Clinical application of ultrasound-guided selective proximal and distal brachial plexus block in rapid rehabilitation surgery for hand trauma

BACKGROUND Anesthesia plays an essential role in the successful surgical procedures for hand trauma.Compared with general anesthesia,brachial plexus block shows lots of benefits for the upper extremity.Specifically,ultrasound-guided selective proximal and distal brachial plexus block may overcome the issues of incomplete block and failure of anesthesia in such circumstances.The present study assessed the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in clinical practice.AIM To explore the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in rapid recovery surgery for hand trauma.METHODS A total of 68 patients with traumatic hand injuries treated at our hospital from January 2018 to June 2019 were selected.They were divided into an observation group and a control group with 34 patients in each group.The observation group underwent selective brachial plexus block guided by ultrasound and the control group underwent conventional brachial plexus block.The analgesic efficacy,intraoperative complications,wound healing time,and length of hospital stay were compared between the two groups under different anesthesia.RESULTS The percentage of cases with analgesia graded as“excellent or very good”was higher in the observation group than in the control group(P<0.05).Moreover,the incidence of intraoperative complications was lower and the wound healing time and length of hospital stay were shorter in the observation group than in the control group(P<0.05).CONCLUSION Ultrasound-guided selective proximal and distal brachial plexus block has remarkable analgesic efficacy in patients with traumatic hand injuries.It can reduce the incidence of intraoperative complications,promote wound healing,and shorten the length of hospital stay.

Comparison of Patient Satisfaction between Brachial Plexus Block (Axillary Approach) and General Anesthesia for Surgical Treatment of Distal Radius Fractures: A Historical Cohort Study

Background: Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). Whether anesthesia type affects patient outcomes is unclear. This study retrospectively compared patient satisfaction between GA and NB after surgery. Methods: This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively. Results: After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p = 0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: -1.27 and -0.77, p = 0.00074 and p = 0.0388, respectively), as was surgery duration (effect size: -0.84, p = 0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p = 0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively. Conclusions: Patient satisfaction between distal radius fracture surgery under GA and NB was similar. Nerve block could help shorten hospital stay length and surgery duration and improve postoperative functional recovery.

Combined thoracic paravertebral block and interscalene brachial plexus block for modified radical mastectomy:A case report

BACKGROUND Modified radical mastectomy(MRM)is the most common surgical treatment for breast cancer.General anesthesia poses a challenge in fragile MRM patients,including cardiovascular instability,insufficient postoperative pain control,nausea and vomiting.Thoracic paravertebral block(TPVB)is adequate for simple mastectomy,but its combination with interscalene brachial plexus block(IBPB)has not yet been proved to be an effective anesthesia method for MRM.CASE SUMMARY We describe our experience of anesthesia and pain management in 10 patients with multiple comorbidities.An ultrasound-guided TPVB was placed at T2-T3 and T5-T6,and combined with IBPB,with administration of 10,15 and 5 mL of 0.5%ropivacaine,respectively.A satisfactory anesthetic effect was proved by the absence of ipsilateral tactile sensation within 30 min.Propofol 3 mg/kg/h and oxygen supplementation via a nasal cannula were administered during surgery.None of the patients required additional narcotics,vasopressors,or conversion to general anesthesia.The maximum pain score was 2 on an 11-point numerical rating scale.Two patients required one dose of celecoxib 8 h postoperatively and none reported nausea or emesis.CONCLUSION This case series demonstrated that combined two-site TPVB and small-volume IBPB with sedation can be used as an alternative anesthetic modality for MRM,providing good postoperative analgesia.

Comparing the Efficacy of Dexmedetomidine When Used as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Blocks under Ultrasound-Guided

Background: Ultrasound-guided for regional anesthesia offers many potential benefits in the emergency setting. Analgesia can be explicitly targeted to the region of pain and provide relief for many hours and decrease needing to the large volume of local anesthetic. The aim of the work: Comparing the efficacy of dexmedetomidine when used as an adjuvant to bupivacaine in supraclavicular brachial plexus blocks on the onset of sensory, motor blockade and postoperative analgesia. Patients and methods: This prospective, randomized, single-blind clinical study conducted on 60 patients underwent upper limb surgery done by ultrasound-guided supraclavicular brachial plexus block;these patients allocated into two equal groups: Group I (control) received 20 ccs (19 cc bupivacaine 0.5% + 1 cc saline), Group II received 20 cc (19 cc bupivacaine 0.5% + 1 cc volume of Dexmedetomidine 1 ug/kg). Results: Demographic data and surgical characteristics were comparable in both groups. The onset times for sensory and motor blocks were significantly shorter in Group II than Group I (P Conclusion: We recommend adding Dexmedetomidine to local anesthetics in peripheral nerve blocks to take advantage of the prolonged time of both sensory and motor blocks and prolonged postoperative analgesia.

