Lateral Rotation of the Lower Extremity Increases the Distance between the Femoral Nerve and Femoral Artery: An Ultrasonographic Study

股神經阻斷術迄今仍是麻醉學者最常使用在下肢的一種區域麻醉方法。儘管高解析度的超音波對於施行股神經阻斷術而言是一項十分有用的工具，不同的下肢姿勢對於股神經與股動脈的相對關係，在過去卻鮮少被討論。本研究的目的就是在超音波影像下，去評估不同的下肢外旋角度，對於股神經與股動脈相對關係的影響。四十一位健康的自願者參予本研究。股神經的二維超音波影樣在腹股溝界限線(inguinal crease)以超音波單位分別在兩側下肢的四個不同的外旋角度一零度、十五度、三十度與四十五度下取得。在每一個位置上，神經到皮膚的最短距離以及神經到地標（股動脈的脈動點）的水平距離都被記錄下來做為分析。我們發現了下肢可以更加向外側旋轉的趨勢。皮膚到神經的最短距離與下肢旋轉角度的相關性是-0.216，神經到地標（股動脈的脈動點）的水平距離與下肢旋轉角度的相關性是0.430。P值各別是0.001與小於0.001。身體質量指數(body mass index)與皮膚到神經的最短距離之間也存有良好的相關性(r=0.76-0.78)。本超音波研究的結果顯示下肢向外側旋轉的角度越大，股神經就越靠近體表面而且也越遠離股動脈。在為了要增加股神經阻斷術的成功率以及降低併發症發生率的前提之下，我們強烈建議在實行阻斷術時將下肢往外側旋轉45度。另外，也儘可能以超音波為導引來實行股神經阻斷術。

關鍵字

股動脈；股神經；區域麻醉；超音波

並列摘要

Femoral nerve block (FNB) is by far the most useful lower extremity regional anesthetic technique for the anesthesiologist, and high-resolution ultrasonography is a useful tool with which to guide the performance of FNB. However, the relationships between the femoral nerve and the femoral artery in different lower extremity positions have rarely been discussed. The purpose of this study was to evaluate the relative positions of the femoral nerve and artery at different lateral rotational angles of the lower extremities using ultrasonographic imaging. We enrolled 41 healthy volunteers in this study. Two-dimensional ultrasonographic images of the femoral nerve were obtained using an ultrasound unit, in the inguinal crease, for four positions of the bilateral lower extremities: 0°, 15°, 30°and 45° lateral rotation of each extremity. The following assessments were made in each position: minimal skin-to-nerve distance (SN) and deviation of nerve-to-landmark (femoral artery pulsation) horizontal distance (NF). Atrend towards lateral rotation of both lower extremities was identified. The Pearson correlation values between rotational degree to SN and rotational degree to NF were -0.216 and 0.430, with p values of 0.001 and less than 0.001, respectively. Body mass index had a good correlation (r=0.76-0.78) with SN. The results of our ultrasound study revealed that the more lateral the rotation of both lower extremities, the closer the femoral nerve was to the skin and the farther away it was from the femoral artery. In order to increase the success rate and decrease the rate of complications, a suggested lateral 45° rotation of both lower extremities is strongly recommended when performing FNB using the peripheral nerve stimulator technique or the field block technique. In any situation, individual ultrasound guidance is recommended for FNB whenever possible.

並列關鍵字

femoral artery ； femoral nerve ； regional anesthesia ； ultrasonography

國際替代計量

Lateral Rotation of the Lower Extremity Increases the Distance between the Femoral Nerve and Femoral Artery: An Ultrasonographic Study

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