神经刺激器引导下连续肌间沟臂丛阻滞用于肩部手术术后镇痛效果观察

Clinical study of neurostimulation-guided continuous interscalene brachial plexus blocks for postoperative analgesia after shoulder surgery

目的评价神经刺激器引导下连续肌间沟臂丛神经阻滞用于肩部手术后镇痛的临床效果。方法 30例肩部手术患者应用抽签法随机分为A组(连续臂丛神经阻滞组)和B组(患者自控静脉镇痛组),每组15例。B组在神经刺激器引导下行单次肌间沟臂丛阻滞,术后行自控静脉芬太尼镇痛。A组在神经刺激器引导下行连续肌间沟臂丛神经阻滞镇痛,同时合用与B组患者相似的自控静脉芬太尼镇痛作为补救措施。观察两组患者术后不同时段的疼痛视觉模拟(VAS)评分(静息及运动)、芬太尼用量、不良反应及患者满意度。结果 A组术后12、16、24、32、40、48 h的静息及运动时的VAS评分均显著低于相应时间段的B组(P<0.05或P<0.01)。A组术后8～48 h各时段的芬太尼消耗量及术后48 h的芬太尼总消耗量均显著小于B组(P<0.05或P<0.01)。A组的镇痛满意率(13/15)显著高于B组(3/15)(P<0.01)。结论神经刺激器引导下连续肌间沟臂丛神经阻滞能有效缓解肩部手术后疼痛,减少阿片类镇痛药物的使用量,提高患者的舒适度。

Objective To observe the clinical efficacy of neurostimulation-guided continuous interscalene brachial plexus blocks for postoperative analgesia after shoulder surgery. Methods Thirty patients undergoing elective shoulder surgery were randomly assigned to either a continuous interscalene brachial plexus block group （A group, n = 15） or patient-con- trolled intravenous analgesia group （B group, n = 15）. In the B group, intravenous PCA was provided with fentanyl. In the A group, continuous brachial plexus block were performed via interscalene approach under neurostimulation guidance, and intravenous PCA was also provided for supplemental analgesia. The pain scores at still and on movement on visual analogue scale （VAS）, patient satisfaction rate, side effects and opioid consumption were observed in the two groups after surgery. Results Pain scores at still and on movement were lower in the A group than those in the B group at 12, 16, 24, 32, 40, and 48 h after operation （P 〈 0.05 or P 〈 0.01）. The opioid consumption within 8-48 h after operation and the total opioid consumption were both significantly lower in the A group than in the B group （P 〈 0.05 or P 〈 0.01）. Patients in the A group had a higher satisfaction rate than that in the B group （13/15 vs 3/15, P 〈 0.01）. Conclusion Neurostimulation-guid- ed continuous interscalene brachial plexus blocks can relieve postoperation pain and decrease the need of opioids after shoulder surgery, thus improving the statisfactory degree of the patients.