Hemodynamic instability following intravenous dexmedetomidine infusion for sedation under brachial plexus block: Two case reports

BACKGROUND Dexmedetomidine(DMED)is frequently used as a sedative in several medical fields.The benefits of DMED include enhanced quality of regional anesthesia,prolonged analgesia,and postoperative opioid-sparing when administered intravenously or perineurally in combination with regional anesthesia.Severe hemodynamic complications,such as profound bradycardia and hypotension,can occur after DMED administration in critically ill patients or overdosage;however,there are few reports of complications with DMED administration following brachial plexus block(BPB).CASE SUMMARY We present two cases of hemodynamic instability that occurred following the initial loading of DMED under supraclavicular BPB.A healthy 29-year-old man without any medical history showed profound bradycardia after receiving a loading dose of DMED 0.9μg/kg for 9 min.DMED administration was promptly stopped,and after receiving a second dose of atropine,the heart rate recovered.A 62-year-old woman with a history of cardiomyopathy became hypotensive abruptly,requiring the administration of inotrope and vasopressors after receiving a reduced loading dose of 0.5μg/kg for 10 min.Half of the recommended loading dose of DMED was administered due to the underlying heart dysfunction.Decrea-sed blood pressure was maintained despite the intravenous administration of ephedrine.With continuous infusion of dopamine and norepinephrine,the vital signs were maintained within normal ranges.Inotropic and vasopressor support was required for over 6 h after the initial loading dose of DMED.CONCLUSION DMED administration following BPB could trigger hemodynamic instability in patients with decreased cardiac function as well as in healthy individuals.

Application value of sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block for children with upper limb fractures

Objective:To study the application value of sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block for children with upper limb fractures. Methods:Children who underwent upper limb fracture surgery in the First Women and Children's Hospital of Huizhou between June 2014 and April 2017 were selected as the research subjects and randomly divided into the combined group who accepted sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block and the control group who accepted sevoflurane light general anesthesia via laryngeal mask airway. The contents of inflammatory cytokines IL-1β, TNF-α, CRP, IL-10 and TGF-β as well as stress hormones FC, Ins, NE and E in serum were determined the same day and 3 days after operation.Results: The same day and 3 days after operation, the contents of IL-1β, TNF-α, CRP, IL-10, TGF-β, FC, Ins, NE and E in serum of combined group were significantly lower than those of control group.Conclusion: Sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block is more effective than sevoflurane light general anesthesia via laryngeal mask airway to suppress the inflammatory stress response in children with upper limb fracture surgery.

Structure of the brachial plexus root and adjacent regions displayed by ultrasound imaging

Brachial plexuses of 110 healthy volunteers were examined using high resolution color Doppler ultrasound. Ultrasonic characteristics and anatomic variation in the intervertebral foramen, interscalene, supraclavicular and infraclavicular, as well as the axillary brachial plexus were investigated. Results confirmed that the normal brachial plexus on cross section exhibited round or elliptic hypoechoic texture. Longitudinal section imaging showed many parallel linear hypo-moderate echoes, with hypo-echo. The transverse processes of the seventh cervical vertebra, the scalene space, the subclavian artery and the deep cervical artery are important markers in an examination. The display rates for the interscalene, and supraclavicular and axillary brachial plexuses were 100% each, while that for the infraclavicular brachial plexus was 97%. The region where the normal brachial plexus root traversed the intervertebral foramen exhibited a regular hypo-echo. The display rate for the C5-7 nerve roots was 100%, while those for C8 and T1 were 83% and 68%, respectively. A total of 20 of the 110 subjects underwent cervical CT scan. High-frequency ultrasound can clearly display the outline of the transverse processes of the vertebrae, which were consistent with CT results. These results indicate that high-frequency ultrasound provides a new method for observing the morphology of the brachial plexus. The C~ vertebra is a marker for identifying the position of brachial plexus nerve roots.

