Zhu Miao, Yuan Liyong, Mei Zhong, Sheng Zhimin, Ge Yeying, Zhang Long, Liu Guanyi
Department of Anesthesiology, Ningbo No.6 hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, People's Republic of China.
Department of Anesthesiology, Zhejiang Xiaoshan Hospital, Hangzhou, People's Republic of China.
Drug Des Devel Ther. 2024 Nov 28;18:5473-5483. doi: 10.2147/DDDT.S483358. eCollection 2024.
The brachial plexus block is conducive to providing postoperative analgesia for patients with humeral fractures. The commonly used brachial plexus block techniques have a high incidence rate of hemidiaphragmatic paralysis (HDP), which may lead to respiratory problems. The combined costoclavicular brachial plexus - cervical plexus blocks (CCB-CPBs) had demonstrated favorable analgesic effects and had reduced the incidence of HDP in shoulder surgeries. However, the clinical experience regarding CCB-CPBs is rather limited. Consequently, our study aims to evaluate its various effects, such as the diaphragmatic and pulmonary functions, as well as the analgesia for humeral fracture surgeries.
We enrolled 30 patients who were slated to undergo surgery for humeral fractures under the combined use of nerve block and general anesthesia. All the patients underwent CCB-CPBs under the guidance of an ultrasound and a nerve simulator. The anesthetic dosage consisted of 20 ml and 10 ml of 0.5% ropivacaine respectively. Following the operation, all the patients were transferred to the Post-Anesthesia Care Unit (PACU). The diaphragmatic excursion, spirometry outcomes, pain score, along with the sensory and motor block, were evaluated.
The diaphragmatic excursion was significantly reduced during the post-block period in contrast to the pre-block period. The mean change in diaphragmatic excursion (with the mean value [SD]) was -25.3 [48.6] %, accompanied by a -value of 0.001. The forced vital capacity (FVC) during the post-block period was approximately 7% lower compared to that during the pre-block period, with a -value of 0.032. The numerical rating scale (NRS) scores of the patients in the PACU were 0 (0-0).
CCB-CPBs can result in a reduction in hemidiaphragm excursion and may slightly affect lung function to some extent. Nevertheless, they can provide a favorable analgesic effect for humeral fracture surgery. Therefore, patients with poor respiratory reserve should exercise caution when using it.
臂丛神经阻滞有助于为肱骨骨折患者提供术后镇痛。常用的臂丛神经阻滞技术发生半膈肌麻痹（HDP）的发生率较高，这可能导致呼吸问题。锁骨下臂丛 - 颈丛联合阻滞（CCB - CPB）已在肩部手术中显示出良好的镇痛效果，并降低了HDP的发生率。然而，关于CCB - CPB的临床经验相当有限。因此，我们的研究旨在评估其各种影响，如膈肌和肺功能，以及对肱骨骨折手术的镇痛效果。
我们纳入了30例计划在神经阻滞和全身麻醉联合使用下进行肱骨骨折手术的患者。所有患者均在超声和神经刺激器引导下接受CCB - CPB。麻醉剂量分别为20 ml和10 ml的0.5%罗哌卡因。术后，所有患者被转移至麻醉后恢复室（PACU）。评估膈肌活动度、肺功能测定结果、疼痛评分以及感觉和运动阻滞情况。
与阻滞前相比，阻滞后期膈肌活动度显著降低。膈肌活动度的平均变化（平均值[标准差]）为 - 25.3 [48.6]%，P值为0.001。阻滞后期的用力肺活量（FVC）比阻滞前期降低了约7%，P值为0.032。PACU中患者的数字评分量表（NRS）评分为0（0 - 0）。
CCB - CPB可导致半膈肌活动度降低，并可能在一定程度上轻微影响肺功能。然而，它们可为肱骨骨折手术提供良好的镇痛效果。因此，呼吸储备较差的患者在使用时应谨慎。
