Majumdar Uma, Mitra Anuradha
Department of Anaesthesiology and Pain Medicine, KPC Medical College and Hospital, Kolkata, West Bengal, India.
Anesth Essays Res. 2022 Jan-Mar;16(1):149-153. doi: 10.4103/aer.aer_80_22. Epub 2022 Aug 9.
Fractures of the clavicle are usually operated under general anesthesia (GA) as they need dense anesthesia, and the airway is difficult to access intraoperatively. There is no established regional anesthesia (RA) technique for clavicular fractures, also as the innervation is contentious. Some studies have been done using RA techniques, but they are all small case numbers. RA is superior to GA in many ways, and we wished to avoid GA specifically during the COVID-19 pandemic.
This study aimed to use a peripheral nerve stimulator and a landmark-based technique to give interscalene block (ISB) and superficial cervical plexus block (SCPB) as a sole anesthetic for clavicular fracture surgeries during the COVID-19 pandemic.
This was a prospective observational study in a tertiary care teaching hospital in eastern India.
After approval from our ethics committee and informed consent, thirty patients of American Society of Anesthesiologists Class I or II, aged 18-65 years, after exclusion criteria were selected who had to undergo clavicular surgery. Three 10-mL syringes were made, each with 5 mL of 0.75% ropivacaine, 2 mL of 2% lignocaine with 1:200,000 adrenaline, and 3 mL of saline. Using the HNS Stimuplex (B. Braun Melsungen AG, Melsungen, Germany) nerve stimulator, 20 mL was given for an ISB and 5 mL for the SCPB. RA was considered successful if there was no conversion to GA and surgery could be performed.
With an onset time of 6.53 ± 2.17 min, good operating conditions were obtained in all our patients. Horner's syndrome was noted in two patients. Surgery was successfully carried out in all thirty patients under RA. Pain relief lasted postoperatively for 5 ± 0.92 h.
ISB combined with SCPB is safe and effective as a sole anesthetic for clavicular surgery. We successfully avoided the use of a general anesthetic in these patients during the COVID-19 pandemic and gave them a safe and effective alternative.
锁骨骨折通常在全身麻醉（GA）下进行手术，因为这类手术需要深度麻醉，且术中气道难以触及。目前尚无成熟的锁骨骨折区域麻醉（RA）技术，其神经支配也存在争议。虽有一些使用RA技术的研究，但病例数都较少。RA在很多方面优于GA，尤其在新冠疫情期间，我们希望避免使用GA。
本研究旨在使用外周神经刺激器和基于体表标志的技术，在新冠疫情期间为锁骨骨折手术实施肌间沟阻滞（ISB）和颈浅丛阻滞（SCPB）作为唯一麻醉方式。
这是一项在印度东部一家三级护理教学医院开展的前瞻性观察研究。
经伦理委员会批准并获得知情同意后，选取30例年龄在18至65岁、美国麻醉医师协会分级为I或II级且符合排除标准、需接受锁骨手术的患者。制作3支10毫升注射器，每支分别装有5毫升0.75%罗哌卡因、2毫升含1:200,000肾上腺素的2%利多卡因和3毫升生理盐水。使用HNS Stimuplex（德国梅尔松根贝朗医疗股份公司）神经刺激器，肌间沟阻滞注射20毫升，颈浅丛阻滞注射5毫升。若未转为全身麻醉且能完成手术，则认为区域麻醉成功。
起效时间为6.53±2.17分钟，所有患者均获得良好的手术条件。2例患者出现霍纳综合征。所有30例患者均在区域麻醉下成功完成手术。术后疼痛缓解持续5±0.92小时。
肌间沟阻滞联合颈浅丛阻滞作为锁骨手术的唯一麻醉方式安全有效。在新冠疫情期间，我们成功避免了对这些患者使用全身麻醉，并为他们提供了一种安全有效的替代方案。
