超声联合神经刺激仪引导两种臂丛神经阻滞定位方法的比较

Comparison of the anesthetic effects between two approaches of infraclavicular brachial plexus block assisted by ultrasound and never stimulator

目的比较超声联合神经刺激仪引导喙突入路与锁骨中点下入路在锁骨下臂丛神经阻滞的临床效果。方法拟行前臂及手外科择期手术患者72例,随机均分为两组,每组36例,分别行超声联合神经刺激仪引导喙突入路(A组)或锁骨中点下入路(B组)锁骨下臂丛神经阻滞。将远端运动反应(手腕或手指屈曲或伸展)作为目标运动反应。记录患者前臂痛觉阻滞情况、穿刺成功率、试穿次数、上肢运动阻滞情况以及并发症。结果 A组有3例因5次调整穿刺针位置均未引出目标运动反应,改为腋路阻滞,被排除出本研究。与A组比较,B组1次、2次穿刺成功率明显增加,进针深度明显加深,环指状包绕腋动脉明显增多,腋路追加局麻药明显减少,所有肌皮神经阻滞明显增多(P<0.05)。两组上肢运动阻滞差异无统计学意义。所有患者无一例气胸、穿刺部位血肿、局麻药中毒等。结论喙突入路或锁骨中点下入路锁骨下臂丛神经阻滞均可安全地用于区域阻滞,而锁骨中点下入路更容易定位到目标神经,麻醉阻滞效果更好。

Objective To compare the anesthetic effects between coracoid approaches and medial clavicular approaches of infraclavicular brachial plexus block.Methods Seventy-two patients scheduled for forearm or hand surgery were randomly assigned to receive infraclavicular brachial plexus block by the coracoid approach（group A,n=36）and medial clavicular approach（group B,n=36）guided by never stimulator.The distal motor response（flexion or extension of the wrist or fingers）was defined as the target motor response.The success rate of forearm pain block,the success rate of puncture,the number of attempts,degree of motor block and complications were recorded.Results In group A,3patients couldn＇t elicite the distal response defined as block failure and 4patients needed additional local anesthetic by axillary.All patients in group B were completed surgery under infraclavicular brachial plexus block.To elicit the distal response,group A needed to adjust the direction of needle more times than group B（P〈0.05）.The block success rate of forearm cutaneous nerves was higher in group B than group A（P〈0.05）.Ultrasonic observation found more cases with local anesthetics surrounding the axillary artery in group B than group A（P〈0.05）.There were not pneumothorax,hematoma,local anesthetics poisoning in two groups.Conclusion Two approaches of infraclavicular brachial plexus block are safe technique in regional anesthesia.Medial clavicular approach can more easily locate the target nerve and get more satisfied anesthesia effect.