超声引导下颈浅丛联合臂丛上干阻滞在锁骨骨折手术中的应用

Application of ultrasound-guided dual superficial cervical plexus and brachial plexus upper trunk blocks in clavicular fracture surgery

目的研究颈浅丛联合臂丛上干阻滞用于锁骨骨折手术的效果,探讨锁骨骨折手术有效的神经阻滞方法。方法选择2017年3月1日-12月1日因锁骨骨折在同济大学附属第十人民医院行内固定手术的患者56例,ASA分级Ⅰ或Ⅱ级,年龄18~65岁,神志清晰,可交流,对局部麻醉药无过敏。采用超声引导下颈浅丛联合臂丛上干阻滞技术,药物为1%罗哌卡因6 mL和2%利多卡因5 mL,以0.9%氯化钠溶液稀释至20 mL,颈浅丛及臂丛上干分别注射5 mL上述局部麻醉药混合液。阻滞操作完成后,静脉泵注右美托咪定,负荷量为0.8μg/kg,10 min泵注完毕,维持速度为0.5μg/(kg·h)。记录感觉阻滞起效时间,分别记录阻滞15 min、手术结束、手术结束2 h,以及手术结束5 h时的运动阻滞评分,记录术中患者镇痛效果评分。结果感觉阻滞起效时间为(2.96±1.17)min,神经阻滞操作结束后15 min、手术结束、手术结束2 h,以及5 h时的肩部肌力评分分别为(3.39±0.75)、(3.12±0.55)、(3.18±0.56)、(4.59±0.61)分;肘部肌力评分在上述对应时刻分别为(4.04±0.80)、(3.78±0.76)、(3.88±0.74)、(4.69±0.51)分。术中镇痛效果评分为(1.55±0.61)分。结论超声引导下颈浅丛联合臂丛上干阻滞用于锁骨骨折手术镇痛完善,对阻滞侧上肢远端运动影响小。

Objective To explore the efficacy of superficial cervical plexus block combined with brachial plexus superior trunk block in clavicular fracture surgery.Methods A total of 56 patients with clavicular fracture who received internal fixation from March 1 to December 1,2017 in Tenth People’s Hospital of Tongji University,ASAⅠorⅡ,aged 18-65 years,who remained conscious,could communicate and had no allergy to local anesthetics were selected for this study.A mixture(5 mL)of 1%ropivacaine(6 mL)and 2%lidocaine(5 mL)diluted to 20 mL with saline was injected for ultrasound-guided superficial cervical plexus block and brachial plexus superior trunk block,respectively.After local anesthetic injection,dexmedetomidine was infused with a loading dose of 0.8μg/kg for 10 min followed by maintenance infusion at a rate of 0.5μg/(kg·h).The onset time of sensory block,the muscle strength of shoulder,elbow and wrist,and analgesic score were recorded.Results The onset time of sensory block was(2.96±1.17)min.The score of shoulder muscle strength was 3.39±0.75 at 15 min after the nerve block,3.12±0.55 at the end of the surgery,3.18±0.56 at 2 h after the operation,and 4.59±0.61 at 5 h after the operation.The score of elbow muscle strength was 4.04±0.80,3.78±0.76,3.88±0.74 and 4.69±0.51 at the above-mentioned time point,respectively.The intraoperative analgesia efficacy score was 1.55±0.61.Conclusion Ultrasound-guided superficial cervical plexus block combined with brachial plexus superior trunk block yields a satisfactory analgesic effect during clavicular fracture surgery,and has little influence on distal movement of the blocked upper limb.