指外伤单点皮下阻滞与传统皮下阻滞局麻效果比较的随机对照试验

Single-Injection Digital Block versus Traditional Digital Block for Local Anesthesia in Digital Injury Patients: A Randomized Controlled Trial

目的比较对指外伤患者行单点皮下注射指神经阻滞与传统指神经阻滞两种不同麻醉方法的麻醉效果。方法选择伤及1或2个手指的指外伤患者,用抛硬币法随机分为传统皮下阻滞组和单点皮下阻滞组。由同一试验人员实施所有麻醉,对患者及结果评估者设盲,采用符合方案集(PP)分析和意向性治疗(ITT)分析比较两种不同方法在麻醉过程中所引发的疼痛程度(10cm视觉模拟评分)、麻醉起效时间和麻醉失败率。结果共纳入指外伤患者93例(109指),其中传统皮下阻滞组51例(61指),单点皮下阻滞组42例(48指)。除2例(3指)分别因醉酒和语言障碍未能评价结局指标外,PP分析及ITT分析均显示,两种麻醉方法在麻醉过程中引发的疼痛、麻醉起效时间及麻醉失败率方面差异无统计学意义(P﹥0.05)。结论单点皮下阻滞与传统的指神经阻滞方法的效果相当,且操作更简单,适用于指外伤患者的手指掌指横纹以远掌侧及中末节背侧的麻醉。对于损伤累及手指近节背侧或拇指背侧的患者则需要辅以指背神经阻滞。

Objective To compare the anesthetic effects of traditional digital block with single-injection digital block in digital injury patients for subcutaneous digital blocks. Methods Patients with one or two digits injured were randomized to the traditional digital block group and single-injection digital block group. All of the blocks were conducted by one investigator. The patients and outcome assessor were blinded to the treatment allocation. Both of the per-protocol-population （PP） analysis and the intention-to-treatment （ITT） analysis were performed to compare the two block techniques in terms of the pain during infiltration, the onset time of anesthesia and the failure rate of anesthesia. Results A total of 93 patients （109 digits） were included with 51 （61 digits） in the traditional block group and 42 （48 digits） in the single-injection block group.Two patients （3 digits） dropped out. Both of the PP analysis and ITT analysis showed that no significant difference between the two groups were detected in terms of the pain during infiltration, the onset time of anesthesia and the failure rate of anesthesia （P 〉 0.05）. Conclusions The subcutaneous single-injection digital block is as effective as the traditional digital block, but is much easier to perform. This technique is indicated for the digital anesthesia of palmar aspect distal to the proximal digital crease and dorsal aspect of the distal and middle phalanxes.