对比间隙定位与神经定位行腋路臂丛置管用于肘松解术后镇痛的效果

Comparative evaluation of ultrasound and neurostimulation guided axillary brachial plexus catheterization for elbow artholysis post-operative analgesia

目的比较应用超声定位技术与传统神经刺激定位法行腋路臂丛神经周围置管的操作易行性及其用于肘关节松解术后镇痛的效果。方法选择拟行肘关节松解手术患者80例，年龄18～65岁，ASA分级I～III级，随机分成超声组（uS组，n=40）和刺激器组（ST组，n=40）。两组患者均于术前行腋路臂丛神经周围置管操作：US组应用平面外超声技术间隙定位，ST组使用神经刺激器行桡神经定位，经导管注入初始量局麻药1％30多卡因20ml，全麻下完成手术，术毕连接电子镇痛泵，持续输注镇痛用量局麻药0．2％盐酸罗哌卡因，总量250ml，背景量5ml／h，单次剂量5ml，锁定时间20分钟。比较两组定位和置管操作时间，初次置管成功率，操作疼痛度，术后24、36、48小时静息、视觉模拟评分法（visualanaloguescale，VAS）及运动阻滞发生率，关节活动范围改善度，患者满意度，不良反应发生情况。结果与ST组比较，US组神经定位及置管操作时间显著缩短（P〈0．01），初次置管成功率高达100％，操作过程患者舒适度高。术后各时间点VAS评分、关节活动范围改善度及不良反应发生率两组问差异无显著性，US组运动阻滞发生率明显低于ST组（P〈0．01），患者满意度高。结论超声引导下腋路臂丛神经周围置管可以缩短定位操作时间，降低运动阻滞发生率，达到等同于神经刺激器定位置管的术后镇痛效果且提高患者满意度。

Objective Comparison of the operation and the use of ultrasonic positioning technology with the traditional nerve stimulation method for the operation of the peripheral nerve of the axillary brachial plexus and its effect on the postoperative analgesia of the elbow joint. Method Select the quasisolution of 80 cases of patients with elbow joint release, ranging in age from 18 to 65 years old, ASA I III grade were randomly divided into ultrasound group （US group, n=40） and electrical stimulation group （st group, n=40）. Two groups of patients were in operation before axillary brachial plexus around catheter operation： application in group us out of the plane of the ultrasound technology gap positioning and ST group using a nerve stimulator for the localization of the radial nerve, transcatheter injection initial amount of local anesthetics 1% lidocaine 20ml, completed under general anesthesia surgery, postoperative connected electronic analgesia pump and continuous intravenous infusion dosage of local anesthetics 0.2% ropivacaine hydrochloride and total 250ml, the background 5ml/h, single dose 5ml, the locking time of 20 minutes. Compared with two groups of positioning and the operation time, the initial success rate of the tube, operating pain, 24, 36, 48 h after the rest, exercise VAS score and motor block incidence, range of motion range, patient satisfaction, adverse reactions. Result Compared with the ST group, the nerve location and the operation time of the US group were significantly shortened （P〈0.01）, the success rate was 100%, and the operation process was high. There were no significant differences between the two groups at each time point VAS score, the range of the joint activity range and the adverse reaction rate. The incidence of motor block in group US was significantly lower than that in ST group （P〈O.O1）. Conclusion Compare to neurostimulator ultrasound guided axillary brachial plexus catheterization provide similar analgesia quality for elbow arthrolysis with shorter procedure time and lower motor block incidence, as well as higher patient＇s satisfaction.