连续臂丛麻醉用于上肢手术及其术后镇痛的应用

Continuous Brachial Plexus Anesthesia Used in Upper Extremity Surgery and Postoperative Analgesia

目的对上肢手术与其术后镇痛应用连续臂丛麻醉的临床疗效及意义进行探究。方法整群选取2014年1月—2014年12月该院拟行上肢手术患者并且ASAI^II级的70例进行随机分组,对照组35例:采用常规臂丛麻醉,术后芬太尼为主的皮下镇痛;研究组35例:行连续臂丛神经阻滞,术后接罗派卡为主的镇痛泵;观察两组麻醉效果、臂丛神经各支麻醉阻滞情况、术后VAS镇痛评分、Ramesay镇静评分、不良反应情况。结果研究组效果明显优于对照组,6个皮区运动和感觉神经阻滞差异无统计学意义,研究组VAS镇痛评分与对照组差异无统计学意义,Ramesay镇静评分明显低于对照组,差异有统计学意义;术后对照组发生不良反应6例,研究组1例,两组不良反应发生率差异无统计学意义。结论上肢手术应用连续臂丛麻醉效果确切、术后镇痛、镇静效果满意、不良反应少。

Objective To explore the clinical efficacy and value of continuous brachial plexus anesthesia in upper extremity surgery and postoperative analgesia. Methods 70 patients who were in ASAI-II level and underwent upper extremity surgery in this hospital between January 2014 and December 2014 were randomized to control group and study group. The 35 in the control group were given conventional brachial plexus anesthesia combined with postoperative subcutaneous analgesia by fentanyl, while the other 35 in the study group underwent continuous brachial plexus anesthesia followed by the mainly use of ropivacaine hydrochloride via analgesia pump. We observe the anesthesia effect, postoperative VAS pain score, anesthetic blocking of 6 nerves,Ramesay sedation score, adverse reactions. Results The anesthesia effect was obvious better in the study group than in the control group; there were no statistically significant differences in motor nerve block and sensory nerve block between 6 skin areas; there was no statistically significant difference in postoperative VAS pain score between the two groups; the Ramesay sedation score was significantly lower in the study group than in the control group with statistical difference; there were 6 cases of adverse reaction in the control group and 1 case in the study group, and the difference was statistically significant. Conclusion Continuous brachial plexus anesthesia applied in upper extremity surgery and postoperative analgesia can produce exact and satisfactory anesthesia effect but less adverse reaction.