屈指肌腱鞘内麻醉在手指外伤中的应用

APPLICATION OF DIGITAL FLEXOR TENDON SHEATH ANESTHESIA IN DIGITAL INJURY

目的:探讨应用屈指肌腱鞘内麻醉进行急诊手指外伤手术的临床应用效果。方法:从2009年3月至2010年7月,192例247指手指外伤采用屈指肌腱鞘内麻醉进行手术,其中拇指39指,食指76指,中指81指,环指42指,小指9指。结果:麻醉起效时间平均1.5min。麻醉效果持续时间平均2h。麻醉药物用量单指平均2ml。麻醉范围:拇指掌指关节以远部分,第2～5指掌指关节以远部分及相邻各半指。麻醉效果以手指中末节最佳,手指近节指背侧较差,拇指近节指背侧几无麻醉作用。结论:屈指肌腱鞘内麻醉具有操作简单、起效迅速、用药安全、副作用小、效果满意等优点,特别适用于指外伤患者的掌指关节以远掌侧及中末节指背侧的麻醉。对于损伤累及手指近节指背侧或拇指背侧的患者则需要辅以指背神经阻滞。

Objective：To investigate the effect of digital flexor tendon sheath anesthesia in digital injury.Methods：During the period from March 2009 to July 2010,the technique of digital flexor tendon sheath anesthesia was used in 247 fingers of 192 digital injury patients,including 39 thumbs,76 forefingers,81middle fingers,42 ring fingers and 9 little fingers.Results：The average time to take effect was 1.5 minutes and the average duration was 2 hours.The average dosage of anesthetic was 2 ml each finger.The bounds of anesthesia：The effective area was distal to metacarpophalangeal joint and half of neighbouring finger.The effect of the distal and middle phalanx was best and the dorsal side of proximal phalanx was poorer.There was almost no effect on the dorsal side of proximal phalanx of thumb.Conclusions：The technique of digital flexor tendon sheath anesthesia is a simply-operated anesthetic method.Taking effect is very rapid.It is safe,especially suitable for the digital anesthesia of palmar side distal to metacarpophalangeal joint and dorsal side of the distal and middle phalanxes.