Objective To explore the application of continuous superior popliteal sciatic nerve block combined with saphenous nerve block for incision debridement and drainage of soft tissue in elderly diabetic foot patients. Methods From January 2022 to December 2023, 90 patients were selected for diabetic foot surgery in our hospital and divided into control group and study group, with 45 cases in each group. Control group: a single superior popliteal sciatic nerve block was given. Study group: Continuous popliteal sciatic nerve block combined with crypenous nerve block. Visual Analogue Scale (VAS) and Symptom Checklist-90 (SCL-90) were used to assess the pain and psychological status; the onset of sensory block, the duration of motor block and the duration of motor block; and the ulcer area and wound exudation; the levels of SBP, DBP, HR, CD3+, CD4+, CD4+ / CD8+; and the conduction velocity of tibial nerve and total peroneal nerve. The incidence of adverse reactions in the two groups was compared. Results One week and two weeks after surgery, compared with the control group, the study group showed significant reductions in VAS score, SCL-90 psychological score, ulcer area, and wound exudation. The study group also exhibited a shorter onset time of sensory block, a longer maintenance time of sensory block, and a prolonged duration of motor block. Regarding hemodynamic parameters, the levels of DBP and SBP at all time points [before anesthesia (Tb), and 5 min (T5), 10 min (T10), 15 min (T15), 30 min (T30) after anesthesia] were significantly lower in the study group than in the control group. Postoperatively, the levels of CD3+, CD4+, and the CD4+/CD8+ ratio were significantly decreased, while the conduction velocity of the tibial nerve and common peroneal nerve was significantly increased. Furthermore, the total incidence of adverse effects was significantly reduced in the study group. Conclusion The continuous popliteal nerve block combined with hidden nerve block can improve the overall anesthesia effect, reduce the ulcer area, reduce the exudation of wound, improve hemodynamics, and improve immune function in the tissue incision and debridement drainage of elderly diabetic foot patients, thus promoting postoperative recovery and having high safety.
Key words
continuous superior sciatic nerve block in the popliteal fossa /
saphpous nerve block /
elderly patient /
diabetic foot /
debridement and drainage
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] AHLUWALIA R, MAFFULLI N, LÁZARO-MARTÍNEZ JL, et al. Diabetic foot off loading and ulcer remission: Exploring surgical off-loading[J]. Surgeon, 2021, 19(6): e526-e535.
[2] STONE A, DONOHUE CM.Diabetic Foot Ulcers in Geriatric Patients[J]. Clin Geriatr Med, 2024, 40(3): 437-447.
[3] CARRO GV, SAURRAL R, WITMAN EL, et al.Ataque de pie diabético. Descripción fisiopatológica, presentación clínica, tratamiento y evolución[Diabetic foot attack. Pathophysiological description, clinical presentation, treatment and outcomes][J]. Medicina (B Aires), 2020, 80(5): 523-530.
[4] PRIMADHI RA, SEPTRINA R, HAPSARI P, et al.Amputation in diabetic foot ulcer: A treatment dilemma[J]. World J Orthop, 2023, 14(5): 312-318.
[5] 柯瑜君, 陈鹭, 林文谦, 等. 右美托咪定局部用药对糖尿病足患者罗哌卡因坐骨神经阻滞半数有效浓度的影响[J]. 福建医科大学学报, 2020, 54(3): 192-195.
[6] ARTEAGA-MARRERO N, HERNÁNDEZ-GUEDES A, ORTEGA-RODRÍGUEZ J, et al. State-of-the-Art Features for Early-Stage Detection of Diabetic Foot Ulcers Based on Thermograms[J]. Biomedicines, 2023, 11(12): 3209.
[7] 柯瑜君, 陈鹭, 林文谦, 等. 右美托咪定局部用药对糖尿病足患者罗哌卡因坐骨神经阻滞半数有效浓度的影响[J]. 福建医科大学学报, 2020, 54(3): 192-195.
[8] 中国医疗保健国际交流促进会, 国际血管联盟中国分部糖尿病足病专家委员会. 中国糖尿病足诊治指南 (2020)[J]. 中国临床医生杂志, 2020, 48(1): 19-27.
[9] 张娟, 张根生, 黄雪, 等. 贝前列素钠片联合当归黄芪汤对糖尿病足溃疡患者创面愈合、血管新生及氧化应激的影响[J]. 中华中医药学刊, 2024, 42(7): 202-205.
[10] 刘晓云, 杨小红, 王娟, 等. 延续性干预对主动脉夹层术后患者生活质量、睡眠质量及SCL-90评分的影响[J]. 河北医药, 2024, 46(9): 1380-1383.
[11] 王冰雪, 林婷, 吴静, 等. 糖尿病足溃疡患者住院时间延长风险预测模型构建及验证[J]. 四川大学学报 (医学版), 2024, 55(4): 972-979.
[12] RODRÍGUEZ-RODRÍGUEZ N, MARTÍNEZ-JIMÉNEZ I, GARCÍA-OJALVO A, et al. Wound Chronicity, Impaired Immunity and Infection in Diabetic Patients[J]. MEDICC Rev, 2021, 24(1): 44-58.
[13] 蓝羚升, 李莎, 黄晓飞. 下肢动脉病变程度对富血小板凝胶治疗糖尿病足溃疡的影响[J]. 实用临床医药杂志, 2024, 28(7): 106-109.
[14] 孙艺玮, 陈炜, 秦巍, 等. 血管腔内介入治疗糖尿病足合并下肢动脉硬化闭塞症患者术后再狭窄与血清炎症因子的相关性[J]. 中华损伤与修复杂志 (电子版), 2024, 19(1): 34-40.
[15] 李京, 李莎燕, 程亮, 等.2型糖尿病患者血红蛋白与糖尿病足风险的相关性研究[J]. 徐州医科大学学报, 2022, 42(1): 30-35.
[16] 王国凤, 赵仁豪, 杨腾, 等. 自体富血小板凝胶治疗2型糖尿病足患者的临床疗效及对外周血单个核细胞中MALAT1表达的影响[J]. 中国医师杂志, 2023, 25(8): 1214-1218, 1224.
[17] 徐艳, 华豪. 罗哌卡因收肌管隐神经阻滞联合坐骨神经阻滞在中老年糖尿病足患者手术中的应用效果[J]. 广西医学, 2023, 45(9): 1028-1033.
[18] MATTA-GUTIÉRREZ G, GARCÍA-MORALES E, GARCÍA-ÁLVAREZ Y, et al. The Influence of Multidrug-Resistant Bacteria on Clinical Outcomes of Diabetic Foot Ulcers: A Systematic Review[J]. J Clin Med, 2021, 10(9): 1948.
[19] 刘宁, 田毅, 向丽萍, 等. 湿润烧伤膏联合封闭负压引流术对糖尿病足溃疡患者神经传导速度、溃疡创面血管新生及氧化应激水平的影响[J]. 现代生物医学进展, 2023, 23(8): 1546-1550.
[20] 王赐玉, 栾丽丽. 糖尿病足患者足底压力参数变化与神经传导速度的关系[J]. 临床内科杂志, 2023, 40(12): 815-819.
PDF(1796 KB)