Improved C_(3-4) transfer for treatment of root avulsion of the brachial plexus upper trunk Animal experiments and clinical application

Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C34 transfer for neurotization of 05-6. Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased. The rate of C3 instead of C5 and the C4 ＋ phrenic nerve instead of C6 myelinated nerve fibers crossing through the anastomotic stoma was approximately 80%. Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side. In clinical applications, 39 patients with root avulsion of the brachial plexus upper trunk were followed for 6 months to 4.5 years after treatment using the improved C3 instead of C5 nerve root transfer and C4 nerve root and phrenic nerve instead of C6 nerve root transfer. Results showed that the strength of the brachial biceps and deltoid muscles recovered to level IIHV, scapular muscle to level Ill-W, latissimus dorsi and pectoralis major muscles to above level Ⅲ, and the brachial triceps muscle to level 0 Ill. Results showed that the improved 03-4 transfer for root avulsion of the brachial plexus upper trunk in animal models is similar to clinical findings and that C3-4 and the phrenic nerve transfer for neurotization of C5-6 can innervate the avulsed brachial plexus upper trunk and promote the recovery of nerve function in the upper extremity.

Bilateral superficial cervical plexus block for parathyroidectomy during pregnancy:A case report

BACKGROUND Primary hyperparathyroidism(PHPT)is the most common cause of pregnancyrelated hypercalcemia.PHPT can cause maternal and fetal complications in pregnant women.General anesthesia for non-obstetric surgery in pregnant women is associated with maternal hazards and concerns regarding long-term neonatal neurocognitive effects.Surgical removal of the lesion in mid-pregnancy is currently the primary treatment option for pregnant patients with PHPT.However,the blood calcium concentration at which surgery should be considered remains under discussion due to the risk of miscarriage.CASE SUMMARY A 31-year-old nulliparous woman at 11 wk of gestation was admitted to our hospital for parathyroidectomy.The patient had a history of intrauterine fetal death with unknown etiology at 16 wk of gestation 1 year prior.Her blood test results showed that the serum calcium level was elevated to 12.9 mg/dL,and the parathyroid hormone level was elevated to 157 pg/mL.In a neck ultrasound,it revealed a 0.8 cm×1.5 cm sized oval,hypoechoic mass in the upper posterior of the left thyroid gland,which was compatible with parathyroid adenoma.Superficial cervical plexus block(SCPB)for parathyroidectomy was performed.After surgery,the obstetrician checked the status of the fetus,and there were no abnormal signs.Since then her calcium level returned to normal values after one week of surgery and a healthy male neonate of 2910 g was delivered vaginally at 38 wk of gestation.CONCLUSION Our case suggests that SCPB can be an anesthetic option for parathyroidectomy during the first trimester of pregnancy.

Schwannoma of the Brachial Plexus Presented as a Neck Mass: A Case Report and Review of the Literature

Schwannomas of the head and neck as well as brachial plexus primary tumors are both uncommon entities, and combination of these conditions is quite rare. Schwannomas of the brachial plexus are usually asymptomatic and they present as slowly enlarging masses in the supra- or infraclavicular regions. Although imaging plays a routine role in the detection of these neoplasms, identification of the nerve origin is not often feasible until the time of surgery. Definitive diagnosis is based on histopathological features with presence of spindle-shaped Schwann cells. We report a case of a middle aged woman with left lateral mid-neck mass, which based on the clinical findings, was provisionally diagnosed as a painless lymphadenopathy. Ensuing excisional biopsy revealed the brachial plexus as the origin of a tumor, which subsequently was confirmed to be a schwannoma with microscopic evaluation. The course of disease was complicated with upper brachial plexus injury which was recovered by sural nerve graft.

Clinical Observation on Brachial Plexus Block with “One Injection Two Points” Method Guiding by Ultrasound

OBJECTIVE: To compare the clinical effect of brachial plexus block with "One Injection Two Points" guided under ultrasound and the conventional method guiding by ultrasound. METHODS: 70 patients were randomized evenly into 2 groups, with 35 patients in each group, while the Experiment Group(Group B) received One Injection Two Points" method, the Control Group(Group A) received the conventional method.The nerve block every 5 s, the success rate of anesthesia, the dosage of local anesthetics, second remedial anesthesia, adverse reactions, etc.were recorded. RESULTS: Group B was superior to group A in the success rate of anesthesia; There were 6 patients in group A who required constant pump injection of Remifentanil to remedy, while no patients in Group B needed remedy treatment. There were no serious adverse reactions in both groups.CONCLUSIONS: The clinical effect of brachial plexus block with "One Injection Two Points" method guided under ultrasoundguiding by ultrasound was superior to that of the conventional method.

