超声引导下选择性臂丛神经阻滞辅助肩关节镜围手术期镇痛

Application of a selective brachial plexus block in the perioperative period of shoulder arthroscopy

目的探讨肩关节镜手术中采用超声引导下选择性臂丛神经阻滞对围手术期镇痛的有效性及安全性。方法选取2021年1月至2021年12月于联勤保障部队第910医院行单侧肩关节镜手术患者共88例,分为两组:选择性阻滞组46例,接受超声引导下选择性臂丛神经阻滞;传统阻滞组42例,接受超声引导下肌间沟臂丛神经阻滞。结果选择性阻滞组患者神经阻滞起效时间明显低于传统阻滞组(P<0.05);选择性阻滞组患者的术后不同时间点疼痛视觉模拟评分(VAS)均明显低于传统阻滞组(P<0.05);选择性阻滞组患者术后不同时间点屈肘、屈腕肌力均明显优于传统阻滞组(P<0.05);选择性阻滞组患者术后膈肌麻痹程度明显低于传统阻滞组(P<0.05);选择性阻滞组患者术后霍纳综合征的发生率明显低于传统阻滞组(P<0.05),而主观满意率明显优于传统阻滞组(P<0.05)。结论在肩关节镜手术中采用超声引导下选择性臂丛神经阻滞可起到更好的围手术期镇痛效果,患者满意度较高,术后可早期开展康复训练。

Objective To explore the effectiveness and safety of an ultrasound-guided selective brachial plexus block in perioperative analgesia during shoulder arthroscopic surgery.Methods Eighty-eight patients who underwent unilateral shoulder arthroscopic surgery at the 910th Hospital of the Joint Support Force from January 2021 to December 2021 were selected.Forty-six patients in the selected group received an ultrasound-guided selective brachial plexus block,while 42 patients in the traditional group received an ultrasound-guided intermuscular sulcus brachial plexus block.Results The onset time of nerve block in the selected group was significantly lower than that in the traditional group(P<0.05);the visual analogue scale(VAS)score of postoperative pain at different time-points in the selected group was significantly lower than that in the traditional group(P<0.05);the elbow flexion and wrist flexion muscle strength of the test group were significantly better than those of the traditional group at different time-points after surgery(P<0.05);the degree of postoperative diaphragmatic paralysis in the test group was significantly lower than that in the traditional group(P<0.05);the incidence of postoperative Horner's syndrome in the test group was significantly lower than that in the traditional group(P<0.05),while the subjective satisfaction rate was significantly greater than that in the traditional group(P<0.05).Conclusion A selective brachial plexus block guided by ultrasound in shoulder joint surgery can achieve a better perioperative analgesic effect,with high patient satisfaction.Early rehabilitation training can be carried out after surgery.