动静脉留置针连续臂丛阻滞及术后镇痛的体会(1)
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[摘要] 目的:探讨动静脉留置针连续臂丛阻滞及术后镇痛的临床应用与效果。方法:上肢手术54例,全部采取肌间沟臂丛入路,其穿刺方法、无痛技术均与传统肌间沟阻滞一致,仅所用穿刺针不同。取22G头皮式留置针,入肌间沟获得异感后,退出针梗先给予局麻药20 ml(0.8%利多卡因+0.3%罗哌卡因混合液),然后再留管3M胶固定,视阻滞情况和手术时间追加5～10 ml/次。术后镇痛48 h。结果:全部病例取得良好麻醉效果,术后镇痛效果满意,无异常局部或全身不良反应。结论:肌间沟入路动静脉留置针连续臂丛阻滞及术后镇痛,既能满足临床麻醉的需要,而且还可延长臂丛阻滞时间,提高臂丛阻滞的可控性,且操作简便,取材方便,值得临床、尤其是基层医院应用。
[关键词] 肌间沟;动静脉留置针;连续臂丛阻滞;术后镇痛
[中图分类号] R614[文献标识码]A [文章编号]1673-7210(2010)06(a)-095-02
The discussion of arterio-venous catheter continuous brachial plexus block and postoperative analgesia
HE Yongxiao, XIE Guoqiang
(The People's Hospital of Sihui City, Guangdong Province, Sihui 526200, China)
[Abstract] Objective: To investigate the application and the effect of arterio-venous catheter continuous brachial plexus block and postoperative analgesia. Methods: 54 upper limbs medical cases were observed and the puncture methods of them were all of muscular sulcus ways, only the needles were different. First insert 22G scalp-type catheter into the muscular sulcus, then withdraw it and inject 20 ml anesthetic (0.8% Lidocaine+0.3% Ropivacaine), then we used 3M glue to fix, anesthetic would be added 5-10 ml/time depending on the situation and the operation time, analgesia was used for 48 hours. Results: All the medical cases achieved good anaesthesia feedback, none of them had adverse reaction. Conclusion: Arterio-venous catheter continuous brachial plexus block through muscular sulcus not only can satisfies the need of clinical anesthesia, but also extends the time of brachial plexus block and improves controllability of the operation, This convenient method deserves more clinical applications especially for primary hospital.
[Key words] Muscular sulcus; Arterio-venous catheter; Continuous brachial plexus block; Analgesia
连续臂丛阻滞既可提高麻醉时间的可控性,又可满足其术后扩张及镇痛的需求,不少学者对其进行了探讨,并且已有不少成功的报道,但到目前为止,麻醉界尚无具有认证的连续臂丛阻滞的操作规范指南和标准用物,我科2003年9月～2009年9月开始探索动静脉留置针连续臂丛阻滞及术后镇痛,并在阻滞定位、穿刺针的选择、导管固定是否到位、给药方式、镇痛液配方、并发症的观察等方面有一定的认识,现总结如下:
1 资料与方法
1.1 一般资料
择期或急诊的上肢手术54例,患者一般情况好,ASAⅠ～Ⅱ级,年龄16～82岁,男32例、女14例。手术种类包括上肢骨折内固定术(包括锁骨骨折)、内固定取出术,清创、肌腱吻合术等。手术前常规禁食,并给予阿托品0.5 mg、鲁米那0.1 g。
1.2 麻醉方法
病例54例,全部采用臂丛阻滞肌间沟入路,其穿刺方法,无痛技术均与传统肌间沟阻滞一致,仅所用穿刺针不同 ......
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