Ootaki C, Hayashi H, Amano M
Department of Anesthesia, Kansai Rosai Hospital, Labor and Welfare Organization, Amagasaki, Japan.
Reg Anesth Pain Med. 2000 Nov-Dec;25(6):600-4. doi: 10.1053/rapm.2000.18184.
Infraclavicular brachial plexus block has been used less than other approaches because of its less uniform landmarks and the necessity of a longer needle, which increases the patient's discomfort. To overcome these drawbacks, we applied ultrasound guidance to infraclavicular approach and prospectively evaluated its feasibility and usefulness in 60 patients undergoing upper extremity surgery.
A 7.0-MHz ultrasound probe was placed near the lower edge of the clavicle, and a transverse view of the subclavian artery and vein was visualized. Using a needle guide, a 23-gauge needle was advanced under real-time ultrasound guidance, and 1.5% lidocaine with 1:200,000 epinephrine was injected near the subclavian artery, 15 mm medially and 15 mm laterally to the artery. The extent of sensory and motor block was evaluated at 30 minutes after the injection.
An adequate ultrasound image was obtained for all the patients. In 57 patients (95%), surgery was performed without supplementation of any other anesthetics or analgesics. The complete sensory block was obtained in 100% of patients for the musculocutaneous and medial antebrachial cutaneous nerves, 96.7% for the median nerve, and 95% for the ulnar and radial nerves. The complete motor block was achieved in 100% of patients for the musculocutaneous nerve, 96.7% for the median nerve, 90% for the ulnar nerve, and 93.3% for the radial nerve. No evidence of any complications was identified.
Real-time ultrasound guidance facilitates accurate infraclavicular approach to the brachial plexus. It could be used as an alternative to the landmark-guided techniques.
锁骨下臂丛神经阻滞因其解剖标志不够清晰且需要更长的穿刺针，从而增加患者不适感，其应用少于其他方法。为克服这些缺点，我们将超声引导应用于锁骨下臂丛神经阻滞，并对60例接受上肢手术的患者进行前瞻性评估，以探讨其可行性和实用性。
将7.0MHz超声探头置于锁骨下缘附近，获取锁骨下动静脉的横向图像。在实时超声引导下，使用穿刺引导器将23G穿刺针进针，在锁骨下动脉内侧15mm和外侧15mm处注射含1:200,000肾上腺素的1.5%利多卡因。注射后30分钟评估感觉和运动阻滞范围。
所有患者均获得了满意的超声图像。57例患者（95%）在未补充任何其他麻醉剂或镇痛药的情况下完成手术。肌皮神经和前臂内侧皮神经的完全感觉阻滞率为100%，正中神经为96.7%，尺神经和桡神经为95%。肌皮神经的完全运动阻滞率为100%，正中神经为96.7%，尺神经为90%，桡神经为93.3%。未发现任何并发症迹象。
实时超声引导有助于准确地在锁骨下臂丛神经阻滞。它可作为解剖标志引导技术的替代方法。
