全清醒无止血带局部麻醉技术在腕管综合征手术中的临床应用及分析

Clinical application and analysis of wide awake local anesthesia without tourniquet in the operation of carpal tunnel syndrome

目的探讨1∶1000000肾上腺素联合0.075%罗哌卡因全清醒无止血带局部麻醉技术在腕管综合征手术中的临床应用及疗效分析。方法选择2017年10月至2019年2月收治的64例腕管综合征患者,根据麻醉方式分成两组,臂丛神经阻滞麻醉组(A组)和肾上腺素+罗哌卡因全清醒无止血带局部麻醉组(B组),记录出血量、切口视觉模拟疼痛评分(visual analogue scale,VAS)等指标,并进行结果统计学分析比较。结果术后所有患者均获得随访,时间为3~6个月。两组患者VAS比较差异无统计学意义(P>0.05);术中B组出血量明显少于A组,差异有统计学意义(P<0.05)。根据顾玉东腕管综合征功能评定标准:A组优10例、良15例、可7例,优良率为78.13%;B组优12例、良14例、可6例,优良率为81.25%。两组优良率比较差异无统计学意义(P>0.05)。结论采用1∶1000000肾上腺素联合0.075%罗哌卡因无止血带局部麻醉技术运用于腕管综合征手术,应用了清晰的无血手术视野,麻醉效果稳定,镇痛效果良好,避免了可能发生的止血带并发症,安全、经济,较传统麻醉方式优势明显,值得临床推广。

Objective To investigate the clinical application and efficacy of 1∶1000000 epinephrine combined with 0.075%ropivacaine in the operation of carpal tunnel syndrome.Methods Sixty-four patients with carpal tunnel syndrome from October 2017 to February 2019 were selected and divided into two groups according to the mode of anesthesia:brachial plexus block anesthesia group(group A)and adrenaline+ropivacaine awake local anesthesia group(group B).The amount of bleeding and visual analogue scale(VAS)of incision were recorded.The results were statistically analyzed and compared.Results All the patients were follow-up for 3 to 6 months.There was no significant difference in VAS between the two groups(P>0.05);the amount of bleeding in group B was significantly less than that in group A(P<0.05).According to Gu Yudong′s criteria of carpal tunnel syndrome:in group A,10 cases were excellent,15 cases good and 7 cases fair,with the excellent and good rate being 78.13%;in group B,12 cases were excellent,14 cases good and 6 cases fair,with the excellent and good rate being 81.25%.There was no significant difference in the excellent and good rate between the two groups(P>0.05).Conclusion The application of 1∶1000000 epinephrine combined with 0.075%ropivacaine local anesthesia without tourniquet in the operation of carpal tunnel syndrome creates a clear vision of bloodless operation,with stable anesthetic effect and good analgesic effect,which can avoid the possible complications of tourniquet.It is safe and economical,and has obvious advantages over the traditional anesthesia,which is worthy of clinical promotion.