Gentili M E, Verton C, Kinirons B, Bonnet F
Centre Médico-Chirurgical, Department of Anaesthesia and Intensive Care, Saint Vincent-Volney, Rennes, Ireland.
Eur J Anaesthesiol. 2002 Feb;19(2):105-8. doi: 10.1017/s0265021502000182.
Patients' perception of limb position during regional anaesthesia is frequently incorrect. The incidence and nature of this phenomenon has not yet been completely described. The aim of this prospective study was to assess phantom sensation in patients undergoing a brachial plexus block.
Axillary block was performed in 81 patients with the aid of a peripheral nerve stimulator. Immediately after the block, patients were allocated randomly to two groups (Group 1, n = 40; Group 2, n = 41) to have the blocked limb placed either on their thorax or in abduction. Fifteen minutes later, when the block was complete, the position of the limb was changed, without the knowledge of the patient, to a new position of abduction and flexion of the forearm. Patients were questioned about the new limb position. Fifteen minutes later, the limb was then transiently shown to the patient and further placed 'blindly' to another position. Patients were once more questioned about this new position.
Correct perception was more frequently observed in both groups following the first interview. Thirty-two and 34 patients gave at least one erroneous response about their limb position when it was initially placed on the thorax or in abduction respectively. Transient visualization of the limb position did not improve the rate of correct response.
Patients' perception of the position of the limb after axillary block in the majority of instances was probably due to persisting sensory inputs from the shoulder joint, which is not involved in this block. This is in contrast to supraclavicular or interscalene blocks. A significant number of patients experienced phantom limb sensation. They reported an arm position in fact related to the position of their arm before the axillary block.
患者在区域麻醉期间对肢体位置的感知常常是错误的。这一现象的发生率及本质尚未得到完整描述。这项前瞻性研究的目的是评估接受臂丛神经阻滞患者的幻肢感觉。
借助外周神经刺激器对81例患者实施腋路阻滞。阻滞完成后，患者立即被随机分为两组（第1组，n = 40；第2组，n = 41），将被阻滞肢体分别置于胸部或外展位置。15分钟后，当阻滞完全起效时，在患者不知情的情况下将肢体位置改变为前臂外展和屈曲的新位置。询问患者关于新的肢体位置情况。15分钟后，将肢体短暂展示给患者，然后再次“盲目”地将其放置到另一个位置。再次询问患者关于这个新位置的情况。
首次询问后，两组中正确感知的情况更为常见。当肢体最初置于胸部或外展位置时，分别有32例和34例患者至少给出了一个关于其肢体位置的错误回答。肢体位置的短暂可视化并未提高正确回答率。
在大多数情况下，患者对腋路阻滞后肢体位置的感知可能归因于来自肩关节的持续感觉输入，而肩关节并不参与此次阻滞。这与锁骨上或肌间沟阻滞不同。相当数量的患者经历了幻肢感觉。他们报告的手臂位置实际上与腋路阻滞前手臂的位置有关。
