Paqueron Xavier, Leguen Morgan, Gentili Marc E, Riou Bruno, Coriat Pierre, Willer Jean Claude
Department of Anesthesiology, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France.
Anesthesiology. 2004 Apr;100(4):979-86. doi: 10.1097/00000542-200404000-00032.
The relation between impairment of sensorimotor function and occurrence of phantom limb syndrome (PLS) during regional anesthesia has not been described. This study assessed the temporal relation between PLS and the progression of sensorimotor impairment during placement of a brachial plexus nerve block.
Fifty-two patients had their arm randomly placed either alongside their body (group A) or in 90 degrees abduction (group B) immediately after brachial plexus nerve block placement. Responses to pin prick, cold, heat, touch, proprioception, and voluntary movement were assessed every 5 min for 60 min. Meanwhile, patients described their perceptions of the size, shape, and position of their anesthetized limb.
Phantom limb syndrome occurred 19 +/- 9 min after nerve block placement. Proprioception was impaired and abolished after 22 +/- 9 and 43 +/- 17 min, respectively (P < 0.05 vs. PLS onset). When PLS occurred, responses to pin prick, cold, heat, and proprioception were abolished in 96, 94, 87, and 4% of patients, respectively. Patients were more likely to feel their anesthetized limb in adduction and in abduction in groups A and B (P < 0.05 vs. group A), respectively. After PLS had become motionless, two stereotyped positions were identified: arm adduction, elbow flexion, hand over the abdomen (68% of group A patients) and arm abduction, elbow flexion, hand held close to the homolateral ear (48% of group B patients).
This study provides a better understanding of the determinants of PLS by showing that the final position of PLS is related both to the abolition of proprioception and the initial position of the anesthetized limb.
区域麻醉期间感觉运动功能损害与幻肢综合征（PLS）发生之间的关系尚未见描述。本研究评估了臂丛神经阻滞置管期间PLS与感觉运动损害进展之间的时间关系。
52例患者在臂丛神经阻滞置管后立即将其手臂随机置于身体一侧（A组）或外展90度（B组）。每隔5分钟评估1次对针刺、冷、热、触觉、本体感觉和自主运动的反应，共评估60分钟。同时，患者描述其对麻醉肢体大小、形状和位置的感知。
神经阻滞置管后19±9分钟出现幻肢综合征。本体感觉分别在22±9分钟和43±17分钟后受损并消失（与PLS发作相比，P<0.05）。当发生PLS时，分别有96%、94%、87%和4%的患者对针刺、冷、热和本体感觉的反应消失。A组和B组患者分别更有可能在内收位和外展位感觉到其麻醉肢体（与A组相比，P<0.05）。PLS静止不动后，确定了两种刻板姿势：手臂内收、肘部屈曲、手放在腹部（A组患者的68%）和手臂外展、肘部屈曲、手靠近同侧耳朵（B组患者的48%）。
本研究通过表明PLS的最终位置与本体感觉的消失和麻醉肢体的初始位置均相关，从而更好地理解了PLS的决定因素。
