| Objective:In recent years,more and more clinical anesthesiologists use ultrasound combined with nerve stimulator to perform peripheral nerve block anesthesia,but there is few research on the comparative analysis of the clinical effect between ultrasound combined with nerve stimulator in brachial plexus intramuscular sulcus approach and independent ultrasound or independent nerve stimulator in brachial plexus anesthesia.The experimental content of this study hopes to compare the anesthetic effect and anesthetic time of ultrasound or nerve stimulator from intermuscular sulcus to brachial plexus block with that of ultrasound combined with nerve stimulator from intermuscular sulcus to brachial plexus block through clinical data sorting and analysis.It aims to explore which anesthesia method is more suitable for the application of brachial plexus block anesthesia,and to explore which approach is better for brachial plexus anesthesia and the adverse reaction is more acceptable under the guidance of ultrasound combined with nerve stimulator.The results of this study provide a reliable basis and reference for clinical anesthesiologists to understand the clinical anesthesia effect.Methods:From December 2019 to December 2020,a total of 156 cases of upper limb surgery were randomly divided into 4 groups with equal number: Group A probed the brachial plexus nerve under ultrasound guidance and injected anesthetic drugs around it;Group B probed the brachial plexus under the guidance of a neurostimulator and implemented a brachial plexus block;Group C applied ultrasound to probe the nerves in the intermuscular sulcus approach,and after the nerve stimulator determined the nerve position,the peripheral nerve block technique was performed;Group D applied ultrasound to probe the nerve walk in the axillary approach,and after nerve stimulator determined the nerve position,the peripheral nerve block technique was performed.The doctor suggested that the patients in the four groups should be prepared for fasting and water deprivation 8 hours before surgery,and that 0.1g of phenobarbital sodium and 0.5mg of atropine should be injected intramuscularly.After the patient enters the operating room,the venous access is opened,and the patient’s blood pressure,heart rate,blood oxygen saturation,dynamic electrocardiogram and other basic vital signs are continuously monitored throughout the operation in coordination with ECG monitoring and oxygen inhalation.The completion time of anesthesia T1,the duration of anesthesia T2,the completion time of exercise block T3,and the completion time of sensory block T4 of the four groups were compared,and the completion time of ulnar nerve,median nerve and radial nerve block of each group were named as T5,T6,T7 respectively,and the complications of the four groups were evaluated as well.Results:(1)Group A was not statistically significant compared with group B,time of onset of anesthesia duration(Group A: 7.45±1.47;Group B: 8.23±2.46),anesthesia completion time(TA1:5.5±1.5;TB1: 6.14±1.20);duration of anesthesia(TA2: 506.1±64.5;TB2: 523.24±86.83);motion block completion time(TA3: 5.88±1.74;TB3: 6.47±1.9);sensory block completion time(TA4:8.05±2.50;TB4: 8.39±2.68)with P>0.05.(2)Group C(time of onset of anesthesia of Group C: 5.75±1.66: TC1: 7.35±2.69;TC2:573.9±75.6;TC3: 13.7±3.80;TC4: 15.56±5.18)was shorter than Group A(time of onset of anesthesia of Group A: 7.45±1.47;TA1:5.5±1.5;TA2: 506.1±64.5;TA3: 5.88±1.74;TA4:8.05±2.50)with P<0.05.(3)The time of onset of anesthesia of Group C was longer than Group B(Group B:8.23±2.46).Group C was shorter than Group B(TB1: 6.14±1.20;TB2: 523.24±86.83;TB3:6.47±1.90;TB4: 8.39±2.68)with P<0.05.(4)Group C was not statistically significant compared with Group D(time of onset of anesthesia of Group D: 6.19±1.87;TD1: 8.79±1.90;TD2: 552.6±45.80;TD3: 14.64±4.75;TD4:18.73±3.25)with P>0.05.(5)Postoperative complications were rare in all patients.In group A,there was one case of complication,which was mistakenly entering the upper limb vessels;In group B,3 cases had complications,2 cases had the upper limb blood vessel by mistake,and 1 case had Horner syndrome;No complications occurred in group C and group D.Conclusion:(1)Compared with the routine application of ultrasound or nerve stimulator to complete brachial plexus block via intermuscular sulcus approach,although the completion time of anesthesia is relatively longer,the effective time of anesthesia is shorter,and the duration of anesthesia,motor block and sensory block are significantly prolonged.At the same time,ultrasound combined with nerve stimulator can improve the accuracy of anesthesia approach location;(2)The incidence of complications of intermuscular sulcus brachial plexus block anesthesia guided by ultrasound combined with nerve stimulator is significantly lower than that of independent application of ultrasound or independent application of nerve stimulator;(3)Under the guidance of ultrasound combined with nerve stimulator,brachial plexus block anesthesia was completed by intermuscular sulcus approach and axillary approach,and there was no significant difference in effect. |
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