背景:探讨超声引导下颈浅筋膜阻滞联合臂丛神经阻滞在锁骨手术中的应用效果。
方法:40名患者,25名男性和15名女性,年龄18-85岁,ASAI级或II级,接受单侧锁骨骨折内固定。将患者随机分为颈浅丛阻滞组(S组,n=20)和颈浅筋膜阻滞组(F组,n=20)。首先,在超声引导下,两组患者的肌间沟臂丛神经均在超声引导下注射1次15ml的0.33%罗哌卡因.第二,S组再次注射5-8ml0.33%罗哌卡因阻断浅颈丛,F组通过注射5-8ml0.33%罗哌卡因阻断颈浅筋膜。我们评估了手术时间,麻醉的开始时间,两组神经阻滞效果的有效时间和分级。此外,我们评估了局部麻醉中毒的发生率,声音嘶哑,呼吸困难,术后恶心呕吐,和24小时内需要补救镇痛的患者人数。重复测量通过重复数据分析进行方差分析,计数数据进行χ2检验。P值<0.05被认为是统计学上显著的。
结果:F组手术时间和起效时间明显短于S组(P<0.05);术中阻滞效果明显优于S组(P<0.05)。F组显效时间明显长于S组(P<0.05)。然而,没有严重的呼吸困难,两组均发生局部麻醉中毒或麻醉后声音嘶哑。两组患者术后挽救镇痛率和术后恶心呕吐发生率差异无统计学意义。
结论:在锁骨手术中应用超声引导下颈浅筋膜阻滞联合臂丛神经阻滞的单次注射技术是有益的,因为它缩短了手术时间。起病更快,产生更有效的阻滞和延长镇痛时间。
背景:中国临床试验注册-ChiCTR2200064642(2022年10月13日)。
To investigate the effects of a single injection technique with ultrasound-guided superficial cervical fascia block combined with brachial plexus block in clavicular surgery.
Forty patients, 25 males and 15 females, aged 18-85 years with ASA class I or II underwent unilateral clavicular fracture internal fixation. The patients were randomly divided into a superficial cervical plexus block group (group S, n = 20) and a superficial cervical fascia block group (group F, n = 20). First, the brachial plexus of the intermuscular sulcus of all patients was blocked with an ultrasound-guided injection of one injection with 15ml 0.33% ropivacaine 15ml in both groups. Second, the superficial cervical plexus was blocked by another injection of 5-8ml 0.33% ropivacaine in group S, and the superficial cervical fascia was blocked by an injection with 5-8ml 0.33% ropivacaine in Group F. We evaluated operation time, onset time of anaesthesia, effective time and the grades of nerve block effect in the two groups. Additionally, we evaluated the incidences of local anaesthetic poisoning, hoarseness, dyspnoea, and postoperative nausea and vomiting, and the number of patients requiring remedial analgesia within 24 h. Repeated measurements were analysed by repeated data analysis of variance, and count data were compared by the χ2 test. A P value < 0.05 was considered statistically significant.
The operation time and onset time in Group F were significantly shorter than those in group S (P < 0.05); the effect of intraoperative block was better than that in group S (P < 0.05), and the effective time was significantly longer in group F than in group S (P < 0.05). However, no severe case of dyspnoea, local anaesthetic poisoning or hoarseness after anaesthesia occurred in either of two groups. There was no significant difference in the rate of postoperative salvage analgesia or that of postoperative nausea and vomiting between the two groups.
The application of the single injection technique with ultrasound-guided superficial cervical fascia block combined with brachial plexus block in clavicular surgery is beneficial because it shortens the operation time, has a faster onset, produces a more effective block and prolongs the longer analgesia time.
Chinese Clinical Trial Registry- ChiCTR2200064642(13/10/2022).