后路与前外侧路连续肌间沟臂丛神经阻滞对肩关节镜术后镇痛效果比较

Comparison of the Analgesic Effect of Posterior Approach and Traditional Anterolateral Approach with Continuous Intermuscular sulcus Brachial Plexus Block after Shoulder Arthroscopy

目的比较超声引导下后路与传统前外侧路连续肌间沟臂丛神经阻滞用于肩关节镜手术术后镇痛的效果。方法选择择期行肩关节镜手术治疗的患者60例,随机分为后路连续肌间沟臂丛神经阻滞组(P组)和前外侧路连续肌间沟臂丛神经阻滞组(I组),每组30例。两组患者入室后在超声引导下行连续臂丛神经阻滞,同时留置神经阻滞导管,操作完成后于全身麻醉下行肩关节镜手术,术后通过神经阻滞导管进行术后镇痛。记录两组患者放置神经阻滞导管时间、穿刺深度和神经阻滞导管留置深度;记录术后6、12、18、24、36、48h静息和运动VAS;记录术后48h镇痛泵有效按压次数、补救镇痛情况、更换敷贴次数及患者满意度评分;记录运动阻滞、不良事件及相关并发症发生情况。结果与I组比较,P组穿刺及置管深度更深(P<0.01),术后12、18、24、36h静息及运动状态VAS更低(P<0.05);与I组比较,P组镇痛泵有效按压次数、补救镇痛次数及更换敷贴次数更少,导管移位、脱出及穿刺点渗液发生率更低,患者满意度更高(P<0.05)。结论超声引导下后路与前外侧路连续肌间沟臂丛神经阻滞均能安全有效地应用于肩关节镜手术术后镇痛,但后路连续肌间沟臂丛神经阻滞术后镇痛效果更好,导管位置更加稳固,不易移位、渗液及脱出,患者满意度更高。

Objective To compare the analgesic effect of continuous intermuscular sulcus brachial plexus block in shoulder arthroscopy with ultrasound-guided posterior approach and traditional anterolateral approach.Methods Sixty patients who received shoulder arthroscopy were randomly divided into two groups:the posterior approach group(group P)and the traditional anterolateral approach group(group I)with 30 patients in each group.After entering the room,the patients in two groups f underwent continuous brachial plexus block under ultrasound guidance,and the nerve block catheter was indwelling at the same time.After the operation,shoulder arthroscopy was performed under general anesthesia,and postoperative analgesia was performed through the nerve block catheter.The time,puncture depth and indwelling depth of the nerve block catheter were recorded.VAS scores were recorded at 6h,12h,18h,24h,36h and 48h after surgery.The times of effective pressure on the analgesia pump 48h after operation,the circumstances of relief,the times of replacement of adhesive plaster during and after operation and patient satisfaction were recorded.Movement block,adverse events and related complications were recorded.Results Compared with group I,group P had deeper puncture depth and longer catheter indwelling depth(P<0.01).VAS scores for resting and exercise state were lower in Group P at 12h,18h,24h and 36h after surgery(P<0.05).Compared with group I,in group P,there were fewer times of effective pressure and remediation of analgesia pump,fewer times of intraoperative and postoperative application replacement,lower incidence of catheter displacement,prolapse and puncture point exudation,and higher patient satisfaction(all P<0.05).Conclusion Ultrasound guiding into the both posterior and anterolateral intermuscular sulcus brachial plexus block can be safely and effectively used for postoperative analgesia after shoulder arthroscopy,but the posterior continuous intermuscular sulcus brachial plexus block has better analgesic effect.The catheter is more firmly positioned,no easy to shift,drainage,hernia,and patient satisfaction is higher.