摘要
目的评价超声引导下臂丛联合胸椎旁阻滞(thoracic paravertebral block,TPVB)对肩胛骨骨折内固定患者术后镇痛效果的影响。方法选择择期肩胛骨骨折内固定患者60例,男48例,女12例,ASAⅠ或Ⅱ级,随机分为臂丛联合TPVB组(B组)和对照组(C组),每组30例。B组患者通过肌间沟和锁骨上两条途径予以臂丛神经阻滞,并在C_7~T_1、T_2~T_3和T_4~T_5水平予以椎旁阻滞,阻滞完成30min后行全麻诱导。C组常规全麻诱导手术。记录患者术中舒芬太尼用量、PACU停留时间、疼痛主诉、追加镇痛药物等情况;观察并记录术后恶心呕吐、眩晕、呼吸抑制、尿潴留等并发症。结果 C组术中舒芬太尼用量明显多于B组[(43.2±7.1)μg vs(12.3±5.2)μg,P<0.05];PACU停留时间明显长于,主诉疼痛比例和芬太尼追加剂量明显大于B组(P<0.05);两组术后并发症差异无统计学意义。结论超声引导下臂丛联合TPVB在肩胛骨骨折内固定患者的术后镇痛中,效果确切,安全可靠。
Objective To evaluate the efficacy of ultrasound-guided combined blockade of brachial plexus and paravertebral block for postoperative analgesia in patients undergoing internal fixation of scapular fracture.Methods Sixty patients,48 males and 12 females,ASA physicalⅠ orⅡ,who were scheduled to undergo internal fixation of scapular fracture were enrolled in the study,and randomized into two groups：group B（combined blockade of brachial plexus and paravertebral block）and group C（regular control）.Patients in B group received combined blockade of brachial plexus nerve block（interscalene or supraclavicular blocks）and paravertebral block（in C7-T1,T2-T3 and T4-T5 levels）,and underwent the procedure with general anesthesia 30 min later.Surgery for patients in group C were performed under general anesthesia without a previous nerve block.Following data were collected：consumption of sufentanil during surgery;agitation and length of stay in post-anesthesia care unit（PACU）;complaint of pain and the need for supplemental analgesia in PACU;anesthesiarelated complications such as nausea,vomiting,depression of respiration and retention.Results The mean total consumption of sufentanil was significantly increased in group C [（43.2±7.1）μg vs（12.3±5.2）μg,P〈0.05];the length of stay,ratio of complaint of pain and need for supplemental analgesia in PACU were increased in group C（P〈0.05）.There was no statistical difference in postoperative complications.Conclusion We demonstrated that ultrasound-guided combined blockade of brachial plexus and paravertebral block provided feasible and reliable analgesia for patients underwent internal fixation of scapular fracture.
作者
杨永刚
严海
YANG Yonggang YAN Hai.(Department of Anesthesiology , Shanghai Jiao Tong University Affiliated Sixth People＇s Hospital, Shanghai 200233, Chin)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2017年第10期977-979,共3页
Journal of Clinical Anesthesiology
关键词
胸椎旁阻滞
肩胛骨
镇痛
Thoracic paravertebral block
Ade scapula
Analgesia
