Koscielniak-Nielsen Z J, Rasmussen H, Hesselbjerg L, Nielsen T P, Gürkan Y
Department of Anesthesia and Operative Services, Center of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Denmark.
Acta Anaesthesiol Scand. 2005 Aug;49(7):1030-4. doi: 10.1111/j.1399-6576.2005.00708.x.
This randomized study was designed to compare discomfort caused by axillary or infraclavicular blocks in ambulatory patients. We identified which of the three block components, needle passes, local anesthetic (LA) injections, and electrical stimulations, is most painful and quantified pain intensity on a visual analog scale (VAS 0-100). We also assessed onset and quality of analgesia, adverse events and patients' acceptance.
Eighty patients were studied. In axillary group-A, four LA injections were made after stimulating median, musculocutaneous, ulnar and radial nerves. In infraclavicular group-I, the whole LA volume was injected after stimulating median or ulnar or radial nerves. Patients were ready for surgery when they had analgesia/anesthesia distal to the elbow.
Median intensity of block discomfort was 22 in A group and 10 in I group (P < 0.01). There was no difference in distribution of the most painful block components between the groups. Block performance times were 4 min in I group and 7 min in A group (P < 0.01). Block onset times were 18 min in A group and 20 min in I group (NS). There was one block failure in I group. Three patients in A group and five in I group required supplementary blocks (NS). Transient adverse events occurred in 14 A-group and two I-group patients (P<0.01). Thirty-seven I-group and 33 A-group patients were satisfied with the block (NS).
Infraclavicular block by single injection caused less discomfort and fewer adverse events than axillary block by multiple injections. Block effectiveness, onset time and patients' acceptance were similar.
本随机研究旨在比较门诊患者接受腋路或锁骨下阻滞时的不适情况。我们确定了三个阻滞步骤（进针、注射局部麻醉药[LA]和电刺激）中哪一个最痛，并通过视觉模拟评分法（VAS 0 - 100）对疼痛强度进行量化。我们还评估了镇痛的起效时间和质量、不良事件及患者的接受度。
对80例患者进行研究。在腋路A组，刺激正中神经、肌皮神经、尺神经和桡神经后进行4次LA注射。在锁骨下I组，刺激正中神经、尺神经或桡神经后注射全部LA剂量。当患者肘部以下出现镇痛/麻醉效果时即可准备手术。
A组阻滞不适的中位强度为22，I组为10（P < 0.01）。两组间最痛的阻滞步骤分布无差异。I组的阻滞操作时间为4分钟，A组为7分钟（P < 0.01）。A组的阻滞起效时间为18分钟，I组为20分钟（无统计学差异）。I组有1例阻滞失败。A组有3例患者、I组有5例患者需要补充阻滞（无统计学差异）。14例A组患者和2例I组患者发生短暂不良事件（P<0.01）。37例I组患者和33例A组患者对阻滞满意（无统计学差异）。
单次注射的锁骨下阻滞比多次注射的腋路阻滞引起的不适更少，不良事件也更少。阻滞效果、起效时间和患者接受度相似。
