The Application Of Brachial Plexus Nerve Stem Block With Ultrasound Combined With Nerve Stimulator In The Operation Of Obese Patients

Objective In obese patients,the skin of the neck is slack and the fat layer is thick,which makes the neck appear short and thick and the location of brachial plexus nerve becomes more difficult.The deep tissue structure of the neck can be observed through the guidance of ultrasound to monitor the puncture position of the puncture needle.The electrical stimulation at a certain frequency of the nerve stimulator can cause the innervated muscles to contract and lock the relevant nerves.It is not known whether the application of the two methods to brachial plexus block during upper limb surgery in obese patients can improve the block effect to some extent.In this study,ultrasound and nerve stimulator were applied to block brachial plexus nerve trunk in obese patients to observe the effect of anesthesia.Method 100 cases of obese patients with upper limb surgery admitted to chaohu hospital affiliated to anhui medical university from October 2017 to October 2018 were selected as the study subjects,whose BMI≥28kg/㎡.According to the random number table method,the patients were divided into ultrasonic combined neural stimulation group(us-ns group)and ultrasonic group(US group),with 50 cases in each group.The patient underwent routine fasting and abstinence before surgery,inhaled oxygen after entering the operating room,and monitored non-invasive blood pressure(BP),heart rate(HR),ECG and pulse oxygen saturation(SPO2).The administration of dexmedetomidine prior to the operation of anesthesia can calm the patient to a certain extent and alleviate the discomfort caused by the electrical stimulation of the nerve stimulator.In the US group,only the brachial plexus nerve at the interscalene groove was guided by ultrasound and anesthesia block was induced by local anesthetic injection.In the us-ns group,the puncture direction of the ultrasound-guided puncture needle and the nerve stimulator were used to locate the corresponding brachial plexus nerve trunk for block operation.Operation time T1,time T2 to achieve complete block effect,time T3 to achieve complete block effect,anesthetic effect grading,success rate of block and incidence of complications(such as punctured blood vessels,puncture site hematoma,local anesthetic poisoning,dyspnea,pneumothorax,postoperative paresthesia,etc.)were compared between the two groups.Results The success rate of blocking in the us-ns group(98.00%)was higher than that in the US group(86.00%)(P<0.05).The onset time of anesthesia in the us-ns group(T2)(7.70±1.54)min was faster than that in the us group(10.30±1.39)min(P<0.05).The duration of anesthesia in the us-ns group(T3)(9.69 ±2.34)h was longer than that in the us group(7.95±2.89)h(P<0.05).The operation time of us-ns group T1(7.43±1.36)min was longer than that of US group(5.30±1.44)min(P<0.05).There were no complications in both groups.Conclusion The combination of ultrasound and nerve stimulator can make nerve localization more accurate and increase the success rate of brachial plexus nerve block in obese patients and also make the needle closer to the nerve,speed up the effect of anesthesia.It can effectively avoid the wrong puncture to the surrounding tissue and reduce the incidence of complications.