超声引导下20ml局部麻醉药腋路臂丛神经阻滞和全身麻醉用于上肢创伤手术的比较：一项双盲、前瞻性、随机对照研究

目的旨在研究超声引导下低剂量局部麻醉药腋路臂丛神经阻滞与全身麻醉对麻醉和围手术期镇痛效果的影响。方法患者随机接受超声引导下腋路臂丛神经阻滞与全身麻醉。超声引导下腋路臂丛神经阻滞采用平面外途径进针法，在识别出正中神经、尺神经、桡神经和肌皮神经后，在神经周围分别注入最多5ml的局部麻醉药（含有1：200000肾上腺素的2％利多卡因和含有7．5mg／ml可乐定的0．5％布比卡因的等量混合液）。局部麻醉药使用最大剂量为20ml。全身麻醉采用常规芬太尼和丙泊酚诱导，七氟烷和O2／N2O混合吸入维持麻醉。记录麻醉恢复室和手术后2、6、24、48小时以及7天的疼痛评分，同时评估无需进恢复室的能力和达到出院标准所需时间。结果所有行超声引导下腋路臂丛神经阻滞的患者均获得了满意的麻醉。超声引导下神经阻滞组患者在恢复室和2小时VAS评分明显降低[0．3（1．3）vs55．8（36．5），P〈0．001）；0．3（1．3）vs45（29．6），P〈0．001]；6小时VAS评分降低[1．1（2．7）vs4（2．8），P〈0．01]。所有未进入恢复室的超声引导神经阻滞组患者较早达到出院标准[30分钟vs120分钟，30／240，P〈0．0001，中位数（范围）]。结论患者行上肢创伤手术时采用超声引导下20ml局部麻醉药混合液腋路臂丛神经阻滞能够提供满意的麻醉效果，以及比全身麻醉更佳的手术后镇痛效果。

OBJECTIVE： We performed a randomized, controlled trial comparing low-dose ultrasound-guided axillary block with general anesthesia evaluating anesthetic and perioperative analgesic outcomes. METHOODS： Patients were randomized to either ultrasound-guided axillary block or general anesthesia. Ultrasound-guided axiliary block was perforned using a needle-out-of- plane approach. Up to 5 rnl of local anesthetic inject,ate （equal parts 2% lidocaine with 1： 200 000 epinephrine and 0.5% bupivacaine with 7. 5 mg/ml donidine） was injected after identifying the median, ulnar, radial, and musoalocutaneous nerves. A maximum of 20 rnl local anesthetic injectate was used. General anesthesia was standardized to include induction with fentanyl and propofol, maintenance with sevoflurane in an oxygen/nitrous oxide mixture. Pain scores were measured in the recovery room and at 2, 6,24, 48 h, and 7 days. Ability to bypass the recovery room and time to achieve hospital discharge criteria were also assessed. RESULTS： All ultrasound-guided axiUary block patients achieved satisfactory anesthesia. The ultrasound-guided axillary block group had lower visual analog scale pain scores in the recovery room （0. 3 [ 1.3 ] vs 55.8 [36. 5 ], P 〈 0. 001 ）, and visual rating scale pain scores at 2 h （0. 3 [ 1.3] vs 45 [29. 6], P 〈 0. 001）, and at 6 h （1.1 [2. 7] vs 4 [2. 8], P 〈 0. 01）. All ultrasotmd-guided axillary block patients bypassed the recovery room and attained earlier hospital discharge criteria （30 min vs 120 min 30/240 P 〈 0. 0001 median [ range ] ）. CONCLUSIONS： Ultrasound-guided axillary brachial plexus block with 20 rnl local anesthetic mixture provided satisfactory anesthesia and superior analgesia after upper limb trauma surgery when compared with general anesthesia.