双重引导行连续肌间沟臂丛神经阻滞及术后镇痛

目的观察神经刺激仪与超声双重引导下行连续肌间沟臂丛神经阻滞的效果，并观察导管放置位置对术后镇痛效果的影响。方法择期行肱骨干手术的患者30例，随机分为3组，每组10例。I组为神经刺激仪引导肌间沟臂丛神经阻滞及盲法置管行连续术后镇痛；Ⅱ组在神经刺激仪下行肌问沟臂丛神经阻滞，并在超声引导下行臂丛上、中干之间置管。In组方法同II组，将导管置在臂丛中、下干之间。观察术后当日、第2日、第3日的镇痛效果并用视觉模拟评分（VAS）评价，并观察有无神经并发症。结果与手术开始前比较，I组患者切皮时的SBP、DBP和HR均有升高（P〈O．05）；II、III组患者SBP、DBP和HR无明显变化。与I组比较，其他两组术后各时点静态VAS较低（P〈0．05）；而动态VAS的差异无统计学意义。Ⅱ、Ⅲ组术后静态与动态时VAS差异均无统计学意义。结论神经刺激仪与超声双重引导下行连续肌间沟臂丛神经阻滞对于肱骨干手术麻醉效果满意，术后镇痛效果良好，导管放置的位置对术后镇痛效果无明显影响。

Double guidance of nerve stimulator and ultrasound for continuous interscalene brachial plexus block and its postoperative analgesia

Objective To observe the effect of continuous interscalene brachial plexus block under double guidance of nerve stimulator and ultrasound, and the influence on postoperative analge- sia effect by the location of the placed catheter. Methods Thirty patients underwent a humeral sur- gery received interscalene brachial plexus block under double guidance of nerve stimulator and ultra- sound, and catheterization under the ultrasound guidance. The patients were randomly divided into three groups, ten cases in each group. In group I , the catheter was placed by blind technique. In groups l] , the catheter was placed between the top and middle branches of brachial plexus. In group I]I, the catheter was placed between the middle and low branches of brachial plesus. VAS and the complications were recorded at the 1st, 2nd and 3rd day after the operation. Results Compared with preoperation, SBP,DBP and HR increased at the beginning of operation in group I , SBP,DBP and HR showed no significant increase in group l] and ill. Compared with group , VAS at rest were low at different times after the operation in the other two groups （P〈0.05）, there was no statistical difference in VAS at movement. No difference was found in VAS between group H and Ⅲ （P 〈0. 05）. Conclusion Under double guidance of nerve stimulator and ultrasound, the effect of opera-tive anesthesia and postoperative analgesia for humeral surgery is satisfied and the effect has little re- lation with the location of the catheter,