Klaastad Oivind, Smedby Orjan, Kjelstrup Trygve, Smith Hans-Jørgen
Department of Anesthesiology and The Interventional Centre, Rikshospitalet University Hospital, Sognsvannsveien 20, NO-0027 Oslo, Norway.
Anesth Analg. 2005 Jul;101(1):273-8, table of contents. doi: 10.1213/01.ANE.0000153861.31254.AC.
The recommended needle trajectory for the vertical infraclavicular brachial plexus block is anteroposterior, caudad to the middle of the clavicle. We studied the risk of pneumothorax and subclavian vessel puncture and the precision of this method by using magnetic resonance imaging in 20 adult volunteers. The trajectory aimed at the lung in six subjects, five of whom were women. However, pleural contact could be avoided in all subjects by halting needle advancement after contact with the subclavian vessels, plexus, or first rib. The subclavian vein was reached by the trajectory in three and the subclavian artery in five subjects. The trajectory had a median distance to the plexus (closest aspect) of 1 mm (range, 0-9 mm) and contacted the nerves in 9 subjects. In conclusion, there is a small probability that the needle may reach the pleura when a vertical infraclavicular brachial plexus block is performed, particularly in women, and a high probability that it will contact the subclavian vein or artery. Although the trajectory is close to the plexus, any medial deviation carries the risk of pleural or subclavian vessel contact at other depths. Clinical accuracy in defining the insertion point is critical.
垂直锁骨下臂丛神经阻滞推荐的进针轨迹是前后方向，向尾侧至锁骨中点。我们通过对20名成年志愿者进行磁共振成像研究了气胸和锁骨下血管穿刺的风险以及该方法的精确性。在6名受试者中，进针轨迹指向肺部，其中5名是女性。然而，通过在与锁骨下血管、臂丛神经或第一肋接触后停止进针，所有受试者均可避免胸膜接触。3名受试者的进针轨迹到达了锁骨下静脉，5名受试者的进针轨迹到达了锁骨下动脉。进针轨迹与臂丛神经（最接近处）的中位距离为1mm（范围0 - 9mm），9名受试者的进针轨迹接触到了神经。总之，进行垂直锁骨下臂丛神经阻滞时，针有可能到达胸膜，尤其是在女性中，这种可能性较小，而针接触锁骨下静脉或动脉的可能性较大。尽管进针轨迹靠近臂丛神经，但任何向内侧的偏差都有在其他深度接触胸膜或锁骨下血管的风险。准确确定进针点在临床上至关重要。
