Effect of proximal-distal brachial plexus block on short-term operation in a department of hand surgery / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the effect of proximal-distal brachial plexus block for short-term operation in a department of hand surgery.Methods One hundred patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 18-64 yr,weighing 45-90 kg,undergoing palm and finger surgery,were divided into 2 groups (n =50 each) using a random number table method:proximaldistal brachial plexus block group (group A) and proximal brachial plexus block group (group B).In group A,1％ lidocaine 20 ml was given using the subclavian coracoid approach,and 0.35％ ropivacaine was given for ulnar nerve,radial nerve and median nerve of forearm (5 ml for each nerve root).In group B,0.35％ ropivacaine 20 ml was given through the subclavian coracoid approach.Sufentanil 0.1 μg/kg was intravenously infused at 5 min before nerve block,and dexmedetomidine was intravenously infused over 10 min in a loading dose of 0.8 μg/kg followed by a continuous infusion of 0.4 pμg · kg-1 · h-1 until the end of operation at the same time.The blocking effect was assessed by pin-prick test at 15 min after administering local anesthetics,and the operation was started after the blocking effect was satisfactory.Muscle strength of upper arm was measured at 2,3,4,6,8,10 and 12 h after administering local anesthetics (T1-7),the recovery of muscle strength (≥ grade 3) was recorded,and visual analogue scale scores were recorded at the same time.When visual analogue scale score ≥4,tramadol 100 mg was intramuscularly injected,and the requirement for tramadol was recorded.The occurrence of adverse events (local anesthetic intoxication,pneumothorax,anaphylaxis,nerve injury,nausea and vomiting,etc.) was recorded,and the tourniquet reaction was recorded.Results Compared with group B,the muscle strength recovery rate was significantly increased at T2-6 (P＜0.05),and no significant change was found in the requirement for tramadol in group A (P＞0.05).Tramadol was used at T6 in group B and at T7 in group A.Conclusion Proximal-distal brachial plexus block can be safely and effectively used for short-term operation in a department of hand surgery and is beneficial to the rapid recovery of muscle strength after operation.