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| 超声引导下颈5与颈6神经根阻滞联合颈浅丛阻滞在锁骨骨折手术中的应用效果 |
| Effect of ultrasound-guided C5 and C6 nerve root block combined with superficial cervical plexus block for the surgery of the clavicle fracture |
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| DOI：10.12089/jca.2020.05.003 |
| 中文关键词: 超声引导 颈神经根阻滞 颈浅丛阻滞 锁骨骨折 并发症 |
| 英文关键词: Ultrasound-guide Cervical nerve root block Superficial cervical plexus block Clavicle fracture Complications |
| 基金项目: |
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| 中文摘要: |
目的 比较超声引导下C5与C6神经根阻滞（NRB）联合颈浅丛阻滞（SCPB）在锁骨骨折手术中的应用效果。
方法 择期行单侧锁骨骨折手术患者60例，男40例，女20例，年龄18～75岁，BMI≤35 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法分为两组，每组30例：C5-NRB复合SCPB组（C5组）和C6-NRB复合SCPB组（C6组）。颈神经根阻滞（CNRB）和SCPB均在超声引导下进行，在每一目标神经区域注射0.5%罗哌卡因5 ml。术中VAS疼痛评分≥4分时，静脉注射芬太尼0.5 μg/kg。记录阻滞后30 min针刺疼痛评分。记录术中芬太尼和丙泊酚用量。记录术后4、12、24 h VAS疼痛评分和术后首次口服镇痛药物时间。采用改良Bromage（MBS）评分评估阻滞后30 min及术后4、12 h患侧上肢运动功能。记录局麻药中毒、星状神经节阻滞、喉返神经阻滞、膈神经阻滞等并发症的发生情况。
结果 两组阻滞后30 min患侧锁骨皮肤针刺疼痛评分以及术中芬太尼、丙泊酚用量差异无统计学意义。两组术后4、12、24 h VAS疼痛评分和术后首次口服镇痛药时间差异无统计学意义。两组阻滞后30 min及术后4、12 h患侧上肢屈肘、屈腕、屈指MBS评分差异无统计学意义。两组均无一例局麻药中毒、喉返神经阻滞发生。C6组1例阻滞后出现星状神经节阻滞，C5组有2例M型超声检查显示膈肌部分麻痹。
结论 超声引导下C5或C6-NRB联合SCPB下均可为锁骨骨折患者提供良好的手术麻醉，并可很好地保留患侧上肢的运动功能，且膈神经阻滞等并发症少。 |
| 英文摘要: |
Objective To compare the application of C5 and C6 nerve root block (NRB) combined with superficial cervical plexus block (SCPB) under the guidance of ultrasound for the surgery of the clavicle fracture.
Methods Sixty patients undergoing the open surgical fixation for unilateral clavicle fracture, 40 males and 20 females, aged 18-75 years, BMI ≤ 35 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups (30 patients per group) using random number table method: C5-NRB combined with SCPB group (group C5) and C6-NRB combined with SCPB group (group C6). Cervical nerve root block(CNRB) and SCPB were performed under the guidance of ultrasound with 0.5% ropivacaine 5 ml at each target nerve area. If the VAS score of pain during surgery was ≥ 4 scores, fentanyl 0.5 μg/kg was injected intravenously. The sensory block of the skin covering the fractural clavicle was confirmed by a pinprick at 30 min after block and the pain intensity was recorded. Requirements of fentanyl and propofol during surgery were recorded. The VAS score of pain was recorded at 4, 12 and 24 h after surgery, and the time to first taking of analgesics after surgery was recorded. The motor function of the affected-side upper limb was assessed at 30 min after block, and 4 h and 12 h after surgery using the modified Bromage score (MBS). The complications such as intoxication of local anesthetics, stellate ganglion block, recurrent laryngeal nerve block and phrenic nerve block were recorded.
Results There were no significant differences in the score of pain of the affected clavicle skin caused by pinprick at 30 min after block, fentanyl requirement during surgery and propofol requirement during surgery between the two groups. No significant difference was showed in the pain VAS scores at 4, 12 and 24 h after surgery, and the time to first taking of analgesics after surgery between the two groups. The MBS scores of the affected-side upper limb (elbow flexion, wrist flexion and finger flexion) at 30 min after block, and 4 and 12 h after surgery were not significantly indifferent in both groups. Intoxication of local anesthetics and recurrent laryngeal nerve block did not occur in any patients. Partial diaphragmatic paralysis diagnosed by M-mode ultrasound occurred in 2 patients of the C5 group.
Conclusion Both C5-NRB and C6-NRB combined with SCPB under the guidance of ultrasound were effective in providing surgical anesthesia for the clavicle fracture, with less loss of the motor function of the affected-side upper limb and minimal possibility of phrenic nerve block. |
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