两点刺激法喙突径路锁骨下臂丛神经阻滞的可行性

A coracoid approach to infraclavicular brachial plexus block using a double-stimulation technique

目的:探讨神经刺激器引导两点刺激法喙突径路锁骨下臂丛神经阻滞的可行性。方法:120例行上肢手术的患者分为一点刺激组(A组)和两点刺激组(B组),每组各60例,分别在神经刺激器引导下行喙突径路锁骨下臂丛神经阻滞,局麻药为0.75%罗哌卡因与2%利多卡因等容量混合液30mL。观察桡神经、腋神经、正中神经、尺神经、臂内侧皮神经、前臂内侧皮神经、臂外侧皮神经的起效时间、阻滞效果和麻醉持续时间,并评定手术全程的麻醉效果。结果:桡神经、腋神经、正中神经、尺神经、臂内侧皮神经、前臂内侧皮神经、臂外侧皮神经神经支配区起效时间比较,B组均明显短于A组(均P<0.05)。注药30min后,桡神经、腋神经、正中神经、尺神经、臂内侧皮神经、前臂内侧皮神经、臂外侧皮神经7根神经的阻滞效果B组明显优于A组(P<0.05)。B组麻醉优良率明显高于A组(93.3%vs80.0%,P<0.05)。A组失败12例,其中9例追加其他途径臂丛神经阻滞,3例改为全麻后完成手术。B组失败4例,其中3例追加其他途径臂丛神经阻滞,1例改为全麻后完成手术。麻醉持续时间A组为(396±156)min,B组为(413±162)min,两组差异无统计学意义(P>0.05)。两组均无并发症。结论:神经刺激器引导两点刺激法喙突径路锁骨下臂丛神经阻滞较一点刺激法的起效时间更短,阻滞效果更好,是较理想的臂丛神经阻滞方法。

Objective To investigate the feasibility of a coracoid approach to infraclavicular brachial plexus block using a double-stimulation technique. Methods 120 patients scheduled for upper limb surgery were divided to receive a coracoid approach to infraclavicular brachial plexus block using single-stimulation （group A, n = 60） or double-stimulation （group B, n = 60） with a 30 mL mixture of 0.75% ropivacaine and 2% lidocaine. The onset time, duration of anesthesia, and analgesic efficacy of radial nerve, axillary nerve, median nerve, ulnar nerve, medial cutaneous nerve of arm, and medial and lateral antebrachial cutaneous nerves were observed. Results The onset time for each nerve block was shorter in Group B than that in group A （P 〈 0.05）. A better efficacy was achieved in 93.3% of the patients in group B, as compared with 80.0% in group A （P〈 0.05）. The duration of anesthesia was （396 ± 156）min in group A and （413 ± 162） rain in group B （P 〉 0.05）. No complications occurred in both groups. Conclusion The coracoid approach to infraclavicular brachial plexus block using double-stimulation technique is an ideal procedure with a faster onset time and better analgesic efficacy.