Objective: To perform the procedure of precision anesthesia through the way of locating the upper trunk of the brachial plexus, then injecting local anaesthetic around it with the help of ultrasound, and observe the clinical effect of the procedure. Methods: 60 ASAⅠ-Ⅱpatients wererandomly divided into two groups, the blind puncture & paresthesia (BP)group and the ultrasound-guide (UG)group,30 patients in each group. 30 ml 0.25% ropivacaine was injected in BP group after locating the brachial plexus by landmarks and complains of paresthesia; 20 ml 0.25% ropivacaine was injected in UG group after locating the upper trunk of thebrachial plexus by ultrasound. Then the degree of pain were scored by visual analogue scale(VAS) at 2,10 min after blocking andthe muscle strength of the shoulder joint,elbow joint,wrist joint was observed after surgery. Results: Compared with the BP group, the clinical effect of ultrasound-guide upper trunk blocking was much better (P<0.001),even though consume less local anaesthetic. The muscular motor block degrees of theshoulder and elbow joint were Similar in two groups, but ultrasound-guide upper trunk block had a less wrist joint block. Conclusion: The technique of ultrasound-guide upper trunk block can be performed during the operations of shoulder joint and upper arm with satisfactory anesthesia. It performs the procedure of precision anesthesia by means of decreasing the amount of local anesthetic, improving the quality of anesthesia, reducing the block degree of the distal joint and which is beneficial tothe rehabilitation of patients. |
[1] URMEYWF,TALTS K H,SHARROCK N E.One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography[J].AnesthAnalg,1991,72(4):498-503.
[2] 邹满英,林平信,苏中文.罗哌卡因复合芬太尼用于连续臂丛神经阻滞术后镇痛的效果分析[J].海南医学,2013,24(21):3234-3236.
[3] YUAN J R,YANG X H,FU S K,et al.Ultrasound guidance for brachial plexus block decreases the incidence of complete hemi-diaphragmatic paresis or vascular punctures and improves success rate of brachial plexus nerve block compared with peripheral nerve stimulator in adults[J].Chinese Medical Journal,2012,125(10):1811-1816.
[4] 杜丽,唐育民.曲马多联合罗哌卡因行肋间神经阻滞用于肺癌患者术后镇痛的临床研究[J].东南大学学报:医学版,2015,34(2):235-239.
[5] 刘光文,郑礼琴,王凤芝,等.高位肌间沟定位精确异感引导行以臂丛神经上干为中心的神经阻滞麻醉[J].医学信息,2012,25(6):117-118.
[6] 田万成,潘风雨.臂丛神经解剖的强化记忆方法探讨[J].实用手外科杂志,2010,24(3):171-174.
[7] 曹文,郭瑞军,周亚静,等.超声引导臂丛神经阻滞的临床研究[J].中华超声影像学杂志,2008,17(5):452-453.
[8] 崔旭蕾,徐仲煌,董锡臣,等.超声引导肌间沟臂丛神经阻滞的临床应用[J].临床麻醉学杂志,2008,24(1):26-28.
[9] 李挺,吴道珠,徐旭仲,等.上肢手术病人超声引导锁骨上臂丛神经阻滞的效果[J].中华麻醉学杂志,2006,26(2):126-129.
[10] HASHIMOTO A,ITO H,HARATO M,et al.Complications of peripheral nerve block[J].Masui,2011,60(1):111-119.
[11] FUJIMURA N,NAMBA H,TSUNODA K,et al.Effect of hemidiaphrag-matic paresis caused by intemcalene braehial plexus block on breathing pattern,chest wall mechanics,and arterial blood gases[J].Anesth Analg,1995,81(5):962-966.
[12] SANDHUN S,BAHNIWAL C S,CAPAN L M.Fessibility of an infraela Vieular block with a reduced volume of lidocaine with sonographie guidance[J].J Ultrasound Med,2006,25(1):51-56. |