BACKGROUND The co-administration of sciatic and femoral nerve blocks can provide anaesthesia and analgesia in patients undergoing lower extremity surgeries. Several approaches to achieve sciatic nerve block have been described, including anterior and posterior approaches. METHODS In total, 58 study patients were randomly assigned to receive either anterior (group A, n = 29) or posterior (group P, n = 29) sciatic nerve block. Thereafter, the following parameters were determined: sensory and motor block start and end times, time to first fentanyl requirement after blockade but before the start of the operation, time to first fentanyl requirement after the start of the operation, mean fentanyl dose administered after blockade but before the start of the operation, mean fentanyl dose after the start of the operation, time to first diclofenac sodium dose, and total dose of diclofenac sodium required. The trial was retrospectively registered on 11 July 2018. RESULTS The time to initiation of sensory block was significantly shorter in group P than in group A (7.70 ± 2.05 min and 12.88 ± 4.87 min, respectively; p = 0.01). Group P also had a significantly shorter time to first fentanyl requirement after block but before the start of the operation (00.00 ± 00.00 min for group P and 4.05 ± 7.47 min for group A; p < 0.01), significantly higher mean fentanyl dose per patient after block but before the start of the operation (44.03 ± 23.78 μg for group P and 31.20 ± 27.79 μg for group A), significantly longer time to first fentanyl requirement after the start of the operation (16.24 ± 7.13 min for group P and 00.00 ± 00.00 min for group A; p = 0.01), and significantly lower mean fentanyl dose per patient after the start of the operation (11.51 ± 2.87 μg for group P and 147.75 ± 22.30 μg for group A). Patient satisfaction (p < 0.01), anaesthesia quality (p = 0.006), and surgical quality (p = 0.047) were significantly higher in group P. CONCLUSIONS Anterior and posterior approaches can be used to achieve sciatic nerve block in patients undergoing surgery for malleolar fractures. However, better anaesthesia and pain control results can be obtained if analgesia is administered preoperatively in patients with a posterior approach block and after the start of the operation in patients with an anterior approach block.

中文翻译：

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使用前后方法比较坐骨神经阻滞质量：一项随机试验。

背景技术坐骨神经和股神经神经阻滞的共同给药可以在进行下肢手术的患者中提供麻醉和镇痛作用。已经描述了几种实现坐骨神经阻滞的方法，包括前入路和后入路。方法共有58例研究患者被随机分配接受前坐骨神经阻滞（A组，n = 29）或后坐神经（P组，n = 29）。此后，确定以下参数：感觉和运动阻滞的开始和结束时间，在阻断后但在手术开始前达到首次芬太尼需要量的时间，在手术开始后达到首次芬太尼需要量的时间，在阻断后给予的平均芬太尼剂量但在手术开始之前，是手术开始后的平均芬太尼剂量，首次服用双氯芬酸钠的时间，以及所需的双氯芬酸钠的总剂量。该研究于2018年7月11日进行了回顾性注册。结果感觉障碍的开始时间明显比P组短（分别为7.70±2.05分钟和12.88±4.87分钟； p = 0.01）。P组在阻滞后但在手术开始之前达到首次服用芬太尼的时间也明显缩短（P组为00.00±00.00分钟，A组为4.05±7.47分钟； p <0.01），每位患者的平均芬太尼剂量明显更高封堵后但开始手术前（P组为44.03±23.78μg，A组为31.20±27.79μg），开始手术后首次达到芬太尼需求的时间明显更长（P组为16.24±7.13分钟，00.00 A组为±00.00分钟； p = 0.01），且开始手术后每位患者的平均芬太尼剂量明显降低（P组为11.51±2.87μg，A组为147.75±22.30μg）。P组患者的满意度（p <0.01），麻醉质量（p = 0.006）和手术质量（p = 0.047）明显较高。结论前后路可用于踝关节手术患者实现坐骨神经阻滞骨折。但是，如果对后入路阻滞患者进行术前镇痛，而对前入路阻滞患者进行手术后镇痛，则可以获得更好的麻醉和疼痛控制效果。P组的麻醉质量（p = 0.006）和手术质量（p = 0.047）明显较高。结论前路和后路入路可用于踝骨骨折手术患者实现坐骨神经阻滞。但是，如果对后入路阻滞患者进行术前镇痛，而对前入路阻滞患者进行手术后镇痛，则可以获得更好的麻醉和疼痛控制效果。P组的麻醉质量（p = 0.006）和手术质量（p = 0.047）明显较高。结论踝关节骨折手术患者可采用前后入路来实现坐骨神经阻滞。但是，如果对后入路阻滞患者进行术前镇痛，而对前入路阻滞患者进行手术后镇痛，则可以获得更好的麻醉和疼痛控制效果。