超声引导下颈中间丛神经阻滞在锁骨内固定术中的应用

Ultrasound-guided intermediate cervical plexus block in clavicle internal fixation

目的探讨超声引导下颈中间丛神经阻滞在锁骨内固定手术中的麻醉效果及安全性。方法选取2017年11月至2019年5月骨科择期行锁骨骨折切开复位内固定手术患者60例,ASA分级Ⅰ级或Ⅱ级,随机分为观察组和对照组,各30例。两组均在超声引导下应用平面内技术实施神经阻滞,观察组采用颈中间丛神经阻滞,对照组采用C5横突前后结节间神经阻滞联合颈浅丛阻滞。观察两组患者麻醉效果、两种阻滞方法下穿刺前(T0)、穿刺成功后10 min(T1)、手术切皮时(T2)、剥离骨膜时(T3)四个时间点患者血压心率稳定性及麻醉并发症发生情况。结果两组患者均在神经阻滞下完成手术,无因镇痛不足需更改全身麻醉病例。两组麻醉优良率均为100%,比较无统计学差异(P>0.05)。两组患者不同时点和组间心率和平均动脉压比较均无统计学差异(P>0.05)。喉返神经阻滞引起的声嘶发生率比较无统计学差异(P>0.05)。结论超声引导下颈中间丛神经阻滞与C5横突结节间神经阻滞联合颈浅丛阻滞麻醉效果类似,均可安全的用于锁骨内固定术中,前者单点注射,操作简单,具有一定优势。

Objective To investigate the anesthesia effect and safety of ultrasound-guided intermediate cervical plexus block in clavicle internal fixation.Methods A total of 60 patients with scheduled operation of open reduction and internal fixation for clavicular fracture from November 2017 to May 2019 were selected [American Society of Anesthesiologists(ASA) Ⅰ-Ⅱ].The patients were randomly divided into intermediate cervical plexus block group(study group,n=30) and control group,in which intertubercular nerve block of C5 transverse process combined with superficial cervical plexus block was performed(n=30).Intra-plane nerve block guided by ultrasound was performed in two groups.The effects of anesthesia,blood pressure and heart rate stability before puncture(T0),10 minutes after puncture(T1),at the time of skin incision(T2),and at the time of stripping periosteum(T3) were observed,and the complications of anesthesia were compared between two groups.Results The operation was successfully completed under nerve block in both groups with no cases of general anesthesia due to inadequate analgesia.There was no statistical difference in excellent and good rate of anesthesia between two groups(100% vs 100%,P>0.05).There were no significant differences in heart rate and mean arterial pressure at different time points and inter-group comparisons(P>0.05),and there was no significant difference in the incidence of vocal sputum caused by recurrent laryngeal nerve block between two groups(P>0.05).Conclusion Ultrasound-guided cervical intermediate cervical plexus block is similar to intertubercular nerve block of C5 transverse process combined with superficial cervical plexus block in anesthesia effects and can be safely used in clavical internal fixation.The former is easily operated with one-point puncture way and has certain advantages.