不同容量和浓度罗哌卡因经喙突入路臂丛神经阻滞的效果

目的比较不同容量和浓度罗哌卡因经喙突入路臂丛神经阻滞的安全性及其效果。方法选择择期上肢手术患者150例,随机分成三组,每组50例。将罗哌卡因150mg稀释到30ml(0.5%,A组)、40ml(0.375%,B组)和50ml(0.3%,C组)。在喙突内下2cm处,经神经刺激器引导下注入罗哌卡因。记录三组不良反应、臂丛神经感觉和运动阻滞起效时间、感觉、运动阻滞时间及阻滞成功率。结果 A组(82%)阻滞成功率明显低于B组(98%)、C组(94%)(P<0.05)。C组感觉、运动阻滞起效时间明显长于A、B组(P<0.05);感觉、运动阻滞时间明显短于A、B组(P<0.05)。三组发生局麻药中毒A、B和C组分别为4例、0例和2例。结论在喙突入路臂丛神经阻滞中150mg罗哌卡因40ml更安全,麻醉阻滞成功率更高,临床效果更好。     

上肢手术病人超声引导锁骨上臂丛神经阻滞的效果

目的探讨上肢手术病人超声引导锁骨上臂丛神经阻滞的效果。方法拟在锁骨上臂丛神经阻滞下行上肢手术病人120例,ASA Ⅰ-Ⅲ级,随机分为3组(n=40):超声引导组(U组)、神经刺激器组(N组)、传统方法组(T组)。局麻药为0．75％罗哌卡因与2％利多卡因等容量混合液,剂量为0．4ml·kg-1。记录肌皮神经、桡神经、正中神经、尺神经阻滞的起效时间,并评价其阻滞完善率; 评定手术全程的麻醉效果(优、良、差),记录并发症。结果 U组4根神经阻滞完善率均接近100％ (P>0．05),N组和T组尺神经的阻滞完善率均低于肌皮神经和桡神经(P<0．05)。与T组比较,U 组和N组正中神经阻滞完善率均较高,麻醉优良率较高,起效时间均较短(P<0．05或0．01)。与N组比较,U组尺神经阻滞完善率和麻醉优等率较高,起效时间较短(P<0．01)。T组穿刺过程中有3例误入血管,3组均无严重并发症。结论上肢手术病人超声引导锁骨上臂丛神经阻滞较神经刺激器辅助和传统方法下的阻滞效果更好,起效时间更短,在临床上具有推广应用价值。     

超声引导肌间沟臂丛神经阻滞的临床应用

目的 比较超声引导联合神经刺激器(US)定位与单纯神经刺激器(NS)定位行肌间沟臂丛神经阻滞的效果及安全性.方法 选择拟行上肢手术的患者40例,ASA Ⅰ或Ⅱ级,随机均分为US组和NS组.两组均给予0.5%的罗哌卡因30ml.记录寻找目标神经所需时间和完成操作所需时间、感觉神经阻滞起效和持续时间;评价各神经支配区域的感觉阻滞程度、手术区域麻醉效果(优、良、失败);观察并记录并发症.结果 US组完成操作所需时间(3.7±1.1)min,明显短于NS组的(7.2±3.5)min(P<0.01).US组感觉阻滞起效时间(12.0±2.4)min,明显快于NS组(15.2±3.0)min(P<0.05).麻醉效果优等率US组为85%,NS组为70%,差异无统计学意义.US组未出现并发症;NS组有3例患者出现与神经阻滞相关的并发症.结论 超声引导下行肌间沟臂丛神经阻滞操作时间短,阻滞起效快,效果好,并发症少.     

超声引导下臂丛神经阻滞在上肢手术中的应用

目的观察超声引导下臂丛神经阻滞在上肢手术中的应用效果。方法 40例急诊或择期行上肢或手部手术的患者,ASAⅠ~Ⅲ级,随机均分为超声引导组(US组)和传统解剖定位组(NS组),两组均合并使用神经刺激器,局麻药均为0.4%罗哌卡因,US组为30 ml,NS组为40 ml。观察两组麻醉操作完成时间、感觉阻滞起效时间、运动起效时间、感觉恢复时间、运动恢复时间。结果 US组麻醉完成时间、感觉阻滞起效时间、运动阻滞起效时间明显短于NS组(P<0.05或P<0.01)。结论超声引导合并神经刺激器行臂丛神经阻滞可缩短麻醉完成时间,减少局麻药用药量,延长麻醉作用时间,减少并发症的发生。     

