喙突锁骨下入路两点法与腋入路臂丛神经阻滞的临床分析

目的观察喙突锁骨下入路两点法臂丛神经阻滞的临床效果,并与腋入路进行比较。方法选择82例上肢手术患者,随机分为两组,采用喙突入路两点法麻醉（C组）47例,穿刺点位于锁骨下喙突骨性标志内下侧2cm。A组采用腋入路臂丛神经阻滞两点法麻醉（A组）35例。两组均在神经刺激仪引导下进行麻醉。分两次各注入0.5%罗哌卡因20ml。注药后30min内每隔5min观察各神经支配皮区的感觉阻滞及运动阻滞程度。观察有无并发症发生。结果麻醉后30min,与A组比较,C组肌皮神经和腋神经的感觉阻滞明显较强（P﹤0.01）。两组在屈肘功能评分上有显著性差异（P﹤0.01）,其他运动功能评分则无显著性差异。两组麻醉效果满意率分别为A组89%、C组91%。术后并发症两组无显著性差异。结论喙突锁骨下入路臂丛神经阻滞两点法麻醉效果较好,是进行臂丛神经阻滞时的一种新的入路选择。

The comparison of anesthetic efficacy of caracoid infraclavicular approach with dual injection and axillary approach foe brachial plexus block

Objective To compare the anesthetic efficacy of the coracoid infraclavicular approach with dualinjection with axillary approach for brachial plexus block. Methods eighty two patients were randomly divided into two groups to receive brachial plexus block guided by nerve stimulator： group C （coracoid infraclavicular approach with dualinjection, n=47）, and group A （axillary approach with dual injection, n=37）. The coracoid infraclavicular approach was performed with the coracoid process （CP） as landmark. Along the sagittal plane, the needle was inserted at the point of 2cm caudal and medial to the CP. The valume of 0.5% Ropivacaine for each injection was 20ml. Sensory and motor block were assessed every 5min till 30min after the end of the injection of local anesthetic. Complications were also evaluated. Results At 30 min after injection of local anesthetic, significant profound analgesia to pinprick in the areas innervated by musculocutaneous and axillary nerves was found in Group C compared with A. Statistical difference were found in flexion of elbow between the two groups, but with no difference in the other motor functions. The percentage of satisfaction with anesthesia were 89%, and 91% respectively for group A,C. No statistical differences were found in postoperative complications between two groups. Conclusions Coracoid infraclavicular approach with dual injection is the better methed and can be a new alternative for blocking brachial plexus.