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急诊医生采用超声引导神经阻滞治疗肢体损伤的可行性与安全性。

Feasibility and safety of ultrasound-guided nerve block for management of limb injuries by emergency care physicians.

作者信息

Bhoi Sanjeev, Sinha Tej P, Rodha Mahaveer, Bhasin Amit, Ramchandani Radhakrishna, Galwankar Sagar

机构信息

Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.

出版信息

J Emerg Trauma Shock. 2012 Jan;5(1):28-32. doi: 10.4103/0974-2700.93107.

DOI:10.4103/0974-2700.93107
PMID:22416151
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3299149/
Abstract

BACKGROUND

Patients require procedural sedation and analgesia (PSA) for the treatment of acute traumatic injuries. PSA has complications. Ultrasound (US) guided peripheral nerve block is a safe alternative.

AIM

Ultrasound guided nerve blocks for management of traumatic limb emergencies in Emergency Department (ED).

SETTING AND DESIGN

Prospective observational study conducted in ED.

MATERIALS AND METHODS

Patients above five years requiring analgesia for management of limb emergencies were recruited. Emergency Physicians trained in US guided nerve blocks performed the procedure.

STATISTICAL ANALYSIS

Effectiveness of pain control, using visual analogue scale was assessed at baseline and at 15 and 60 minutes after the procedure. Paired t test was used for comparison.

RESULTS

Fifty US guided nerve blocks were sciatic- 4 (8%), femoral-7 (14%), brachial- 29 (58%), median -6 (12%), and radial 2 (4%) nerves. No patients required rescue PSA. Initial median VAS score was 9 (Inter Quartile Range [IQR] 7-10) and at 1 hour was 2(IQR 0-4). Median reduction in VAS score was 7.44 (IQR 8-10(75%), 1-2(25%) (P=0.0001). Median procedure time was 9 minutes (IQR 3, 12 minutes) and median time to reduction of pain was 5 minutes (IQR 1,15 minutes). No immediate or late complications noticed at 3 months.

CONCLUSION

Ultrasound-guided nerve blocks can be safely and effectively performed for upper and lower limb emergencies by emergency physicians with adequate training.

摘要

背景

患者在治疗急性创伤性损伤时需要进行程序性镇静和镇痛（PSA）。PSA存在并发症。超声（US）引导下的外周神经阻滞是一种安全的替代方法。

目的

在急诊科（ED）中，超声引导下的神经阻滞用于处理创伤性肢体急症。

设置与设计

在ED进行的前瞻性观察性研究。

材料与方法

招募五岁以上因肢体急症需要镇痛的患者。由接受过超声引导神经阻滞培训的急诊医生实施该操作。

统计分析

使用视觉模拟量表评估基线时以及操作后15分钟和60分钟时的疼痛控制效果。采用配对t检验进行比较。

结果

50例超声引导下的神经阻滞分别为坐骨神经阻滞4例（8%）、股神经阻滞7例（14%）、臂丛神经阻滞29例（58%）、正中神经阻滞6例（12%）和桡神经阻滞2例（4%）。没有患者需要补救性PSA。初始VAS评分中位数为9（四分位间距[IQR]7 - 10），1小时时为2（IQR 0 - 4）。VAS评分中位数降低了7.44（IQR 8 - 10（75%），1 - 2（25%）（P = 0.0001）。操作中位数时间为9分钟（IQR 3，12分钟），疼痛减轻的中位数时间为5分钟（IQR 1，15分钟）。在3个月时未发现即时或晚期并发症。

结论

经过充分培训后的急诊医生能够安全有效地对上肢和下肢急症进行超声引导下的神经阻滞。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/871b/3299149/749da5b65ce6/JETS-5-28-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/871b/3299149/585e7e6f2171/JETS-5-28-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/871b/3299149/0c6778f473cd/JETS-5-28-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/871b/3299149/478b6dbe828a/JETS-5-28-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/871b/3299149/f697bd2ed0f6/JETS-5-28-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/871b/3299149/749da5b65ce6/JETS-5-28-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/871b/3299149/585e7e6f2171/JETS-5-28-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/871b/3299149/0c6778f473cd/JETS-5-28-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/871b/3299149/478b6dbe828a/JETS-5-28-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/871b/3299149/f697bd2ed0f6/JETS-5-28-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/871b/3299149/749da5b65ce6/JETS-5-28-g008.jpg

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