超声引导、神经刺激器与传统盲探臂丛神经阻滞应用于肥胖患者效果对比研究

目的 比较超声引导、神经刺激器与传统盲探法3种不同臂丛神经阻滞方法应用于肥胖患者效果及安全性。 方法 行上肢手术患者90例,根据入院顺序编号按照随机数字法分为3组,每组30例,均行肌间沟臂丛神经阻滞。传统盲探组通过异感判断针刺部位行神经阻滞,神经刺激器组于神经刺激仪引导下行臂丛神经阻滞,超声引导组于超声引导下行臂丛神经阻滞,均给予0.375%盐酸罗哌卡因25 ml。比较3组麻醉效果及副作用发生率。 结果 3组神经阻滞操作时间比较,差异无统计学意义（P〉0.05）;超声引导组感觉阻滞起效时间短于传统盲探组、神经刺激器组,且超声引导组感觉阻滞持续时间均长于传统盲探组、神经刺激器组（P〈0.05）。超声引导组手术区域麻醉效果优良率100.0%（30例）,均高于传统盲探组76.7%（23例）及神经刺激器组83.3%（25例）（P〈0.05）。超声引导组并发症发生1例（3.3%）,均低于传统盲探组8例（26.7%）及神经刺激器组4例（13.3%）（P〈0.05）。 结论 超声引导下行肌间沟臂丛神经阻滞感觉阻滞起效时间短,维持时间长,麻醉效果更优,且并发症发生率低,临床应更为安全。     

等剂量不同浓度局麻药用于锁骨下臂丛神经阻滞效果的比较

目的 比较等剂量不同浓度局麻药用于锁骨下臂丛神经阻滞的效果.方法 90例尺桡骨骨折的患者,随机均分为三组.分别将左旋布比卡因50 mg复合利多卡因100 mg用生理盐水稀释至20 ml(A组)、30 ml(B组)、40 ml(C组),行垂直法锁骨下臂丛神经阻滞.观察感觉与运动神经阻滞的起效时间、维持时间、麻醉效果及其不良反应.结果 三组患者桡神经、正中神经阻滞起效时间及不良反应差异无统计学意义;A组患者尺神经阻滞起效时间长于B、C组(P＜0.05),感觉、运动神经完全阻滞例数明显少于B、C组(P＜0.01);A、C组运动恢复时间、切口疼痛时间明显短于B组(P＜0.05).结论 相同药物等剂量情况下低浓度的麻醉药可以减少不良反应和增加麻醉阻滞效果,超过一定的容量后,高浓度会延长神经阻滞的时间.     

不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果

目的 探讨不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果.方法 择期上肢手术患者90例,ASA分级Ⅰ～Ⅲ级,年龄16～75岁,体重40～85 kg.均在超声引导联合神经刺激器辅助定位下行腋路臂丛神经阻滞,根据不同罗哌卡因浓度分为3组(n=30):0.15%罗哌卡因组(A组),0.10%罗哌卡因组(B组),0.05%罗哌卡因组(C组).于注射局麻药后10、30、60、240 min(T1～4)时记录感觉与运动分离阻滞情况、感觉阻滞完善情况和臂丛神经阻滞成功情况,术毕时评定麻醉效果.记录手术时间、镇痛时间.结果 与A组比较,B组T1.2时感觉阻滞完善率较低(P＜0.05),T3.4时感觉阻滞完善率差异无统计学意义(P＞0.05),感觉与运动分离阻滞率较高(P＜0.01),C组T1.2时感觉与运动分离阻滞率较低(P＜0.01),T3.4时感觉与运动分离阻滞率差异无统计学意义(P＞0.05),各时点感觉阻滞完善率较低(P＜0.01).与B组比较,C组各时点感觉阻滞完善率、感觉与运动分离阻滞率均较低(P＜0.01).A组麻醉效果优于B组,B组麻醉效果优于C组(P＜0.01),与A组和B组比较,C组臂丛神经阻滞成功率较低(P＜0.01),A组与B组差异无统计学意义(P＞0.05).结论 0.10%罗哌卡因用于臂丛神经阻滞可产生感觉与运动分离阻滞效果.     

