使用神经刺激器进行臂丛神经阻滞：三个部位的运动反应特征

Brachial plexus block with the nerve stimulator: motor response characteristics at three sites.

作者信息

Riegler F X

机构信息

Department of Anesthesia, University of Pennsylvania, Philadelphia.

出版信息

Reg Anesth. 1992 Sep-Oct;17(5):295-9.

PMID:1419945

Abstract

BACKGROUND AND OBJECTIVES

Differences in motor response patterns, minimum electrical currents, and success rates using a nerve stimulator for brachial plexus block were determined for the interscalene, supraclavicular, and axillary approaches.

METHODS

Supervised, resident physicians performed 106 brachial plexus blocks. For each block, the minimum stimulating current, the strongest joint motion at the minimum current immediately before local anesthetic injection, presence or absence of other joint motion, and anesthetic success or failure were recorded.

RESULTS

In the interscalene group (n = 43), strongest joint motions clustered at the shoulder (40%) and elbow (54%). In the supraclavicular group (n = 29), strongest joint motions distributed bimodally at the elbow (62%) and fingers (31%). In the axillary group (n = 34), strongest joint motions clustered at the wrist (35%) and fingers (61%). Overall, concurrent, weaker joint motion was observed in 26% (p not significant). Overall, the minimum current producing visually observable or palpable upper extremity motor responses was 0.69 +/- 0.02 mA (mean +/- SEM, range 0.2-1.5). No significant differences were found for minimum currents by site of approach, presence or absence of weaker joint motion, or success or failure of anesthesia. The overall success rate was 89%, with the rate being 91% for interscalene, 97% for supraclavicular, and 79% for axillary approaches (p not significant). Within the axillary group, elbow flexion as the strongest joint motion was a significant predictors of failure compared with other responses (p < 0.05).

CONCLUSIONS

Localization of the brachial plexus with the nerve stimulator is equally effective at the interscalene, supraclavicular, and axillary sites. Current values in the range reported have no predictive value for success. Advantages of the nerve stimulator for brachial plexus block include an objective endpoint and continuous feedback.

摘要

背景与目的

确定在肌间沟、锁骨上和腋路臂丛神经阻滞中，使用神经刺激器时运动反应模式、最小电流及成功率的差异。

方法

在指导下，住院医师实施了106例臂丛神经阻滞。对于每例阻滞，记录最小刺激电流、在注射局部麻醉药前最小电流时最强的关节运动、是否存在其他关节运动以及麻醉成功或失败情况。

结果

在肌间沟组（n = 43）中，最强的关节运动集中在肩部（40%）和肘部（54%）。在锁骨上组（n = 29）中，最强的关节运动在肘部（62%）和手指（31%）呈双峰分布。在腋路组（n = 34）中，最强的关节运动集中在腕部（35%）和手指（61%）。总体而言，26%的患者观察到同时出现较弱的关节运动（p无显著性差异）。总体而言，产生视觉上可观察到或可触及的上肢运动反应的最小电流为0.69±0.02 mA（平均值±标准误，范围0.2 - 1.5）。在不同进针部位、是否存在较弱关节运动或麻醉成功与否方面，最小电流未发现显著差异。总体成功率为89%，肌间沟法为91%，锁骨上法为97%，腋路法为79%（p无显著性差异）。在腋路组中，与其他反应相比，以肘部屈曲作为最强关节运动是失败的显著预测因素（p < 0.05）。