超声引导下臂丛上干和颈浅丛神经阻滞联合全身麻醉在肩关节镜手术中的应用

Ultrasound-guided superior trunk of brachial plexus block and superficial cervical plexus block combined with general anesthesia in arthroscopic shoulder surgery

目的评价超声引导下臂丛上干和颈浅丛神经阻滞联合全身麻醉应用于肩关节镜手术的优势。方法择期行肩关节镜下肩袖修补手术的患者50例,美国麻醉医师协会(ASA)分级为Ⅰ或Ⅱ级,年龄45～75岁,被随机分入全身麻醉组(采用单纯全身麻醉)和联合组(采用超声引导下臂丛上干和颈浅丛神经阻滞联合全身麻醉),每组25例。在术前(T_0)、手术开始5min(T_1)、手术开始30min(T_2)、手术结束时(T_3)和拔除喉罩30min后(T_4)各时间点,观察并记录患者的平均动脉压(MAP)和心率。记录T_1和T_2时间点的脑电双频指数(BIS)值。记录手术时间、拔管时间(停用七氟烷至拔除喉罩时间)、阿片类镇痛药物(舒芬太尼)用量、七氟烷用量。记录在麻醉后监测治疗室(PACU)中、术后6h、术后12h各时间点的疼痛VAS评分和肱二头肌肌力分级。结果两组间T_1和T_2时间点的BIS值的差异均无统计学意义(P值均>0.05)。两组间T_0时间点的MAP和心率的差异均无统计学意义(P值均>0.05);联合组T_1至T_4时间点的MAP均显著低于全身麻醉组同时间点(P值均<0.01),心率均显著慢于全身麻醉组同时间点(P值分别<0.01、0.05)。与全身麻醉组比较,联合组的拔管时间显著缩短(P<0.01),舒芬太尼和七氟烷用量显著减少(P值均<0.01),在PACU中的肌力分级显著降低(P<0.01),在PACU中、术后6h和术后12h的疼痛VAS评分均显著降低(P值均<0.01);两组间术后6h和术后12h的肌力分级的差异均无统计学意义(P值均>0.05)。结论超声引导下臂丛上干和颈浅丛神经阻滞联合全身麻醉用于肩关节镜手术,能够提供平稳的麻醉状态,减少术中阿片类镇痛药物和七氟烷的用量,有利于术后镇痛。

Objective To investigate the value and advantage of ultrasound-guided superior trunk of brachial plexus block and superficial cervical plexus block in combination with general anesthesia in arthroscopic shoulder surgery.Methods Fifty patients scheduled for arthroscopic shoulder surgery,American Society of Anesthesiologist(ASA)physical statusⅠorⅡ,aged from 45to 75years old,were divided into two groups(n=25).Group A only underwent general anesthesia.Group B was given ultrasound-guided superior trunk of brachial plexus block and superficial cervical plexus block before general anesthesia.Mean arterial pressure(MAP)and heart rate were recorded before surgery(T0),5min after the beginning of the surgery(T1),30min after the beginning of the surgery(T2),at the end of the surgery(T3),and 30min after removing laryngeal mask(T4).Bispectral index(BIS)was recorded at T1 and T2.The operation time,extubation time (from stopping using sevoflurane to removing the laryngeal mask),dosage of opioids (sufentanyl),dosage of sevoflurane,visual analogue scale(VAS)scores and muscle strength at post-anesthesia care unit(PACU),6 hand 12 hafter the surgery were also recorded.Results There were no significant differences in the BIS between two groups at Tor T2(both P>0.05).Neither was the MAP or heart rate at T0(both P>0.05).MAP and heart rate in group Bwere significantly lower than those in group A from T1to T4(P<0.01or 0.05).Compared with group A,patientsin group B had significantly shorter extubation time(P<0.01),smaller dosages of sufentanyl and sevoflurane(both P<0.01),lower muscle strength at PACU(P<0.01),and lower VAS scores at PACU,6 hand 12 hafterthe surgery(all P<0.01).But there were no significant differences in the muscle strength at 6 hor 12 hafter the surgery between groups(both P>0.05).Conclusion Ultrasound-guided superior trunk of brachial plexus blockand superficial cervical plexus block combined with general anesthesia can offer better anesthesia status,reduced osage of opioid and sevoflurane and help postoperative analgesia.