Objective:To evaluate the efficacy of ultrasound-guided modified brachial plexus block at costoclavicular space (CCS) for forearm surgery.Methods:Eighty patients of both sexes, aged 18-75 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective forearm surgery from September 2020 to May 2021 in our hospital, were randomized into 2 groups ( n=40 each) using a random number table method: single-injection control group (group C) and double-injection modified group (group T). Single-injection was performed in the anterior chamber of CCS in group C, double-injection was performed in the anterior and posterior chambers of CCS in group T, and the solution injected in both groups was a mixture (20 ml) of 1.0% lidocaine and 0.375% ropivacaine.The effect of block, onset time of block, completion time of block and duration of block for each nerve branch and anesthesia-related adverse reactions were recorded at 5, 10, 15, 20, 25 and 30 min after injection of local anesthesia. Results:Compared with group C, the rate of motor block of radial nerve at 5-20 min after injection of local anesthesia, the rate of sensory block of musculocutaneous nerve and radial nerve at 10 and 15 min after injection of local anesthesia, the rate of motor block of median nerve at 15-30 min after injection of local anesthesia and the rate of sensory and motor block of ulnar nerve at 20-30 min after injection of local anesthesia were significantly increased, and the onset time and completion time of block were shortened in group T ( P<0.05). There was no significant difference between the two groups in the duration of block and anesthesia-related adverse reactions ( P>0.05). Conclusions:Ultrasound-guided modified brachial plexus block at CCS provides better efficacy for forearm surgery.

Objective:To study the efficacy of ultrasound-guided lower back quadrate fascia plane block combined with dexmedetomidine in postoperative analgesia after cesarean section.Methods:98 cases of women who underwent cesarean section in our hospital from Jan. 2021 to Jan. 2024 were selected, and all patients were divided into control group and study group with 49 cases each using random number table method. Both groups received routine cesarean section, the control group was given quadrate fascia plane block, and the study group was given quadrate fascia plane block combined with dexmedetomidine. The postoperative recovery, pain score, sufentanil dosage, sleep quality and incidence of adverse reactions were compared between the two groups.Results:There was no significant difference in age, gestational age or BMI between the two groups ( P>0.05). The first standing time of the study group was (5.52±1.09) h, the walking time of getting out of bed was (7.45±1.79) h, and the colostrum time was (27.61±2.92) h. The three indexes of the control group were (6.94±1.48) h, the walking time of getting out of bed was (9.52±2.03) h, and the colostrum time was (32.08±3.45) h, respectively. The study group was lower than the control group ( P<0.05). The NRS score at rest 12h and 24h after surgery was (2.58±0.53; 1.57±0.68) score, 12h, 24h resting NRS score of control group was 3.54±0.75, 3.12±1.01; The score was lower in the study group than that in the control group ( P<0.05). The NRS scores of 12h and 24h postoperative activities in the study group were (3.61±0.72; The NRS score of 12h and 24h activities in the control group was 4.12±0.79, 3.73±1.08; The score in the study group was lower than that in the control group ( P<0.05). The dosage of sufentanil for 12h, 24h and 48h in the study group was (15.17±3.24; 23.28±4.02; 41.61±4.82) μg, 48h analgesic pump compression times were (2.94±1.22) times, the number of relief analgesia cases were 3 times, the dosage of sufentanil at 12h, 24h, 48h in the control group was (20.08±4.03; 36.14±4.57; 59.33±6.25) μg, 48h analgesic pump compression times were (6.15±1.71) times, the number of relief analgesia cases was 10 times, the study group was lower than the control group ( P<0.05). The PSQI scores at 1d, 2d and 3d were 15.14±1.15; 16.31±1.21; 17.34±1.31 in the control group, while they were 13.25±1.08; 15.28±1.16; 16.45±1.25 in the study group, lower than that in the control group ( P<0.05). The incidence of adverse reactions was 10.20% in the study group and 26.53% in the control group, lower than that in the control group ( P<0.05) . Conclusion:Ultrasound-guided lower back quadrate fascia plane block combined with dexmedetomidine can improve the recovery after cesarean section, reduce the pain after delivery and sufentanil dosage, improve the quality of sleep and reduce adverse reactions, and have a good analgesic effect.