Combined sevoflurane-dexmedetomidine and nerve blockade on post-surgical serum oxidative stress biomarker levels in thyroid cancer patients

BACKGROUND The incidence of thyroid cancer is increasing annually.Clinical routine thyroid surgery can be performed under a cervical plexus block,but cannot mediate the stress response during the surgery.If thyroid surgery is performed under nerve block,an inappropriate level of blockade may occur.Similarly,the stress response caused by surgery is more serious than that caused by conventional anesthesia.Therefore,it is important to combine blockade with more effective anesthesia methods.AIM To investigate the effects of combining sevoflurane-dexmedetomidine inhalation general anesthesia with the cervical plexus nerve block on the post-surgical levels of the serum oxidative stress biomarkers levels in thyroid cancer patients.METHODS We enrolled 96 thyroid cancer patients admitted to the hospital between January 2019 and December 2020.Participants were divided into a control group(n=47)and an experimental group(n=49).The experimental group received a combination of inhaled sevoflurane-dexmedetomidine and cervical plexus block,while the control group received conventional general anesthesia.The groups were compared for serum levels of monocyte chemotactic protein-1(MCP-1)and glutathione peroxidase(GSH-Px)before and after surgery,and the adrenocorticotropic hormone(ACTH)and norepinephrine(NE)levels at 1 and 12 h postsurgery.The Bispectral index(BIS)and the incidence of anesthesia side effects were also compared.RESULTS Following surgery,MCP-1 was significantly lower in the experimental group compared to the control group,whereas GSH-Px was significantly higher than that in the control group(P<0.001).The serum ACTH and NE levels were significantly lower in the experimental group than those the control group at 1 and 12 h post-surgery(P<0.001).BIS was significantly lower in the experimental group than that in the control group at 20 minutes into the operation,but the direction of the difference was reversed at eye opening(P<0.001).The incidence of side effects was 10.20%(5/49)and 12.76%(6/47)in the experimental and control groups,respectively,the difference being non-significant.CONCLUSION Sevoflurane-dexmedetomidine inhalation general anesthesia combined with cervical plexus nerve block can reduce the postoperative stress and inflammatory responses in thyroid cancer patients,while maintaining high anesthesia effectiveness and safety.

Ultrasound guidance for brachial plexus block decreases the incidence of complete hemi-diaphragmatic paresis or vascular punctures and improves success rate of brachial plexus nerve block compared with peripheral nerve stimulator in adults

Background The use of traditional techniques （such as landmark techniques, paresthesia and peripheral nerve stimulator） for upper-limb anesthesia has often been restricted to the expert or enthusiast, which was blind. Recently, ultrasound （US） has been applied to differ blood vessel, pleura and nerve, thus may reduce the risk of complications while have a high rate of success. The aim of this study was to determine if the use of ultrasound guidance （vs. peripheral nerve stimulator, （PNS）） decreases risk of vascular puncture, risk of hemi-diaphragmatic paresis and risk of Homer syndrome and improves the success rate of nerve block. Methods A search strategy was developed to identify randomized control trials （RCTs） reporting on complications of US and PNS guidance for upper-extremity peripheral nerve blocks （brachial plexus） in adults available through PubMed databases, the Cochrane Central Register of Controlled Trials, Embase databases, SinoMed databases and Wanfang data （date up to 2011-12-20）. Two independent reviewers appraised eligible studies and extracted data. Risk ratios （OR） were calculated for each outcome and presented with 95% confidence intervals （CI） with the software of Review Manager 5.1.0 System （Cochrane Library）. Results Sixteen trials involving 1321 adults met our criteria were included for analysis. Blocks performed using US guidance were more likely to be successful （risk ratio （RR） for block success 0.36, 95% CI 0.23-0.56, P 〈0.00001）, decreased incidence of vascular puncture during block performance （RR 0.13, 95% CI 0.06-0.27, P 〈0.00001）, decreased the risk of complete hemi-diaphragmatic paresis （RR 0.09, 95% CI 0.03-0.52, P=-0.0001）. Conclusions US decreases risks of complete hemi-diaphragmatic paresis or vascular puncture and improves success rate of brachial plexus nerve block compared with techniques that utilize PNS for nerve localization. Larger studies are needed to determine whether or not the use of US can decrease risk of neurologic complications.

The Crucial Role of Bilateral Infraclavicular Nerve Blocks in the Anesthetic Management of a Trauma Patient

Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerve blocks were placed as part of a multimodal approach to pain management in a trauma patient. We discuss potential hazards, important considerations, and rationale for attempting this procedure. Ultimately, performing bilateral brachial plexus nerve blocks in trauma patients is a viable option when choosing pain management techniques.

