超声引导下锁骨上入路臂丛神经阻滞麻醉效果观察

Anesthetic effect of ultrasound-guided supraclavicular approach brachial plexus block

目的观察超声引导下锁骨上入路臂丛神经阻滞的麻醉效果。方法选择2014年5月至2016年3月间我院收治的拟行单侧上肢手部手术男性患者100例,所有患者ASAΙ~Ⅱ级、体格正常、18~55岁,在超声引导下行锁骨上臂丛神经阻滞,对比注药前的超声解剖图像,观察记录臂丛神经鞘的位置,观察记录操作用时,麻醉阻滞效果,不良反应发生率。局麻药用量为0.5%罗哌卡因30 m L,超声设备为迈瑞彩色多普勒超声系统。结果臂丛神经鞘到皮肤的距离(平均值):上缘1.002 cm(100例),下缘2.26 cm(45例);操作平均用时3分56秒,92%的操作用时在3~5 min内;麻醉效果中优90%,良8%,差2%,无效0,有效率为98%;不良反应发生有霍纳征1例、注药后寒颤1例。结论超声引导下锁骨上入路臂丛神经阻滞对由桡神经和正中神经支配的区域基本上都能获得满意的阻滞效果,在安全范围内,使用较大剂量(浓度)的局麻药和(或)追加尺神经阻滞是有必要的。

Objective To observe the anesthetic effect of ultrasound-guided supraclavicular brachial plexus block anesthesia. Methods One hundred male patients of ASA Ⅰ~Ⅱ grade, normal physique, 18~55 years old, who were scheduled for unilateral upper extremity surgery, were selected during May 2014 to March 2016. Compared with ultrasound anatomy images before the injection, the brachial plexus sheath position, the operation duration, anesthetic effect, adverse reaction incidence were recorded after ultrasound-guided supraclavicular approach brachial plexus block. The amount of local anesthetic was 0.5% ropivacaine 30 m L. The ultrasound equipment used in the study was Mindray color Doppler ultrasound system. Results The distance of brachial plexus sheath to skin(average value) was1.002 cm(100 cases) for upper edge and 2.26 cm(45 cases) for lower edge. The operation duration was 3 minutes and56 seconds in average, and 92% of the operation lasted for 3 minutes to 5 minutes. The anesthetic effect was excellent in 90%, good in 8%, poor in 2%, and invalid in 0, with the effective rate of 98%. The occurrence of adverse reaction included Horner syndrome in 1 case, and shivering after the injection in 1 case. Conclusion Ultrasound-guided supraclavicular approach brachial plexus block can achieve satisfactory results for both radial nerve and the area of the median nerve. In margin of safety, using a larger dose(concentration) of local anesthetic and(or) additional ulnar nerve block is necessary.