Efficacy of retroclavicular approach to brachial plexus block in overweight patients undergoing upper extremity surgery with general anesthesia / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the efficacy of retroclavicular approach to brachial plexus block in overweight patients undergoing upper extremity surgery with general anesthesia.Methods:Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 18-64 yr, with body mass index≥25 kg/m 2, undergoing hand or wrist, forearm and elbow surgery, were divided into 2 groups ( n=30 each) using a random number table method: paracoracoid approach group (P group) and retroclavicular approach group (R group). The retroclavicular and paracoracoid approaches to brachial plexus block were performed with 0.2% ropivacaine 30 ml under ultrasound guidance in group P and group R, respectively.After completion of local anesthetic injection, sensory and motor blocks were evaluated every 10 min, lasting 30 min, and the comprehensive score ≥14 was considered as successful brachial plexus block.The surgery was performed under general anesthesia with laryngeal mask after successful block.Patient-centrolled intravenous analgesia(PCIA) was performed after surgery.PCIA solution contained 100 μg sufentanil, 800 mg tramadol and 5 mg tothenesetron in normal saline 200 ml.The PCA pump was set up with a 2 ml bolus dose, a 30 min lockout interval and background infusion at a rate of 2 ml/h.Analgesia was performed until 72 h after surgery.Parecoxib sodium 40 mg/12 h was intramuscularly injected within 48 h after surgery.Visual analogue scale score was maintained≤3 points.If visual analogue scale score was>3 points, 100 mg pethidine hydrochloride was intramuscularly injected as rescue analgesia.The success of brachial plexus nerve block was recorded.Imaging time, the number of puncture, puncture time, sensory block duration and motor block duration were recorded.The requirement for rescue analgesia and the first time for rescue analgesia were recorded within 72 h after surgery.The patient′s satisfaction with postoperative analgesia (0 for dissatisfaction, 1 for satisfaction, 2 for great satisfaction) was assessed and recorded at 72 h after surgery.The occurrence of adverse reactions such as nerve injury, vascular puncture injury, redness and swelling at the puncture site, and blood oozing and oozing from the puncture site were recorded. Results:The success rate of brachial plexus block was 97% in both groups.Compared with group P, the number of puncture was significantly reduced, motor block duration was prolonged ( P<0.05), and no significant change was found in imaging time, puncture time, sensory block duration, requirement for rescue analgesia, the first time for rescue analgesia, patient′s satisfaction with analgesia or incidence of blood oozing from the puncture site in group R ( P>0.05). No adverse reactions such as sensory nerve injury, vascular puncture injury, redness and swelling at the puncture site, or oozing from the puncture site were found in both groups ( P>0.05). Conclusion:Retroclavicular approach to brachial plexus block can be safely and effectively used for overweight patients undergoing upper extremity surgery with general anesthesia.