超声引导下C4联合颈浅丛神经阻滞在锁骨骨折手术中的麻醉效果

Anesthesia effect of C 4 combined with superficial cervical plexus block under ultrasound guidance in clavicular fracture operation

目的观察超声引导下C 4联合颈浅丛神经阻滞在锁骨骨折手术中的麻醉效果。方法将行锁骨骨折切开复位内固定术的60例患者随机分为颈丛组与臂丛组,每组30例。颈丛组在超声引导下行C 4联合颈浅丛神经阻滞,臂丛组在超声引导下行常规臂丛神经阻滞。比较两组患者锁骨感觉神经阻滞评分、术中麻醉效果及并发症的发生情况。结果颈丛组锁骨内侧感觉神经阻滞评分高于臂丛组,术中麻醉效果优于臂丛组(均P<0.05),而两组锁骨中点及外侧感觉神经阻滞评分比较,差异均无统计学意义(均P>0.05)。两组均未发生刺破血管、局麻药中毒或喉返神经阻滞,两组膈神经阻滞发生率差异无统计学意义(P>0.05)。结论在锁骨骨折手术中采用超声引导下C 4联合颈浅丛神经阻滞的麻醉效果较肌间沟臂丛神经阻滞麻醉效果更佳,且不增加并发症的发生率。

Objective To observe the anesthesia effect of C 4 combined with superficial cervical plexus block under ultrasound guidance in the clavicular fracture operation.Methods Sixty patients who underwent open reduction and internal fixation of clavicular fracture were randomly divided into cervical plexus group and brachial plexus group,with 30 cases in each group.C 4 combined with superficial cervical plexus block under ultrasound guidance was performed in the cervical plexus group,and conventional brachial plexus block under ultrasound guidance was performed in the brachial plexus group.Score of clavicular sensory nerve block,intraoperative anesthesia effect,and incidence of complications were compared between the two groups.Results The cervical plexus group exhibited higher score of medial clavicular sensory nerve block and superior intraoperative anesthesia effect than the brachial plexus group(all P<0.05),but no statistically significant difference was found in score of median or external clavicular sensory nerve block between the two groups(all P>0.05).No blood vessel puncturing,local anesthetic poisoning,or recurrent laryngeal nerve block occurred in the two groups,and there was no statistically significant difference in incidence rate of phrenic nerve block between the two groups(P>0.05).Conclusion During clavicular fracture operation,C 4 combined with superficial cervical plexus block under ultrasound guidance has a better anesthesia effect than interscalene brachial plexus block,and not increasing incidence rate of complications.