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。

Ultrasound-guidance improves accuracy in locating interscalene for brachial plexus nerve blocking in obese patients

Objective To compare efficiency and safety of ultrasound guidance, nerve stimulation, and traditional blind methods in locating interscalene for brachial plexus blocking in patients with obesity. Methods A total of ninety patients with obesity, treated for upper extremity surgery in our hospital, were enrolled in this study. They were randomly divided into three groups (30 cases in each group). In these patients, the interscalene was located respectively by ① traditional method: search for the acupuncture point, ② nerve stimulation, triggering muscle contraction, ③ guidance of ultrasound. Brachial plexus block was performed by injecting 25 ml 0.375%ropivacaine hydrochloride into interscalene. Results The duration of surgery in three groups were similar (P>0.05). Sensory block developed faster and lasted longer in the group received ultrasound guidance than other groups (P<0.05). The satisfactory ratio of the sensory block under ultrasound guidance was 100%, significantly higher than that under nerve stimulation (83.3%) and traditional blind method (76.7%) (P<0.05). Complication occurred in only one case under ultrasound guidance, significantly lower than that in cases under traditional blind method (26.7%) and nerve stimulation (13.3%) (P<0.05). Conclusions Ultrasound guidance significantly improved the efficiency and safety of interscalene brachial plexus blocking.