周围神经刺激器引导腋路臂丛神经阻滞用于肘部尺神经松解术

Axillary brachial plexus block guided by peripheral nerve stimulator

目的评价周围神经刺激器(peripheral nerve stimulator,PNS)引导的腋路臂丛神经阻滞用于肘部尺神经松解术的临床效果,并比较不同的注药方法(2点注药或3点注药)对神经阻滞成功率的影响。方法对60例肘管综合征拟行肘管切开尺神经松解前置的手术患者,随机分成2点注药组(30例)和3点注药组(30例)。2点注药组定位在桡神经和肌皮神经,3点注药组定位增加正中神经。臂丛神经阻滞成功被定义为肘部远端5支神经(肌皮神经、桡神经、正中神经、尺神经和前臂内侧皮神经)感觉阻滞完全,比较2组在臂丛神经阻滞成功率和并发症等方面的差异。结果 3点注药组的阻滞成功率(95.5%)要高于2点注药组(54.5%,P<0.01),两组间差异主要由于2点组的正中神经阻滞率较低。但2组的外科麻醉完全率并无显著差别。结论神经刺激器辅助的多点腋路臂丛神经阻滞可有效地用于肘部尺神经松解前置术,对于这一术式,定位肌皮神经和桡神经2支神经足以满足外科手术的需要。

Objective To evaluate the efficacy of axillary brachial plexus block guided by peripheral nerve stimulator （PNS） in surgeries of ulnar nerve neurolysis at the elbow, and compare two nerve-localization techniques with a PNS： double-injection versus triple-injection. Methods Sixty patients who were diagnosed with cubital tunnel syndrome and had indications for surgery were involved in the study. They were randomly divided into double-injections group （group 2N, n = 30） and triple-injection group （group 3N, n = 30）. The muscolocutaneous nerve and the radial nerve were located by PNS in group 2N while the musculocutaneous, radial and median nerves were located in group 3N. Double injections and triple injections were done respectively. The bmchial plexus block was defined as complete when analgesia was present in all the sensory area distal to the elbow. Success rate of blockade, latency time of analgesia and occurrence of complications were compared hetwecn two groups. Results The success rate of group 3N was higher than that of group 2N （95.5% vs .54.5%, P 〈 0.01）. This was related to a lower success rate for blocking the median nerves （ P 〈 0.05）. However the effect of anesthesia for surgery did not show significant difference between the two groups. Conclusion PNS guided axillary bmchial plexus block leads to effective anesthesia for ulnar nerve release and anterior transposition at the elbow. Double-injections to block the musculocutancous nerve and radial nerve is enough for this kind of operation.