Rukewe Ambrose, Adeoye Imoniche I, Sule Umar M, Fatiregun Akinola
Department of Anaesthesia, University College Hospital, Ibadan, Nigeria.
Ann Afr Med. 2011 Apr-Jun;10(2):185-7. doi: 10.4103/1596-3519.82063.
Fracture dislocation of the shoulder is a common musculoskeletal injury following road traffic accident. Peripheral nerve block has become a recognized anesthetic technique due to the rapid onset of prolonged analgesia, sufficient for both pain and surgical management. However, interscalene block for shoulder surgery has not been reported as a primary anesthetic technique in our environment. We report its successful use in open reduction and internal fixation of left humeral surgical neck fracture dislocation. The interscalene brachial plexus were localized by a Polystim II nerve stimulator (te me na, Bondy, France) with sustained biceps motor response at 0.2 mA and 40 ml of local anesthetic, comprising 0.25% bupivacaine and 1.0% of lidocaine with 1 : 200,000 epinephrine in equal parts was administered to establish the block. Surgical anesthesia was achieved 18 minutes after instituting the block and surgery lasted 70 minutes without complications. This technique may obviate the use of general anesthesia with its risks.
肩部骨折脱位是道路交通事故后常见的肌肉骨骼损伤。由于起效迅速且镇痛时间长，外周神经阻滞已成为一种公认的麻醉技术，足以满足疼痛和手术管理的需求。然而，在我们所在的环境中，尚未有报道将肌间沟阻滞作为肩部手术的主要麻醉技术。我们报告了其在左侧肱骨外科颈骨折脱位切开复位内固定术中的成功应用。使用Polystim II神经刺激器（法国邦迪的te me na公司）定位肌间沟臂丛神经，在0.2 mA时获得持续的肱二头肌运动反应，然后注入40 ml局部麻醉剂，其中0.25%布比卡因和1.0%利多卡因与1:200,000肾上腺素等份混合，以建立阻滞。阻滞建立后18分钟实现手术麻醉，手术持续70分钟，无并发症发生。该技术可能避免使用具有风险的全身麻醉。
