Brachial plexuses of 110 healthy volunteers were examined using high resolution color Doppler ultrasound. Ultrasonic characteristics and anatomic variation in the intervertebral foramen, interscalene, supraclavicular ...Brachial plexuses of 110 healthy volunteers were examined using high resolution color Doppler ultrasound. Ultrasonic characteristics and anatomic variation in the intervertebral foramen, interscalene, supraclavicular and infraclavicular, as well as the axillary brachial plexus were investigated. Results confirmed that the normal brachial plexus on cross section exhibited round or elliptic hypoechoic texture. Longitudinal section imaging showed many parallel linear hypo-moderate echoes, with hypo-echo. The transverse processes of the seventh cervical vertebra, the scalene space, the subclavian artery and the deep cervical artery are important markers in an examination. The display rates for the interscalene, and supraclavicular and axillary brachial plexuses were 100% each, while that for the infraclavicular brachial plexus was 97%. The region where the normal brachial plexus root traversed the intervertebral foramen exhibited a regular hypo-echo. The display rate for the C5-7 nerve roots was 100%, while those for C8 and T1 were 83% and 68%, respectively. A total of 20 of the 110 subjects underwent cervical CT scan. High-frequency ultrasound can clearly display the outline of the transverse processes of the vertebrae, which were consistent with CT results. These results indicate that high-frequency ultrasound provides a new method for observing the morphology of the brachial plexus. The C~ vertebra is a marker for identifying the position of brachial plexus nerve roots.展开更多
Background The use of traditional techniques （such as landmark techniques, paresthesia and peripheral nerve stimulator） for upper-limb anesthesia has often been restricted to the expert or enthusiast, which was blin...Background The use of traditional techniques （such as landmark techniques, paresthesia and peripheral nerve stimulator） for upper-limb anesthesia has often been restricted to the expert or enthusiast, which was blind. Recently, ultrasound （US） has been applied to differ blood vessel, pleura and nerve, thus may reduce the risk of complications while have a high rate of success. The aim of this study was to determine if the use of ultrasound guidance （vs. peripheral nerve stimulator, （PNS）） decreases risk of vascular puncture, risk of hemi-diaphragmatic paresis and risk of Homer syndrome and improves the success rate of nerve block. Methods A search strategy was developed to identify randomized control trials （RCTs） reporting on complications of US and PNS guidance for upper-extremity peripheral nerve blocks （brachial plexus） in adults available through PubMed databases, the Cochrane Central Register of Controlled Trials, Embase databases, SinoMed databases and Wanfang data （date up to 2011-12-20）. Two independent reviewers appraised eligible studies and extracted data. Risk ratios （OR） were calculated for each outcome and presented with 95% confidence intervals （CI） with the software of Review Manager 5.1.0 System （Cochrane Library）. Results Sixteen trials involving 1321 adults met our criteria were included for analysis. Blocks performed using US guidance were more likely to be successful （risk ratio （RR） for block success 0.36, 95% CI 0.23-0.56, P 〈0.00001）, decreased incidence of vascular puncture during block performance （RR 0.13, 95% CI 0.06-0.27, P 〈0.00001）, decreased the risk of complete hemi-diaphragmatic paresis （RR 0.09, 95% CI 0.03-0.52, P=-0.0001）. Conclusions US decreases risks of complete hemi-diaphragmatic paresis or vascular puncture and improves success rate of brachial plexus nerve block compared with techniques that utilize PNS for nerve localization. Larger studies are needed to determine whether or not the use of US can decrease risk of neurologic complications.展开更多
