超声引导下胸锁乳突肌间隙颈浅丛神经阻滞麻醉用于锁骨手术的临床效果

Analgesic efficacy of ultrasound-guided spatium intermusculare block of superficial cervical plexus during clavicle fixation

目的比较超声引导下胸锁乳突肌间隙行颈浅丛神经阻滞麻醉与传统皮下阻滞麻醉的临床麻醉效果。方法选择择期因锁骨骨折或肩锁关节脱位行切开复位内固定的患者96例,按照随机数字表法分为超声引导下肌间隙组(USI组)、超声引导下皮下组(USC组)和传统技术组(TT组),每组32例。记录3组患者的麻醉效果、术中芬太尼用量、苏醒时间和不良反应,应用数字评分法(NRS评分)评价患者术后1、4、8、24h静息时的疼痛程度。结果 USI组的麻醉效果显著优于USC组和TT组(P值均<0.05),芬太尼用量显著少于USC组和TT组(P值均<0.01),苏醒时间显著短于USC组和TT组(P值分别<0.05、0.01)。USI组术后1、4、8h的疼痛NRS评分显著低于USC组同时间点(P值分别<0.05、0.01),术后1、4、8、24h的疼痛NRS评分显著低于TT组同时间点(P值均<0.01);USC组术后1、4、24h的疼痛NRS评分显著低于TT组同时间点(P值分别<0.01、0.05)。仅USI组有1例患者在阻滞麻醉后10min内出现声音嘶哑。3组患者均未发生膈神经阻滞、恶心、Horner综合征等不良反应。结论超声引导下胸锁乳突肌间隙颈浅丛神经阻滞麻醉用于锁骨手术的麻醉效果较超声引导下皮下颈浅丛神经阻滞麻醉更为完善、确切。

Objective To compare ultrasound-guided spatium intermusculare block with traditional subcutaneous block. Methods Ninety-six patients with clavicle fracture or acromioclavicular dislocation scheduled for open reduction and internal fixation were enrolled in the present study. They were assigned to three groups according to random digits table （n = 32） ： ultrasound-guided spatium intermusculare block group （USI group）, ultrasound-guided subcutaneous block group （USC group） and traditional technique group （TT group）. Analgesic efficacy, dose of intraoperative fentanyl, recovery time and postoperative complications were recorded. The pain was assessed by numerical rating scale （NRS） at 1 h, 4 h, 8 h and 24 h postoperatively. Results Ultrasound-guided spatium intermusculare block provided better analgesic efficacy than ultrasound-guided subcutaneous block and traditional technique （both P〈0. 05）. Compared with USC and TT groups, the dose of fentanyl was significantly decreased （both P 〈 0.01 ） and the recovery time was significantly shortened in USI group （P〈0.05, 0.01）. NRS scores of USI group at 1 h, 4 h and 8 h postoperatively were significantly less than those of USC group （P〈0.05, 0.01）. NRS scores of USI group at 1 h, 4 h, 8 h and 24 h postoperatively were significantly less than those of TT group （all P〈0. 01）. NRS scores of USC group at 1 h, 4 h and 24 h postoperatively were significantly less than those of TT group （P〈0. 01, 0.05）. No adverse reaction such as phrenic nerve block, nausea, or Homer syndrome occurred except for one case of hoarseness in the USI group. Conclusion Ultrasound-guided spatium intermusculare block of superficial cervical plexus can provide more effective analgesic efficacy than subcutaneous block.