神经刺激器在超声引导腋路臂丛神经阻滞的辅助作用

Adjunct role of nerve stimulator in ultrasound-guided axillary brachial plexus block

目的评价神经刺激器在超声引导腋路臂丛神经阻滞的辅助作用。方法选择2016年9月至2017年11月接受肘关节以下手术的50例患者,随机分为超声联合神经刺激器组(US组)和单纯超声组(U组),每组各25例。两组局麻药均为0.4%罗哌卡因32mL,行腋路臂丛神经阻滞。记录肌皮神经、桡神经、正中神经、尺神经的感觉阻滞起效时间和维持时间,评价各神经支配区域的感觉阻滞程度,手术区域麻醉效果(优、良、差),观察并记录与神经阻滞相关并发症。结果两组患者各神经支配区域感觉阻滞起效时间和维持时间差异并无统计学意义(P>0.05),麻醉效果优等率US组为92%,U组为84%,差异无统计学意义(P>0.05),两组患者均未出现与神经阻滞相关并发症。结论超声联合神经刺激器与单纯超声引导腋路臂丛神经阻滞均能获得理想的阻滞效果,应用神经刺激器并未明显增加阻滞成功率;神经刺激器在超声引导腋路臂丛神经阻滞的辅助作用可能有限。

Objective To evaluate the adjunct role of nerve stimulator in ultrasound-guided axillary bra-chial plexus block. Methods 50 patients undergoing lower elbow surgery in our hospital were selected from Sep-tember 2016 to November 2017. They were randomly divided into two groups with 25 cases each,which are guid-ance of ultrasound combined with nerve stimulator group（group US）and ultrasound alone group（group U）. 32mL of 0.4% ropivocaine were administered in both groups. The onset time and duration of sensory blockade in mus-culocutaneous,radial,median and ulnar nerve were recorded. The extent of sensory block of each in nervated re-gion and the anesthetic effect of surgical field（rated as excellent,good and failure）were both assessed. The anes-thetic complications were also observed and recorded. Results There were no significant differences in the onsettime and duration of sensory blockade in both groups（P〉0.05）. The anesthetic effects of surgical field were 92%in group US and 84% in group U（P〉 0.05）. No major anesthetic complications occurred in two groups. Conclusion Ideal anesthetic effects are achieved in both groups,and the successful rate of anesthesia in group US is notsignificantly increased. The role of nerve stimulator as an adjunct to ultrasound-guided axillary brachial plexusblock may be very limited.