Application Of Ultrasound-Guided Forearm Nerve Block In Painless Reduction Of Distal Radius Fractures In The Elder Patients

Research BackgroundManual reduction and plaster fixation of fractures has the advantages of small trauma,no hospitalization,short process time,and the key reduction process is also the main cause of pain.The treatment process is often only a few to more than ten minutes,which is precisely this feature,so the anesthesia and analgesia in the whole treatment process is not paid attention to.The good thing is that the situation is improving.For example,radius fracture,ulnar and radius fracture,humerus fracture,shoulder joint dislocation,clavicle fracture,etc.These are common fractures in orthopedic outpatient department.At present,there are still many hospitals,which are in a natural state,that is,doctors carry out manual reduction without anesthesia operation.The patient is suffering,and the matching is poor,which increases the reduction failure rate,especially for young,muscular shoulder joint dislocation patients Pain stimulates the increase of muscle tension,and some patients can’t be reset successfully without anesthesia.Therefore,under the guidance of establishing a painless hospital,painless reduction and precise anesthesia,the treatment process of manual reduction in outpatient department also needs painless and muscle relaxation,as well as anesthesia.At the same time,because the process of manual reduction is usually 2-10 minutes,the matching anesthesia should also have the characteristics of short anesthesia preparation and operation time,fast onset,quick recovery and low risk.The elderly patients with distal radius fractures account for a large proportion of outpatient patients.They usually have hypertension,blood glucose,old myocardial infarction,old cerebral infarction,chronic bronchitis and other medical history,showing the characteristics of geriatric disease.At present,there are several common methods of manual reduction anesthesia for distal radius fracture clinic.(1)intravenous general anesthesia can better solve this kind of anesthesia.The disadvantage is that it needs almost the same personnel and hardware configuration as the general anesthesia in the operation room.There are more strict requirements for non general anesthesia and vital signs of patients Especially in elderly patients,the risk is relatively high,such as opening fluid access,induction,awakening,observation,and leaving after operation.(2)Ultrasound guided brachial plexus block can be divided into the following approaches: intermuscular sulcus,supraclavicular,subclavian,axillary brachial plexus.It belongs to the category of daytime anesthesia.Compared with the brachial plexus block in clinical elective surgery,there are obvious differences in the patient’s pre anesthesia evaluation,anesthesia preparation,local anesthetic dosage,local anesthetic concentration,depth of block,risk control,etc.Generally speaking,ultrasound-guided block anesthesia has the advantages of accurate anesthesia,low concentration and short-acting local anesthetics,low-risk,short-term anesthesia preparation and anesthesia operation time-consuming.Manual reset can be achieved within 5-10 minutes after anesthesia,and the reset is successful and the film is taken,and the medicine can be taken according to the doctor’s advice.It can be completed within half an hour from the reception to the patient’s departure.Under the premise of safety,it greatly facilitates the patients And then.(3)Local infiltration anesthesia has the smallest anesthesia scope and seems to be accurate.However,swelling of injection site hinders the operation and increases the risk of infection in the affected area.Direct infiltration operation in the affected area has the risk of medical disputes.At present,block anesthesia is more commonly used in clinic.Radial nerve block of forearm and median nerve block of forearm are used in our hospital,After comparative study,domestic and foreign studies,ultrasound-guided forearm radial nerve block,forearm median nerve block,can achieve good anesthesia effect,meet the requirements of painless and muscle relaxation,the patients’ clothing preparation is simpler before anesthesia,patients do not need to take off heavy clothes in winter,to avoid cold and pain 。ObjectiveObjective to explore the effect of distal radial nerve block in elderly patients with fracture guided by ultrasound.Objective to find out the more suitable anesthesia for the manipulative reduction of distal radius fractures.MethodsMethods: 90 patients with distal radius fracture were randomly divided into three groups,30 cases in each group.Group A was the observation group and BC two groups were the control group.In group A,ultrasound-guided forearm nerve block was used,mainly radial nerve block and median nerve block,and medial forearm cutaneous nerve was optional.Ultrasound guided axillary brachial plexus block was used in group B,and ultrasound-guided interscalene brachial plexus block was used in group C.Anesthesia was performed by the same person.The observation data and indicators were completed by another physician.The anesthetic injection was 1%lidocaine injection.The amount of local anesthetic was used.5-7 ml of local anesthetic was used for each part of forearm nerve block,with a total of 10-15 ml.The axillary and intermuscular sulcus brachial plexus block were applied with 15 ml respectively.The onset time was recorded and the onset time of anesthesia was compared among the three groups.The VAS score,operation time,and complications were recorded,including respiratory depression,chest tightness,phrenic nerve block,Horner severity and number of cases,and patient comfort.ResultThe onset time of anesthesia in forearm nerve block group A was shorter than that in control group,axillary nerve block group B and intermuscular sulcus block group(Group C),P < 0.01,with significant difference.There was no significant difference in the effect of anesthesia and analgesia among the three groups.In terms of anesthesia comfort,including anesthesia preparation process,group A was more convenient to expose the anesthesia puncture point,and the patients’ pain was light.Compared with group B,there was significant difference(P < 0.05),but compared with group C,there was no significant difference(P > 0.05),especially when the clothes were heavy in winter.There was significant difference between group A and control group B and C(P < 0.01).ConclusionUltrasound guided forearm nerve block in the elderly outpatient rehabilitation,the anesthetic effect is satisfactory,has a good application prospect,reduce or eliminate the unnecessary pain of patients in the process of medical treatment,compared with other anesthesia methods and approaches,more safe and comfortable,more in line with the reality.In line with the concept of precision anesthesia.