Although some patients have successful peripheral nerve regeneration,a poor recovery of hand function often occurs after peripheral nerve injury.It is believed that the capability of brain plasticity is crucial for th...Although some patients have successful peripheral nerve regeneration,a poor recovery of hand function often occurs after peripheral nerve injury.It is believed that the capability of brain plasticity is crucial for the recovery of hand function.The supplementary motor area may play a key role in brain remodeling after peripheral nerve injury.In this study,we explored the activation mode of the supplementary motor area during a motor imagery task.We investigated the plasticity of the central nervous system after brachial plexus injury,using the motor imagery task.Results from functional magnetic resonance imaging showed that after brachial plexus injury,the motor imagery task for the affected limbs of the patients triggered no obvious activation of bilateral supplementary motor areas.This result indicates that it is difficult to excite the supplementary motor areas of brachial plexus injury patients during a motor imagery task,thereby impacting brain remodeling.Deactivation of the supplementary motor area is likely to be a serious problem for brachial plexus injury patients in terms of preparing,initiating and executing certain movements,which may be partly responsible for the unsatisfactory clinical recovery of hand function.展开更多
目的观察不同剂量右美托咪定(Dex)复合罗哌卡因腋路臂丛阻滞用于小儿多指手术的比较的效果及安全性。方法小儿多指手术患者80例,随机均分为:不同剂量Dex组(D1-3组)和对照组(C组)。D1-3组腋路臂丛用药分别为Dex 0.25、0.5、0.75μg/kg+0....目的观察不同剂量右美托咪定(Dex)复合罗哌卡因腋路臂丛阻滞用于小儿多指手术的比较的效果及安全性。方法小儿多指手术患者80例,随机均分为:不同剂量Dex组(D1-3组)和对照组(C组)。D1-3组腋路臂丛用药分别为Dex 0.25、0.5、0.75μg/kg+0.25%罗哌卡因0.20 m L/kg,C组为0.25%罗哌卡因0.20 m L/kg。记录阻滞完成、起效、维持及术后苏醒时间及并发症情况。结果 D2组及D3组在起效时间及术后苏醒时间上均比C组短,而维持时间长,D3组比D1组在起效时间及术后苏醒时间上均缩短,而维持时间长。D1-3组的阻滞成功率高于C组,差异有统计学意义(P<0.05),D1-3组间无统计学差异。并发症方面,4组未出现血肿病例,各有1例患儿出现喉返神经阻滞,各有1例呼吸抑制,2或3例霍纳综合征,D3组出现1例患儿心率<70 min,经处理均安全恢复。结论单纯罗哌卡因或复合Dex臂丛神经阻滞,均可以用于小儿多指手术,中剂量Dex(0.5μg/kg)+0.25%罗哌卡因0.20 m L/kg的配伍较佳。展开更多
目的确定0.375%罗哌卡因用于肥胖和健康体重患者超声引导锁骨上臂丛神经阻滞的最低有效剂量（MED）。方法择期在超声引导锁骨上臂丛神经阻滞下行上肢手术患者60例,根据体重指数分为肥胖组和健康体重组,每组30例,ASA分级Ⅰ~Ⅱ级,均采用Di...目的确定0.375%罗哌卡因用于肥胖和健康体重患者超声引导锁骨上臂丛神经阻滞的最低有效剂量（MED）。方法择期在超声引导锁骨上臂丛神经阻滞下行上肢手术患者60例,根据体重指数分为肥胖组和健康体重组,每组30例,ASA分级Ⅰ~Ⅱ级,均采用Dixon序贯法进行试验,第1例患者0.375%罗哌卡因起始剂量为30 m L,相邻剂量之间的比值为1.1。采用Probit概率单位回归法计算0.375%罗哌卡因用于肥胖及健康体重患者超声引导锁骨上臂丛神经阻滞的MED及其95%可信区间（95%CI）。结果 0.375%罗哌卡因用于肥胖患者超声引导锁骨上臂丛神经阻滞的MED为20.89 m L,95%CI为19.83~21.96 m L;健康体重MED为19.80 m L,95%CI为18.68~20.91 m L。结论 0.375%罗哌卡因用于肥胖和健康体重患者超声引导锁骨上臂丛神经阻滞的MED分别为20.89 m L和19.80 m L。展开更多
基金funded by the Fundamental Research Funds for the Higher Learning Schools of Youth Teacher Education Program of Sun Yat-sen University in 2009,No.09YKPY05the Natural Science Foundation of Guangdong Province,No.S2011010004708
文摘Brachial plexuses of 110 healthy volunteers were examined using high resolution color Doppler ultrasound. Ultrasonic characteristics and anatomic variation in the intervertebral foramen, interscalene, supraclavicular and infraclavicular, as well as the axillary brachial plexus were investigated. Results confirmed that the normal brachial plexus on cross section exhibited round or elliptic hypoechoic texture. Longitudinal section imaging showed many parallel linear hypo-moderate echoes, with hypo-echo. The transverse processes of the seventh cervical vertebra, the scalene space, the subclavian artery and the deep cervical artery are important markers in an examination. The display rates for the interscalene, and supraclavicular and axillary brachial plexuses were 100% each, while that for the infraclavicular brachial plexus was 97%. The region where the normal brachial plexus root traversed the intervertebral foramen exhibited a regular hypo-echo. The display rate for the C5-7 nerve roots was 100%, while those for C8 and T1 were 83% and 68%, respectively. A total of 20 of the 110 subjects underwent cervical CT scan. High-frequency ultrasound can clearly display the outline of the transverse processes of the vertebrae, which were consistent with CT results. These results indicate that high-frequency ultrasound provides a new method for observing the morphology of the brachial plexus. The C~ vertebra is a marker for identifying the position of brachial plexus nerve roots.
