Comparison of efficacy of ultrasound-guided brachial plexus block between the position on the uninjured arm and the supine position
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摘要: 目的 对比观察健侧卧位与常规仰卧位行超声引导下臂丛阻滞术,探索一种简单易行、安全高效的方法实施超声引导下臂丛神经阻滞术。 方法 选取2014年3月-2015年8月间,于嘉兴市第一医院择期采用B超引导锁骨上侧入路平面内穿刺技术行臂丛神经阻滞下肩关节松解术的肩周炎患者60例,采用随机数字表法分为2组,A组30例于健侧卧位下行B超引导穿刺针进行穿刺操作,B组30例于常规仰卧位下操作,针尖抵达臂丛神经干后注入0.3%罗哌卡因+甲钴胺0.5 mg混合液10 ml,对比2组的操作时间(从穿刺针进入皮肤至局麻药注射完毕)、穿刺针在超声平面内可调节角度(穿刺针刺入皮肤后沿超声探头平面内的最大可调节角度)、患者各神经分支的阻滞效果和操作并发症发生率。 结果 健侧卧位与常规仰卧位操作可调节角度分别为[(123.4±4.2)° vs.(28.9±4.6)°],阻滞操作时间分别为[(4.3±1.8) min vs.(5.2±2.0)min],差异均有统计学意义(均P<0.05);而并不影响麻醉成功率、麻醉维持时间、感觉阻滞程度和并发症的发生率。 结论 在行超声引导下锁骨上入路平面内穿刺技术臂丛阻滞时,健侧卧位较常规仰卧位操作穿刺针可调节角度与范围明显增大,显著缩短了操作时间,并不影响操作的成功率和安全性,简化了操作过程,值得临床推广。Abstract: Objective To compare the effect of ultrasound-guided brachial plexus block between the position on the uninjured arm and the supine position. Methods Sixty cases of frozen shoulder undergoing ultrasound-guided brachial plexus block and arthroscopic release in our hospital between March,2014 and August,2015 were enrolled and randomly divided into two groups.The brachial plexus block in Group A was performed with B ultrasound-guided needle by the position on the uninjured arm;while in Group B was performed by the supine position.When the needle point reached the plexus,10 ml drug (0.3% Ropivacaine+0.5 mg Mecobalamin) was injected.The operation time,needle adjustable angle,block efficiency and the probability of complications were compared between the two groups. Results By the position on the uninjured arm,the adjustable angle of needle was significantly increased from (123.4±4.2 vs.28.9±4.6),the operation time was reduced[(4.3±1.8) min vs.(5.2±2.0) min],the difference were statistically significant with 95% possibility.Meanwhile,the block efficiency,lasting time,sensory degree and the probability of complications remained at the same level. Conclusion The ultrasound-guided brachial plexus block from the position on the uninjured arm should increase the needle adjustable angle,shorten the operation time,and maintain the operation success rate and safety,it is more efficient and convenient as compared with the supine position,which suggests that the healthy lateral position holds a promising future of clinical utility.
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