She Gaoming, Nie Cai, Liu Yuyong, Peng Xuemei, Zhang Qingde, Li Yalan
Department of Anesthesiology, First Affiliated Hospital of Jinan University, Guangzhou 510630, China. E-mail:
Nan Fang Yi Ke Da Xue Xue Bao. 2015 Aug;35(8):1193-6.
To observe the anesthetic efficacy and safety of bilateral ultrasound-guided supraclavicular brachial plexus block in patients undergoing arthrolysis for shoulder periarthritis.
Twenty-seven patients (ASA class I-II) undergoing bilateral shoulder joint release surgery and 24 ml received bilateral ultrasound-guided supraclavicular brachial plexus block anesthesia with 0.4% ropivacaine and 0.8% lidocaine. The visual analogue scale (VAS) scores for shoulder joint pain were recorded before and after anesthesia. The efficacy of axillary nerve, dorsal scapular nerve and suprascapular nerve block was evaluated, and the anesthetic effect and complications was assessed during surgery. Before and after anesthesia, the range of left and right diaphragmatic muscle movement was measured when the patient took a quiet breath and a deep breath.
The patients showed no significant variations in MAP, HR, or SpO₂after anesthesia. The VAS scores of shoulder joint pain during anteflexion, abduction, posterior extension, rotation, posterior extension and medial rotation were significantly lowered after anesthesia (P<0.05), but the left and the right diaphragm movement range showed no significant difference between quiet breath and deep breath (P>0.05). The rates of complete block of the axillary nerve and dorsal scapular nerve was 100%, and that of suprascapular nerve was 92.6%. Partial phrenic nerve block occurred in 1 case with mild local anesthetic toxicity in another.
Bilateral ultrasound-guided supraclavicular brachial plexus block in patients has excellent analgesic effect in should joint release surgery with good safely.
观察双侧超声引导下锁骨上臂丛神经阻滞用于肩周炎松解术患者的麻醉效果及安全性。
27例(ASA分级I-II级)拟行双侧肩关节松解手术的患者,采用0.4%罗哌卡因与0.8%利多卡因行双侧超声引导下锁骨上臂丛神经阻滞麻醉,用量24 ml。记录麻醉前后肩关节疼痛视觉模拟评分(VAS)。评估腋神经、肩胛背神经和肩胛上神经阻滞效果,术中观察麻醉效果及并发症。麻醉前后分别测量患者静息呼吸及深呼吸时左右膈肌运动幅度。
麻醉后患者MAP、HR、SpO₂无明显变化。麻醉后肩关节前屈、外展、后伸、旋转、后伸内旋时VAS评分明显降低(P<0.05),静息呼吸及深呼吸时左右膈肌运动幅度差异无统计学意义(P>0.05)。腋神经和肩胛背神经完全阻滞率为100%,肩胛上神经为92.6%。发生1例膈神经部分阻滞,另1例出现轻度局麻药中毒。
双侧超声引导下锁骨上臂丛神经阻滞用于肩周炎松解术患者镇痛效果良好,安全性高。