神经刺激器引导用于臂丛神经阻滞及术后镇痛研究

目的 观察神经刺激器定位下经斜角肌间沟留置导管用于持续臂丛神经阻滞及术后镇痛的临床效果和可行性。方法 ASAⅠ～Ⅱ级上肢手术患者60例。随机分为套管针组（A组）和留置导管组（B组），每组30例。A组患者用20G静脉穿刺套管针行常规方法臂丛神经阻滞留置，B组患者在周围神经刺激器引导下穿刺置入专用的柔软导管，手术结束后两组患者均连接一电子镇痛泵行持续术后臂丛神经阻滞镇痛。结果 术中需辅助用药患者两组无统计学差异（P〉0．05）。A组患者术后镇痛失败率达23．3％，B组无镇痛失败患者，两组比较差异有显著性（P〈0．05）。剔除A组镇痛失败患者后，两组患者术后48h内的VAS评分、Ramsay评分和PCA按压次数无统计学差异（P〉0．05）。结论 周围神经刺激器精确引导下经斜角肌间沟留置导管行臂丛神经阻滞和持续术后镇痛是一种可行性好、镇痛效果确切、不良反应少的方法。

An evaluation on the clinical effects of nerve stimulator and continuous catheter insertion system.in treating interscalene brachial plexus block and postoperative analgesia

Objective To evaluate the clinical effects and feasibility of interscalene brachial plexus block and postoperative analgesia using a Nerve Stimulator and a continuous catheter insertion system, Methods 60 patients ef ASA class Ⅰ～Ⅱ undergoing upper extremity surgery, aged 21 ～ 58y, weighed 48 ～ 67 kg, were randomly divided into 2 groups. In group A , all the patients received traditional continous intetscalene brachial plexus block by using a 20 - guage intravenous cannula fixed to the skin with a tape. In group B, all the blocks were performed by using a nerve stimulator and a insulated touhy needle system, then a special soft catheter was threaded through the needle and were secured tightly. Postoperatively, a compute - controlled infusion system were connected to provided pain relief. Results The need for Ⅳ narcotics supplementation was compared in two groups. The failure rate of postoperative analgesia wns 23.3% in group A, it was significantly higher when compared with group B （P 〈0.05）. In group B, all the patients were provided with successful pain relief. No statistically significant differences were noted in VAS, Ramsay scores and the frequency of PCA pressed between two groups after rejecting the group A patients failed to postoperative pain relief （ P 〉 0.05）. Conclusions Interscalene brachial plexus block and postoperative analgesia using a nerve stimulator as guide and a continuous retention catheter insertion system provides a good way for pain relief after upper extremity surgery with good feasibility, ensured analgesia effects and little side effects.