神经刺激器定位下肌间沟置管连续臂丛神经阻滞的临床应用.doc

神经刺激器定位下肌间沟置管连续臂丛神经阻滞的临床应用 李振威 廖荣宗 区锦燕 罗富荣 刘晓捷 张诚章 （佛山市中医院麻醉科，广东佛山528000） 摘要：目的：研究神经刺激器定位下肌间沟置管行连续臂丛神经阻滞及术后镇痛的临床效果及可行性。方法：ASAⅠ-Ⅱ级的前臂、腕部或手部手术60例，随机等分成两组，Ⅰ组为对照组，采用传统盲探异感法定位和普通静脉留置针穿刺并置入硬外导管行连续臂丛神经阻滞和术后镇痛，Ⅱ组为实验组，采用神经刺激器定位和特制导管装置经肌间沟置管行连续臂丛神经阻滞和术后镇痛。结果：Ⅱ组麻醉操作时间、起效时间、感觉运动阻滞完善时间较Ⅰ组短，有显著性差异（P0.05）P0.05）P0.05）Clinical use of nerve stimulator located cathetering for continuous interscalene brachial plexus block Li Zhen-wei, Luo Fu-rong, Ou Jin-yan, Liao Rong-zhong, Liu Xiao-jie, Zhang Chen-zhang Department of Anesthesiology,Hospital of Traditional Chinese Medicine in Foshan,Guangdon Foshan 528000,China [ABSTRACT] OBJECTIVES: To study clinical results and feasibility of continuous brachial plexus nerve block and postoperative anagesia with catheters located by nerve stimulator in interscalene approach. METHODS：60 ASAⅠ-Ⅱ patients receiving continuous interscalene brachial plexus block and postoperative analgesia for forearm, wrist or hand surgery were randomized into two groups.In group I,nerve blocks were performed using a normal venous needle located with traditional method which elicites numbness of the limb. Then a epidural catheter was passed and secured. Group Ⅱ were guided by nerve stimulator and special catheters were placed. CONCLUSIONS：compared to group I, time to perform the block, time to block and time to obtain satisfactory sensory and motor blockade in group II are shorter（P0.05）.All are successful in group Ⅱ, and group Ⅰ with 3 fail to block ulnar never，failure rate 10%.postoperative analgesics results are good in two groups, but group II better（P0.05）, 3 analgesics leakage and 2 catheters dislocation arised in groupⅠ；group Ⅱ has less intraoperative sedative usage and postoperative analgesics and local aneasthetics usage（P0.05）；with 4 hematoma and 4 nerve injury arise in group I when Ⅱ of no complication. CONCLUSIONS：nerve stimulator-guided catheters for continuous brachial plexus nerve block and postoperative anagesia have a higher success rate, more accur