外周神经刺激器引导下的锁骨下路和腋路臂丛神经阻滞效果的比较研究

A comparison study on the effects of infraclavicular and axillary technique for brachial plexus block using peripheral nerve stimulator

目的比较神经刺激器引导下垂直锁骨下和两点法腋路臂丛神经阻滞的效果。方法 60名ASAⅠ～Ⅱ级需于臂丛神经阻滞下行前臂或手部手术的患者随机分为2组,分别行垂直锁骨下臂丛神经阻滞(组I,n=30)和两点法腋路臂丛神经阻滞(组A,n=30)。使用局麻药40 mL(20 mL 0.5%罗哌卡因+10 mL 2%利多卡因+10 mL生理盐水),记录肌皮神经、桡神经、尺神经、正中神经、臂内侧皮神经、前臂内侧皮神经、肋间臂神经感觉阻滞情况、手臂运动阻滞情况以及成功率和相关副作用等。结果除I组肋间臂神经阻滞成功率显著高于A组外(P<0.05),2组在感觉阻滞和运动阻滞效果几乎没有差异,但A组有更高的血管刺破率(P<0.05)。结论 2种方法都能为外科手术提供良好的麻醉和镇痛,但垂直锁骨下方法能更好阻滞肋间臂神经而腋路方法出现刺破血管的发生率较高。

Objective To compare the effects of infraclavicular and axillary techniques for brachial plexus block. Methods Sixty patients scheduled for elective forearm and hand surgery were randomly divided into 2 equal groups. The patients were then allocated to receive the block either by vertical infraclavicular （group I, n -- 30） or axillary approach （group A, n = 30） using 40 mL of drug （20 mL of 0.5% ropivacaine ＋ 10 mL of 2% lidocaine ＋ 10 mL normal saline）. Sen- sory block of musculocutaneous, radial, ulnar, median, medial cutaneous nerves of arm and forearm and intercostobrachial nerve, motor block, duration of sensory block, incidence of successful block and various complications were recorded. Results The differences between the two groups were statistically insignificant except the sensory block of intercostobrachial nerve, which was blocked significantly more in group I than in group A （P〈（0.05） and a higher rate of vessel puncture in ax- illary group （P 〈 0.05）. Conclusion Both techniques provide adequate surgical anaesthesia for up- per limb surgeries. And the infraclavicular can block intercostobrachial nerve better while the axil- lary leads to a higher vascular puncture.