锁骨骨折手术中单独应用颈浅丛神经阻滞或联合肌间沟臂丛神经阻滞

背景    

 适用于锁骨骨折的区域麻醉技术一直存在争议。本研究旨在比较颈浅神经丛单独或联合间肌间沟臂丛神经阻滞在锁骨骨折内固定手术中的应用。

方法    

将70例锁骨骨折内固定术患者纳入本临床试验，随机分为两组；颈浅丛神经阻滞（CPB）组和颈浅丛神经阻滞联合肌间沟阻滞（ISB）组。在诱导全身麻醉之前进行区域麻醉。记录术中芬太尼、异氟醚用量、术后吗啡用量、术后疼痛评分、术后镇痛持续时间、围手术期并发症发生率及患者满意度。

结果    

与联合使用CPB和ISB相比，单独使用CPB没有显着改变术后吗啡消耗量（8.4±3.3 mg vs 7.3±3.2 mg [P=0.2]）术后首次镇痛时间（396.7±193.4 min vs 407.7±150.0 min [P=0.8]），或术后疼痛评分（P˃0.05）。术中芬太尼用量（P=0.3）、术中异氟醚用量（P=0.7）、围手术期并发症发生率、患者满意度（P˃0.05）均无变化。单独使用CPB显著降低膈神经麻痹的发生率（P=0.03）。

结论    

在全身麻醉下的锁骨骨折内固定术患者中，单独使用SCP的围手术期镇痛效果与其联合ISB效果相同。

原始文献来源    

Abdelghany MS, Ahmed SA, Afandy ME. Superficial cervical plexus block alone or combined with in-terscalene brachial plexus block in surgery for clavicle fractures: a randomized clinical trial. Minerva Anestesiol 2021;87:523-32. DOI: 10.23736/S0375-9393.21.14865-5).

Superficial cervical plexus block alone or combined with interscalene brachial plexus block in surgery for clavicle fractures: a randomized clinical trial

原 文

ABSTRACT

BACKGROUND: The regional anesthesia technique which is suitable for fracture clavicle is a matter of debate. This study aimed to compare the use of superficial cervical plexus alone or in combination with interscalene block in patients undergoing internal fixation of fractured clavicle.

METHODS: Seventy patients undergoing internal fixation of fractured clavicle were enrolled in this clinical trial and randomly distributed into two groups; superficial cervical plexus block (CPB) group and combined superficial cervical plexus block and interscalene block (ISB) group. The regional anesthesia techniques were performed before induction of general anesthesia. The intraoperative fentanyl and isoflurane consumption, the postoperative morphine consumption, the postoperative pain score, the duration of postoperative analgesia, the incidence of perioperative complications, and the patient’s satisfaction were recorded.

RESULTS: In comparison to the use of combined CPB and ISB, the use of CPB alone did not significantly change the postoperative morphine consumption (8.4±3.3 mg versus 7.3±3.2 mg [P=0.2]), the time to the first request of postoperative analgesia (396.7 193.4 min versus 407.7±150.0 min [P=0.8]), or the postoperative pain score (P>0.05). Also, it did not change the intraoperative fentanyl consumption (P=0.3), the intraoperative isoflurane consumption (P=0.7), the incidence of perioperative complication, or the degree of patient’s satisfaction (P>0.05). It significantly decreased the incidence of phrenic nerve palsy (P=0.03).

CONCLUSIONS: In patients undergoing internal fixation of clavicular fracture, the perioperative analgesic effect of SCP alone is equally effective to its use in combination with ISB.

(Cite this article as: Abdelghany MS, Ahmed SA, Afandy ME. Superficial cervical plexus block alone or combined with interscalene brachial plexus block in surgery for clavicle fractures: a randomized clinical trial. Minerva Anestesiol 2021;87:523-32. DOI: 10.23736/S0375-9393.21.14865-5)

KEY WORDS: Cervical plexus; Analgesia; Clavicle