요골 원위부 골절 환자에서 정형외과 의사가 시행한 초음파 유도 액와 상완 신경총 차단술 = Ultrasound-Guided Axillary Brachial Plexus Block Performed by OIrthopedic Surgeon for Distal Radius Fracture Surgery

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study was to evaluate the usefulness of ultrasound-guided axillary brachial plexus block performed by orthopedic surgeon as an anesthetic method for distal radius fracture surgery.Methods: From October 2017 to October 2018, an ultrasound-guided axillary brachial plexus block was performed on 161 cases of distal radius fracture requiring surgery. The procedure was performed by orthopedic surgeons using solution (20 mL of lidocaine HCl in 2%, 20 mL of ropivacaine in 0.75%, and 10 mL of normal saline in 0.9%). The success rate of the anesthetic procedure, the duration of analgesic effect, and the complications were investigated. If the anesthesia induc-tion failed, additional local anesthetic methods were performed stepwise and reassessment about whether the operation could proceed was made.Results: Anesthesia was successful in 155 patients and the success rate was 96.3%. The duration of analgesic effect was 6 hours (3-10 hours). In 6 failed cases of anesthesia, local anesthesia was applied to the pain site in the operating room. In 5 cases, the operation was completed without discomfort. In 1 case complaining of pain around fracture site after the local anesthesia, ultrasound-guided radial nerve block was effective in controlling the pain.Conclusion: In open surgery of distal radius fractures, an ultrasound-guided axillary brachial plexus block performed by orthopedic surgeon allows anesthesia with high success rates. Even if the surgical anesthesia is incomplete, it is expected that the surgery cab be completed safely if the nerve is identified and the stepwise additional local anesthesia method is performed.

국문 초록 (Abstract)

목적: 요골 원위부 골절 수술 시 정형외과 의사가 시행한 초음파 유도 액와 상완 신경총 차단술의 유용성에 대하여 알아보고자 한다.방법: 2017년 10월부터 2018년 10월까지 요골 원위부 골절 수술 전 마취 방법으로 초음파 유도 액와 상완 신경총 차단술을 시행한 161명을 대상으로 하였다. 2% lidocaine HCl 20 mL, 0.75% ropivacaine 20 mL, 0.9% nor-mal saline 10 mL의 혼합액을 이용하였으며 술기의 성공률, 무통 지속 시간 및 합병증을 조사하였다. 술기가 실패한 경우 단계적으로 추가 국소 마취를 시행한 뒤 재평가하였다. 결과: 161명 중 155명에서 마취가 성공하여 96.3%의 성공률을 보였다. 무통 지속 시간은 평균 6시간(3-10시간)이었다. 6명이 마취 실패로 수술실에서 통증 부위에 국소 마취제를 추가 투여하였으며 5명은 이후 환자의 불편감 없이 수술을 마칠 수 있었고, 1명은 초음파 유도 요골 신경 차단술을 통해 수술을 완료할 수 있었다.결론: 요골 원위부 골절 수술 시 정형외과 의사가 시행한 초음파 유도 액와 상완 신경총 차단술은 높은 마취 성공률을 보였고, 마취가 불완전 하더라도 해당 신경을 파악하여 단계적 추가 국소 마취 방법을 시행한다면 안전하게 수술을 완료할 수 있을 것으로 기대한다.

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