Application Effect Of Ultrasound-Guided Single-Penetration Interscalene Brachial Plexus Block Combined With Supraclavicular Nerves Block(SCNB) In Clavicle Surgery

Background and Objective:In clavicular surgery,because the skin and muscles around the clavicle are not just innervated by the cervical plexus or brachial plexus but by both of them,therefore,in order to avoid the phenomenon of incomplete nerve block,we can use interscalene brachial plexus block combined with superficial cervical plexus block.Because the skin above the clavicle is mainly innervated by supraclavicular nerves,some people have also performed interscalene brachial plexus block combined with supraclavicular nerves block in recent years,and they have proved it effective.Because of the use of ultrasound technology,the success rate of nerve blocks has increased while the complications have decreased.However,both of these two methods above require ultrasonic location and needle insertion respectively,and the operation time is long,the patient is uncomfortable and has pain in the needle insertion points.However,ultrasound-guided single-penetration interscalene brachial plexus block combined with supraclavicular nerves block(SCNB)in clavicular surgery has not been reported in China.In foreign countries,although this method has been used and reported by some scholars before,there is no comparative study between it and other methods.Objective:It is intended to guide clinical anesthesia by observing the anesthesia effect of ultrasound-guided single-penetration interscalene brachial plexus block combined with supraclavicular nerves block(SCNB)in clavicular surgery.We anticipate to obtain a higher anesthesia quality,to improve the efficiency and effect of anesthesia,to improve the satisfaction of the operators and patients.Methods:A total of 80 patients who received open reduction and internal fixation of clavicle fracture from June 2020 to February 2021 were included in this study.They were divided into the observation group(n = 40)and the control group(n = 40)by computer random number table method.Ultrasound-guided interscalene brachial plexus block combined with superficial cervical plexus block was used in the control group,and ultrasound-guided single-penetration interscalene brachial plexus block combined with supraclavicular nerves Block(SCNB)was used in the observation group.The difference in the operating time,onset time of sensory block,the duration of analgesia,the level of hemodynamic indexes and the pain situation at different time points [ preanesthesia(Tpre)、skin cut(Tcut)、periosteum stripping(Tstrip)、reduction and fixation(Tfix)、skin suture(Tsuture)],the occurrence ratio of complications and the rate of additional analgesic drugs between the two groups were analyzed.Results:1.The operating time and the onset time of sensory block in the observation group were both significantly shorter than those in the control group,while the duration of analgesia was significantly longer than that in the control group(all P < 0.05).2.The levels of mean arterial pressure(MAP)and heart rate(HR)at Tpre～Tsuture in the observation group were not significantly different from those of the control group(all P > 0.05).3.The VAS scores of Tstrip and Tfix in the observation group were significantly lower than those of the control group(all P < 0.05),while there were no significant differences in the VAS scores of Tpre、Tcut、Tsuture between the two groups(all P >0.05).4.The incidence ratio of various complications and the rate of additional analgesic drugs were not significantly different between these two groups(all P > 0.05).Conclusion:Ultrasound-guided single-penetration interscalene brachial plexus block combined with supraclavicular nerves block(SCNB)has a significant effect in clavicular surgery with high safety,which is worthy of clinical promotion and application.Main innovative points:After ultrasound-guided interscalene brachial plexus block,the needle is retreated to the surface of the middle scalene muscle where we inject local anesthetics to block the supraclavicular nerves with no need to reposition the midpoint of the posterior margin of the sternocleidomastoid muscle and re-insert the needle to block the superficial cervical plexus。Moreover,single block of the supraclavicular nerves can make local anesthetics concentrate on the supraclavicular nerves,avoiding the block of other cutaneous branches of the superficial cervical plexus,with the characteristics of strong pertinence and more perfect block.At the same time,the less local anesthetic dosage reduced the occurrence of phrenic nerve block.