Comparison Of Ultrasound-guided Cervical Nerve Root Block With Brachial Plexus Block Combined With Superficial Cervical Plexus Block In Clavicle Fracture Surgery

Objective:To compare the application of C₅ or C₆ nerve root block?NRB?and interscalene brachial plexus block?ISBPB?combined with superficial cervical plexus block?SCPB?under the guidance of ultrasound for the surgery of the clavicle fracture.Methods:Ninety patients?male 60 and female 30,aged 18-75 years,BMI?28 kg/m²?undergoing the surgical fixation for unilateral clavicle fracture were randomly divided into three groups?30 patients per group?using random number table method:C₅-NRB combined with SCPB group?group C5?and C₆-NRB combined with SCPB group?group C6?and ISBPB combined with SCPB group?group S?.Cervical nerve root block and SCPB were performed under the guidance of ultrasound with 0.5%ropivacaine 5 ml at each target nerve area.And ISBPB was performed under the guidance of ultrasound with 0.5%ropivacaine 10 ml.If the VAS score of pain during surgery was?4,fentanyl 0.5?g/kg was injected intravenously.The onset time of nerve block was recorded.The sensory block of the skin covering the fractural clavicle was confirmed by a pinprick at 30 min after block and the pain intensity was recorded.Requirements of fentanyl and propofol during surgery were recorded.The VAS score of pain was recorded at 4,12 and 24 h after surgery,and the time to first taking of analgesics after surgery was recorded.The motor function of the affected-side upper limb was assessed at 30 min after block,and 4h and 12 h after surgery using the modified Bromage score?MBS?.The complications such as intoxication of local anesthetics,stellate ganglion block,recurrent laryngeal nerve block and phrenic nerve block were recorded.Results:There were no significant differences in the score of pain of the affected clavicle skin caused by pinprick at 30 min after block,fentanyl requirement during surgery and propofol requirement during surgery between the three groups.No significant difference was showed in the pain VAS scores at 4,12 and 24 h after surgery,and the time to first taking of analgesics after surgery between the three groups.The MBS scores of the affected-side upper limb?elbow flexion,wrist flexion and finger flexion?at 30 min after block,and 4 and 12 h after surgery were not significantly indifferent in the C5 group and the C6 group.But compared with the C5 group or C6 group,MBS scores of the affected-side upper limb?elbow flexion,wrist flexion and finger flexion?at 30 min after block,and 4 h after surgery were significantly decreased.Intoxication of local anesthetics and recurrent laryngeal nerve block did not occur in any patients.Stellate ganglion block occurred after nerve block in 1 patient in group C6.In the C5 group,2 patients were found to have partial paralysis of diaphragm by M-mode ultrasound examination and in group S,4 patients showed partial paralysis of diaphragm by M-mode ultrasound,and the difference was statistically significant.Conclusion:C₅-NRB and C₆-NRB and ISBPB combined with SCPB under the guidance of ultrasound were effective in providing surgical anesthesia for the clavicle fracture.Cervical nerve root block can retain the motor function of the affected side of the upper limb,and there are less complications of phreatic nerve block.Compared with cervical nerve root block,ultrasound-guided brachial plexus block showed a significant decrease in upper limb muscle strength and high incidence of diaphragmatic muscle paralysis.