超声引导下锁骨上入路与腋入路臂丛神经阻滞效果比较

目的比较超声引导下不同入路臂从神经阻滞（BPB）的效果。方法选择该院2012年6月至2013年6月BPB下行择期骨科前臂手术的成年患者40例,随机分为A组（腋入路组）和C组（锁骨上入路组）,每组20例。两组患者均采用超声引导技术行神经阻滞,局部麻醉药为0.375%罗哌卡因20 mL。分别记录操作时间,操作后5、10、15、20、30min测定臂从神经主要分支的神经阻滞起效时间以及神经阻滞并发症。术后48 h使用疼痛数字评价量表（NRS）对疼痛进行评分;记录术后第1、2天辅助镇痛药使用率。结果 A组操作时间（812.6±230.6）s]明显长于C组（644.5±218.2）s],而神经阻滞起效时间（67.3±24.9）s]则明显快于C组（457.8±118.4）s],差异均有统计学意义（P〈0.05）。A组桡神经的感觉神经阻滞有效率在5 min时明显高于C组,而在5、10 min时,无论是感觉还是运动神经阻滞,肌皮神经阻滞有效率均明显高于C组,差异均有统计学意义（P〈0.05）;A组患者术后48 h疼痛整体自我评分（3.3±3.2）分]与C组（2.8±3.4）分]基本相似,差异无统计学意义（P〉0.05）;两组术后第1、2天辅助镇痛药使用率,差异无统计学意义（P〉0.05）。结论超声引导下锁骨上入路可能较腋入路BPB更为迅速,操作简易,但起效时间并不快于后者。

Effect comparison of ultrasound-guided axillary and supraclavicular brachial plexus blocks

Objective To compare the efficacy of ultrasound-guided brachial plexus block（BPB）by different approaches. Methods Forty adult patients underwent elective forearm surgery in Orthopedic Department were randomized into two groups： group A （axillary group） and group C （supraclavicular group）, 20 cases in each group. The patients in both groups were treated with nerve block by ultrasound-guided technology with local anesthetics of 0.375% ropivacaine 20 mL. The operating time were recorded in all patients. At 5,10,15,20,and 30 min after the operation,to measure the onset time and complications of nerve block BPB main branches. The pain response was scored by numerical rating scale （NRS） 48 h after surgery;the usage rates of auxiliary analgesics on 1st and 2nd d after operation were recorded. Results The operation time of the group A（812.6±230.6）s] was significantly longer than that of the group C（644.5±218.2）s] ,the onset time of nerve block（67.3±24.9）s] was obviously shorter than that of the group C （457.8±118.4 ）s], and the differences had statistical significance （P〈0.05）. The effective rate of sensory nerve block of radial nerve at 5 min in the group A was obviously higher than that in the group C ,while at 5 min and 10 min,the effective rate of musculoeutaneous nerve of either sensory or motor block in the group A were apparently higher than that in the group C, and the difference was statistically significant （P〈0.05）. The self scores of patients in the group A （3.3±3.2） and group C （2.8±3.4） 48 h after surgery were similar to each other without statistically significant difference （P〉0.05）. The difference on usage rate of auxiliary analgesics on 1 st, 2nd d between the two groups had no statistical significance （P〉O.05）. Conclusion Ultrasound- guided supraclavicular BPB is more quickly and easier to operate than axillary approach, but the onset time is not faster than the axillary approach.