超声引导下连续锁骨上臂丛阻滞用于肘部手术后镇痛的临床效果  

Clinical study of ultrasound-guided continuous supraclavicular brachial plexus blocks for postoperative analgesia after elbow surgery

作　　者：张骐[1] 陈长宝[2] 王爱忠[2] 

机构地区：[1]安徽省芜湖市第二人民医院麻醉科,241000 [2]上海交通大学附属第六人民医院麻醉科

出　　处：《上海医学》2011年第6期421-423,共3页Shanghai Medical Journal

摘　　要：目的观察超声引导下连续锁骨上臂丛神经阻滞用于肘部手术后镇痛的临床效果。方法选择择期行肘关节粘连松解术的患者20例,随机分为连续臂丛神经阻滞组（CBB组）和患者自控静脉镇痛组（PCA组）,每组10例。PCA组患者术后使用自控静脉吗啡镇痛。CBB组患者在超声引导下行连续锁骨上臂丛神经阻滞镇痛,同时并用与PCA组患者相似的自控静脉吗啡镇痛作为补救措施。观察两组患者在术后静息及运动时的疼痛视觉模拟（VAS）评分、不同时段吗啡用量、不良反应及患者满意度。结果 CBB组在术后12、16、24、32、40和48 h静息及运动时的疼痛VAS评分均显著低于对应时间的PCA组（P值分别〈0.05、0.01）。CBB组在术后8~48 h各时段的吗啡消耗量及术后48 h的吗啡总消耗量均显著小于PCA组（P值分别〈0.01、0.05）。CBB组的镇痛满意率为9/10,显著高于PCA组的2/10（P〈0.01）。结论超声引导下的连续锁骨上臂丛神经阻滞能有效缓解肘部手术后疼痛,减少阿片类镇痛药物的使用量,提高患者的舒适度。Objective To observe the clinical efficacy of ultrasound-guided continuous supraclavicular brachial plexus blocks for postoperative analgesia after elbow surgery.Methods Twenty patients undergoing elective elbow surgery were randomly assigned to either a continuous brachial block group（CBB group,n=10） or patient-controlled intravenous analgesia group（PCA group,n=10）.In the PCA group,intravenous PCA was provided with morphine.In the CBB group,continuous brachial blocks were performed via supraclavicular approach under ultrasound guidance,and intravenous PCA was also provided for supplemental analgesia.The pain scores at still and on movement on visual analogue scale（VAS）,patient satisfaction rate,side effects and opioid consumption were observed in the two groups after surgery.Results Pain scores at still and on movement were lower in the CBB group than those in the PCA group at 12,16,24,32,40 and 48 h after operation（P0.05 or P0.01）.The opioid consumption within 8-48 h after operation and the total opioid consumption were both significantly lower in the CBB group than in the PCA group（P0.05 or P0.01）.Patients in the CBB group had a higher satisfactory rate than that in the PCA group（9/10 vs.2/10,P0.01）.Conclusion Ultrasound-guided continuous supraclavicular brachial plexus blocks can relieve postoperative pain and decrease the need of opioids after elbow surgery,thus improving the satisfactory degree of the patients.

关 键 词：连续臂丛阻滞 术后镇痛 超声引导 肘关节 

分 类 号：R614[医药卫生—麻醉学]