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超声引导下颈浅丛阻滞联合锁骨下入路喙锁筋膜间隙阻滞或肌间沟臂丛阻滞在锁骨手术中的应用:一项单中心、双盲、随机对照试验。

Ultrasound-guided superficial cervical plexus block combined with clavipectoral fascial plane block or interscalene brachial plexus block in clavicle surgery: a single-centre, double-blind, randomized controlled trial.

机构信息

Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China.

Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.

出版信息

J Clin Monit Comput. 2023 Aug;37(4):985-992. doi: 10.1007/s10877-022-00968-1. Epub 2023 Jan 10.

DOI:10.1007/s10877-022-00968-1
PMID:36625982
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10371927/
Abstract

The sensory innervation of the clavicle is complex, and the best regional block technology for clavicular surgery has yet to be determined. The purpose of this study was to compare the application of ultrasound-guided superficial cervical plexus block combined with clavipectoral fascial plane block verses interscalene brachial plexus block in clavicular surgery. Fifty patients undergoing internal fixation surgery for elective clavicle fractures were randomly divided into two groups (n = 25 for each group): group I and group II. Superficial cervical plexus block combined with clavipectoral fascial plane block was used in group I, and superficial cervical plexus block combined with interscalene brachial plexus block was used in group II. The primary outcome measure was the duration of analgesia. The duration of analgesia in group I was significantly longer than that in group II (P < 0.05). The modified Bromage scale function score in group II was lower than that in group I (P < 0.01). There was no significant difference in the skin acupuncture pain score 30 min after block and visual analog scale (VAS) scores at 6 and 12 h after surgery. However, the 24 h VAS score in group I was lower than that in group II (P < 0.05). The incidence of diaphragmatic paralysis was significantly increased in group II (P < 0.01). Ultrasound-guided superficial cervical plexus block combined with clavipectoral fascial plane block can be used for clavicular surgery. It has a long postoperative analgesia time, can retain the motor function of the involved upper limb and does not cause hemidiaphragmatic paresis.Clinical trial number and registry URL: Clinical Trials.gov; Trial registration number: ChiCTR2000039383; Date of registration: 25 October 2020.

摘要

锁骨的感觉神经支配较为复杂,目前尚不确定哪种区域阻滞技术最适合锁骨手术。本研究旨在比较超声引导下颈浅丛阻滞联合锁骨下筋膜平面阻滞与肌间沟臂丛阻滞在锁骨手术中的应用。50 例行择期锁骨骨折内固定手术的患者随机分为两组(每组 25 例):I 组和 II 组。I 组采用颈浅丛阻滞联合锁骨下筋膜平面阻滞,II 组采用颈浅丛阻滞联合肌间沟臂丛阻滞。主要观察指标为镇痛持续时间。I 组的镇痛持续时间明显长于 II 组(P<0.05)。II 组改良 Bromage 功能评分低于 I 组(P<0.01)。阻滞 30min 后皮肤针刺痛评分和术后 6、12h 视觉模拟评分(VAS)无显著差异,但 I 组 24h VAS 评分低于 II 组(P<0.05)。II 组膈神经麻痹发生率显著升高(P<0.01)。超声引导下颈浅丛阻滞联合锁骨下筋膜平面阻滞可用于锁骨手术。它具有较长的术后镇痛时间,可保留受累上肢的运动功能,且不会引起膈肌麻痹。临床试验编号和注册网址:ClinicalTrials.gov;注册号:ChiCTR2000039383;注册日期:2020 年 10 月 25 日。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1ed/10371927/f9cbe806eb7a/10877_2022_968_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1ed/10371927/96d191e4a016/10877_2022_968_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1ed/10371927/f9cbe806eb7a/10877_2022_968_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1ed/10371927/96d191e4a016/10877_2022_968_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1ed/10371927/f9cbe806eb7a/10877_2022_968_Fig3_HTML.jpg

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