神经刺激器辅助肌间沟臂丛阻滞在锁骨手术中的临床应用

Peripheral nerve stimulator assisted interscalene brachial plexus anesthesia for clavicle surgery

目的比较传统的异感法和外周神经刺激器法在锁骨手术时的麻醉效果。方法 60例锁骨手术的患者随机分为传统肌间沟组(A组)和神经刺激器(PNS)组(B组),每组各30例。A组以传统异感法定位行肌间沟臂丛神经阻滞,再行颈浅丛神经阻滞;B组以PNS定位行肌间沟臂丛神经阻滞,再同A组行颈浅丛神经阻滞。局麻药为1%利多卡因+0.375%罗哌卡因混合液,臂丛阻滞剂量为20～30 ml,颈浅丛阻滞剂量为5ml,记录并比较两组麻醉起效维持时间、麻醉效果、辅助用药、不良反应。结果 B组感觉消失时间(T1)、运动消失时间(T2)短于A组(P<0.05),镇痛时间(T3)、运动阻滞时间(T4)长于A组(P<0.05),B组麻醉效果优于A组。结论肌间沟臂丛神经阻滞复合颈浅丛阻滞可以满足锁骨手术麻醉需要,PNS辅助肌间沟臂丛神经阻滞能提高臂丛阻滞效果,延长术后镇痛时间。

Objective To compare the effect of peripheral nerve stimulator assisted interscalene brachial plexus anesthesia with traditional method for clavicle surgery.Methods Sixty patients undergoing clavicle surgery were randomly divided into two groups,with 30 in each： group A（traditional paresthesia group）;group B（peripheral nerve stimulator group）.All patients received interscalene brachial plexus block by different techniques and superficial cervical plexus block in the same way.The local anesthetic drug was the mixture of 1% lidocaine and 0.375% ropivicaine.The amount of drug for brachial plexus blockade was 20～30 ml and 5 ml for superficial cervical plexus blockade.The onset time,duration,efficacy,auxiliary agents and adverse reactions of two groups were recorded.Results T1（the onset time of sensory block） and T2（the onset time of motor block） of group B were shorter than those of group A（P〈0.05）.Compared with group A,T3（analgesia） and T4（the duration of motor block） of group B were longer（P〈0.05）.The efficacy of group B was better than group A.Conclusions The anesthetic strategy of interscalene brachial plexus block combining with superficial plexus block can meet the needs of clavicle surgery.The interscalene brachial plexus block directed by peripheral nerve stimulator can increase the efficacy and prolong the duration of postoperative analgesia.