超声引导下选择性颈神经根阻滞在肩关节镜术后镇痛中的应用

发布时间：2018-04-26 13:41

本文选题：颈神经根阻滞 + 肌间沟臂丛阻滞　；参考：《临床麻醉学杂志》2017年12期

【摘要】：目的比较超声引导下选择性颈神经根阻滞与传统肌间沟臂丛阻滞在肩关节镜术后镇痛的应用效果。方法择期行肩关节镜手术全麻患者70例,男25例,女45例,年龄18~75岁,随机分为两组,选择性颈神经根阻滞组(S组)和传统肌间沟臂丛阻滞组(ISB组),每组35例。S组在超声引导下分别给予C5、C6神经根0.5%罗哌卡因各5ml;ISB组在超声引导下给予0.5%罗哌卡因10ml。记录神经阻滞起效时间;记录术后4、12、24h的VAS评分和前臂(屈肘、屈腕、屈指)MBS运动评分;记录术后24h曲马多用量,以及患者满意度和不良反应发生情况。结果 S组起效时间明显短于ISB组[(8.24±2.96)min vs(13.85±7.45)min,P0.01];S组术后12h的VAS评分明显低于ISB组[(1.7±0.8)分vs(3.6±0.7)分,P0.05],术后4h前臂(屈肘、屈腕、屈指)MBS运动评分明显高于ISB组[(3.5±0.6)分vs(0.8±0.3)分,(3.4±0.5)分vs(0.9±0.4)分,(3.6±0.6)分vs(0.7±0.4)分,P0.01];术后24h曲马多用量明显少于ISB组[(37.5±35.9)mg vs(112.5±43.5)mg,P0.05],患者满意率明显高于ISB组(88%vs 56%,P0.05),术后不良反应两组差异无统计学意义。结论在肩关节镜手术后镇痛中,超声引导下选择性颈神经根阻滞优于臂丛神经阻滞。
[Abstract]:Objective to compare the effect of selective cervical nerve root block and traditional intermuscular sulcus brachial plexus block under ultrasonic guidance in postoperative analgesia. Methods 70 patients (25 males and 45 females, aged 1875 years) undergoing selective shoulder arthroscopic anesthesia were randomly divided into two groups. The selective cervical nerve root block group (group S) and the traditional intermuscular sulcus brachial plexus block group (group ISB) were treated with 0.5% ropivacaine (0.5% ropivacaine) and 10 ml ropivacaine (10 ml) under ultrasound guidance respectively. The onset time of nerve block, the score of VAS and the motor score of forearm (elbow, wrist and finger flexion), the dosage of tramadol, the satisfaction of patients and the occurrence of adverse reactions were recorded. Results the effective time of S group was significantly shorter than that of ISB group [8.24 卤2.96)min vs(13.85 卤7.45 min P0.01] the VAS score of S group was significantly lower than that of ISB group (1.7 卤0.8 vs(3.6 卤0.7) at 12 hours after operation, and the forearm (elbow flexion, wrist flexion) 4 hours after operation was significantly lower than that in ISB group. The motor score of flexion was significantly higher than that of ISB group (3.5 卤0.6 vs(0.8 卤0.3) vs(0.9 卤0.4), and the dosage of tramadol at 24 hours after operation was significantly lower than that in ISB group [37.5 卤35.9)mg vs(112.5 卤43.5mgP0.05], the satisfaction rate was significantly higher than that in ISB group (88 卤0.50 vs 5656 vs 0.05), and there was no significant difference in postoperative adverse reactions between the two groups. Conclusion selective cervical nerve root block under ultrasonic guidance is superior to brachial plexus block in postoperative analgesia.
【作者单位】：南京中医药大学附属医院麻醉科;
【分类号】：R614

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