锁骨下喙突入路臂丛神经阻滞——单点定位法和两点定位法的比较

Infraclavicular brachial plexus block by the coracoid approach:a comparison of the effectiveness between single-and dual-injection techniques

目的采用随机对照临床试验的方法对两点法和单点法这两种定位方法在锁骨下喙突入路臂丛阻滞中的效果进行比较。方法57名拟于锁骨下臂丛神经阻滞下行前臂和手部手术的患者被随机分为单点组(Group Single,n=29)和两点组(Group Dual,n=28),采用神经刺激仪在锁骨下部定位臂丛神经,单点组定位臂丛后束,引发伸腕伸指动作后注入0.5%罗哌卡因30mL;两点组除定位后束外,追加定位臂丛外侧束肌皮神经组分,引发屈肘反应,分别注入0.5%的罗哌卡因20mL和10mL。阻滞后每隔10min评价臂丛神经所支配的所有上肢7支终末神经的感觉阻滞情况,同时记录总体评分、操作时间和不良反应的发生率。结果阻滞后10min,两点组的肌皮神经的阻滞率高于单点组,阻滞后30min,两点组中肌皮神经和前臂内侧皮神经的阻滞率高于单点组(89.3%vs62.1%;85.7%vs58.6%,P<0.05)。两组的总体评分无差异(11.5±2.4vs10.8±4.3)。结论对于锁骨下喙突入路神经阻滞,用神经刺激器引发2个运动反应后分次注入局麻药的方法优于单点法。

Objective To evaluate the hypothesis that dual injection technique in infraclavicular brachial plexus block by the coracoid approach might enhance sensory block for anesthesia of the upper limb compared with a single-injection technique. Methods Fifty-seven patients scheduled for surgery below the elbow were randomly assigned to receive the infraclavicular brachial plexus block by the cor- acoid approach guided by nerve stimulator with either single-injection technique （Group Single, n = 29） or dual-injection technique （Group Dual, n = 28）. In group single, 30 mL 0.5% ropivacaine was injected after eliciting one distal extensive motor response in the upper limb with a nerve stimulator for block. In group dual, the musculocutaneus nerve of brachial plexus was also located, the same volume of anesthetic was injected in separate doses of 10 mL and 20mL after elicitation of two different motor responses（ flection of the elbow and extensive of the wrist or fingers）. Sensory block was assessed in the upper limb every 10 minutes after the end of injection of the local anesthetic. The time that needed to complete the block and the side effects were also recorded. Results Ten minutes after blockade, higher rates of sensory block in the derrnatome of musculocutaneus nerve was read in group dual than in group single. Thirty minutes after blockade, significantly higher rates of sensory block to pinprick on the distributions of musculocutaneous nerve（89. 3 % vs 62. 1%, P〈0. 05） and medial antebrachial cutaneous nerve（85.7% vs 58. 6%, P〈0. 05 ） were found in group dual than in group single. No difference was observed in global scores between the two groups（P〉0. 05）. Condusios Dual- in-jection technique guided by nerve stimulator increases block by the coracoid approach compared with a single anesthetic. the efficacy for infraclavicular brachial plexus injection technique with the same dose of local