超声引导锁骨上神经与颈浅丛联合肌间沟臂丛阻滞用于锁骨手术的临床观察

Clinical Observation of Ultrasound-guided Supraclavicular Nerves Block(SCNB)and Superficial Cervical Plexus Combined with Interscalene Brachial Plexus Block for Clavicle Surgery

目的观察超声引导下锁骨上神经与颈浅丛联合肌间沟臂丛神经阻滞的效果和并发症发生情况。方法将60例择期行锁骨手术的病人随机分为A、B、C 3组,每组20例,均选用0.25%罗哌卡因共30 mL在超声引导下实施神经阻滞。A组:肌间沟臂丛阻滞(注药30 mL);B组:颈浅丛阻滞(注药10 mL)+肌间沟臂丛阻滞(注药20 mL);C组:锁骨上神经阻滞(注药10 mL)+肌间沟臂丛阻滞(注药20 mL)。麻醉实施后,记录患者的生命体征,锁骨上神经、颈浅丛、臂丛神经所支配颈肩区域感觉阻滞(针刺法)起效时间和完善时间、镇痛持续时间、VAS评分和并发症发生情况。结果B、C组感觉阻滞起效、完善时间较A组缩短(P<0.05)。B、C组镇痛持续时间与A组相比延长(P<0.05)。B、C组术中VAS评分较A组更低(P<0.05)。C组阻滞后并发症的发生率、镇痛药的使用率低于A、B组(P<0.05)。结论超声引导下10 mL 0.25%罗哌卡因锁骨上神经阻滞联合20 mL0.25%罗哌卡因肌间沟臂丛神经阻滞用于锁骨手术,起效迅速、镇痛时间长、并发症少。

Objective To observe the anesthesia effect of ultrasound-guided supraclavicular nerves block（SCNB）and superficial cervical plexus block（SCPB）combined with interscalene brachial plexus block（ICBPB）for clavicle surgery. Methods A total of 60 adult patients undergoing clavicle surgery were allocated randomly to receive ICBPB using 30 ml of 0.25% ropivacaine（group A）, SCPB using 10 ml of 0.25% ropivacaine combined with ICBPB using 20 ml of 0.25% ropivacaine（group B）, SCNB using 10 ml of 0.25% ropivacaine combined with ICBPB using 20 mL of 0.25% ropivacaine（group C）.There were twenty patients in each group. All patients accepted ultrasound-guided nerve block. The onset time and sufficient time of sensory block, duration of analgesia, VAS pain scores and complications were recorded. Results The onset time and sufficient time of sensory block were short in group B and C than that of group A（P〈0.05）. The duration of analgesia of group B and C tended to be longer than that of group A（P〈0.05）. The VAS pain scores in B, C group were significantly lower than that of group A（P〈0.05）. The incidence of complication and rescue analgesia after block in C group were significantly lower than that of A and B group（P〈0.05）. Conclusions In this study, ultrasound-guided SCNB using 10 ml of 0.25%ropivacaine combined with ICBPB using 20 ml of 0.25% ropivacaine were effective and safe for clavicle surgery.