Fajardo入路腋神经阻滞对肱骨近端骨折患者术后镇痛的影响

Effect of Fajardo approach axillary nerve block on postoperative analgesia in patients with proximal humeral fracture

中文关键词: Fajardo入路  腋神经阻滞  臂丛阻滞  肱骨近端骨折  膈肌功能  术后镇痛

英文关键词: Fajardo approach  Axillary nerve block  Brachial plexus block  Proximal humeral fracture  Diaphragm function  Postoperative analgesia

中文摘要:

      
目的：探讨Fajardo入路腋神经阻滞（FANB）与肌间沟臂丛阻滞（ISB）对肱骨近端骨折患者术后镇痛的影响。
方法：选择2023年2月至2024年8月择期于全麻下行肱骨近端骨折手术的患者70例，男20例，女50例，年龄30～79岁，BMI 18.5～30.0 kg/m²，ASA Ⅰ—Ⅲ级。将患者随机分为两组：FANB组（F组）和ISB组（I组），每组35例。F组和I组分别在麻醉诱导前30 min于超声引导下行FANB和ISB，均给予0.375%罗哌卡因20 ml。记录阻滞前、阻滞完成后30 min、PACU内、术后8、16、24和48 h静息及活动时NRS疼痛评分。记录镇痛持续时间、运动阻滞持续时间、术后48 h内累计氢吗啡酮消耗量、镇痛泵有效按压次数及补救镇痛情况。记录阻滞完成后30 min半膈肌麻痹（HDP）的发生情况、阻滞前和阻滞完成后30 min的膈肌偏移幅度并计算膈肌偏移幅度减少比例。记录阻滞前和阻滞完成后30 min的SpO₂（吸空气）和握力、出PACU时的改良Bromage评分。记录术后头晕、恶心呕吐等不良反应的发生情况。
结果：F组无一例发生运动阻滞，I组均发生运动阻滞。与I组比较，阻滞完成后30 min时F组膈肌偏移明显升高，膈肌偏移幅度减少比例明显降低，SpO₂、握力明显升高，出PACU时改良Bromage评分明显降低（P<0.05）。F组无一例发生HDP，I组有35例（100%）发生HDP。两组不同时点的静息及活动时NRS疼痛评分、镇痛持续时间、术后48 h内累计氢吗啡酮消耗量、镇痛泵有效按压次数、补救镇痛情况及术后不良反应发生率差异无统计学意义。
结论：在肱骨近端骨折患者中，Fajardo入路腋神经阻滞可提供与肌间沟臂丛阻滞类似的术后镇痛效果，并能更好地保留膈肌功能，避免发生HDP，且不引起运动阻滞。

英文摘要:

      
Objective: To investigate the effects of Fajardo approach axillary nerve block (FANB) and interscalene brachial plexus block (ISB) on postoperative analgesia in patients with proximal humeral fracture.
Methods: Seventy patients underwent proximal humeral fracture surgery scheduled for general anesthesia from February 2023 to August 2024 were enrolled, 20 males and 50 females, aged 30-79 years, BMI 18.5-30.0 kg/m², ASA physical status Ⅰ-Ⅲ. The patients were randomly divided into two groups: FANB group (group F) and ISB group (group I), 35 patients in each group. FANB and ISB were respectively performed under ultrasound guidance 30 minutes before induction of general anesthesia in group F and group I, and 0.375% ropivacaine 20 ml was given to both groups. The NRS pain scores at rest and during activity were recorded before block, 30 minutes after block, during PACU, 8, 16, 24, and 48 hours after operation. The duration of analgesia, the duration of motor block, the cumulative hydromorphone consumption within 48 hours after surgery, the number of effective analgesic pump compressions and rescue analgesia were recorded. The occurrence of hemidiaphragmatic paralysis (HDP) 30 minutes after block, the diaphragmatic excursion and reduction amplitude before block and 30 minutes after block were recorded. The SpO₂(air inhalation) and the handgrip strength before block and 30 minutes after block, modified Bromage score at discharge from PACU were recorded. The occurrence of adverse reactions such as dizziness, nausea and vomiting after surgery were recorded.
Results: No patient in group F developed motor block, while all patients in group I developed motor block. Compared with group I, the diaphragmatic excursion in group F 30 minutes after block was significantly increased, the reduction amplitude of diaphragmatic excursion was significantly reduced, the SpO₂ was significantly increased, the handgrip strength was significantly increased, and the modified Bromage score at discharge from PACU was significantly reduced (P < 0.05). No patient in group F developed HDP, and 35 patients (100%) in group I developed HDP. There were no significant differences in at rest and during active NRS pain scores at each time point, analgesia duration, cumulative hydromorphone consumption within 48 hours after surgery, effective analgesic pump compression times, rescue analgesia, and incidence of postoperative adverse reaction between the two groups.
Conclusion: Fajardo approach axillary nerve block can provide postoperative analgesia in patients with proximal humeral fractures similar to that of interscalene brachial plexus block, better preserve diaphragmatic function, avoid the occurrence of HDP, and do not cause motor block.