超声定位在肥胖患者臂丛神经阻滞中的应用

目的评价超声引导下肥胖患者臂丛神经阻滞的临床效果。方法上肢手术患者60例,ASAⅠ～Ⅲ级,BMI≥30 kg/m~2,将患者随机均分为两组:A组采用超声定位法,B组采用针刺异感定位法,两组均采用肌间沟路径。记录两组完成阻滞所需时间,评价神经分布区的痛觉和麻醉效果。结果 A组完成阻滞所需时间为(10.5±2.5)min,明显短于B组的(18.5±3.5)min(P<0.05)。A组麻醉成功率高于B组(100%vs 70%),麻醉效果优良率高于B组(100%vs 70%),A组刺破血管和感觉异常发生率明显低于B组(3%vs 33%和0 vs 20%)。结论超声定位在肥胖患者臂丛神经阻滞,能提高阻滞的精确性,缩短操作时间,加快起效速度,减少并发症,是一种安全、有效的局部神经阻滞方法。     

神经刺激器辅助肌间沟臂丛阻滞在锁骨手术中的临床应用

目的比较传统的异感法和外周神经刺激器法在锁骨手术时的麻醉效果。方法 60例锁骨手术的患者随机分为传统肌间沟组（A组）和神经刺激器（PNS）组（B组）,每组各30例。A组以传统异感法定位行肌间沟臂丛神经阻滞,再行颈浅丛神经阻滞;B组以PNS定位行肌间沟臂丛神经阻滞,再同A组行颈浅丛神经阻滞。局麻药为1%利多卡因＋0.375%罗哌卡因混合液,臂丛阻滞剂量为20～30 ml,颈浅丛阻滞剂量为5ml,记录并比较两组麻醉起效维持时间、麻醉效果、辅助用药、不良反应。结果 B组感觉消失时间（T1）、运动消失时间（T2）短于A组（P〈0.05）,镇痛时间（T3）、运动阻滞时间（T4）长于A组（P〈0.05）,B组麻醉效果优于A组。结论肌间沟臂丛神经阻滞复合颈浅丛阻滞可以满足锁骨手术麻醉需要,PNS辅助肌间沟臂丛神经阻滞能提高臂丛阻滞效果,延长术后镇痛时间。     

超声引导在肱骨骨折患者锁骨上臂丛神经阻滞的临床应用及其效果分析

目的 探讨超声引导在肱骨骨折患者锁骨上臂丛神经阻滞的临床应用及其效果.方法选取肱骨骨折患者60例,随机分为A、B组,每组各30例.A组给予超声引导锁骨上臂丛神经阻滞,B组给予单纯手法定位锁骨上臂丛神经阻滞.记录两组的手术麻醉情况,评估臂丛各神经感觉阻滞情况,评估肩、肘、腕关节的运动阻滞程度,比较麻醉并发症.结果 A组臂丛各神经感觉阻滞起效时间、阻滞完善时间均小于B组,阻滞完善率均高于B组 （P＜0.05或P＜0.01）.两组肩关节运动阻滞效果均较肘关节和腕关节差（P＜0.05）,A组肩、肘、腕关节的0级比例均高于B组,2级比例均低于B组.A、B组麻醉优良率分别为100%、76.67% （P＜0.05）.结论超声引导可为肱骨骨折患者进行锁骨上臂丛神经阻滞提供客观的定位指标,动态观察和即时反馈纠正,保障局麻药均匀扩散到神经束表面.该方法起效迅速,完全阻滞高,且未见明显的并发症,具有较高的安全性.     

喙突下臂丛神经阻滞用于骨科上肢手术的效应观察

目的观察用神经刺激仪定位喙突下臂丛神经阻滞的临床效应。方法将80例ASAⅠ~Ⅱ级骨科肘关节以下部位择期手术患者按照随机数字表达法分为喙突下组(A组)和腋路组(B组),每组40例。分别应用神经刺激仪进行喙突下和腋路途径施行臂丛神经阻滞。记录两组阻滞起效时间和维持时间;比较臂丛阻滞效果及感觉阻滞成功率;记录副作用;评价综合满意度。结果同样浓度容量的局麻药,阻滞起效时间A组较B组短(P0.05);维持时间两组间比较差异无统计学意义(P0.05)。桡神经、肌皮神经、腋神经、前臂内侧皮神经、正中神经感觉完全阻滞率A组为93.3%~100%,明显高于B组的60.0%~86.7%(P0.05);两组尺神经感觉完全阻滞率均为100%。两组均无副作用发生;综合满意度A组较B组高(P0.05)。结论用神经刺激仪定位喙突下臂丛阻滞操作简便,阻滞起效时间短,阻滞成功率高,效果确切。     

