平面内技术与平面外技术在超声引导下的斜角肌间隙臂丛神经阻滞中的临床效果

Clinical effect ultrasound-guided inter-scalene brachial plexus blockage: in-plane technology versus out-of-plane technology

目的:探讨平面内穿刺技术和平面外穿刺技术在超声引导下的斜角肌间隙臂丛神经阻滞中的效果,便捷性及并发症的发生率。方法:选择上肢手术需要行臂丛麻醉的患者60例,随机分为超声平面内技术组(UI组)和超声平面外技术组(UO组)。观察两组患者臂丛神经阻滞图像定位时间、操作时间、臂丛神经主要分支阻滞程度(完全阻滞、部分阻滞、未阻滞)、麻醉效果(优、良、差)、并发症(局麻药中毒、血肿、声嘶、气胸、神经损伤、呼吸困难、Horner综合征)发生率。结果:两组患者图像定位时间无明显差异[(66.90±2.13s) vs(67.83±3.53s),P>0.05],与平面内组相比,平面外组穿刺操作时间更短[(137.66±18.95s) vs(191.19±15.60s),P<0.05];两组患者的臂丛神经主要分支阻滞程度、麻醉效果、并发症发生率无显著差异。结论:平面内及平面外技术都可以较好地用于超声引导的斜角肌间隙臂丛神经阻滞,平面外技术用时更短。

Objective To investigate the effect,convenience and the incidence of complications of ultrasound-guided interscalene brachial plexus blockage when in-plane technology and out-of-plane technology were used.Method Sixty patients undergoing selective upper limb operation were selected and randomly devided into two groups:In-plane technology group(group UI)and Out-of-plane technology group(group UO).The duration of image acquisition and puncture were recorded and compared.The exent of sensory blockade of main branches of branchial plexus(rated as completely-block,partial block,not block)was recorded and compared.The anesthetic effect of surgical field(rated as exellence,good and failure)was also assessed and compared.The incidence of complications(such as local anesthesia intoxication,Hematoma,Hoarseness,Pneumothorax,Nerve injury,Dyspnea,Horner syndrome)were observeded and compared.Results There were no difference with the image acquisition time between group UI and group UO[(66.90±2.13)s vs(67.83±3.53)s,P>0.05];Compared with group UI,group UO had a obviously shorter puncture time[(137.66±18.95)s vs(191.19±15.60)s,P<0.05].There were no difference with the exent of sensory blockade of main branches of branchial plexus,the anesthetic effect of surgical field or the incidence of complications between group UI and group UO.Conclusion Both in-plane and out-plane technology can be used for ultrasound-guided inter-scalene brachial plexus blockage but the out-of-plane technology takes shorter time.