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

摘要

Objective To compare effectiveness,performance,and complications between ultrasound-guided selective cervical nerve root block and interscalene brachial plexus block for patients undergoing arthroscopic surgery in perioperative period.Methods Seventy patients scheduled for arthroscopic surgery,25 males and 45 females,aged 18-75 years,were randomly divided into two groups.They were given either selective cervical nerve root block (group S,n =35) or interscalene brachial plexus block (group ISB,n=35).In group S,C5 and C6 nerve roots were given 0.5％ ropivacaine 5 ml respectively;In group ISB,patients were given 0.5％ ropivacaine 10 ml under ultrasound guidance.The primary outcome:VAS score and forearm modified Bromage scale (MBS) score were recorded at 4,12 and 24 hours after surgery;Secondary outcomes:cumulative tramadol consumption,the patients' satisfaction rate and adverse effects were recorded.Results The VAS scores in group S was significantly lower than that in group ISB at 12 hours after surgery (1.7±0.8 vs 3.6±0.7,P＜0.05).The forearm MBS scores in group S was significantly higher than that in group ISB 4 hours after surgery (P＜0.01).Compared with group ISB,the amount of tramadol consumption was lower at 24 hours after surgery [(37.5±35.9) mg vs (112.5±43.5) mg,P＜0.05)].The satisfaction rate of group S was higher than group ISB (88％ vs 56％,P＜0.05).There was no significant difference in side effects between the two groups.Conclusion In arthroscopic surgery,the selective cervical nerve root block is superior to the brachial plexus block.%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5 ml;ISB组在超声引导下给予0.5％罗哌卡因10 ml.记录神经阻滞起效时间;记录术后4、12、24 h的VAS评分和前臂(屈肘、屈腕、屈指)MBS运动评分;记录术后24 h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,P＜0.01];S组术后12 h的VAS评分明显低于ISB组[(1.7±0.8)分vs (3.6±0.7)分,P＜0.05],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,P＜0.01];术后24 h曲马多用量明显少于ISB组[(37.5±35.9)mgvs (112.5±43.5)mg,P＜0.05],患者满意率明显高于ISB组(88％ vs 56％,P＜0.05),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.