不同方式引导腋路置管对肘关节松解术后镇痛的影响

Analgesic efficacy of different continuous axillary brachial plexus block after elbow stiffness

目的比较不同方式引导腋路置管对肘关节松解术后镇痛的影响。方法选取2011-03至2014-09北京积水潭医院行90例肘关节松解术后患者,随机分成3组,每组30例,分别为超声引导组(U组)、神经刺激器组(N组)和神经刺激器联合超声引导组(NU组)。分别运用超声、神经刺激器和超声联合刺激器在桡神经周围置入导管镇痛。记录3组患者的置管时间、是否有血管损伤及术后(静息和功能锻炼时)24、48、72 h的数字疼痛分级法(NRS)评分,并同时监测3组患者术后镇痛泵的舒芬太尼按压总次数(72 h)及患者不良反应的发生情况(恶心、呕吐、皮肤瘙痒、呼吸抑制等)。结果 N组置管时间(5.2±1.6)min明显比U组(3.2±0.5)min和NU组(3.6±1.2)min长,差异有统计学意义(P<0.05)。N组有7例在置管过程中血管损伤而U组与NU组无损伤血管发生。3组的NRS评分不论是在静息状态下还是在功能锻炼时均无明显差异。3组患者术后72 h舒芬太尼的按压总次数N组(20.8±5.5)明显多于U组(15.7±3.5)和NU组(17.0±3.7),差异有统计学意义(P<0.01)。3组患者不良反应发生率差异无统计学意义。结论在超声引导下桡神经部位置管术后镇痛效果优于神经刺激器,同时在超声引导下腋路置管可以避免血管损伤。

Objective To compare the analgesic efficacy of different continuous auxiUary brachial plexus block after elbow stiffness. Methods Ninety patients were randomly and equally allocated into three groups ： U group （ ultrasound-guided alone ） , N group（ nerve stimulator-guided） and NU group（ nerve stimulator-guided and ultrasound-guided）. The catheter was placed around ra- dial nerves, respectively. The time taken to place the catheter and injury to blood vessels were recorded, respectively. The numerical rating scale scores（NRS） were assessed at rest and during passive mobilization at 24 h , 48 h and 72 h, postoperatively. The number of times the sufentanil PCA button was pressed was recorded at 72 h,postoperatively and the occurrence of such adverse reactions as nausea, vomiting, itching and respiratory depression was observed. Results The time it took to place the catheter in the N group（5, 2 ± 6） rain was significandy longer than that of U group （ 3.2 ± 0.5 ） rain and NU group （ 3.6 ± 1.2） min （ P 〈 0.05 ）. The difference of NRS scores was not significant between the three groups at rest or during passive mobilization at 24 h, 48 h and 72 h after operation. There were seven cases of injury to blood vessels in the N group, but there was none in the U group or NU group （P 〈 0.05 ）. The sufentanil PCA button was pressed more often in the N group than in the other two groups （ P 〈 0.05 ）. Conclusions The postoperative analgesia effect of the ultrasound guided approach is better than that of the nerve stimulator. Placing the catheter around radial nerves guided by ultrasound can prevent injury to blood vessels.