罗哌卡因混合碳酸利多卡因与等效浓度罗哌卡因用于逆行锁骨下臂丛神经阻滞效果的比较

目的 比较罗哌卡因混合碳酸利多卡因与等效浓度罗哌卡因用于逆行锁骨下臂丛神经阻滞的效果.方法 择期行上肢手术患者60例,ASA分级Ⅰ或Ⅱ级,年龄18～64岁,体重49～ 98 kg,均在超声引导下行逆行锁骨下臂丛神经阻滞.采用随机数字表法,将患者随机分为2组(n＝30),A组应用0.35％罗哌卡因30ml,B组应用0.233％罗哌卡因和0.346％碳酸利多卡因混合液30 ml.于麻醉给药后每隔5 min记录臂丛神经各分支的阻滞效果(感觉阻滞效果评估采用针刺法,运动阻滞效果评估采用Bromage分级),记录感觉和运动阻滞起效时间、麻醉给药后30 min时感觉与运动阻滞有效情况和并发症的发生情况.结果 两组臂丛神经各分支的感觉和运动阻滞起效时间及阻滞有效率比较差异无统计学意义(P＞0.05).两组均未见严重并发症发生.结论 罗哌卡因混合碳酸利多卡因与等效浓度罗哌卡因行逆行锁骨下臂丛神经阻滞效果相似,提示碳酸利多卡因不能增强罗哌卡因的臂丛神经阻滞效应.     

Multiple-injection axillary brachial plexus block: A comparison of two methods of nerve localization-nerve stimulation versus paresthesia

We conducted this prospective study to compare the onset time and the success rate of a multiple-injection axillary brachial plexus block performed by using two methods of nerve localization: paresthesia elicitation or nerve stimulation. Each of the major nerves of the plexus was located by elicitation of a paresthesia (Group PAR; n = 50) or by nerve stimulation (Group PNS; n = 50) and injected with 10 mL of local anesthetic solution. Time to perform the block, onset time of the primary block, time to achieve readiness for surgery, and total anesthetic time were significantly shorter in Group PNS than in Group PAR. The incidence of complete block was larger in Group PNS than in Group PAR (91% vs 76%; P: < 0. 05), and this was related to a larger success rate for anesthetizing the radial and the musculocutaneous nerves (P: < 0.05). The frequency of venous puncture was larger in Group PAR (P: < 0.05). For multiple-injection axillary brachial plexus block, we conclude that nerve stimulation resulted in a greater success rate and a faster onset than paresthesia elicitation, and it should be considered when the radial and musculocutaneous nerve distributions are involved in the surgical area. IMPLICATIONS: Two methods of nerve localization were compared when performing an axillary brachial plexus block by the multiple-injection technique. Nerve stimulation provided a faster onset and a greater incidence of complete block, related to a better success rate for anesthetizing the radial and the musculocutaneous nerves, than paresthesia elicitation.     

The effects of clonidine on ropivacaine 0.75% in axillary perivascular brachial plexus block

INTRODUCTION: The new long-acting local anesthetic ropivacaine is a chemical congener of bupivacaine and mepivacaine. The admixture of clonidine to local anesthetics in peripheral nerve block has been reported to result in a prolonged block. The aim of the present study was to evaluate the effects of clonidine added to ropivacaine on onset, duration and quality of brachial plexus block. METHODS: Patients were randomly allocated into two groups. In group I brachial plexus was performed using 40 ml of ropivacaine 0.75% plus 1 ml of NaCL 0.9%, and in group II brachial plexus was performed using 40 ml of ropivacaine 0.75% plus 1 ml (0.150 mg) of clonidine. Onset of sensory and motor block of radial, ulnar, median and musculocutaneous nerve were recorded. Motor block was evaluated by quantification of muscle force, according to a rating scale from 6 (normal contraction force) to 0 (complete paralysis). Sensory block was evaluated by testing response to a pinprick in the associated innervation areas. Finally, the duration of the sensory block was registered. Data were expressed in mean+/-SD. For statistical analysis a Student t-test was used. A P-value of < or = 0.05 was considered as statistically significant. RESULTS: The duration of blockade was without significant difference between the groups. Group I: 718+/-90 min; Group II: 727+/-117 min. There was no intergroup difference in sensory and motor onset or in quality of blockade. CONCLUSION: The addition of clonidine to ropivacaine 0.75% does not lead to any advantage of block of the brachial plexus when compared with pure ropivacaine 0.75%.     

