[Clinical observation of ultrasound guided popliteal sciatic nerve combined saphenous nerve block for hallux valgus patients with metatarsophalangeal joint dislocation]

Abstract

Objective: To explore clinical effects of ultrasound guided popliteal sciatic nerve combined saphenous nerve block in patients with anterior foot orthopedics.

Methods: From January 2017 to October 2017, 60 hallux valgus patients with metatarsophalangeal joint dislocation were randomly divided into experimental and control group according to random number table. Thirty patients in experimental group were treated by ultrasound guided popliteal sciatic nerve combined saphenous nerve block, including 13 males and 17 females, aged 31 to 76 years old with an average of (59.23±10.07) years old;and body mass index ranged from 21 to 30 kg/m² with an average of (24.57±1.85) kg/m²; 12 cases were grade I and 18 cases were grade II according to ASA grading. Thirty patients in control group were treated by spinal anesthesia, including 12 males and 18 females, aged from 20 to 74 years old with an average of (54.20±15.87) years old; and body mass index ranged from 20 to 29 kg/m² with an average of (24.43 ± 3.15) kg/m²; 11 cases were grade I and 19 cases were grade II according to ASA grading. Block time of anesthesia, onset time of sensory nerve block, onset time of motor nerve block, invalid time of motor nerve block, invalid time of sensory nerve block were compared between two groups. Hemodynamic changes before anesthesia(T₀), 15 min after block(T₁), 30 min after block(T₂), at the beginning of the operation(T₃), 30 min after the beginning(T₄) of surgery and at the end of operation(T₅), adverse reactions and subjective satisfactory between two groups were also recorded.

Results: Both of the anesthetic protocol could achieved satisfied clinical effects. In experimental group, block time of patients, onset time of sensory block, invalid time of motor nerve block and invalid time of sensory nerve block were longer than those in control group, and there were significant differences between two groups(P<0.001). There was no significant difference between two groups in onset time of motor nerve block(P> 0.05). There were no significant differences of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) in experimental group at different time points(P> 0.05). There were significant differences of SBP, DBP in control group at different time points (P<0.05). There was no significant difference of HR in control group at different time points(P> 0.05).

Conclusions: Ultrasound guided popliteal sciatic nerve combined saphenous nerve block could meet demand of hallux valgus patients with metatarsophalangeal joint dislocation. Compared with lumbar anesthesia, it could maintain hemodynamic stability, prolong effective analgesia time after operation, and improve patients' overall comfort and safety for free activity above the knee joint.

Keywords: Hallux valgus; Joint dislocations; Metatarsophalangeal joint; Sciatic nerve.