Serradell A, Herrero R, Villanueva J A, Santos J A, Moncho J M, Masdeu J
Service of Anaesthesiology and Resuscitation, Hospital de la Creu Roja, Dos de Maig 301, E-08025 Barcelona, Spain.
Br J Anaesth. 2003 Oct;91(4):519-24. doi: 10.1093/bja/aeg215.
The multiple injection technique for axillary block, in which the four distal nerves of the plexus are located by a nerve stimulator and separately injected, has been shown to provide a high success rate and a short onset time. This randomized double-blind study was conducted to compare the effectiveness of three different volumes of mepivacaine 10 mg x ml(-1) in patients undergoing elective distal upper limb surgery under axillary brachial plexus block with the four-nerve approach. The number of complete sensory blocks was the primary efficacy variable.
A total of 114 adult patients were randomly allocated to receive 36 (n=38), 28 (n=38), and 20 ml (n=38) of mepivacaine 10 mg x ml(-1). In each group, volumes were equally distributed in the four nerve territories. In all patients, performance time, latency time, block characteristics, need of supplementary blocks, tourniquet tolerance, duration of analgesia, and complications were recorded.
Complete sensory block was obtained in 97% of patients receiving a volume of 36 ml, 97% of those receiving 28 ml, and 94% of those receiving 20 ml. One patient in the group of 28 ml and five patients in the group of 20 ml experienced pain on inflation of the tourniquet. Two months after surgery, no case of postoperative neurological dysfunction was observed.
The three volumes (38, 28, and 20 ml) of mepivacaine 10 mg x ml(-1) ensured a similar and high percentage of complete sensory blocks in axillary brachial plexus anaesthesia with nerve stimulation involving the location of four motor responses.
腋路阻滞的多点注射技术是通过神经刺激器定位臂丛神经的四条远端神经并分别注射，已被证明成功率高且起效时间短。本随机双盲研究旨在比较在采用四神经法进行腋路臂丛阻滞的择期上肢远端手术患者中，三种不同剂量的10mg/ml甲哌卡因的有效性。完全感觉阻滞的数量是主要疗效变量。
总共114例成年患者被随机分配接受36ml（n = 38）、28ml（n = 38）和20ml（n = 38）的10mg/ml甲哌卡因。在每组中，剂量在四个神经区域平均分配。记录所有患者的操作时间、潜伏期、阻滞特征、补充阻滞的需求、止血带耐受情况、镇痛持续时间和并发症。
接受36ml剂量的患者中97%获得完全感觉阻滞，接受28ml剂量的患者中97%获得完全感觉阻滞，接受20ml剂量的患者中94%获得完全感觉阻滞。28ml组中有1例患者和20ml组中有5例患者在止血带充气时出现疼痛。术后两个月，未观察到术后神经功能障碍病例。
三种剂量（38ml、28ml和20ml）的10mg/ml甲哌卡因在通过神经刺激定位四个运动反应的腋路臂丛麻醉中确保了相似且高比例的完全感觉阻滞。