“鸡尾酒”封闭在GartlandⅢ型儿童肱骨髁上骨折术后的早期镇痛效果

目的 比较“鸡尾酒”封闭与臂丛神经阻滞在GartlandⅢ型儿童肱骨髁上骨折术后镇痛的临床效果。方法2018年1月至2020年2月,58例儿童肱骨髁上骨折患者纳入本研究。其中,男34例,女24例;年龄2~10岁,平均(6.53±2.44)岁。根据抽签法随机分组,封闭组(39例)采用骨折端血肿内“鸡尾酒”封闭镇痛,神经阻滞组(19例)采用臂丛神经阻滞镇痛。记录术后WB-FACES疼痛评分、肿胀分级及麻醉中毒反应情况,在随访过程中记录骨折临床愈合时间及Mayo肘关节功能评分、肘关节屈-伸ROM、前臂旋前-旋后ROM。结果 所有患者均获得随访,随访时间12~37个月,平均(17.32±4.02)个月。术后1 d和7 d时两组间的WB-FACES疼痛评分、肿胀分级比较,差异无统计学意义(P>0.05);但术后2 d和3 d,封闭组的WB-FACES疼痛评分和肿胀分级显著低于神经阻滞组,差异有统计学意义(P<0.05)。两组间麻醉中毒反应分级比较,差异无统计学意义(P>0.05)。封闭组骨折愈合时间为(5.46±1.41)周,神经阻滞组则为(5.11±1.15)周,两组间比较差异无统计学意义(t=0.955,P=0.343)。术后3个月和末次随访时,两组患者Mayo肘关节评分、肘关节屈-伸ROM和前臂旋前-旋后ROM比较,差异无统计学意义(P>0.05)。结论 儿童GartlandⅢ型肱骨髁上骨折采用“鸡尾酒”封闭在术后早期疼痛控制中优于臂丛神经阻滞,而且操作简单,安全性与神经阻滞类似。

Supplementary motor area deactivation impacts the recovery of hand function from severe peripheral nerve injury

Although some patients have successful peripheral nerve regeneration,a poor recovery of hand function often occurs after peripheral nerve injury.It is believed that the capability of brain plasticity is crucial for the recovery of hand function.The supplementary motor area may play a key role in brain remodeling after peripheral nerve injury.In this study,we explored the activation mode of the supplementary motor area during a motor imagery task.We investigated the plasticity of the central nervous system after brachial plexus injury,using the motor imagery task.Results from functional magnetic resonance imaging showed that after brachial plexus injury,the motor imagery task for the affected limbs of the patients triggered no obvious activation of bilateral supplementary motor areas.This result indicates that it is difficult to excite the supplementary motor areas of brachial plexus injury patients during a motor imagery task,thereby impacting brain remodeling.Deactivation of the supplementary motor area is likely to be a serious problem for brachial plexus injury patients in terms of preparing,initiating and executing certain movements,which may be partly responsible for the unsatisfactory clinical recovery of hand function.

Giant tumor resection under ultrasound-guided nerve block in a patient with severe asthma:A case report

BACKGROUND General anesthesia in critically ill patients is associated with increased risk of complications.Nerve block anesthesia is an alternative,but could be challenging in cases with surgical field that involves multiple dermatomes.CASE SUMMARY We report resection of a giant lipoma in the left shoulder and upper back under supraclavicular brachial plexus block plus T3-4 paravertebral block in an older patient with severe asthma.A 70-year-old patient presented with a slow-growing giant mass(25,15 and 5 cm in length,width and depth,respectively)that extended from the lateral side of the left scapula to the axillary midline,and from the T5 thoracic vertebra intercostal to the mid-medial section of the left upper arm.He had sharp intermittent pain over the mass for the past 7 d.The patient also had severe bronchial asthma for the past 8 years.A pulmonary function test revealed only 20%of the predicted forced expiratory volume in 1 second(FEV1,0.49 L).After controlling asthma with glucocorticoid,the tumor was resected under ultrasound-guided supraclavicular brachial plexus block and T3-4 paravertebral block.The surgery was completed without incident.CONCLUSION Ultrasound-guided regional nerve block is a viable alternative for patients with poor cardiopulmonary function undergoing shoulder,back and axillary surgery.

