超声引导下前臂正中神经阻滞在小儿扳机指手术中的应用研究

Application of ultrasound-guided median forearm nerve block in trigger finger surgery in children

目的 探讨超声引导下前臂正中神经阻滞在小儿扳机指手术中的应用效果。方法 选择2021年1—6月北京积水潭医院收治的拟全身麻醉下行屈肌腱松解术的扳机指患儿60例,采用随机数字表法将患儿分为前臂正中神经阻滞组(M组)和腋路臂丛神经阻滞组(A组),每组30例。全身麻醉诱导完成后,M组接受超声引导下前臂正中神经阻滞,A组接受超声引导下腋路臂丛神经阻滞。记录阻滞操作时间、手术时间、术中全身麻醉药物用量、苏醒时间和恢复室停留时间;术后2 h、4 h、8 h、12 h评估前臂运动情况,使用FLACC量表评估患儿疼痛情况;记录术后恶心呕吐、围术期喉痉挛等并发症情况,以及曲马多使用例次和家长对术后镇痛的满意度。结果 M组与A组术后各时点疼痛FLACC量表评分比较,差异均无统计学意义(P>0.05);M组术后2 h、4 h前臂活动度明显优于A组(术后2 h运动评分为1分、2分、3分,M组有0例、1例、29例,A组有5例、18例、7例;术后4 h运动评分为1分、2分、3分,M组有0例、0例、30例,A组有0例、9例、21例),差异有统计学意义(P<0.05);两组曲马多使用例次、恶心呕吐、喉痉挛发生率及家长满意度比较,差异均无统计学意义(P>0.05);两组阻滞操作时间、手术时间、苏醒时间、恢复室停留时间、全身麻醉药物用量和躁动情况比较,差异均无统计学意义(P>0.05)。结论 超声引导下前臂正中神经阻滞用于小儿扳机指手术围术期镇痛效果良好,对运动影响小,可操作性强,有临床推广意义。

Objective To investigate the effectiveness of ultrasound-guided median forearm nerve block in pediatric trigger finger surgery. Methods A total of 60 trigger finger children undergoing flexor tendon release under general anesthesia were selected from January to June 2021 in Beijing Jishuitan Hospital. The children were divided into the median forearm nerve block group(group M) and axillary brachial plexus block group(group A) by random number table method, 30 cases in each group. After the induction of general anesthesia, patients in group M received ultrasound-guided median nerve block of the lower forearm, while patients in group A received ultrasound-guided subaxillary brachial plexus block. Block operation time, operation time, intraoperative general anesthetic dosage, recovery time and recovery room stay time were recorded. FLACC scale scores and forearm movement at 2 h, 4 h, 8 h, 12 h after surgery were recorded. Postoperative nausea and vomiting, perioperative laryngeal spasm and other complications, as well as the number of use of tramadol and parents’ satisfaction with postoperative analgesia were recorded. Results There was no significant difference in FLACC score between group M and group A at each time point after surgery(P > 0.05). The forearm activity of group M was significantly better than that of group A at 2 h and 4 h after surgery(Two hours after surgery, there were zero, one and 29 cases in group M,and five, 18 and seven cases in group A whose exercise scores were 1, 2 and 3 points respectively. Four hours after the surgery, there were zero, zero and 30 cases in group M, and zero, nine and 21 cases in group A), the difference was statistically significant(P < 0.05). There were no significant differences in the number of tramadol use, the incidence of nausea and vomiting, laryngeal spasm and satisfaction of parents between the two groups(P>0.05). There were no statistically significant differences in block operation time, operation time, recovery time, recovery stay time, amount of general anesthetic and agitation between the two groups(P>0.05). Conclusions Ultrasound-guided median forearm nerve block provides sufficient perioperative analgesia and less motor block for pediatric trigger finger surgery, with little effect on movement and strong operability, which has clinical significance.