摘要
目的采用随机对照的方法对神经刺激器法和异感法这两种定位方法在三点腋路臂丛阻滞中的效果进行比较。方法45名拟行前臂和手部手术的病人被随机分入异感定位组(paresthesia,PAR组n=23)和周围神经刺激器定位组(peripheralnervestimulator,PNS组n=22),分别采用异感定位法和神经刺激器定位法定位支配上肢的4支混合神经中的3支(肌皮神经、正中神经、桡神经或尺神经),将等量的2%利多卡因和0.5%布比卡因混合液40mL分别注射于3支神经周围,其中肌皮神经5mL,正中神经15mL,桡神经或尺神经15mL,另5mL侵润上臂内侧的皮神经。臂丛阻滞成功被定义为注射30min后,肘部远端5支神经(肌皮神经、桡神经、正中神经、尺神经和前臂内侧皮神经)支配区域的感觉阻滞完全,比较2组在臂丛阻滞成功率、时效和并发症等方面的差异。结果PNS组的阻滞成功率要高于PAR组(95.5%对54.5%,P<0.01),两组间差异主要由于PAR组的肌皮神经和桡神经阻滞率较低(P<0.05)。PNS组的麻醉起效时间短于PAR组(19min对29min,P<0.01)。两组中共有3例病人(6.6%)发生术后短暂的神经功能障碍,3周内均获完全恢复。结论PNS法是一种良好的定位手段。将该方法应用于三点法腋路臂丛神经阻滞,可获得优于传统异感定位法的效果。臂丛阻滞后神经功能障碍并不少见,应引起足够重视。
Purpose To evaluate the efficacy and latency time of two nerve-localization techniques： paresthesia elicitation or nerve stimulation. Methods Forty-five patients, were studied and randomly divided into paresthesia group（PAR, n = 23） and peripheral nerve stimulator group（ PNS. n = 22）. The musculocutaneous nerve, the median nerve, the radial nerve or the ulnar nerve were located by either elicitation of a paresthesia（Group PAR） or nerve stimulation（Group PNS）, A mixture of 2% lidocaine and 0.5% bupivacaine was used as the local anesthetic. Forty millilitres local anesthetic was divided among 3 nerves,5 mL for the musculocutaneous nerve.15 mL for the median nerve and 15 mL for either the radial nerve or ulnar nerve. another 5 mL local anesthetic was used to infiltrate the subcutaneous tissue to block the medial cutaneous nerve of the arm. Success was defined as a sensory block of the 5 nerves with territories distal to the elbow 30 minutes after performing the block. The block success rate,latency time of analgesia and occurrence of complication were compared between two groups, Results The success rate of group PNS was higher than that of group PAM（95.5% vs 54. 5 % . P 〈0.01 ）. and this wss related to a larger success rate for blocking the radial and the musculocutaneous nerves（ P 〈 0.05）, Time to achieve readiness for surgery was shorter in group PNS than group PAR（ 19min vs 29min. P 〈0.01）. Among the patients,3（6.6% ） devloped transient neurologic dysfunction on the operated limb, complete recovery was observed within 3 weeks. Conclusions The technique of PNS is superior to the paresthesia as a nerve localization method in triple-injection axilllary brachial plexus block. Postoperative neurologic dystunction is not a rare event, and more attention should be paid on it.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2005年第5期529-532,535,共5页
Fudan University Journal of Medical Sciences
关键词
神经阻滞
臂丛
腋部
神经刺激器
nerve block
brachial plexus
axilla
peripheral nerve stimulator
