Desroches Jean
Department of Anesthesia, Hôtel-Dieu de Saint-Jérôme, Saint-Jérôme, Québec, Canada.
Can J Anaesth. 2003 Mar;50(3):253-7. doi: 10.1007/BF03017794.
To evaluate the sensory distribution, motor block and the clinical efficacy of the infraclavicular block by the coracoid approach.
In this prospective descriptive study, 150 patients received an infraclavicular block by the coracoid approach performed by a single anesthesiologist. Neurostimulation was used and 40 mL of mepivacaine 1.5% with adrenaline were injected. Block performance time, sensory distribution, motor block and tourniquet tolerance were evaluated.
Time to perform the block was 5 +/- 2 min (mean +/- SD). Success rate defined as analgesia in the five nerves distal to the elbow (musculocutaneous, median, ulnar, radial and medial cutaneous nerve of the forearm) was 91% (137 patients). A proximal block of the axillary nerve was present in 98.5% of the patients and of the medial cutaneous nerve of the arm in 60%. An arm tourniquet ( 250 mmHg of pressure ) was applied to 115 of the 137 patients with a successful block and all tolerated the tourniquet for a duration of 37 +/- 21 min ( mean +/- SD).
Infraclavicular block by the coracoid approach provides an extensive sensory distribution with an excellent tourniquet tolerance. We conclude that this approach provides highly consistent brachial plexus anesthesia for upper extremity surgery.
评估喙突入路锁骨下阻滞的感觉分布、运动阻滞及临床效果。
在这项前瞻性描述性研究中，150例患者接受了由单一麻醉医生实施的喙突入路锁骨下阻滞。采用神经刺激技术，并注入40毫升含肾上腺素的1.5%甲哌卡因。评估阻滞操作时间、感觉分布、运动阻滞及止血带耐受情况。
阻滞操作时间为5±2分钟（均值±标准差）。以肘部以下五条神经（肌皮神经、正中神经、尺神经、桡神经及前臂内侧皮神经）镇痛为成功标准，成功率为91%（137例患者）。98.5%的患者出现腋神经近端阻滞，60%的患者出现臂内侧皮神经阻滞。137例阻滞成功的患者中有115例应用了臂部止血带（压力250 mmHg），所有患者均耐受止血带，持续时间为37±21分钟（均值±标准差）。
喙突入路锁骨下阻滞可提供广泛的感觉分布，止血带耐受良好。我们得出结论，该入路可为上肢手术提供高度一致的臂丛神经麻醉。
