CAJ | 학술논문

目的探讨超声引导喙突径路锁骨下臂丛神经阻滞应用于上肢手术患者时的局麻药物最低有效剂量.方法温州市中西医结合医院2007年8月至12月择期行上肢手术的患者160例,随机分为A、B、C、D 4组,每组40例,在超声引导下行喙突径路锁骨下臂丛神经阻滞,局麻药为0.75%罗哌卡因与2%利多卡因等量混合液,各组患者每神经束分别注射局麻药8、7、 6、 5 ml.观察桡神经、腋神经、正中神经、尺神经、臂内侧皮神经、前臂内侧皮神经、臂外侧皮神经的麻醉起效时间、阻滞效果和麻醉持续时间;评定手术全程的麻醉效果.结果 4组患者各神经分支麻醉起效时间差异无统计学意义(P>0.05).注药30 min后,A、B两组患者各神经分支的阻滞完善率95%,C组为90%,D组为77.5%,A、B两组阻滞效果优于D组(P=0.021).A、B、C组麻醉优良率100%,高于D组(87.5%,P=0.027).A、B、C、D 4组麻醉持续时间分别为(377 ±111)、(369 ±135)、(351±112)、(296±101)min,D组小于其他3组(P=0.024).4组均无并发症.结论超声引导喙突径路锁骨下臂从神经阻滞可以减少局麻药需要量,每神经束只需注射局麻药6 ml(共18 ml)即获得成功阻滞效果,麻醉起效时间不受影响.
목적 탐토초성인도훼돌경로쇄골하비총신경조체응용우상지수술환자시적국마약물최저유효제량.방법 온주시중서의결합의원2007년8월지12월택기행상지수술적환자160례,수궤분위A、B、C、D 4조,매조40례,재초성인도하행훼돌경로쇄골하비총신경조체,국마약위0.75%라고잡인여2%리다잡인등량혼합액,각조환자매신경속분별주사국마약8、7、 6、 5 ml.관찰뇨신경、액신경、정중신경、척신경、비내측피신경、전비내측피신경、비외측피신경적마취기효시간、조체효과화마취지속시간;평정수술전정적마취효과.결과 4조환자각신경분지마취기효시간차이무통계학의의(P>0.05).주약30 min후,A、B량조환자각신경분지적조체완선솔95%,C조위90%,D조위77.5%,A、B량조조체효과우우D조(P=0.021).A、B、C조마취우량솔100%,고우D조(87.5%,P=0.027).A、B、C、D 4조마취지속시간분별위(377 ±111)、(369 ±135)、(351±112)、(296±101)min,D조소우기타3조(P=0.024).4조균무병발증.결론초성인도훼돌경로쇄골하비종신경조체가이감소국마약수요량,매신경속지수주사국마약6 ml(공18 ml)즉획득성공조체효과,마취기효시간불수영향.
Objective To investigate the optimal dose of local anesthetic mixture in ultrasound-guided infractavicular brachial plexus block via coracoid approach. Methods 160 patients scheduled for surgery of the hand or forearm were randomly divided into 4 equal groups ( Groups A, B, C, and D). To receive 8,7,6, or 5 ml of anesthetic mixture of 0.75% ropivacaine and 2% lidocaine for radial nerve, axillary nerve, median nerve, ulnar nerve, median cutaneous nerve of arm, median antebrachial cutaneous nerve, and lateral antebrachial cutaneous nerve respectively ultrasound-guided infraclavicular brachial plexus block via coracoid approach. The time for anesthesia taking effect ,anesthesia maintenance time, and quality of sensory block were observed. Results Anesthesia took effect about 4 minutes after injection in these 4 groups without significant differences among then( all P > 0. 05 ). The good analgesic effect rates of Groups A, B, and C were all 100%, all significantly higher than that of Group D ( 87. 5 %, P = 0. 027 ). The block maintenance times of Groups A, B, and C were (377 ± I 11 ) min, (369 ± 135) min, and (351 ± 112) min respectively , all significantly longer than that of Group D [ (296 ± 101 ) min,P =0. 024]. No anesthesia-related complication was found in these 4 groups. Conclusion Ultrasound-guided infraclavicular brachial plexus block via coracoid approach can reduce the volume of local anesthetic mixture. The dose of 6 ml local anesthetic mixture for each nerve fascicle, totally 18 ml, provides good analgesic effect and does not seem to affect the time for anesthesia taking effect.