收稿日期: 2021-12-22
录用日期: 2022-05-18
网络出版日期: 2022-05-28
基金资助
上海市第六人民医院院级科学研究基金(ynts202005)
Observation of analgesic effect of ultrasound-guided brachial plexus combined with intercostal brachial nerve block in the operation of distal humeral fracture
Received date: 2021-12-22
Accepted date: 2022-05-18
Online published: 2022-05-28
Supported by
Scientific Research Foundation of Shanghai Sixth People's Hospital(ynts202005)
目的·探讨超声引导下臂丛复合肋间臂神经（intercostobrachial nerve，ICBN）阻滞技术对后入路的肱骨远端骨折手术患者的镇痛效果。方法·选取上海交通大学医学院附属第六人民医院2016年2月?2021年3月行非全身麻醉，后入路肱骨远端骨折择期手术149例患者进行回顾性分析。纳入符合标准的患者后，根据神经阻滞方式将患者分为2组：单纯臂丛神经阻滞（brachial plexus block）107例（BP组），臂丛联合ICBN阻滞42例（ICB组）。其中ICB组根据ICBN阻滞入路的不同分为2个亚组：胸小肌下组17例（ICB1组），腋区组25例（ICB2组）。分析BP组与ICB组及2个ICB亚组的患者一般情况、手术基本情况以及术中静脉给予舒芬太尼的剂量、术毕时的疼痛评分［视觉模拟评分（visual analogue scale，VAS）］、镇静需求率和其他镇痛药物需求率。结果·BP组和ICB组患者在年龄、性别、美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级、体质量指数（body mass index，BMI）、手术时间、出血量方面的差异均无统计学意义（P>0.05）。ICB1组和ICB2组患者在年龄、性别、ASA分级、BMI、手术时间和出血量方面亦无统计学意义（P>0.05）。在术中舒芬太尼使用量、出手术室时VAS评分、镇静需求率和其他镇痛药物需求率方面，ICB组显著低于BP组（P=0.001，P=0.000，P=0.012，P=0.018），差异具有统计学意义。2个亚组之间，术中舒芬太尼使用量、出手术室时VAS评分、镇静需求率和其他镇痛药物需求率方面的差异无统计学意义（P>0.05）。结论·后入路的肱骨远端骨折手术中，臂丛复合ICBN阻滞与单纯臂丛阻滞相比，能显著增强镇痛效果；2种ICBN阻滞技术镇痛效果类似。
陈默曦 , 许涛 , 高晓云 , 汪文英 , 陈勇柱 . 超声引导下臂丛复合肋间臂神经阻滞在肱骨远端骨折手术中的镇痛效果观察[J]. 上海交通大学学报（医学版）, 2022 , 42(5) : 624 -628 . DOI: 10.3969/j.issn.1674-8115.2022.05.010
·To investigate the analgesic effect of ultrasound-guided intercostobrachial nerve (ICBN) block on patients with distal humeral fracture who need surgical treatment through posterior approach.
·One hundred and forty-nine patients with distal humeral fracture were enrolled in Shanghai Sixth People's Hospital from February 2016 to March 2021. They underwent elective surgery via posterior approach under non-general anesthesia and were selected for retrospective analysis. They were divided into two groups according to the way of nerve block: 107 cases of brachial plexus block (BP group), and 42 cases of brachial plexus combined with ICBN block (ICB group). The ICB group was divided into two subgroups according to different approaches of ICBN block: 17 cases in “under pectoralis minor” group (ICB1 group) and 25 cases in “axillary region” group (ICB2 group). The general condition of the four groups, the intraoperative sufentanil dosage, visual analogue scale (VAS) pain score, sedation rate and other analgesic demand rates were analyzed.
·There was no significant difference in age, sex, ASA classification, BMI, operation time and bleeding volume between the BP group and ICB group (P>0.05). There was also no significant difference in these general features between the ICB1 group and ICB2 group (P>0.05). The usage of sufentanil, VAS score, sedation rate and other analgesic drug demand rates in the ICB group were lower than those in the BP group (P=0.001, P=0.000, P=0.012, P=0.018), which was statistically significant. There was no significant difference in aspects mentioned above between the two subgroups (P>0.05).
·Compared with brachial plexus block alone, ICBN block combined with brachial plexus block can significantly enhance the analgesic effect in the operation of distal humeral fracture through posterior approach, and the analgesic effect of the two ICBN block techniques is similar.
| 1 | ROBINSON C M, HILL R M, JACOBS N, et al. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment[J]. J Orthop Trauma, 2003, 17(1): 38-47. |
| 2 | MCKEE M D, WILSON T L, WINSTON L, et al. Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach[J]. J Bone Joint Surg Am, 2000, 82(12): 1701-1707. |
| 3 | HENRY B M, GRAVES M J, P?KALA J R, et al. Origin, branching, and communications of the intercostobrachial nerve: a meta-analysis with implications for mastectomy and axillary lymph node dissection in breast cancer[J]. Cureus, 2017, 9(3): e1101. |
| 4 | 王爱忠, 范坤, 赵达强. 超声引导下的神经阻滞技术[M].上海: 上海交通大学出版社, 2019: 71. |
| 4 | WANG A Z, FAN K, ZHAO D Q. Ultrasound-guided nerve block technique[M]. Shanghai: Shanghai Jiao Tong University Press, 2019:71. |
| 5 | PURCELL N, WU D. Novel use of the PECS Ⅱ block for upper limb fistula surgery[J]. Anaesthesia, 2014, 69(11): 1294. |
| 6 | QUEK K H, LOW E Y, TAN Y R, et al. Adding a PECS Ⅱ block for proximal arm arteriovenous access: a randomised study[J]. Acta Anaesthesiol Scand, 2018, 62(5): 677-686. |
| 7 | SHAH S, MATHKAR S. Ultrasound-guided multiple peripheral nerve blocks, a way out for anesthesia in morbidly obese patients for bone marrow aspiration[J]. Braz J Anesthesiol, 2020, 70(3): 295-298. |
| 8 | THALLAJ A K, AL H M K, ALZAHRANI T A, et al. Ultrasound imaging accurately identifies the intercostobrachial nerve[J]. Saudi Med J, 2015, 36(10): 1241-1244. |
| 9 | MAGAZZENI P, JOCHUM D, IOHOM G, et al. Ultrasound-guided selective versus conventional block of the medial brachial cutaneous and the intercostobrachial nerves: a randomized clinical trial[J]. Reg Anesth Pain Med, 2018, 43(8): 832-837. |
| 10 | VARELA V M, RUIZ C A, MONTECINOS S, et al. Ultrasound-guided selective block of the medial brachial cutaneous and the intercostobrachial nerves for proximal arteriovenous fistula surgery[J]. Reg Anesth Pain Med, 2019. DOI:10.1136/rapm-2018-100298. |
| 11 | WIJAYASINGHE N, DURIAUD H M, KEHLET H, et al. Ultrasound guided intercostobrachial nerve blockade in patients with persistent pain after breast cancer surgery: a pilot study[J]. Pain Physician, 2016, 19(2): E309-E318. |
| 12 | YAMAK A E, GALLUCCIO F, SALAZAR C, et al. New approach for blocking intercostobrachial and medial brachial cutaneous nerve in the axillary area: response to Varela[J]. Reg Anesth Pain Med, 2020, 45(10): 841-842. |
/
| 〈 |
|
〉 |