ĐÁNH GIÁ CÁC TÁC DỤNG KHÔNG MONG MUỐN CỦA PHONG BẾ ĐÁM RỐI THẦN KINH ĐƯỜNG LIÊN CƠ BẬC THANG VÀ PHONG BẾ THẦN KINH TRÊN VAI PHỐI HỢP THẦN KINH NÁCH DƯỚI HƯỚNG DẪN SIÊU ÂM CHO PHẪU THUẬT KHỚP VAI

Abstract

Objective: To assess the adverse effects of brachial plexus nerve blocking at the interscalene line and suprascapular nerve combined with axillary nerve blocking with ropivacaine 0.25%. Method: Prospective intervention, comparing 60 patients receiving regional anesthesia for shoulder arthroscopy and randomly divided into 2 groups: Group 1: 30 patients receiving 10 ml ropivacaine to the supraclavicular nerve and 10 ml of 0.25% ropivacaine to the axillary nerve under ultrasound guidance pre-anesthesia. Group 2: 30 patients were injected with 20 ml of ropivacaine 0.25% into the brachial plexus at the interscalene line under ultrasound guidance pre-anesthesia. Results: The feeling of nausea or vomiting after surgery gradually decreased over the study time points from T0-T8.The rate of diaphragmatic paralysis and hoarseness after surgery of brachial plexus nerve blocking at the interscalene line was higher than that of the group with axillary nerve combined with axillary nerve blocking, respectively 33.3% compared with 0% and 36.7% compared to 0%, the difference was statistically significant with p<0.01. None of the patients in brachial plexus nerve blocking at the interscalene line group could move the arm and thumb after anaesthesia, only 5 patients (16.7%) could move the hand, and the state of numbness of forearm was prolonged after the surgery. Recovery of numbness after 24 hours 36.7%, after 36 hours is 10% more,  and after 48 hours it is still about 10%. While the patients in supraclavicular nerve combined with the axillary nerve blocking group still able to move and feel the forearm, hand, thumb normally. Patients had a high level of satisfaction in both study groups. The rate of very satisfied patients in group 1 was 90%, higher than that in group 2 was 63.3% (p<0.05). Conclusion: The rate of diaphragmatic paralysis and hoarseness was significantly lower in the group with selective supraclavicular nerve combined with axillary nerve blocking compared with the brachial plexus blocking at the interscalene line. In group 2, the rate of postoperative numbness was very high causing discomfort to the patient, while this rate in group 1 was 0%. Patients had a high level of satisfaction in both study groups.