神经刺激与异感两种定位方法对腋路臂丛多点阻滞效果的比较

Multiple point injection for axillary brachial plexus block: A comparison of two methods of nerve localization nerve stimulation versus paresthesia

目的 :比较异感定位或神经刺激定位对腋路臂丛多点注射阻滞的起效时间、成功率以及并发症 .方法 :以神经刺激定位法 (PNS)或诱发异感法 (PAR)定位臂丛神经主支 ,于各点分别注入 8mL 2 0g·L-1利多卡因和 7.5g·L-1布比卡因合剂 ,观察和记录阻滞操作时间 ,阻滞起效时间 ,可行手术时间及总的麻醉时间 .结果 :PNS组各项时间均明显短于PAR组 .PNS组的完全阻滞发生率较PAR组高 (P <0 .0 5 ) ,这与其桡神经与肌皮神经的阻滞成功率高相关 (P <0 .0 5 ) .PAR组的静脉误伤率较高 (P <0 .0 5 ) .结论 :PNS较PAR成功率更高 ,阻滞出现更快 。

AIM: To compare the onset time and the success rate of a multiple point injection for axillary brachial plexus block performed by using two methods of nerve localization: paresthesia elicitation or nerve stimulation. METHODS: Each of the major nerves of the plexus was located by elicitation of a paresthesia (Group PAR; n = 48) or by nerve stimulation (Group PNS; n =48) and injected with 8 mL of local anesthetic solution. Time of blocking, onset, beginning of surgery and total anesthetic period was recorded respectively. RESULTS: The time recorded in Group PNS was significantly shorter than that in Group PAR (91% vs 76%; P <0.05) and the success rate for anesthetizing the radial and the musculocutaneous nerves in Group PNS was higher in Group PNS ( P <0.05). The rate of venous puncture was higher in Group PAR ( P <0.05). CONCLUSION: Nerve stimulation is a better than paresthesia elicitation for axillary brachial plexus block.