B超引导下C5横突阻滞联合颈浅丛阻滞用于锁骨骨折切开复位内固定手术的效果观察  

Effectiveness of B-ultrasound-guided C5 Transverse Process Block Combined with Superficial Cervical Plexus Block for Clavicle Fracture Incision and Internal Fixation Surgery

作　　者：彭丹丹 王敏 李贝 梁凌 钟爱群 农兰依 区锦辉 PENG Dan-dan;WANG Min;LI Bei(Department of Anesthesiology,Gaoming Hospital Affiliated to Guangdong Medical College,Foshan,Guangdong,528500,China)

机构地区：[1]佛山市医学院附属高明医院麻醉科,广东佛山528500

出　　处：《黑龙江医学》2023年第8期922-924,928,共4页Heilongjiang Medical Journal

基　　金：佛山市卫生局科研项目(20190429);佛山市高明区十三五重点专科建设项目。

摘　　要：目的:探讨B超引导下C5横突阻滞联合颈浅丛阻滞用于锁骨骨折切开复位内固定手术的效果,为临床工作提供参考。方法:选取佛山市医学院附属高明医院收治的60例择期或急诊进行锁骨骨折切开复位内固定手术的患者作为研究对象,ASA分级Ⅰ~Ⅱ级,将其随机平均分为两组,每组各30例。B超引导组(A组)通过B超定位,确定C5横突位置,在C5神经根前支周围注射0.4%罗哌卡因;解剖手法定位组(B组)通过触摸确定C5横突位置,定位C5横突注射0.4%罗哌卡因。比较两组患者阻滞完成时间,皮肤痛觉消失的时间,骨折断端痛觉消失时间,镇痛时间,切皮、剥骨膜、骨折端复位时的VAS评分,麻醉效果,麻醉相关并发症出现情况。结果:B组与A组麻醉穿刺的时间相比较,差异无统计学意义(P>0.05)。患者皮肤痛觉消失的时间、骨折断端痛觉消失时间缩短,镇痛时间更长,差异有统计学意义(P<0.05)。A组切皮时、剥骨膜时、骨折端复位时的VAS评分更低,麻醉效果更好;B组出现1例刺破血管,1例单侧喉返神经阻滞,1例霍纳综合征,A组出现1例单侧喉返神经阻滞醉相关并发症。结论:与解剖手法定位相比,B超引导下C5横突阻滞联合颈浅丛阻滞麻醉起效快,麻醉效果更好,并发症的发生率更低。Objective:To investigate the effect of B ultrasound-guided C5 transverse process block combined with superficial cervical plexus block for clavicle fracture incision and internal fixation surgery,and to provide a reference for clinical work.Methods:60 patients with ASA grade I to II who underwent elective or emergency clavicle fracture incision and internal fixation surgery in the hospital were selected and randomly divided equally into two groups,with 30 cases in each group.The ultra⁃sound-guided group(group A)was located by ultrasound to determine the location of the C5 transverse process,and 0.4%ropiva⁃caine was injected around the anterior branch of the C5 nerve root.The anatomical maneuver localization group(group B)deter⁃mined the location of the C5 transverse process by touch and positioned the C5 transverse process for injection of 0.4%ropiva⁃caine.The time of block completion,the time of disappearance of skin nociception in patients,the time of disappearance of noci⁃ception in patients’fracture ends,the time of analgesia,the VAS score during skin incision,osteotomy,and fracture end reposi⁃tioning,the effect of anesthesia,and the occurrence of anesthesia-related complications were recorded.Results:There was no sta⁃tistically significant difference between the time of anesthesia puncture in group B compared with group A(P>0.05).The time to disappearance of skin nociception,the time to disappearance of nociception at the fracture end was shortened and the duration of analgesia was longer in patients,and the difference was statistically significant(P<0.05).Group A had lower VAS scores and better anesthesia during skin incision,during periosteal stripping,and during fracture end repositioning.1 case of punctured vessel,one case of unilateral recurrent laryngeal nerve block,and 1 case of Horner’s syndrome occurred in group B.1 case of complications related to unilateral recurrent laryngeal nerve block intoxication occurred in group A.Conclusion:Compared with anatomical ma⁃neuver positioning

关 键 词：麻醉 超声 神经阻滞 锁骨骨折 

分 类 号：R614.4[医药卫生—麻醉学]