The Clinical Application Of Ultrasound-guided Interscalene Brachial Plexus Block And Superior Trunk Block Combined With General Anesthesia In Shoulder Arthroscopic Surgery

Objective:To investigate the analgesia effect and hemodynamic influence of ultrasound-guided interscalene brachial plexus block and superior trunk block combined with general anesthesia for shoulder arthroscopic surgery and to compare the myodynamia and satisfaction after operation.Methods: This randomized controlled trial included 37 patients undergoing arthroscopic shoulder surgery from September 2019 to January2021.These 30 patients were divided into experimental group 1(GA/ISBB group,n=12 cases),experimental group 2(GA/STB group,n=13 cases)and control group(GA group,n=12 cases).Patients in GA/ISBB group received an ultrasound-guided interscalene brachial plexus block before general anesthesia(n = 10),patients in GA/STB group recieved an ultrasound-guided superior trunk block before general anesthesia(n=10),and the other one received general anesthesia only(n=10).The Narcotrend index was maintained at 40-60.The intraoperative blood pressure criteria: MAP was controlled between 60 and70 mm Hg;Or while MAP > 70 mm Hg,systolic blood pressure was not higher than 80% of the baseline.The anesthetic medication and vaso-active drugs dosage,operative time and extubation time,hemodynamics,postoperative complications and satisfaction and score of visual analogue scale(VAS)among three groups were recorded.Moreover,elbow flexion and wrist flexion strength score between the two experimental groups were compared.Statistical analysis was performed by SPSS 23.0 statistical analysis software.Results:Finally,30 cases were included for statistical analysis.(1)The dosage of propofol,remifentanil and nitroglycerin in the two experimental groups were less than those in the control group(P < 0.05).The incidence of postoperative nausea,vomiting,dizziness,drowsiness and other adverse reactions was also lower(P < 0.05).(2)There was no significant difference in MAP and HR at each time point among the three groups(P > 0.05);the MAP in the two experimental groups was stable(P > 0.05),while the control group was unstable(P < 0.05);the HR in the three groups was stable(P > 0.05).(3)Compared with the control group,the extubation time of the experimental groups was shorter(P < 0.05).(4)The resting VAS scores were not significantly different among the three groups 24-hour after the surgery(P>0.05).The scores of the two experimental groups within 18 hours after the surgery were lower than those of the control group(P< 0.05).(5)The elbow flexor and wrist flexor of the GA /ISBB group decreased more than those of the GA/STB group within 18 hours after operation(P< 0.05).(6)Compared with the control group,the satisfaction of the experimental groups was higher(P< 0.05).Conclusion: Ultrasound-guided interscalene brachial plexus block and superior trunk block combined with general anesthesia for patients undergoing shoulder arthroscopic surgery can not only provide better perioperative analgesia,reduce the dosage of general anesthesia drugs,shorten the recovery time of patients,but also facilitate the implementation of controlled hypotension,making the hemodynamics more stable during operation.On this basis,ultrasound-guided superior trunk block combined with general anesthesia can reduce the influence on elbow flexion and wrist flexion and improve the satisfaction of patients.