摘要【目的】研究利多卡因混合肾上腺素在完全清醒无止血带局部麻醉(wide awake local anesthesia no tourniquet,WALANT)腕管松解手术中的应用价值。【方法】选取2018年1月至2021年1月在本院接受治疗的100例腕管综合征患者作为研究对象,按照随机数字表法将其随机分为观察组和对照组,每组50例,两组均行常规腕管松解手术。观察组采用利多卡因混合肾上腺素进行WALANT麻醉,对照组采用利多卡因进行臂丛神经阻滞麻醉。比较两组患者手术时间、手术出血量、麻醉起效时间、麻醉持续时间、利多卡因用量、腕关节功能恢复时间;两组手术前(T0)、手术结束时(T1)、手术结束后30 min(T2)Ramsay镇静(RSS)、疼痛视觉模拟评分(VAS);两组术后肌电图检查结果和腕管功能恢复优良率及并发症发生率。【结果】观察组利多卡因用量、麻醉持续时间均显著低于对照组,差异有统计学意义(P<0.05);两组T1时RSS、VAS评分组内比较显著高于T0时、T2时,差异有统计学意义(P<0.05),而两组肌电图参数运动传导速度(MCV)、末端运动潜伏期(DML)、复合肌肉动作电位(CMAP)、感觉传导速度(SCV)、潜伏期(ML)和感觉神经动作电位(SNAP)水平比较,差异无统计学意义(P>0.05)。观察组和对照组腕管功能恢复优良率分别为84.00%、74.00%,其差异无统计学意义(P>0.05)。观察组术后并发症总发生率为12.00%,低于对照组的16.00%,但差异无统计学意义(P>0.05)。【结论】利多卡因混合肾上腺素用于腕管松解手术WALANT麻醉具有较高的临床价值。
Abstract：【Objective】 To explore the value of lidocaine combined with epinephrine in carpal tunnel Release surgery with wide awake local anesthesia no tourniquet (WALANT). 【Methods】A total of 100 patients with carpal tunnel syndrome treated in our hospital from January, 2018 to January, 2021 were selected as research objects, and they were randomly divided into the observation group and the control group according to random number table method, with 50 cases in each group. The observation group received WALANT anesthesia with lidocaine combined with epinephrine, while the control group received brachial plexus block anesthesia with lidocaine alone. The operation time, blood loss, anesthesia onset time, anesthesia duration, lidocaine dosage and wrist function recovery time were recorded and compared between the two groups. We also compared Ramsay sedation (RSS) and pain visual analogue scale (VAS) scores before surgery (T0), at the end of (T1) and 30 min after (T2) operation between the two groups, The results of postoperative electromyography, excellent and good rate of carpal tunnel function recovery and complication rate were compared between the two groups. 【Results】The lidocaine dosage in the observation group was significantly less than those in the control group, and the anesthesia duration was significantly shorter than that in the control group, both with statistical significance (P<0.05).RSS and VAS scores at T1 were significantly higher than those at T0 and T2, and the difference was statistically significant (P<0.05).The electromyography parameters such as MCV(motor conduction velocity), DML, CMAP (compound muscle action potential), SCV (sensory conduction velocity), ML and SNAP (sensory nerve Action potential) of sensory nerve were compared between the two groups, and none of them showed significant difference (P>0.05).The excellent and good rates of carpal tunnel function recovery in the two groups were 84.00% and 74.00%, respectively, with no significant difference (P>0.05).The total incidence of postoperative complications in the observation group was 12.00%, which was no significantly difference with the control group (16.00%, P>0.05). 【Conclusion】Lidocaine combined with epinephrine is of high value in WALANT anesthesia for carpal tunnel loosening surgery.
叶明, 赵巧炎. 利多卡因混合肾上腺素在完全清醒无止血带局部麻醉腕管松解手术中的应用[J]. 医学临床研究, 2021, 38(10): 1462-1465.
YE Ming, ZHAO Qiao-yan. Application of Lidocaine Combined with Epinephrine in Carpal Tunnel Release Surgery with WALANT. JOURNAL OF CLINICAL RESEARCH, 2021, 38(10): 1462-1465.
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2021, Vol. 38 
