Objective To evaluate the influence of different injection sites on ultrasound-guided supraclavicular brachial plexus block.Methods Ninety ASA Ⅰ-Ⅱ patients scheduled for upper extremity operation were randomly divided into three groups,with 30 patients in each group.In anatomical approach targeting group (group A),the site of needle insertion was about 1 cm above the midpoint of the clavicle and local anesthetic solution (10 mL) was injected through needle; In single-point injection group (group S),local anesthetic solution (20 mL) was injected at single injection at the junction of subclavian artery,brachial plexus and the first rib under ultrasound guidance; In two-point injection group (group D),local anesthetic solution (20 mL) was firstly injected at single injection at the junction of subclavian artery,brachial plexus and the first rib,and the second injection (10 mL) was performed at superior brachial plexus.The local anesthetic solution was composed of 10 mL 0.75％ ropivacaine and 10 mL 2％ lidocaine.The time spent performing the block,duration of analgesia and onset time of analgesia in the areas innervated by ulnar,median,radial and musculocutaneous nerves were measured.The degree of sensory block of the region innervated by each nerve and the effectiveness of block were assessed and the incidence of complications were recorded in all patients.Results There were no significant differences in the time spent performing the block among the three groups (P＞0.05).Compared with group A,anesthesia satisfaction,duration of analgesia and complete block rates of ulnar and musculocutaneous nerves significantly increased in both group S and group D (P＜0.05).Compared with group D,onset time of analgesia in the areas innervated by ulnar and musculocutaneous nerves significantly increased in group S (P＜0.05).No obvious differences in complete block rates of median and radial nerves were found among the three groups (P＞0.05).In group A,vascular puncture occurred in 3 patients,local anesthetics intoxication in 1 patient and ptosis in 6 patients.No vascular puncture and anesthetics intoxication occurred in group S and group D.However,ptosis occurred in 8 patients in group S and in 5 patients in group D.Conclusion Single-point or twopoint injection is superior to anatomical positioning for ultrasound-guided supraclavicular brachial plexus block,with longer duration of analgesia,fewer complications and shorter time for block in ulnar and musculocutaneous nerves.%目的 评价不同注射点对超声引导下锁骨上臂丛神经阻滞效果的影响.方法 选取择期拟行上肢手术患者90例,性别不限,ASA Ⅰ-Ⅱ级,按随机数字表法将其分为3组,每组30例:解剖手法定位组(A组)取锁骨中点上1 cm左右为穿刺点,注射20 mL局部麻醉药；单点注射组(S组)超声引导下在臂丛神经、锁骨下动脉及第一肋骨三者相接的位置注射20 mL局部麻醉药；两点注射组(D组)超声引导下先在臂丛神经、锁骨下动脉及第一肋骨三者相接的位置注射10 mL局部麻醉药,然后在臂丛神经的上方再注射10 mL局部麻醉药.局部麻醉药为0.75％罗哌卡因10 mL和2％利多卡因10 mL的混合液.记录各组的操作时间,尺神经、正中神经、桡神经及肌皮神经支配区域痛觉消失时间及镇痛时间,评价各神经支配区域的阻滞程度及手术时的麻醉效果,并观察相关并发症的发生情况.结果 3组操作时间差异无统计学意义(P＞0.05).与A组相比,S组和D组麻醉效果满意率更高,镇痛持续时间延长(P＜0.05),尺神经和肌皮神经阻滞完全率升高(P＜0.05).与D组相比,S组尺神经和肌皮神经支配区域痛觉消失时间延长(P＜0.05).3组桡神经和正中神经阻滞完全率差异无统计学意义(P＞0.05).A组刺破血管3例,局部麻醉药中毒1例,眼睑下垂6例；S组和D组无刺破血管和局部麻醉药中毒发生,发生眼睑下垂分别为8、5例.结论 与解剖手法定位相比,超声引导下锁骨上臂丛神经阻滞单点和两点注射法的麻醉效果较好,镇痛时间较长,相关并发症较少,两点注射法对尺神经和肌皮神经的阻滞较快.
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