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超声引导与非超声引导下肋间臂神经阻滞对臂丛神经腋路阻滞术后止血带疼痛影响的比较:一项随机临床试验

Comparison of the Effect of Intercostobrachial Nerve Block with and Without Ultrasound Guidance on Tourniquet Pain After Axillary Block of Brachial Plexus: A Randomized Clinical Trial.

作者信息

Seyed Siamdoust Seyed Alireza, Zaman Behrooz, Noorizad Samad, Alimian Mahzad, Barekati Mona

机构信息

Department of Anesthesiology and Pain Medicine, Pain Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

出版信息

Anesth Pain Med. 2023 Mar 29;13(2):e134819. doi: 10.5812/aapm-134819. eCollection 2023 Apr.

DOI:10.5812/aapm-134819
PMID:37601964
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10439685/
Abstract

BACKGROUND

A tourniquet is used to control bleeding in the surgical field. Because part of the inner arm is innervated by the intercostobrachial nerve (ICBN), a tourniquet can cause intolerable pain.

OBJECTIVES

The present study aimed to compare the effect of ICBN block with and without ultrasound (US) guidance on tourniquet pain after axillary block.

METHODS

This study was performed on 60 patients who were candidates for surgery. The patients were divided into 3 groups: the control group (n = 22), the traditional ICBN (TICBN) blockade group (n = 19), and the US-guided ICBN blockade group (n = 19). After the intervention, the duration of the onset and intensity of pain was recorded for all patients according to the Numeric Rating Scale (NRS). Data analysis was performed using SPSS.

RESULTS

No significant differences were observed in demographic variables between the 3 groups (P > 0.05). The pain intensity in the TICBN blockade (P = 0.001) and US-guided ICBN blockade (P = 0.001) groups was significantly less than in the control group. The mean duration of pain onset was significantly higher in the TICBN blockade (P = 0.021) and US-guided ICBN blockade (P = 0.013) groups than in the control group. No significant difference was observed in the mean of pain intensity (P = 0.48) and the mean duration of pain onset (P = 0.44) between the US-guided ICBN blockade and TICBN blockade groups.

CONCLUSIONS

The pain caused by a tourniquet can be managed by ICBN block during hand and forearm surgery. It is recommended to use US guidance for more success and safety.

摘要

背景

止血带用于控制手术区域的出血。由于臂内侧部分由肋间臂神经(ICBN)支配,止血带可引起难以忍受的疼痛。

目的

本研究旨在比较有超声(US)引导和无超声引导的ICBN阻滞对腋路阻滞后止血带疼痛的影响。

方法

本研究对60例拟行手术的患者进行。患者分为3组:对照组(n = 22)、传统ICBN(TICBN)阻滞组(n = 19)和超声引导下ICBN阻滞组(n = 19)。干预后,根据数字评分量表(NRS)记录所有患者疼痛发作的持续时间和强度。使用SPSS进行数据分析。

结果

3组间人口统计学变量无显著差异(P > 0.05)。TICBN阻滞组(P = 0.001)和超声引导下ICBN阻滞组(P = 0.001)的疼痛强度明显低于对照组。TICBN阻滞组(P = 0.021)和超声引导下ICBN阻滞组(P = 0.013)疼痛发作的平均持续时间明显高于对照组。超声引导下ICBN阻滞组与TICBN阻滞组在疼痛强度平均值(P = 0.48)和疼痛发作平均持续时间(P = 0.44)方面无显著差异。

结论

在手部和前臂手术中,止血带引起的疼痛可通过ICBN阻滞来控制。建议使用超声引导以获得更高的成功率和安全性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b21f/10439685/ae0f42811dc5/aapm-13-2-134819-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b21f/10439685/917b7f442936/aapm-13-2-134819-i001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b21f/10439685/ae0f42811dc5/aapm-13-2-134819-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b21f/10439685/917b7f442936/aapm-13-2-134819-i001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b21f/10439685/ae0f42811dc5/aapm-13-2-134819-g001.jpg

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New approach for blocking intercostobrachial and medial brachial cutaneous nerve in the axillary area: response to Varela.腋窝区域阻滞肋间臂神经和臂内侧皮神经的新方法:对瓦雷拉的回应。
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