锁骨上入路臂丛神经阻滞技术体系:精准阻滞已向临床迈进

Supraclavicular brachial plexus blocks technique system:precise blocks have advanced to clinical practice

锁骨上入路臂丛神经阻滞是上肢手术麻醉和镇痛的常用技术。近年来,超声使臂丛神经轨迹、筋膜层次和周围解剖标记可视化,在此基础上通过规范的扫描和成像、穿刺和注药方法,形成精准锁骨上入路臂丛神经阻滞技术体系。然而,临床应用精准锁骨上入路臂丛神经阻滞技术处于起步阶段,神经内注射风险、膈神经麻痹、阻滞动力学数据缺乏等是限制其临床应用的难点和痛点。本文着重从解剖基础、入路和技术特点和临床应用如肩关节镜手术进行系统阐述,以期提高麻醉医师对该精准技术体系的认识并促进其临床应用。

Supraclavicular brachial plexus block is a commonly used technique for upper limb anesthesia and analgesia.Recently,ultrasound can visualize the trajectory of the brachial plexus,surrounding fascia and ana⁃tomical markers,among which standardized scanning and imaging,needle techniques and drug injection methods gradually formed a precise supraclavicular block technique system.However,the application and promotion of precise supraclavicular blocks are in their infancy,risk of intraneural injection,phrenic paralysis,and lack of block dynamics are still difficult and painful points in clinical anesthesia practice.To improve the anesthesiologists'understanding of these techniques and promote their clinical application,this paper focuses on its anatomical basis,approach,and technical characteristics as well as their application in arthroscopic shoulder surgery.