关键词: 骨折, 角袋注射技术, 锁骨上臂丛神经阻滞

Abstract:

Objective  To explore the effect of horn pocket injection technique on diaphragmatic paralysis after supraclavicular brachial plexus block(SCBPB).

Methods  In total, 40 patients who underwent upper limb fracture surgery in our hospital were selected, and randomly divided into a research group(n=20) and a control group(n=20). SCBPB was performed in both groups, the research group was given ultrasound-guided angle pocket injection technique, and the control group was given traditional plexus block anesthesia. The duration of operation of anesthesia block, the score of block effect, the duration of anesthesia, the onset time of each peripheral nerve block, diaphragmatic paralysis under different respiratory states and the incidence of adverse reactions were compared between two groups. Diaphragmatic movement and lung function indicators［forced expiratory volume in first second(FEV1), forced vital capacity(FVC)］ before and at 30 min after block were compared.

Results  There was no significant difference in duration of operation of anesthesia block, block effect score and anesthesia duration between research group and the control group(P＞0.05). There was no significant difference in the onset time of radial nerve, median nerve, ulnar nerve, musculocutaneous nerve and medial forearm cutaneous nerve block between two groups(P＞0.05). At 30 min after block, the diaphragmatic movement of the two groups in the state of calm breathing and forced breathing was lower than that before block, which was higher in the research group than in the control group(P＜0.05). FEV1 and FVC in the two groups were lower than those before block, which were higher in the research group than in the control group(P＜0.05). The rate of diaphragmatic paralysis at 30 min after block in the research group was lower than that in the control group(P＜0.05). There was no significant difference in the incidence of adverse reactions between two groups(P＞0.05).

Conclusion  Under the premise of ensuring the effective anesthesia block effect, the corner pocket injection technique can significantly reduce the incidence of diaphragmatic paralysis after SCBPB, improve the patient's lung function indicators, and provide new ideas for SCBPB.

Key words: fractures, bone； angle pocket injection technique, supraclavian brachial plexus block