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| 超声引导下颈浅丛或颈中间丛神经阻滞联合肌间沟臂丛神经阻滞在锁骨骨折手术中的比较 |
| Comparison of ultrasound-guided superficial cervical plexus or intermediate cervical plexus block combined with interscalene brachial plexus block for the surgery of the clavicle fracture |
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| DOI：10.12089/jca.2021.12.006 |
| 中文关键词: 超声 颈浅丛阻滞 颈中间丛阻滞 锁骨骨折 |
| 英文关键词: Ultrasound Superficial cervical plexus block Intermediate cervical plexus block Clavicular fracture |
| 基金项目:南京医科大学康达学院科研发展基金（KD2020KYJJYB058） |
| 作者 | 单位 | E-mail | | 钱龙 | 222200,连云港市,南京医科大学康达学院附属灌云县人民医院麻醉科 | | | 朱家军 | 222200,连云港市,南京医科大学康达学院附属灌云县人民医院麻醉科 | gyyymzk@126.com | | 刘洪亚 | 222200,连云港市,南京医科大学康达学院附属灌云县人民医院麻醉科 | | | 王艳 | 222200,连云港市,南京医科大学康达学院附属灌云县人民医院麻醉科 | | | 李越 | 222200,连云港市,南京医科大学康达学院附属灌云县人民医院麻醉科 | |
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| 中文摘要: |
目的 比较超声引导下颈浅丛联合肌间沟臂丛神经阻滞与颈中间丛联合肌间沟臂丛神经阻滞在锁骨骨折内固定术中的应用效果。
方法 选择择期拟行单侧锁骨骨折内固定术的患者60例，男36例，女24例，年龄18～64岁，BMI≤30 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法分为两组：颈浅丛神经阻滞组（S组）和颈中间丛神经阻滞组（M组），每组30例。两组均先行超声引导下肌间沟臂丛神经阻滞，给予患侧0.4%罗哌卡因15 ml，S组行超声引导下颈浅丛神经阻滞，给予患侧0.4%罗哌卡因10 ml；M组行超声引导下颈中间丛阻滞，给予患侧0.4%罗哌卡因10 ml。记录颈浅丛和颈中间丛神经阻滞操作时间、麻醉起效时间。记录神经阻滞效果满意例数。记录术后1、2、4、6、12、24 h的VAS疼痛评分。记录局麻药物中毒、声音嘶哑、术后恶心呕吐等不良反应的发生情况。
结果 M组阻滞操作时间和麻醉起效时间明显短于S组（P<0.05）。两组神经阻滞效果满意率均为100%。M组术后1、2、4、6 h的VAS疼痛评分明显低于S组（P<0.05）。两组均无局麻药物中毒、声音嘶哑等不良反应发生，两组术后恶心呕吐发生率差异无统计学意义。
结论 超声引导下颈浅丛联合肌间沟臂丛神经阻滞与颈中间丛联合肌间沟臂丛神经阻滞均可为锁骨骨折内固定术提供安全有效的麻醉效果，但颈中间丛阻滞操作时间及起效时间更短、术后早期镇痛效果更优。 |
| 英文摘要: |
Objective To compare the anesthetic and postoperative analgesic effects of ultrasound-guided interscalene brachial plexus block with either superficial cervical plexus or intermediate cervical plexus block for clavicular fracture surgery.
Methods Sixty patients undergoing surgery for calvicular fracture, 36 males and 24 females, aged 18-64 years, BMI ≤ 30 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups: the superficial cervical plexus block group (group S) and the intermediate cervical plexus block group (group M), 30 patients in each group. All the patients were performed ultrasound-guided interscalene brachial plexus block with 15 ml of 0.4% ropivacaine. Patients were randomized to receive additional ultrasound-guided superficial cervical plexus block in group S or intermediate cervical plexus block in group M with 10 ml of 0.4% ropivacaine. The superficial cervical plexus block and intermediate cervical plexus block operation time and onset time of sensory block were recorded. VAS pain scores were recorded 1, 2, 4, 6, 12, and 24 hours after operation. The satisfactory rate of anesthesia block effect was recorded, adverse reactions such as local anesthetic poisoning, postoperative nausea and vomiting, hoarseness were also recorded.
Results Compared with group S, the operation time and onset time of sensory block in group M were significantly shorter (P < 0.05), VAS pain scores 1, 2, 4, and 6 hours after operation in group M were significantly lower (P < 0.05). The satisfactory rate of anesthesia block effect in both groups was 100%. Intoxication of local anesthetics and hoarseness did not occur in any patients, there was no significant difference in postoperative nausea and vomiting.
Conclusion Ultrasound-guided interscalene brachial plexus block with either superficial cervical plexus or intermediate cervical plexus block can provide safe and effective anesthesia for clavicular surgery, but the operation time and onset time of intermediate cervical plexus block are shorter, and the early postoperative analgesic effect is better. |
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