超声引导经锁骨上窝进针在喙突旁臂丛神经阻滞中的应用

Application of supraclavicular fossa puncture in coracoid approach brachial plexus block guided by ultrasound

目的评价经锁骨上窝进针在超声引导下喙突旁臂丛神经阻滞中的临床效果。方法选择实施前臂或手部手术的患者60例,男33例,女27例,18～60岁,BMI 18.5～28.0kg/m2,ASAⅠ—Ⅲ级。随机分为两组:锁骨下进针组(A组)和锁骨上窝组(B组),每组30例,实施超声引导下喙突旁臂丛神经阻滞,分别从锁骨下进针(A组)和锁骨上窝进针(B组),在腋动脉周围注射0.5%罗哌卡因20ml。记录操作时间、调针次数、起效时间、注药后15min感觉阻滞评分、阻滞成功率和并发症发生率。结果与A组比较,B组操作时间明显缩短(P<0.05);两组调整针次数、起效时间、注药后15min感觉阻滞评分、阻滞成功率和并发症发生率差异无统计学意义。结论经锁骨上窝进针实施超声引导喙突旁臂丛神经阻滞,操作期间更短,效果确切,不增加并发症的发生率。

Objective To evaluate the clinical effect of supraclavicular fossa puncture in coracoid approach brachial plexus block under ultrasonic guidance.Methods Sixty patients scheduled for distal upper extremity surgery,male 33 and female 27,BMI 18.5-28.0 kg/m2,aged 18-60 years old,falling into ASA physical statusⅠ-Ⅲ,were randomly divided into groups A and B,30 cases in each.Coracoid approach brachial plexus block was carried out under ultrasonic guidance.The puncturing point was located in infraclavicula(group A)or supraclavicular fossa(group B),and 0.5%ropivacaine 20 ml was injected around axillary artery for each patient.The procedure time and the number of needle adjustment were recorded as primary outcome,and the onset time,sensory block score at 15 min after injection,the success rate of block and the incidence of complications were noted also.Results Compared with group A,the procedure time was shorter in group B(P<0.05).There was no significant difference in the number of needle adjustment,onset time,sensory block score at 15 min,the success rate of block and incidence of complications between the two groups.Conclusion Puncturing through supraclavicular fossa can shorten the procedure time of coracoid approach brachial plexus block guided by ultrasound.It is effective and safe,and does not increase the complications.