The Comparison Of The Effect Between Combined Brachial Plexus Block And Interscalene Block In The Digital Replantation

Background:The Brachial Plexus Block (BPB), as the most valuable upper limb regional anaesthesia, has been applied in clinic for many years. Constantly new approaches, anesthetics and devices improved the BPB more advanced. However, the anatomy of brachial plexus, many dependent trunks, divisions, the separated sheaths and the surround tissues, interfere with the diffusion of the anaesthetics, which impede the penetration of drug by single approach injection. In addition, the brachial plexus beneath to the cervical vertebral, cervical sympathetic chain, cupula of pleura and axillary artery, also associated with some severe complications. The interscalene approach, which has been proved, is a very safe, highly successful and with less complication block method. Although the interscalene approach can not block the medial cutaneous nerve of arm and medial cutaneous nerve of the forearm, which is need to block in the digital replantation operations, and a high rate of failure to block the ulnar nevre.Recent years, with the development of microsurgery, the number of digital replantation has increased. A long time, complex operation and the use of tourniquet need the improvement of the single approach BPB.Aims:To compare the efficacy and safety of combined BPBs to interscalene approach BPB in providing a reference of regional anaesthesia of the digital replantation. Methods:We enrolled97patients undergoing replantation surgery. The patients ranged in age from18to50years old and in body mass index (BMI) from20to25kg/m2, ASA Ⅰ-Ⅱ. The patients were randomly divided into three groups:group A was control group, with the nerve stimulator guided, injected30ml0.5%ropivacaine through interscalene approach; group B was combined BPB group Ⅰ, with the nerve stimulator guided, injected20ml0.5%ropivacaine through interscalene approach,10ml0.5%ropivacaine through axillary approach and only block the unlar side; group C was combined BPB group Ⅱ, with the nerve stimulator guided, injected27ml0.5%ropivacaine through interscalene approach,3ml0.5%ropivacaine through groove for ulnar nerve block the unlar nerve.Recorded the onset time for complete sensory block (both radial side and ulnar side),the efficacy of the BPB (excellent, good, bad, both radial side and ulnar side) the last time for complete block, the tolerant time for tourniquet and complications.Results:To compare with group A, the onset time for complete sensory block of group B and C was shorter (group A12.1±2.8min, group B5.9±0.8min, P<0.01; group A12.1±2.8min, group C4.7±0.9min, P<0.01), efficacy was higher (group A78.79%, group B100%, P<0.05; group A78.79%, group C100%, P<0.05), and the tolerant time for tourniquet of group B was longer than group A and C (group A5.1±0.6h, group B7.2±0.4h, P<0.01; group C4.9±0.4h, group B7.2±0.4h, P<0.05). And there is no significant difference in last time for complete block between these groups (P<0.05)Conclusion:With the application of nerve stimulator, combined BPB had quicker onset time and more efficacy than traditional interscalene BPB. Interscalene BPB associated with axillary approach (ulnar side) BPB had a better tolerance when used the tourniquet, reduced discomfort of the patients during the operations.