关键词: 股神经, 股动脉, 神经阻滞, 膝关节镜, 止血带反应

Abstract: Objective   To investigate the effect of femoral nerve combined with femoral artery block on intraoperative tourniquet response in patients with knee microscopic ligament reconstruction.  Methods   150 patients with knee microscopic ligament reconstruction were selected.They were divided into three control groups (group A),femoral nerve block (Group B) and femoral nerve combined femoral artery nerve block (Group C),with 50 patients in each group.No nerve block was performed in group A,group B received 20 ml of 0.2% ropivacaine femoral nerve block and Group C received 0.2% ropivacaine 10 ml femoral nerve block + 10 ml femoral artery block.Perioperative vital signs,lactate values at different time points,amount of esmolol,incidence of tourniquet reaction,postoperative sensory block time,and VAS scores at different postoperative time points were compared in the 3 groups.   Results  The systolic blood pressure of patients in group A, Group B and group C at 60 minutes after applying tourniquet was (140.14±5.46)mmHg, (136.02±4.55)mmHg and (131.02±9.26)mmHg, respectively,MAP values were (90.26±4.45)mmHg, (84.62±4.28)mmHg and (79.18±3.53)mmHg, respectively,the heart rate was (86.9±3.80) times/min, (76.18±3.19) times/min and (72.90±3.33) times/min, respectively. The systolic blood pressure at 1 minute before the tourniquet was (150.06±5.69)mmHg, (145.20±4.83)mmHg and (136.66±9.04)mmHg, respectively. MAP was (103.30±4.74)mmHg, (95.24±3.89)mmHg and (83.98±3.97)mmHg, respectively; Heart rate was (92.44±5.79) times/min, (81.66±4.44) times/min and (74.26±4.93) times/min, respectively;the difference was statistically significant (P< 0.05).The 5minute lactic acid values of pine tourniquet were (1.38±0.10)mmol/L, (1.35±0.09)mmol/L and (1.26±0.09)mmol/L, respectively. The lactate values at 30min were (1.48±0.08)mmol/L, (1.46±0.08)mmol/L and (1.29±0.07)mmol/L, respectively, and there was statistical significance among all groups (P<0.05). The intraoperative dosage of esmolol in 3 groups were (31.20±16.12)mg, (25.4±21.11)mg and (8.80±8.49)mg, respectively. The incidence of tourniquet reaction was 72%, 64% and 32%, respectively, with statistical significance (P<0.05).The VAS scores of the 3 groups were (2.72±0.73) , (0.32±0.47) and (0.30±0.46) at 1 hour after operation, and (5.40±0.61), (1.62±0.67) and (1.66±0.63) at 6 hours, respectively. At 12 hours (4.28±0.78), (3.24±0.77) and (3.36±0.60), 24hour VAS scores were (3.16±0.68) and (2.50±0.74), respectively. There was statistical significance at all time points (P<0.05).  Conclusion   The femoral nerve combined with femoral artery block can reduce the incidence of intraoperative tourniquet reaction in patients with knee endoscopic ligament reconstruction,make the intraoperative circulation more stable,reduce the rapid growth of lactic acid value,and reduce the postoperative pain.

Key words: femoral nerve, femoral artery, nerve block, knee arthroscopy, tourniquet reaction