超声引导下前臂神经阻滞与前臂静脉区域麻醉在腕管松解术中的疗效比较：一项随机对照试验。
Efficacy of ultrasound-guided forearm nerve block versus forearm intravenous regional anaesthesia in patients undergoing carpal tunnel release: A randomized controlled trial.
机构信息
Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium.
I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium.
出版信息
PLoS One. 2021 Feb 19;16(2):e0246863. doi: 10.1371/journal.pone.0246863. eCollection 2021.
BACKGROUND AND OBJECTIVES
Distal upper extremity surgery is commonly performed under regional anaesthesia, including intravenous regional anaesthesia (IVRA) and ultrasound-guided forearm nerve block. This study aimed to investigate if ultrasound-guided forearm nerve block is superior to forearm IVRA in producing a surgical block in patients undergoing carpal tunnel release.
METHODS
In this observer-blinded, randomized controlled superiority trial, 100 patients undergoing carpal tunnel release were randomized to receive ultrasound-guided forearm nerve block (n = 50) or forearm IVRA (n = 50). The primary outcome was anaesthetic efficacy evaluated by classifying the blocks as complete vs incomplete. Complete anaesthesia was defined as total sensory block, incomplete anaesthesia as mild pain requiring more analgesics or need of general anaesthesia. Pain intensity on a numeric rating scale (0-10) was recorded. Surgeon satisfaction with hemostasis, surgical time, and OR stay time were recorded. Patient satisfaction with the quality of the block was assessed at POD 1.
RESULTS
In total, 43 (86%) of the forearm nerve blocks were evaluated as complete, compared to 33 (66%) of the forearm IVRA (p = 0.019). After the forearm nerve block, pain intensity was lower at discharge (-1.76 points lower, 95% CI (-2.92, -0.59), p = 0.0006) compared to patients treated with forearm IVRA. No differences in pain experienced at the start of the surgery, during surgery, and at POD1, nor in surgical time or total OR stay were observed between groups. Surgeon (p = 0.0016) and patient satisfaction (p = 0.0023) were slightly higher after forearm nerve block.
CONCLUSION
An ultrasound-guided forearm nerve block is superior compared to forearm IVRA in providing a surgical block in patients undergoing carpal tunnel release.
TRIAL REGISTRATION
This trial was registered as NCT03411551.
背景和目的
远端上肢手术通常在区域麻醉下进行，包括静脉内区域麻醉（IVRA）和超声引导下前臂神经阻滞。本研究旨在探讨超声引导下前臂神经阻滞是否优于前臂 IVRA，以产生行腕管松解术患者的手术阻滞。
方法
在这项观察者盲、随机对照优效性试验中，100 例行腕管松解术的患者被随机分为接受超声引导下前臂神经阻滞（n = 50）或前臂 IVRA（n = 50）组。主要结局是通过将阻滞分为完全和不完全来评估麻醉效果。完全麻醉定义为完全感觉阻滞，不完全麻醉定义为轻微疼痛需要更多的镇痛药或需要全身麻醉。记录数字评分量表（0-10）上的疼痛强度。记录外科医生对止血、手术时间和手术室停留时间的满意度。患者在术后第 1 天（POD1）评估对阻滞质量的满意度。
结果
总共 43 例（86%）的前臂神经阻滞被评估为完全，而前臂 IVRA 为 33 例（66%）（p = 0.019）。与前臂 IVRA 治疗的患者相比，前臂神经阻滞后出院时的疼痛强度较低（低 1.76 分，95%CI[-2.92，-0.59]，p = 0.0006）。两组之间在手术开始时、手术过程中和 POD1 时的疼痛、手术时间或总手术室停留时间均无差异。外科医生（p = 0.0016）和患者满意度（p = 0.0023）略高前臂神经阻滞。
结论
与前臂 IVRA 相比，超声引导下前臂神经阻滞在为行腕管松解术的患者提供手术阻滞方面更具优势。
试验注册
该试验在 NCT03411551 注册。
Zotero 插件