B超声引导下肋锁间隙与喙突入路连续臂丛神经阻滞对Barton骨折术后镇痛效果比较

目的:比较超声引导下肋锁间隙与喙突两种入路连续臂丛神经阻滞对Barton骨折手术患者术后的镇痛效果。方法:选择择期行Barton骨折手术患者60例,随机分为肋锁间隙入路连续臂丛神经阻滞组(A组,n=30)和喙突入路连续锁骨下臂丛神经阻滞组(B组,n=30)。两组均在超声引导下进行臂丛神经阻滞,同时留置神经阻滞导管,麻醉后2小时经神经阻滞导管连接无线电子镇痛泵。记录手术过程中神经深度、麻醉操作时间,并评估麻醉效果;记录术后第一次追加药物时间;记录麻醉后6 h、12 h、18 h、24 h、36 h、48 h静息及运动状态VAS评分;记录术后第一天和第二天镇痛泵有效按压次数及补救镇痛情况;记录患者满意度及并发症发生情况。结果:与B组相比,A组神经深度明显减浅(P<0.05),麻醉操作时间显著缩短(P<0.05),术后第一次追加药物时间延长(P<0.05),麻醉后12 h、18 h、24 h、36 h静息及运动状态VAS评分较低(P<0.05),术后第一天有效按压次数明显减少(P<0.05),患者满意度评分高(P<0.05),误穿血管发生率明显减少(P<0.05)。结论:超声引导下肋锁间隙入路与喙突入路连续锁骨下臂丛神经阻滞均可安全有效用于Barton骨折手术术后镇痛;但肋锁间隙连续臂丛神经阻滞术后镇痛效果更好,且具有神经阻滞深度浅、操作时间更短、阻滞效果更好、患者满意度更高及并发症更少等优点。

Comparison of Postoperative Analgesic Effects of Continuous Brachial Plexus Block Via Costoclavicular Approach and Via Coracoid Approach under the Guidance of Ultrasound for Patients Who Underwent Barton's Fracture Surgery

Objective:To compare the postoperative analgesia of patients who take either ultrasound-guided costoclavicular space approach or coracoid approach of continuous infraclavicular brachial plexus block anesthesia undergoing Barton's fracture surgery.Methods:Sixty patients(ASAⅠ~Ⅱ)with Barton's fractures were randomly divided into two groups:group A and group B(n=30 each).Group A received continuous brachial plexus block via costoclavicular space approach under ultrasound guidance,group B received continuous brachial plexus block via coracoid approach under ultrasound guidance.Nerve block catheters were indwelling in both groups,wireless electronic analgesia pump were connected to the nerve block catheter 2 hours after anesthesia.The nerve depth,operation time of anesthesia and effect of anesthesia were recorded.The first additional drug time after surgery were recorded.The resting and motor status VAS scores at 6 h,12 h,18 h,24 h,36 h,48 h after anesthesia were recorded.The number of effective presses of analgesic pumps and the remedial analgesia on the first and second day after surgery were recorded.The patients'satisfaction score and complications were recorded.Results:The nerve depth of group A was shallower than that of group B(P<0.05);the operation time of anesthesia in group A was shorter than that of group B(P<0.05).Compared with group B,the first postoperative addition time of group A was significantly longer(P<0.05),and the scores of rest and motor VAS in group A were significantly lower at 12 h,18 h,24 h,36 h after anesthesia(P<0.05).The number of effective compressions in group A was significantly less than that in group B on the first day after surgery(P<0.05),and Patient satisfaction score of group A was higher than that in group B(P<0.05).The incidence of accidental vascular puncture in group A was significantly lower than that in group B(P<0.05).Conclusion:Ultrasound-guided costoclavicular space continuous brachial plexus block and coracoid approach continuous infraclavicular brachial plexus block could be safely and effectively used in postoperative analgesia of Barton's fractures.However the costoclavicular space continuous brachial plexus block has a better postoperative analgesic effect and more advantages of superficial nerve position,convenient operation,high patient satisfaction and less complications.