罗哌卡因两针和四针注射法对臂丛神经阻滞的疗效比较

Effect of two-injection technique versus four-injection of ropivacaine in brachial plexus nerve block

目的 比较两针和四针注射法联合超声(USG)和神经刺激仪对患者行腋路臂丛阻滞的疗效。方法 将60例患者随机分为2组。2组患者的腋窝均注射生理盐水和罗哌卡因的混合物30mL。2组待肌皮神经阻滞后,两针组行正中神经阻滞,而四针组行正中神经、尺神经、桡神经阻滞。臂丛神经的感觉神经阻滞用针刺试验评估,运动阻滞用每根神经支配的肌肉收缩评估。记录并比较手术中阻滞程序开始时间、有效性及持续时间,并观察不良反应和并发症、视觉模拟量表(VAS)评分和术后患者满意度。结果 2组患者均获得了充分镇痛和麻醉效果,无需再进行局部麻醉。四针注射组中,患者均获得更快、更有效的完全阻滞,而两针注射组中,1例患者桡神经无法实现阻滞,其他神经均被成功阻滞。四针注射组的阻滞过程持续时间较长,且VAS评分较高。2组患者满意度无显著差异,且各组均无不良反应和并发症发生。结论 与两针注射法相比,多次注射法需要操作时间较长,但麻醉效果更快和更完善。

Objective To compare two-injection and four-injection techniques of ropivacaine combined with ultrasonography (USG) and nerve stimulator in patients with brachial plexus nerve block. Methods Sixty patients were randomly divided into two groups, given injection of a mixture of ropivacaine and normal saline for 30 mL. After the blockage of the musculocutaneous nerve in both the groups, the two-injection group was given median nerve blockage while the four-injection group was additionally given ulnar nerve, and radial nerve blockage. Sensorial blockage in brachial plexus nerves was evaluated with pinprick test, and motor block was evaluated by contraction of the muscles innervated by each nerve. The start time of blockage, its effectiveness and duration were recorded, and adverse events and complications, visual analog scale (VAS) scores, and postoperative patient satisfaction were observed. Results Sufficient analgesia and anaesthesia were achieved, So no additional local anaesthetics in both the groups was needed. A faster and more effective complete block were achieved in four-injection group. In the two-injection group, the nerve block successfully achieved excepted for radialis block in one patient. The blockage procedure lasted longer and VAS scores was higher in the four-injection group. No statistical difference was found with regard to patients′ satisfaction, and no adverse effects and complications were observed in any group. Conclusion Although the multi-injection method takes more time, it provides faster anaesthesia and more complete blockage than the two-injection method.