超声引导下锁骨下臂丛神经阻滞与腋路臂丛神经阻滞在小儿肘部手术中的应用效果比较

Comparison of ultrasound-guided infraclavicular and axillary approaches to brachial plexus for pediatric elbow surgeries

目的比较超声引导下锁骨下臂丛神经阻滞(infraclavicular brachial plexus block,ICB)与腋路臂丛神经阻滞(axillary brachial plexus block,AXB)应用于小儿肘部手术的麻醉效果。方法选取2019年6月至2020年12月首都医科大学附属北京儿童医院收治的择期行肘部手术的患儿70例,采用随机数字表法分为锁骨下入路组(I组)与腋路组(A组),每组35例。喉罩全身麻醉下以0.375%罗哌卡因0.5 ml/kg行超声引导下ICB或AXB。记录两组的显像时间、穿刺时间、阻滞操作时间、穿刺次数、穿刺针清晰度、阻滞成功率、术后入麻醉后恢复室和术后1 h、6 h、12 h及24 h的疼痛行为量表(FLACC)评分,镇痛持续时间、运动阻滞时间和补救镇痛率。结果I组穿刺次数为(1.6±0.8)次,明显少于A组的(2.4±0.5)次,但穿刺针清晰度较A组差(2级,10例比31例),差异均有统计学意义(P<0.05)。两组阻滞成功率均为100.0%,在显影时间、穿刺时间、阻滞操作时间、术后各时点FLACC评分、镇痛持续时间、运动阻滞持续时间、补救镇痛率和镇痛满意度评分比较,差异均无统计学意义(P>0.05)。结论超声引导下ICB和AXB均可安全有效地应用于小儿肘部手术。

Objective To compare the anesthetic effect of ultrasound-guided infraclavicular brachial plexus block(ICB) and axillary brachial plexus block(AXB) for pediatric elbow surgery. Methods A total of 70 children admitted to Beijing Children’s Hospital, Capital Medical University for elective elbow surgery from June 2019 to December 2020 were selected. The patients were divided into infraclavicular approach group(group I) and axillary approach group(group A) by random number table method, 35 cases in each group. Ultrasound-guided ICB or AXB was performed with 0.375%ropivacaine 0.5 ml/kg under laryngeal mask general anesthesia. The imaging time, puncture time, block operation time,puncture times, clarity of puncture needle, block success rate, postoperative anesthesia recovery room, pain behavior scale(FLACC) score at 1 h, 6 h, 12 h and 24 h after surgery, analgesia duration, motor block time and recovery analgesia rate of both groups were recorded. Results The number of puncture times in group I was(1.6 ± 0.8) times, significantly less than that in group A was(2.4 ± 0.5) times, but the definition of puncture needle was worse than that in group A(grade 2, 10 cases vs. 31 cases), the differences were statistically significant(P < 0.05). The success rate of the block in both groups was 100.0%.There were no statistical differences in imaging time, puncture time, block operation time, FLACC score, analgesia duration,motor block duration, recovery analgesia rate and analgesia satisfaction score(P>0.05). Conclusions Both ultrasoundguided ICB and AXB could provide satisfying anesthesia for pediatric elbow surgery safely.