三角肌运动反应用于小儿经肌间沟臂丛神经阻滞的临床观察

目的为三角肌运动反应作为在外周神经刺激器定位下小儿经肌间沟臂丛神经阻滞终点的临床应用提供参考。方法60例拟行上肢手术患儿,在外周神经刺激器定位下行经肌间沟臂丛神经阻滞,随机分为3组:A组(20例),三角肌运动反应终点组;B组(20例),肱二头肌运动反应终点组;C组(20例),三角肌和肱二头肌运动反应终点组。比较各组在刺激域电流、获得终点时间、合作患儿运动阻滞起效时间及神经阻滞效果的差异。结果组间刺激域电流、运动阻滞起效时间、神经阻滞效果差异无统计学意义(P>0.05);A、B组获得终点时间大于C组(P<0.05)。结论三角肌运动反应终点可以作为小儿经肌间沟臂丛神经阻滞穿刺针正确定位的标志。     

超声引导下锁骨上入路单靶点或三靶点注射法臂丛神经阻滞的效果

目的 比较超声引导下锁骨上入路单靶点和三靶点注射法与传统解剖定位法臂丛神经阻滞的效果.方法 择期拟行上肢手术患者90例,性别不限,ASA Ⅰ或Ⅱ级,随机分为3组(n=30):单靶点组(S组)超声引导下锁骨上臂丛神经周围注射21 ml局麻药;三靶点组(T组)超声引导下在锁骨上臂丛神经与锁骨下动脉相接位置的下方注射7 ml局麻药,再2次(各7 ml)调整穿刺针的位置形成以臂丛神经为中心的扇形注射;传统解剖定位组(A组)取锁骨中点上1 cm左右为穿刺点,注射21 ml局麻药.局麻药为0.375%罗哌卡因和1%利多卡因的混合液.记录各组操作时间和尺神经、正中神经、桡神经支配区域痛觉消失时间及镇痛持续时间;评价各神经支配区域的阻滞程度及切皮时的麻醉效果,观察并发症的发生情况.结果 与A组相比,T组操作时间延长,尺神经分支配区域痛觉消失时间缩短,S组和T组麻醉效果满意率升高,镇痛持续时间延长,尺神经、正中神经的阻滞完全率升高(P＜0.05);与T组相比,S组操作时间缩短,尺神经分支配区域痛觉消失时间延长(P＜0.05);三组桡神经阻滞完全率差异无统计学意义(P＞0.05).A组刺破血管4例,轻度局麻药中毒1例,S组和T组未见并发症发生.结论 与传统解剖定位法相比,超声引导下锁骨上臂丛神经阻滞的单靶点和三靶点注射法麻醉效果较好、镇痛持续时间较长,且并发症较少;三靶点注射法的操作时间较单靶点注射法长,但对尺神经的阻滞较快且完全.     

成人肌间沟臂丛神经阻滞运动反应终点的研究

目的研究胸大肌、三角肌运动反应作为外周神经刺激器(PNS)定位下成人经肌间沟臂丛神经阻滞终点的可行性。方法择期成人上肢手术240例,PNS定位下行经肌间沟臂丛神经阻滞,随机均分为四组:胸大肌运动反应终点组(A组)、三角肌运动反应终点组(B组)、肱二头肌运动反应终点组(C组)和胸大肌、三角肌或肱二头肌运动反应终点组(D组)。比较组间刺激域电流、获得终点时间、运动阻滞起效时间、各神经分支感觉阻滞起效时间、运动阻滞效果、各神经分支感觉阻滞效果及神经阻滞综合效果。结果D组获得终点时间短于A、B、C组(P<0.05),组间刺激域电流、运动阻滞起效时间、各神经分支感觉阻滞起效时间、运动阻滞效果、各神经分支感觉阻滞效果及神经阻滞综合效果差异无统计学意义。神经阻滞综合优良率90.8%。结论胸大肌、三角肌运动反应终点可作为PNS定位下成人经肌间沟臂丛神经阻滞穿刺针正确定位的满意、安全标志。     

Arteriovenous fistula in chronic renal failure patients: comparison between three different anesthetic techniques

