| 摘要: |
| 目的 评价基于耳大神经辅助定位的超声引导下颈浅神经丛阻滞用于锁骨手术的效果。方法 选择拟行锁骨手术患者，经超声和经皮电刺激确认耳大神经后，共100例患者纳入本研究。将100例患者随机分为常规超声引导组和耳大神经辅助定位组，每组50例。采用1%利多卡因和0.375%罗哌卡因混合液进行局部麻醉。常规超声引导组经常规穿刺点即胸锁乳突肌后缘（从锁骨头附着点至乳突最突出点）中点穿刺行神经阻滞；耳大神经辅助定位组穿刺前测量相关形态学数据，超声引导下经耳大神经穿刺点穿刺行神经阻滞。采用针刺法评估阻滞效果，记录相关不良反应。结果 两组年龄、性别、BMI、手术时间差异均无统计学意义（P均>0.05）。耳大神经辅助定位组患者引出耳大神经阳性反应的平均电刺激电流强度为（1.1±0.3）mA，从开始扫查至完成耳大神经穿刺点标记的平均时间为（30.5±8.2）s。耳大神经辅助定位组中有94.0%（47/50）的患者穿刺点与常规穿刺点重合或位于其尾侧，仅3例位于常规穿刺点头侧，两点平均相距（1.27±0.84）cm。耳大神经辅助定位组阻滞成功率高于常规超声引导组[98.0%（49/50）vs 78.0%（39/50），P<0.05]，且耳大神经辅助定位组起效更快。两组患者术后均观察24 h，各有1例患者在阻滞后出现声音嘶哑，未出现其他不良反应或并发症。结论 基于耳大神经辅助定位的超声引导下颈浅神经丛阻滞具有起效快、成功率高、并发症少的优势。 |
| 关键词: 超声引导 神经阻滞 耳大神经 颈浅神经丛阻滞 |
| DOI：10.16781/j.0258-879x.2020.03.0298 |
| 投稿时间：2020-01-07修订日期：2020-03-05 |
| 基金项目:2018贝朗麻醉科学研究基金（BBDF2018-009）. |
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| Ultrasound-guided superficial cervical plexus block positioned by great auricular nerve in clavicle surgery |
| LIN Li1△,JIANG Xin2△,LUO Shi-yuan1,LUO Yan1* |
(1. Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
2. Department of Anesthesiology, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To evaluate the application value of ultrasound-guided superficial cervical plexus block positioned by great auricular nerve in clavicle surgery. Methods A total of 100 patients who were scheduled to undergo clavicular surgery were enrolled in this study after the great auricular nerve was confirmed by ultrasound and transcutaneous electrical stimulation. The patients were randomly assigned to two groups:routine ultrasound-guided group and great auricular nerve-positioned group, with 50 cases in each group. A mixture of 1% lidocaine and 0.375% ropivacaine was used for local anesthesia. In the routine ultrasound-guided group, nerve block was performed by skin puncture at the midpoint of the sternocleidomastoid muscle posterior margin (from the attachment point of the clavicular head to the most prominent point of the mastoid process). In the great auricular nerve-positioned group, relevant morphological data were measured before puncture, and then nerve block was performed by skin puncture at the great auricular nerve puncture point under ultrasound guidance. Pinprick test was used to evaluate the blocking effect and the adverse events were recorded. Results There were no significant differences in age, gender, body mass index (BMI) or operation time between the two groups (all P>0.05). In the great auricular nerve-positioned group, the average current intensity to elicit positive reaction of great auricular nerve was (1.1±0.3) mA, and mean time from start of scan to completion of marking of the great auricular nerve puncture point was (30.5±8.2) s. In the great auricular nerve-positioned group, the puncture sites of 94% (47/50) patients were coincident or caudal to the routine ones, only 3 patients' puncture sites were cranial to the routine ones, with average distance between the two points being (1.27±0.84) cm. The success rate of nerve blocking was significantly higher in the great auricular nervepositioned group than that in the routine ultrasound-guided group (98.0%[49/50]vs 78.0%[39/50], P<0.05), and the great auricular nerve-positioned group had a faster onset. At 24 h of post-operative observation, one patient in each group had hoarseness after block, and no other adverse events or complications occurred. Conclusion Ultrasound-guided superficial cervical plexus block positioned by great auricular nerve has the advantages of rapid onset, high success rate, and few complications. |
| Key words: ultrasound-guided nerve block great auricular nerve superficial cervical plexus block |
