超声引导下颈横突旁阻滞与肌间沟臂丛阻滞在肱骨近端手术中的比较

目的比较超声引导下颈横突旁阻滞与肌间沟臂丛阻滞在肱骨近端手术中的应用效果。方法拟行肱骨近端手术患者60例,男27例,女33例,年龄18~70岁,ASAⅠ或Ⅱ级,随机分为两组,每组30例。T组超声引导下行C_4、C_5、C_6横突旁阻滞,分别给予0.5%罗哌卡因2、2、4ml;I组在超声引导下行肌间沟臂丛神经阻滞,给予0.5%罗哌卡因8ml。记录神经阻滞操作时间、起效时间、麻醉维持时间、阻滞是否成功和不良反应发生情况。结果T组阻滞起效时间明显短于I组[(8.73±3.17)min vs.(14.40±8.21)min,P0.01],阻滞成功率明显高于I组(100%vs.80%,P0.05),膈肌麻痹发生的严重程度明显低于I组(P0.01)。结论在肱骨近端手术神经阻滞中,与肌间沟臂丛阻滞比较,横突旁阻滞可以提供更短的神经阻滞起效时间、更高的成功率和更少的膈神经阻滞不良反应。

Comparison between ultrasound-guided cervical transverse process block and interscalene brachial plexus block in patients undergoing proximal humeral surgeries

Objective To compare effectiveness,performance,onset time and complications between ultrasound-guided cervical transverse process block and interscalene brachial plexus block in patients undergoing proximal humeral surgeries.Methods Sixty patients,27 males and 33 females, aged 18-70 years,scheduled for proximal humeral surgeries were randomly divided into two groups. They were given either cervical transverse process block (group T,n =30)or ultrasound-guided in-terscalene brachial plexus block (group I,n =30).All patients received a total of 8 ml of 0.5% ropiv-acaine.The performance, anesthetic onset time, the side effects and block success rate were evaluated.Results Block procedure was quicker in group T than in group I [(8.73 ±3.1 7)min vs. (14.40±8.21)min,P <0.01].The severity of diaphragmatic paralysis in group T was significantly lower than in group I (P <0.01).The ultrasound-guided cervical transverse process block was more effective than the interscalene brachial plexus block in patients undergoing proximal humeral surgeries (100% vs.80%,P <0.05).Conclusion The ultrasound-guided cervical transverse process block has a higher success rate and fewer incidence of diaphragmatic paralysis than the interscalene brachial plexus block in patients undergoing proximal humeral surgeries.