文摘Background The use of traditional techniques （such as landmark techniques, paresthesia and peripheral nerve stimulator） for upper-limb anesthesia has often been restricted to the expert or enthusiast, which was blind. Recently, ultrasound （US） has been applied to differ blood vessel, pleura and nerve, thus may reduce the risk of complications while have a high rate of success. The aim of this study was to determine if the use of ultrasound guidance （vs. peripheral nerve stimulator, （PNS）） decreases risk of vascular puncture, risk of hemi-diaphragmatic paresis and risk of Homer syndrome and improves the success rate of nerve block. Methods A search strategy was developed to identify randomized control trials （RCTs） reporting on complications of US and PNS guidance for upper-extremity peripheral nerve blocks （brachial plexus） in adults available through PubMed databases, the Cochrane Central Register of Controlled Trials, Embase databases, SinoMed databases and Wanfang data （date up to 2011-12-20）. Two independent reviewers appraised eligible studies and extracted data. Risk ratios （OR） were calculated for each outcome and presented with 95% confidence intervals （CI） with the software of Review Manager 5.1.0 System （Cochrane Library）. Results Sixteen trials involving 1321 adults met our criteria were included for analysis. Blocks performed using US guidance were more likely to be successful （risk ratio （RR） for block success 0.36, 95% CI 0.23-0.56, P 〈0.00001）, decreased incidence of vascular puncture during block performance （RR 0.13, 95% CI 0.06-0.27, P 〈0.00001）, decreased the risk of complete hemi-diaphragmatic paresis （RR 0.09, 95% CI 0.03-0.52, P=-0.0001）. Conclusions US decreases risks of complete hemi-diaphragmatic paresis or vascular puncture and improves success rate of brachial plexus nerve block compared with techniques that utilize PNS for nerve localization. Larger studies are needed to determine whether or not the use of US can decrease risk of neurologic complications.
基金supported by the Youth Researcher Foundation of Shanghai Health Development Planning Commission,No.20124319
文摘Although some patients have successful peripheral nerve regeneration,a poor recovery of hand function often occurs after peripheral nerve injury.It is believed that the capability of brain plasticity is crucial for the recovery of hand function.The supplementary motor area may play a key role in brain remodeling after peripheral nerve injury.In this study,we explored the activation mode of the supplementary motor area during a motor imagery task.We investigated the plasticity of the central nervous system after brachial plexus injury,using the motor imagery task.Results from functional magnetic resonance imaging showed that after brachial plexus injury,the motor imagery task for the affected limbs of the patients triggered no obvious activation of bilateral supplementary motor areas.This result indicates that it is difficult to excite the supplementary motor areas of brachial plexus injury patients during a motor imagery task,thereby impacting brain remodeling.Deactivation of the supplementary motor area is likely to be a serious problem for brachial plexus injury patients in terms of preparing,initiating and executing certain movements,which may be partly responsible for the unsatisfactory clinical recovery of hand function.
文摘目的观察不同剂量右美托咪定(Dex)复合罗哌卡因腋路臂丛阻滞用于小儿多指手术的比较的效果及安全性。方法小儿多指手术患者80例,随机均分为:不同剂量Dex组(D1-3组)和对照组(C组)。D1-3组腋路臂丛用药分别为Dex 0.25、0.5、0.75μg/kg+0.25%罗哌卡因0.20 m L/kg,C组为0.25%罗哌卡因0.20 m L/kg。记录阻滞完成、起效、维持及术后苏醒时间及并发症情况。结果 D2组及D3组在起效时间及术后苏醒时间上均比C组短,而维持时间长,D3组比D1组在起效时间及术后苏醒时间上均缩短,而维持时间长。D1-3组的阻滞成功率高于C组,差异有统计学意义(P<0.05),D1-3组间无统计学差异。并发症方面,4组未出现血肿病例,各有1例患儿出现喉返神经阻滞,各有1例呼吸抑制,2或3例霍纳综合征,D3组出现1例患儿心率<70 min,经处理均安全恢复。结论单纯罗哌卡因或复合Dex臂丛神经阻滞,均可以用于小儿多指手术,中剂量Dex(0.5μg/kg)+0.25%罗哌卡因0.20 m L/kg的配伍较佳。
文摘目的确定0.375%罗哌卡因用于肥胖和健康体重患者超声引导锁骨上臂丛神经阻滞的最低有效剂量（MED）。方法择期在超声引导锁骨上臂丛神经阻滞下行上肢手术患者60例,根据体重指数分为肥胖组和健康体重组,每组30例,ASA分级Ⅰ~Ⅱ级,均采用Dixon序贯法进行试验,第1例患者0.375%罗哌卡因起始剂量为30 m L,相邻剂量之间的比值为1.1。采用Probit概率单位回归法计算0.375%罗哌卡因用于肥胖及健康体重患者超声引导锁骨上臂丛神经阻滞的MED及其95%可信区间（95%CI）。结果 0.375%罗哌卡因用于肥胖患者超声引导锁骨上臂丛神经阻滞的MED为20.89 m L,95%CI为19.83~21.96 m L;健康体重MED为19.80 m L,95%CI为18.68~20.91 m L。结论 0.375%罗哌卡因用于肥胖和健康体重患者超声引导锁骨上臂丛神经阻滞的MED分别为20.89 m L和19.80 m L。
