and effectively used to reduce the reaction of tourniquet in patients with knee arthroplasty, and can shorten the time of getting out of bed after surgery, contributing to promoting postoperative rehabilitation.

Cite this article

Xiaoqing FAN , Xiaojing ZHENG , Ling HU . Application of ultrasound⁃guided combined femoral nerve and femoral artery block on tourniquet response in lower extremity surgery[J]. The Journal of Practical Medicine, 2024 , 40(6) : 796 -800 . DOI: 10.3969/j.issn.1006-5725.2024.06.011

References

1 何涛,曹力,杨德盛,等. 全膝关节置换术中使用止血带疗效和安全性的meta分析[J]. 中华外科学杂志, 2011,49(6):551-557.
2 CAO Z, GUO J, LI Q,et al. Comparison of efficacy and safety of different tourniquet applications in total knee arthroplasty: a network meta-analysis of randomized controlled trials[J]. Ann Med,2021,53(1):1816-1826. doi:10.1080/07853890.2021.1991588
3 CHEN H, WEI J Q, WANG Y W, et al. Protective effects of Rocuronium bromide on ischemia-reperfusion injury in skeletal muscle induced by tourniquet in patients undergoing elective unilateral Total knee arthroplasty: a prospective, double blind, randomized[J]. Drug Des Devel Ther,2020,14:3373-3384. doi:10.2147/dddt.s252546
4 YAMASHITA S, YAMAGUCHI H, HISAJIMA Y, et al. Preoperative oral dextromethorphan attenuated tourniquet-induced arterial blood pressure and heart rate increases in knee cruciate ligament reconstruction patients under general anesthesia[J]. Anesth Analg, 2004,98(4):994-998.
5 VENKATESWARLU Y, MAHANTY P R, SAHU S, et al. Effect of Tourniquet Deflation on Intracranial Pressure Measured by Ultrasound of the Optic Nerve Sheath Diameter in Patients Undergoing Orthopedic Surgery Under Spinal Anesthesia: An Observational Study[J]. Cureus, 2023,15(10):e46700.
6 WAHAL C, GRANT S A, GADSDEN J, et al. Femoral artery block (FAB) attenuates thigh tourniquet-induced hypertension: a prospective randomized, double-blind, placebo-controlled trial[J]. Reg Anesth Pain Med, 2021,46(3):228-232. doi:10.1136/rapm-2020-102113
7 气压止血带在四肢手术中应用的专家共识协作组. 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. doi:10.3760/cma.j.cn131073.20200915.01003
8 SAIED A, AYATOLLAHI MOUSAVI A, ARABNEJAD F, et al. Tourniquet in surgery of the limbs: a review of history, types and complications[J]. Iran Red Crescent Med J, 2015,17(2):e9588. doi:10.5812/ircmj.9588
9 ESTEBE J P, DAVIES J M, RICHEBE P.The pneumatic tourniquet: mechanical, ischaemia-reperfusion and systemic effects[J]. Eur J Anaesthesiol, 2011,28(6):404-411. doi:10.1097/eja.0b013e328346d5a9
10 KAM P C, KAVANAGH R, YOONG F F, et al. The arterial tourniquet: pathophysiological consequences and anaesthetic implications[J]. Anaesthesia, 2001,56:534-545. doi:10.1046/j.1365-2044.2001.01982.x
11 WAKAI A, WINTER D C, STREET J T, et al. Pneumatic tourniquets in extremity surgery[J]. J Am Acad Orthop Surg, 2001,9:345-351. doi:10.5435/00124635-200109000-00008
12 ALLEE J, MUZAFFAR A R, TOBIAS J D. Dexmedetomidine controls the hemodynamic manifestations of tourniquet pain[J]. Am J Ther, 2011,18:e35-9. doi:10.1097/mjt.0b013e3181c35088
13 KUMAR K, RAILTON C, TAWFIC Q. Tourniquet application during anesthesia: "What we need to know?" [J].Anaesthesiol Clin Pharmacol, 2016,32(4):424-430. doi:10.4103/0970-9185.168174
14 彭旭导,王美容,陈太新,等. 超声引导下收肌管复合四种不同入路坐骨神经阻滞在全膝关节置换术术后镇痛中的比较[J].实用医学杂志, 2020,36(16):2279-2284. doi:10.3969/j.issn.1006-5725.2020.16.022
15 王露,王鑫,张婷,等. 收肌管阻滞联合静脉自控镇痛对全膝关节置换术患者术后抑郁状态的影响[J]. 实用医学杂志,2023,39(6):696-700. doi:10.3969/j.issn.1006-5725.2023.06.007
16 XU F, WANG X, LI Y, et al. Combined femoral artery block and femoral nerve block reduces thigh tourniquet-induced hypertension[J]. J Clin Anesth, 2023,85:111039. doi:10.1016/j.jclinane.2022.111039
17 周丹,程鹏飞,汪宏,等. 股动脉联合股神经阻滞对膝关节镜下韧带重建术病人术中止血带反应及术后镇痛的影响[J]. 临床外科杂志, 2023,31(10):978-981. doi:10.3969/j.issn.1005-6483.2023.10.021
18 GENTILI M, BERNARD J M, BONNET F. Adding clonidine to lidocaine for intravenous regional anesthesia prevents tourniquet pain[J]. Anesth Analg, 1999,88:1327-1333. doi:10.1213/00000539-199906000-00024
19 BOEZAART A P, SMITH C R, CHEMBROVICH S, et al. Visceral versus somatic pain: an educational review of anatomy and clinical implications[J]. Reg Anesth Pain Med,2021,46:629-636. doi:10.1136/rapm-2020-102084
20 QIN L, LI J. Nerve growth factor in muscle afferent neurons of peripheral artery disease and autonomic function[J]. Neural Regen Res,2021,16:694-699. doi:10.4103/1673-5374.293132
21 MCNAMEE D A, PARKS L, MILLIGAN K R. Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block[J]. Acta Anaesthesiol Scand, 2002,46(1):95-99. doi:10.1034/j.1399-6576.2002.460117.x
22 MOUZI L K, ADAMS O, CUFF G, et al. Plasma concentrations of ropivacaine following ultrasound-guided or nerve-stimulator-guided femoral nerve block: A prospective randomised study[J]. Anaesth Crit Care Pain Med, 2016,35(1):45-48. doi:10.1016/j.accpm.2015.08.002
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