The effect of ultrasound-guided selective upper arm nerve block on motor function of elbow joint
Objective To explore the effect of ultrasound-guided selective upper arm nerve block on motor function of elbow joint.Methods Ultrasound-guided selective upper arm nerve scanning was performed on 25 healthy volunteers to track the course of the radial and musculocutaneous nerves.On this basis,20 patients who underwent elective hand,wrist,and forearm surgery,aged≥18 years,with ASA grades Ⅰ to Ⅲ,were selected to undergo ultrasound-guided selective upper arm nerve block using a 6 to 15 MHz linear array probe and a 5 cm nerve block needle.25 ml of 0.375％ropivacaine was injected under ultrasound-guided guidance.Results At the junction of the upper one-third of the upper arm,68％of the median nerve was located between 12 o'clock and 1 o'clock in the brachial artery,and 56％of the ulnar nerve and medial forearm cutaneous nerve were located near 3 o'clock in the basilic vein.Near the midpoint of the upper arm,94％of the radial nerve had branches visible on ultrasound,and 100％of the musculocutaneous nerve had branches visible on ultrasound.At the junction of the middle and lower one-third of the upper arm,the radial nerve branch innervated below the elbow in ultrasound images was located between the brachial muscle and the humerus,near the lateral side.The musculocutaneous nerve branch that innervates the lateral forearm was located between the biceps and brachialis muscles,near the medial side.80％of the radial nerve was located between 9 o'clock and 12 o'clock,and 84％of the musculocutaneous nerve was located between 3 o'clock and 12 o'clock.Among the 20 patients,one had weakened elbow joint extension function,with a recovery time of 120 minutes.The shoulder joint movement function was not blocked.The blockage onset time was(5.2±1.3)minutes for musculocutaneous nerve,(6.2±1.5)minutes for radial nerve,(8.4±1.7)minutes for ulnar nerve,(8.2±1.7)minutes for medial forearm cutaneous nerve,(10.4±1.9)minutes for median nerve.The recovery time of sensory function was 540(540,600)minutes.Conclusion Ultrasound-guided selective upper arm nerve block can ensure surgical requirements while maximizing the preservation of elbow joint motor function.
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