Anesthetic management of patient with hypertrophic cardiomyopathy and automatic implantable cardioverter defibrillator with a hand fracture

A 26-year-old male with a history of hypertrophic cardiomyopathy(HCM) and ventricular arrhythmias s/p automatic implantable cardioverter defibrillator(AICD) placement presented for open reduction and internal fixation of an open third metacarpal fracture and extensor tendon repair. He underwent successful surgery after placement of an ultrasound-guided infraclavicular brachial plexus block with ropivacaine 0.5% as the main anesthetic. This case report discusses the anesthetic management of patients with HCM and AICD, different approaches available for brachial plexus blockade, and potential complications of anesthesia and surgery in this group of patients.

脑电双频指数监测下腋路臂丛神经阻滞复合全身麻醉在肩关节镜手术中的应用效果

目的:探究脑电双频指数(BIS)监测下腋路臂丛神经阻滞复合全身麻醉在肩关节镜手术中的应用效果。方法:选择2020年1月—2023年1月在宁夏医科大学总医院、吴忠市人民医院进行肩关节镜手术的患者86例,应用随机数字表法将其分为对照组(采用BIS监测下锁骨上入路臂丛神经阻滞复合全身麻醉)及观察组(采用BIS监测下腋路臂丛神经阻滞复合全身麻醉),各43例。对比两组不同时刻[麻醉前(T_(0))、气管插管即刻(T_(1))、切皮时(T_(2))、拔管时(T_(3))]心率(HR)、平均动脉压(MAP)、BIS值;对比两组麻醉苏醒后及术后2、12 h疼痛评分[视觉模拟评分法(VAS)]、肌力评分;对比两组术中舒芬太尼用量;对比两组不良反应发生率。结果:T_(0)时,两组HR、MAP比较,差异均无统计学意义(P>0.05);T_(1)、T_(2)、T_(3)时,观察组HR、MAP均低于对照组,差异均有统计学意义(P<0.05);T_(0)、T_(1)、T_(2)时,两组BIS比较,差异均无统计学意义(P>0.05);观察组T_(3)时BIS高于对照组,差异有统计学意义(P<0.05)。观察组麻醉苏醒后及术后6、12 h的VAS评分均低于对照组,肌力评分均高于对照组,差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计意义(P>0.05)。结论:BIS监测下腋路臂丛神经阻滞复合全身麻醉在肩关节镜手术中的麻醉效果显著,可稳定血流动力学,患者术后疼痛程度较轻,对肌力影响较小,安全性较高。

0.25%罗哌卡因用于超声引导颈中间丛阻滞的有效容量探讨

目的探索0.25%罗哌卡因用于超声引导颈中间丛阻滞的半数有效容量和95%有效容量。方法选择29例行择期颈部手术的患者,均在超声引导下进行0.25%罗哌卡因颈中间丛阻滞,若颈丛分支所属皮区痛觉均消失,则视为完全阻滞(完全阻滞组,14例),否则视为不完全阻滞(不完全阻滞组,15例)。记录阻滞效果,分析0.25%罗哌卡因用于超声引导颈中间丛阻滞的有效容量;比较完全阻滞组和不完全阻滞组患者的一般特征、罗哌卡因阻滞容量、并发症发生情况及阻滞前后深吸气膈肌移动度。结果0.25%罗哌卡因用于超声引导颈中间丛阻滞的半数有效容量为10.3 ml[95%可信区间(CI)=(7.7,13.5)ml],95%有效容量为15.6 ml[95%CI=(12.8,44.0)ml]。完全阻滞组和不完全阻滞组年龄、性别、美国麻醉医师协会(ASA)分级、身高、体重及体质量指数(BMI)比较差异无统计学意义(P>0.05)。完全阻滞组用罗哌卡因容量(11.1±2.0)ml显著高于不完全阻滞组的(9.2±2.0)ml,差异有统计学意义(P<0.05)。不完全阻滞组与完全阻滞组阻滞前深吸气膈肌移动度分别为(4.17±0.87)、(4.09±0.85)cm,比较差异无统计学意义(P>0.05);不完全阻滞组与完全阻滞组阻滞后深吸气膈肌移动度分别为(4.09±0.85)、(3.99±0.70)cm,比较差异无统计学意义(P>0.05)。完全阻滞组1例患者发生声音嘶哑,其给药容量为14 ml;其余所有患者均未发生膈神经阻滞、迷走神经阻滞、局部麻醉药物中毒、Horner征或低氧血症等情况。结论0.25%罗哌卡因用于超声引导颈中间丛阻滞的半数有效容量为10.3 ml[95%CI=(7.7,13.5)ml],95%有效容量为15.6 ml[95%CI=(12.8,44.0)ml]。