超声引导不同注药方式肌间沟臂丛阻滞的效果比较

The comparison of different ultrasound-guided interscalene brachial plexus block injection methods on the effect of anesthesia

目的比较超声引导肌间沟臂丛阻滞方式对麻醉效果的影响。方法选择拟行肩部或上肢手术的患者90例，ASAⅠ-Ⅱ级，用随机数字表法随机分成3组（每组30例），用0．5％的罗哌卡因进行肌间沟臂丛阻滞。S组：超声引导单点注射组；M组：超声引导多点注射组；R组：超声引导减药注射组。S组和M组各给予0．5％的罗哌卡因30m1，R组臂丛各干均被局麻药包裹呈“甜圈征”即停止局麻药注射。结果s组前臂内侧皮神经、臂内皮神经平均起效时间（9．2±3．1）min和（10．6±．2．8）rain明显长于M组（7．6±2．3）min和（6．0±2．2）min和R组（8．2±2．6）min和（7．6±2．7）min；S组臂内皮神经阻滞完善率（60％）明显低于M组（100％）和R组（94．3％）；M组并发症发生率（60％）明显高于S组（20％）。结论超声引导多点肌间沟臂丛神经阻滞可以加快前臂内侧皮神经和臂内侧皮神经起效时间，提高臂丛阻滞完善率，但与单点和减药注射组相比并发症发生率增加。

Objective To compare the effect of interscalene brachial plexus block using three kinds of ultrasound-guided injection methods. Methods Ninety ASA Ⅰ-Ⅱ/patients scheduled for surgery of the shoulder or the upper extremity were randomly divided into three groups （n=30）, S group： ultrasound-guided and single-point-injection group, M group： ultrasound -guided and three-point-injection group, R group： ultrasound-guided multiple injection group using as little local anesthetic as assessed by sonography that the nerve was soaked by local anesthetic. A total dose of 30 ml ropivocaine was injected in the S and M group. In the R group, if the stems of brachial plexus were coated to show ＂donut sign＂, then we stopped injecting local anesthetic. Results The average onset time of sensory blockade on the area innervated by the medial antebrachial cutaneous nerve and the medial braehial cutaneous nerve in the M group （7.6±2.3） min and （6.0＋2.2） min and R group （8.2±2.6） min and （7.6±2.7） min was significantly shorter than that in the S group （9.2±3.1） min and （ 10.6±2.8 ） min. The rate of satisfactory sensory blockade on the area innervated by the medial braehial cutaneous nerve in the S group （60%） was significantly lower than in the M group （100%） and R （94.3%）. The incidence of complications in the M group （60%） was significantly higher than in the S group （20%）. Conclusions The ultrasound-guided multi-point intersealene brachial plexus nerve block can speed up the block onset time of the medial antebrachial cutaneous nerve and the medial brachial cutaneous nerve and improve the success rate of interscalene brachial plexus nerve block. Multi-point injection of local anesthetic can increase the incidence of complications.