| Objective The purpose of this study was to compare the effect of femoral nerve block in supine foot position with 30 supine foot position and upright supine foot position,so as to provide help and guidance for clinical work.Methods 60 patients with ASA grade I-III,age > 65 years old,BMI 18-27 kg/m2 and joint deformity unable to straighten were selected for selective total knee arthroplasty.According to the random number table method,they were randomly divided into two groups: supine foot rotation 30 degree position group(R group)(n = 30),supine foot upright position group(N group)(n = 30).Ultrasound combined with nerve stimulation guided puncture was used to block femoral nerve in patients.After admission,patients were routinely monitored for vital signs,including ECG,NIBP,SPO 2,BIS and other items;intravenous access was opened and sodium lactate Ringer's solution was continuously infused 500 ml/h.Femoral nerve block was performed in group R and group N.The inguinal region was exposed and femoral artery pulsation was marked.Routine disinfection towel,disinfection with Iodophor disinfectant.The strongest pulsation point of femoral artery was 1 cm below the inguinal ligament.Connect the nerve stimulator and set the stimulus current to 0.3-0.5mA.The femoral artery was identified in the ultrasound image,and the femoral nerve puncture block was performed by in-plane puncture technique.The first step is to inject 1% lidocaine 2-3 ml on the skin surface,and then use 100 mm nerve stimulation needle to insert the needle.The angle of insertion depends on the depth of femoral nerve.The tip of the needle first breaks through the fascia lata,and then breaks through the iliac fascia above the iliopsoas muscle to reach the position of the femoral nerve on the lateral side of the femoral artery.After the nerve stimulator leads out the contraction of quadriceps femoris and patellar motion,the tip of the needle reaches the target nerve.Start injecting local anesthetics.By adjusting the angle of the puncture needle,the drug wrapped the nerve as much as possible.The mixture of 0.375% ropivacaine and 1% lidocaine was injected for 30 ml.During each puncture,the tip of the needle should be kept in the field of ultrasound to avoid injuring blood vessels and surrounding important tissues.The operation time,onset time,duration and complications of the two groups were recorded.Result The operation time of group N was 8.66 +1.18 min,that of group R was 3.96 +0.66 min,that of group N was 7.55 +0.97 min,that of group R was 6.15 +0.60 min,that of group N was 269 +29 min,that of group R was 324 +41 min,and that of group N was 1 case of blood vessel injury,but no complications were found in group R.Conclusion The operation time and the onset time of drugs in group N were longer than those in group R(P < 0.05).The duration of drugs in group N was shorter than that in group R(P < 0.05).Compared with supine foot upright position,supine foot external rotation 30 degree femoral nerve block operation time is shorter,drug onset time is shorter and duration is longer,which is worthy of clinical promotion. |
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