The creation of arteriovenous fistula is an established form of therapy for patients with chronic renal failure. Anesthetic management in such patients is governed by the presence of risk factors such as hypertension, ischemic heart disease, diabetes, chronic pulmonary disease, anemia, coagulopathy, metabolic acidosis and/or hyperkalemia. In an attempt to improve the quality of anesthetic care and outcome we designed the present study to compare the different anesthetic techniques which are used for creation of arteriovenous fistula. Retrospectively we reviewed 164 patients who underwent creation of arteriovenous fistula. We retrieved the data concerning the age, sex, ASA class, and coexisting diseases. The patients were classified into three groups depending on the anesthetic technique received. Group A (n = 48) patients received general anesthesia; group B (n = 39), patients received brachial plexus block and group C (n = 77), patients received local infiltration anesthesia. Chi-square test was used to compare between the percentages among the different groups. The percentages of cardiac patients showed significant differences between groups A and B and also between groups A and C. There was a significant difference between the groups A and B also between the groups A and C but not between groups B and C concerning age. ASA classes were not significantly different among the groups. Among the total number of patients, 34 were diabetics and 75 patients were cardiac. Axillary brachial plexus block was complete in 70% of patients and incomplete in 27% and failed in 3% of patients. We conclude that chronic renal failure patients are at increased risk during anesthesia. We conclude that brachial plexus blockade or local anesthetic infiltration are good alternatives to general anesthesia in these patients undergoing creation of arteriovenous fistula. Age, ASA class and cardiac status were the three determining factors for the choice of the anesthetic technique. Further multivariate prospective study are needed to confirm these results.     

改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉的临床研究

目的 研究腋窝顶定位穿刺锁骨下位点阻滞麻醉的可行性.方法 520例急诊成人上肢手术的患者随机均分为两组:腋窝顶定位穿刺锁骨下位点阻滞麻醉组(观察组)和腋窝内径路阻滞麻醉组(对照组),两组均采用0.375%罗哌卡因,容量(40.0±2.7)ml作为臂丛神经阻滞麻醉药物.比较组间穿刺注药完成后的30 min内,感觉运动阻滞起效时间、感觉运动阻滞效果、各神经分支感觉阻滞效果及神经阻滞综合效果;比较组间穿刺注药完成30 min后,2、4、6、8 h四个时点的视觉模拟评分法(VAS)评分及止血带止痛时间.结果 穿刺注药完成后的30 min内,观察组感觉运动阻滞起效时间显著短于对照组,维持时间显著长于对照组(P＜0.01);组间感觉运动阻滞评分及正中、尺神经阻滞效果差异无统计学意义,肌皮、桡神经阻滞效果显著好于对照组(P＜0.05).穿刺注药完成30 min后,VAS评分各时点组间比较观察组显著小于对照组(P＜0.01),止血带止痛时间组间比较观察组显著长于对照组(P＜0.01).结论 改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉,可提供上肢完善的阻滞技术,取得满意的麻醉效果,并具有较高的安全性.

Abstract：

Objective To study the feasibility of subclavicular brachial plexus block with localized puncture at the apex of the axilla.Methods 520 adult patients who underwent upper limb emergency surgery were randomly assigned to receive subclavicular brachial plexus block with localized puncture at the apex of the axilla ( experimental group) and block anesthesia with intraclavicular route ( control group).Patients in both groups received 0.375% ropivacaine, volume (40.0± 2.7)ml.During the 30 minutes after the blockade, the onset and effect of motor and sensory block, the sensory block effect of each nerve branches and integrated effect of nerve block were recorded.The VAS score and acesodyne duration with tourniquet were compared between the two groups at 2, 4, 6 and 8 hours after the drug had been used for 30 minutes.Results Within 30 minutes after the drug was delivered, the onset of motor and sensory block in the experimental group was evidently shorter than that in the control group, while the duration of motor and sensory block was evidently longer ( P ＜ 0.01).There were no statistically significant differences in motor and sensory block score, median nerve block effect and ulnar nerve block effect between the two groups.The musculocutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group ( P ＜ 0.05).After the drug had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the oontrol group ( P ＜0.01).The analgesia duration of tourniquet in the experimental group was significantly longer than that of the control group ( P ＜ 0.01 ).Conclusion The modified subclavicular brachial plexus block with localized puncture at the apex of the axilla can provide perfect blockade, satisfactory anesthetic effect and higher safety in upper limb surgery.