Guntz Emmanuel, Herman Pierre, Delbos Alain, Sosnowski Maurice
Department of Anesthesiology, Université Libre de Bruxelles, Hôpital Universitaire Saint-Pierre, Brussels, Belgium.
Can J Anaesth. 2004 Apr;51(4):354-7. doi: 10.1007/BF03018239.
The brachial plexus block through the humeral canal as described by Dupré is indicated in hand and forearm surgery. This block requires a multi-stimulation technique that emphasizes the necessity of a rigorous and safe technique. Nerve injury associated with regional anesthesia can entail significant morbidity for patients. Thus, we investigated the brachial block sequence in terms of unintended nerve stimulation as a surrogate of potential nerve injury.
Sixty patients were randomly allocated in two groups of 30. In Group I the radial nerve was blocked before the ulnar nerve. In Group II the ulnar nerve was blocked before the radial nerve. During the radial nerve approach we recorded, if present, an ulnar nerve response. During the ulnar nerve approach we recorded, if present, a radial nerve response.
In Group I while looking for the radial nerve, in 50% of the cases, an ulnar motor response was recorded. In Group II while looking for the ulnar nerve, a radial motor response was recorded in 10% of the cases.
Our results indicate that the radial nerve should be blocked before the ulnar nerve when performing a brachial plexus block at the humeral canal.
Dupré所描述的经肱骨管臂丛神经阻滞适用于手部和前臂手术。这种阻滞需要一种多刺激技术，强调严格和安全技术的必要性。与区域麻醉相关的神经损伤可能给患者带来严重的发病风险。因此，我们以意外神经刺激作为潜在神经损伤的替代指标，研究了臂丛神经阻滞顺序。
60例患者随机分为两组，每组30例。第一组先阻滞桡神经，再阻滞尺神经。第二组先阻滞尺神经，再阻滞桡神经。在寻找桡神经的过程中，若出现尺神经反应则记录。在寻找尺神经的过程中，若出现桡神经反应则记录。
在第一组寻找桡神经时，50%的病例记录到尺神经运动反应。在第二组寻找尺神经时，10%的病例记录到桡神经运动反应。
我们的结果表明，在肱骨管进行臂丛神经阻滞时，应先阻滞桡神经，再阻滞尺神经。
