腕肘部神经阻滞在手部手术的应用

Clinical application of wrist and elbow nerve block in hand surgery

目的探讨手部手术患者腕肘部神经阻滞的麻醉效果。方法120例拟行手部手术的患者，ASA分级为Ⅰ-Ⅲ级，随机分为两组，每组60例。A组采用腕肘部神经阻滞，B组采用肌间沟臂丛神经麻醉。麻醉药均为0．75％罗哌卡因与2％利多卡因等容量混合液，腕肘部每部位神经阻滞应用5ml局麻药，共计30ml，臂丛神经阻滞应用30ml局麻药。记录手部正中神经、尺神经及其腕背支、桡神经浅支麻醉后的起效时间，比较两组间阻滞完善率及麻醉效果为优的患者比例差异，记录并发症。结果神经阻滞起效时间A组明显短于B组（P〈0．01），A组正中神经、尺神经、尺神经腕背支阻滞完善率高于B组，桡神经浅支阻滞完善率两组差异无统计学意义，A组麻醉效果为优的患者比例高于B组（P〈0．01），A组无并发症，B组4例并发症。结论腕肘部神经阻滞操作简便，起效时间短，麻醉效果良好，是手部手术安全、可靠的神经阻滞方法。

Objective To investigate the anesthetic effect of wrist and elbow nerve block in hand surgery. Methods One hundred and twenty patients, with ASA classification being Ⅰ to Ⅲ grade, who underwent hand surgery were divided into two groups, 60 patients in each. Wrist and elbow nerve block was used in group A, and interscalene braehial plexus block in group B. The anesthetics were the mixture of equal volumes of 0.75% ropivacaine and 2% lidocaine. The nerve block in each part of wrist and elbow was applied with 5 ml local anesthetic, totaling 30 ml, and the brachial plexus block was treated with 30 ml local anesthetic. The onset time of hand median nerve, ulnar nerve and its dorsal carpal branch and superficial branch of radial nerve was recorded. The differences of block rate and anesthetic efficacy between the two groups were compared and analyzed, and the complications were recorded. Results Nerve block onset time of group A was significantly shorter than that of group B （P〈0.01）. The block rate of median nerve, ulnar nerve and dorsal carpal branch of ulnar nerve from group A was higher than that from group B, and there was no significant difference in block rate of superficial branch of radial nerve between two groups. The proportion of patients with excellent anesthetic effect in group A was higher than that in group B （P〈0.01）. There was no complication in group A, and there were 4 cases of complications in group B. Conclusion The wrist and elbow nerve block is simple with short onset time and good anesthesia effect. It is a safe and reliable method of nerve block for hand surgery.