肌间沟两点臂丛阻滞的临床观察

目的比较3种肌间沟臂丛阻滞法在上臂、前臂、手部手术中的麻醉效果。方法93例上臂、前臂、手部手术患者随机分为A、B、C3组，每组31例。A组于C。横突水平与皮肤垂直进针，出现异感或触及横突时注入1．0％利多卡因＋0．3％罗哌卡因混合液25ml（内含1：20万肾上腺素）；B组于C，横突水平与皮肤垂直进针，触及横突时注入上述麻药25ml；C组分别同A、B组方法注入上述麻药12．5ml。据患者主诉和骨科医师评定阻滞效果，分Ⅰ～Ⅲ级。结果B组中Ⅰ级的百分比高于A组（P〈0．05），而Ⅲ级的百分比低于A组（P〈0．05）；C组中Ⅰ级的百分比高于A、B组（P〈0．01），而Ⅲ级的百分比低于A、B组（P〈0．01）。3组不良反应的发生率比较差异无统计学意义（P〉0．05）。结论对于上臂、前臂、手部手术，肌问沟两点臂丛阻滞的效果明显优于各自的单点阻滞法。

Clinical observation of brachial plexus block by two-point injection technique

Objective To compare the anesthetic effects of three approaches by brachial plexus block through interscalene in surgery of the upper arm, forearm and hand. Methods 93 patients scheduled for upper arm, forearm and hand surgery were randomly divided into A, B and C groups （ n = 31 ）. The needle was inserted perpendicularly to the skin at the level of the transverse process of C6 until a paresthesia was elicited or the bone was encountered, when 25 ml of the mixture of 1% lidoeaine and 0.3% ropivacaine （with 1：200 000 epinephrine） was injected in group A. The needle was inserted perpendicularly to the skin at the level of the transverse process of C7 until bone was encountered, when 25 ml of the above mixture was injected in group B. 12.5 ml of the above mixture was injected in group C with the same methods as in group A and B respectively. The block effects were graded into Ⅰ , Ⅱ and Ⅲ, based on the evaluation by patient＇s chief complaints and orthopedists. Results The percentage of gradeⅠ was higher in group B than in group A （ P 〈 0.05 ）, while the percent of grade Ⅲ was lower in group B than that in group A （P 〈 0.05）. The percent of grade Ⅰ was significantly higher in group C than in A and B groups （P 〈0.01 ）. The percent of grade Ⅲ was significantly lower in group C than in A and B groups （ P 〈 0.01 ）. The incidences of adverse reactions had no statistical differences among the three groups （ P 〉 0.05 ）. Conclusion Brachial plexus block through interscalene with two - point injection approach at the levels of the transverse process of C6 and C7 is more effective than that with single injection at their respective levels in the upper arm, forearm and hand surgery.