Influence Of Regional Nerve Block On Anesthesia And Postoperative Analgesia Effect In Patients Undergoing Operative For Scapula Fractures

Objective:To characterize the function of regional nerve block for anesthesia and postoperative analgesia effect in patients with operation of scapula fractures.Methods:Ethics approval was obtained from the Second Hospital Affiliated to Chengde College.All patients signed an informed consent.From August 2016to August 2018,1 participants was excluded:who used other analgesis.59patients with elective scapula fractures surgery were randomly assigned into two groups.General anesthesia group（group G,n=29）,Regional nerve block with general anesthesia group（group N,n=30）.ECG,Spo₂,ABP,BIS and Etco₂ were monitored after arrival in the operating room.Patients in group G received general anesthesia,The induction of anesthesia through Propofol2-2.5 mg/kg,Remifentanil 0.5-1ug/kg,vecuronium 0.08-0.1 mg/kg.Patients in group N received the guidance of ultrasound with nerve stimulator to perform suprascapular nerve block,subscapular nerve block,dorsal scapular nerve block and accessory nerve block in turn combined with general anesthesia which is the same with group G.Treatment modifications were made by their physical status,surgical stimulation,vital signs and BIS to maintain in the normal range.The vital signs（SBP,DBP,HR）,the consumption of remifentanil,propofol and vecuronium bromide were recorded and compared.All patients were given PCIA（sufentanil 150ug+ondansetron 12mg+NS to 150ml,with a baseline rate of 1ml/once,patient-controlled boluses of 1ml/h,lockout interval 10 minutes）after surgery.When VAS>4,additional boluses may be required to relieves pain.If it plays no useful role,other analgesis were needed and the patient was excluded.Following date were collected:the VAS and RS at 2,4,8,12,24h,the number of successfully delivered doses,anesthesia related complications such as nausea and vomiting,pruritus,depression of respiration,chest stiffness,headache and dizziness.Results:1 Participants in group G was excluded:who used other analgesis（G=29）.There was no difference in the general condition between two groups（P>0.05）.Comparing the patients of two groups,the SBP,DBP and HR at arrival in the operating room（M₀）were significantly higher than those at intubation（M₁）,skin incision（M₂）,fixation（M₃）and extubation（M₄）（p<0.05）.The consumption of remifentanil and propofol in group N were significantly less than that in group G（P<0.05）.The VAS at 2,4,8,12h in group N were significantly lower than that in group G（P<0.05）.The number of successfully delivered doses in group N were significantly fewer than that in group G（P<0.05）within 24h.The incidence of nausea and vomiting in group N（1%）,The incidence of nausea and vomiting,pruritus,headache and dizziness in group G（13.8%,3.3%,3.3%）.There is no depression of respiration and chest stiffness in two groups.Conclusion:For patients of scapula fractures surgery,regional nerve block combined with general anesthesia reduced the degree of pain and the consumption of Opioids.Regional nerve block combined with PCIA provided superior pain relief,reduced the adverse effects.