双重引导下三点法颈部神经根阻滞在锁骨骨折内固定术中的应用

目的探究超声联合神经刺激仪引导下三点法颈部神经根阻滞在锁骨骨折内固定术中的应用价值。方法78例行锁骨骨折内固定术治疗的患者,依据麻醉方式的不同分为对照组与观察组,每组39例。对照组选用臂丛与颈浅丛联合神经阻滞,观察组在超声联合神经刺激仪引导下分别在C4、C5、C6横突处三点给予小剂量局麻药行颈部神经根阻滞。比较两组麻醉阻滞情况、感觉阻滞效果、麻醉效果满意度与并发症发生情况。结果观察组麻醉操作时间(5.32±1.67)min及阻滞起效时间(4.35±0.81)min短于对照组的(14.68±1.46)、(12.18±1.40)min,感觉恢复时间(630.58±13.62)min长于对照组的(579.16±10.48)min,差异有统计学意义(P<0.05)。观察组阻滞完全率89.74%高于对照组的51.28%,阻滞不全率10.26%低于对照组的48.72%,差异均有统计学意义(P<0.05)。观察组非常满意率82.05%高于对照组的61.54%,基本满意率17.95%低于对照组的38.46%,差异均有统计学意义(P<0.05)。观察组不良反应发生率为0,低于对照组的43.59%,差异有统计学意义(P<0.05)。结论在锁骨骨折内固定术中应用超声联合神经刺激仪双重引导下行C4~6神经根阻滞,小剂量的局麻药即可取得满意的麻醉效果,并且麻醉操作时间与阻滞起效时间较短,并发症少,值得广泛应用于临床中。

Application of double-guided three-point cervical nerve root block in internal fixation of clavicle fracture

Objective To investigate the clinical value of cervical nerve root block under ultrasound guidance combined with nerve stimulator in internal fixation of clavicular fracture.Methods A total of 78 clavicle fracture patients undergoing internal fixation were divided into control group and observation group by different anesthesia methods,with 39 cases in each group.The control group received combined nerve block of brachial plexus and superficial cervical plexus,and the observation group received small doses of local anesthetics at C4,C5 and C6 transverse process for cervical nerve root block under ultrasound guidance combined with nerve stimulation.The anesthesia block,analgesia effect in operation area,satisfaction of anesthesia effect and occurrence of complications were compared and observed between the two groups.Results The operation time of anesthesia(5.32±1.67)min and onset time of block(4.35±0.81)min in the observation group was shorter than(14.68±1.46)and(12.18±1.40)min in the control group,and sensory recovery time(630.58±13.62)min was longer than(579.16±10.48)min in the control group.Their difference was statistically significant(P<0.05).The complete block rate of the observation group was 89.74%,which was higher than 51.28%of the control group,and incomplete block rate was 10.26%,which was less than 48.72%of the control group.Their difference was statistically significant(P<0.05).The very satisfied rate of the observation group was 82.05%,which was higher than 61.54%of the control group,and the basic satisfied rate was 17.95%,which was lower than 38.46%of the control group.Their difference was statistically significant(P<0.05).The incidence of adverse reactions was 0 in the observation group,which was lower than 43.59%in the control group,and the difference was statistically significant(P<0.05).Conclusion In the internal fixation of clavicle fracture,C4-6 cervical nerve root block under ultrasound guidance combined with nerve stimulator can achieve satisfactory anesthetic effect with small dose of local anesthetics,and the operation time of anesthesia and onset time of block are short,the complications are less.It is worthy of extensive application in clinical practice.