Wang Li, Yu Xiao-Jun, Yang Fan, Li Juan, Wang Zhi-Qiang
Department of Anesthesiology, Suining Central Hospital, Suining 629000, Sichuan, China.
Ward One, Orthopaedic Center, Suining Central Hospital, Suining 629000, Sichuan, China.
Zhongguo Gu Shang. 2025 Apr 25;38(4):411-4. doi: 10.12200/j.issn.1003-0034.20230317.
To explore the efficacy of ultrasound-guided selective nerve block anesthesia in the distal third of the forearm while maintaining active flexion and extension during surgery for stenosing tenosynovitis.
A retrospective analysis was conducted on 61 patients including 15 males and 46 females with American Society of Anesthesiologists(ASA)gradesⅠorⅡ, who underwent surgery for stenosing tenosynovitis in our hospital between January 2017 and January 2022. These patients, aged from 16 to 72 years old (weighing 44 to 75 kg), underwent selective nerve blocks targeting the median and ulnar nerves at the middle and distal third of the forearm, and the superficial branch of radial nerve at the dorsal radial side of wrist joint, under ultrasound guidance. A 0.5% ropivacaine solution was used for each nerve block. The anesthetic dosage for each nerve was recorded, and the efficay of each nerve block was monitored by acupuncture every 30 seconds post-administration. The onset time and ability to perform active finger flexion and extension were recorded. Outpatient or telephone follow-up was performed 1, 3 and 6 months postoperatively to evaluate the efficacy of release.
The efficacy of anesthesia block was excellent in 60 patients and good in 1 patient. One patient with simple stenosing tenosynovitis of the middle finger reported slight pain intraoperatively, which resolved with additional block of superficial branch of radial nerve of the wrist. Superficial branch of radial nerve was blocked in 20 patients, with a single dose of (1.7±0.3) ml and the onset time of (0.6±0.2) min. Median nerve was blocked in 45 patients, with a single dose of (4.1±1.0) ml and the onset time of (1.2±0.3) min;Ulnar nerve was blocked in 16 patients, with a single dose of (3.9±0.5) ml and the onset time of (1.7±0.3) min. All the patients retained active flexion and extension of the fingers. All 61 patients were followed up for 6 to 10 months with an average of (8.0±2.0) months, and no recurrence was observed.
Ultrasound-guided selective nerve block of distal third of the forearm can provide safe, rapid and good anesthesia for patients undergoing surgery for stenosing tenosynovitis of fingers, while maintaining the active finger movement. This technique facilitates intraoperative assessment of release and improves overall surgical outcomes.
探讨超声引导下选择性神经阻滞麻醉在前臂远侧三分之一处用于狭窄性腱鞘炎手术时维持手指屈伸活动的效果。
对2017年1月至2022年1月期间在我院接受狭窄性腱鞘炎手术的61例患者进行回顾性分析，其中男性15例，女性46例，美国麻醉医师协会（ASA）分级为Ⅰ或Ⅱ级，年龄16至72岁（体重44至75千克）。这些患者在超声引导下，对前臂中、远侧三分之一处的正中神经和尺神经以及腕关节背桡侧的桡神经浅支进行选择性神经阻滞。每次神经阻滞使用0.5%的罗哌卡因溶液。记录每条神经的麻醉剂量，给药后每30秒通过针刺监测每次神经阻滞的效果。记录起效时间以及进行手指主动屈伸的能力。术后1、3和6个月进行门诊或电话随访，评估松解效果。
麻醉阻滞效果优60例，良1例。1例单纯中指狭窄性腱鞘炎患者术中诉轻微疼痛，追加腕部桡神经浅支阻滞缓解。20例患者进行了桡神经浅支阻滞，单次剂量为（1.7±0.3）毫升，起效时间为（0.6±0.2）分钟。45例患者进行了正中神经阻滞，单次剂量为（4.1±1.0）毫升，起效时间为（1.2±0.3）分钟；16例患者进行了尺神经阻滞，单次剂量为（3.9±0.5）毫升，起效时间为（1.7±0.3）分钟。所有患者均保留手指的主动屈伸。61例患者均随访6至10个月，平均（8.0±2.0）个月，未观察到复发。
超声引导下前臂远侧三分之一处选择性神经阻滞可为手指狭窄性腱鞘炎手术患者提供安全、快速且良好的麻醉，同时保持手指的主动活动。该技术有助于术中评估松解效果，改善整体手术结局。
