超声引导臂丛复合上臂根部肋间臂神经阻滞用于肱骨远端骨折手术的效果

Effect of ultrasound-guided brachial plexus combined with intercostobrachial nerve block at the root of upper arm in the operation of distal humeral fracture

目的回顾性分析超声引导臂丛复合上臂根部肋间臂神经(ICBN)阻滞用于后侧入路肱骨远端骨折手术的临床效果。方法选取2019年1月至2023年12月在晋江市中医院接受神经阻滞下行后侧入路肱骨远端骨折手术患者60例,根据神经阻滞方式不同分为观察组(n=30,实施臂丛复合ICBN阻滞)和对照组(n=30,实施臂丛阻滞)。记录阻滞起效时(t0)、切皮时(t1)、显露骨折断端时(t2)、骨折解剖复位时(t3)、缝皮时(t4)的视觉模拟评分法(VAS)评分。记录阻滞起效时间、针刺疼痛阻滞效果、术中需辅助镇痛药物例数以及患者麻醉满意度评分。结果观察组在t1、t2、t3、t4的VAS评分均低于同一时间点对照组,阻滞起效时间低于对照组,上臂远端内侧区和后侧区的皮肤痛觉阻滞效果优于对照组,术中需辅助镇痛药物比例低于对照组,患者麻醉满意度评分高于对照组,差异均有统计学意义(P<0.05)。两组在t0的VAS评分比较,差异无统计学意义(P>0.05)。两组上臂远端外侧区的皮肤痛觉阻滞效果比较,差异无统计学意义(P>0.05)。结论与臂丛阻滞比较,臂丛复合上臂根部ICBN阻滞能为肱骨远端骨折手术提供更完善的麻醉效果,患者的满意度评分更高。

Objective To retrospectively analyze the clinical effect of ultrasound-guided brachial plexus combined with intercostobrachial nerve(ICBN)block at the root of upper arm in the operation of distal humeral fracture through a posterior approach.Methods A total of 60 patients with distal humeral fracture who were admitted to Jinjiang Hospital of Traditional Chinese Medicine from January 2019 to December 2023 were selected and divided into the observation group(n=30,brachial plexus combined with ICBN block)and the control group(n=30,brachial plexus block)according to different nerve block methods.Visual analogue scale(VAS)scores was recorded at the time of onset of block(t0),skin incision(t1),exposure of fracture end(t2),anatomical reduction of fracture(t3)and skin suture(t4).The onset time of block,the effect of acupuncture pain block,the number of patients requiring auxiliary analgesic drugs during operation and the score of patient satisfaction with anesthesia were recorded.Results The VAS scores at t1,t2,t3 and t4 of the observation group were lower than those of the control group,the onset time of block was lower than that of the control group,the effect of skin pain block in the distal medial and posterior regions of the upper arm was better than that of the control group,the proportion of patients requiring auxiliary analgesic drugs during operation was lower than that of the control group,and the score of patient satisfaction with anesthesia was higher than that of the control group,with statistically significant differences(P<0.05).There was no significant difference between the two groups in the VAS score at t0(P>0.05).There was no significant difference in the effect of skin pain block in the distal lateral region of the upper arm between the two groups(P>0.05).Conclusion Compared with brachial plexus block,brachial plexus combined with ICBN block at the root of upper arm can provide more perfect anesthesia effect for distal humeral fracture surgery,with higher score of patient satisfaction.