超声引导下不同入路臂丛神经阻滞在桡骨远端手术中效果的比较

Comparison of the anesthetic effect of ultrasound-guided brachial plexus block by different approaches in distal radius surgery

目的 比较超声引导下不同入路臂丛神经阻滞（肌间沟、腋路、锁骨上）在桡骨远端手术中的麻醉效果。 方法 90例择期行“桡骨远端骨折切开复位内固定术”或“桡骨远端骨折术后内固定取出手术”的成年患者，在超声引导下行臂丛神经阻滞，按照随机数字表法分为3组（每组30例）：肌间沟入路臂丛神经阻滞组（A组）、腋路臂丛神经阻滞组（B组）、锁骨上入路臂丛神经阻滞组（C组）。记录操作时间、镇痛持续时间，测定桡神经、尺神经、正中神经、前臂外侧皮神经和前臂内侧皮神经分布区的痛觉消失时间，评价感觉阻滞效果、麻醉效果及并发症的发生情况。 结果 3组患者基本资料与操作时间比较，差异无统计学意义（P〉0.05）。3组的镇痛持续时间差异无统计学意义（P〉0.05）。3组桡神经、正中神经、前臂外侧皮神经痛觉消失时间差异均无统计学意义（P〉0.05）。A组和C组患者尺神经痛觉消失时间比较［（21±6） min比（20±5） min］，差异无统计学意义（P〉0.05），但均长于B组［（8±5） min］（P〈0.05）；A组和C组前臂内侧皮神经痛觉消失时间比较［（18±6） min比（17±6） min］，差异亦无统计学意义（P〉0.05），但与B组［（10±6） min］比较，差异均有统计学意义（P〈0.05）。B组麻醉效果优秀率最高（90%）。A组和C组分别有2例和1例患者出现膈神经阻滞，B组有1例患者止血带不耐受。 结论 超声引导下腋路臂丛神经阻滞时尺神经及前臂内侧皮神经痛觉消失时间短，在桡骨远端手术中麻醉优秀率高、并发症少。

Objective To compare the anaesthetic effect of ultrasound-guided brachial plexus block by different approaches （interscalene, axillary, supraclavicular） in distal radius surgery. Methods Ninety adult patients undergoing elective surgery for distal radius fracture open reduction and internal fixation, distal radius fracture after implant removal surgery distal radius fracture, were randomly divided into interscalene group（group A）, axillary group（group B） and supraclavicular group （group C） for brachial plexus block under ultrasound-guided（n=30）. The performance time and complications were recorded. Besides, the onset time and block execution time of median nerve, ulnar nerve, radial nerve, lateral medial cutaneous nerve, forearm medial cutaneous nerve were evaluated. Results There is no significant difference in performance time（P〉0.05） and the onset time of pain block in median nerve, radial nerve, lateral medial cutaneous nerve （P〉0.05）. As for ulnar nerve and medial antebrachial cutaneous nerve, there were no difference in onset time of pain block between group A[（21±6） min] and group C[（20±5） min] （P〉0.05）, but they were longer than group B[（8±5） min] （P〈0.05）. While for forearm medial cutaneous nerve, there were no difference too, between group A[（18±6） min] and group C[（17±6） min] （P〉0.05）, but they were longer than group B[（10±6） min] （P〈0.05）. The complete suceess rate of group B（90%） were higher than other two groups. We found that two patients in group A and one patient in group C were complicated with phrenic nerve block and one patient in group B showed little tolerance of tourniquet. Conclusions Ultrasound-guided axillary brachial plexus block in the distal radius surgery is recommended because of better blockage of ulnar nerve and medial antebrachial cutaneous nerve and fewer complications.