Ertug Z, Yegin A, Ertem S, Sahin N, Hadimioglu N, Dösemeci L, Erman M
Department of Anesthesiology and Reanimation, Akdeniz University Medical Faculty, Antalya, Turkey.
Acta Anaesthesiol Scand. 2005 Aug;49(7):1035-9. doi: 10.1111/j.1399-6576.2005.00756.x.
Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing arm or forearm surgery.
After institutional approval and informed consent were obtained, 30 patients (ASA physical status I or II) scheduled for forearm and hand surgery under brachial plexus anesthesia were included in the study. Patients were randomly allocated into two groups. Brachial plexus block was performed via the axillary approach in the Group A patients and via the infraclavicular approach in the Group I patients using a peripheral nerve stimulator. All blocks were performed with a total dose of 40 ml 0.375% bupivacaine.
In each nerve territory (radial, ulnar, median, and musculocutaneous), the mean values of the degree and the duration of the sensory block and motor block were not significantly different between the two groups (P > 0.05). Inadvertent vessel puncture was significantly more frequent in the axillary approach (P < 0.05).
Brachial plexus block performed via the infraclavicular approach is as safe and effective as the axillary approach. Infraclavicular approach may be preferred to the axillary approach when the upper arm mobility is impaired or not desired.
对于手臂活动受限的患者，经腋路臂丛神经阻滞存在问题。在这种情况下，锁骨下途径可能是一种有价值的替代方法。我们研究的目的是比较腋路和锁骨下技术在接受手臂或前臂手术患者中的臂丛神经阻滞效果。
在获得机构批准和知情同意后，30例计划在臂丛神经麻醉下进行前臂和手部手术的患者（ASA身体状况I或II）纳入研究。患者被随机分为两组。A组患者采用腋路进行臂丛神经阻滞，I组患者采用锁骨下途径，均使用外周神经刺激器。所有阻滞均使用总量为40ml的0.375%布比卡因。
在每个神经区域（桡神经、尺神经、正中神经和肌皮神经），两组之间感觉阻滞和运动阻滞的程度及持续时间的平均值无显著差异（P>0.05）。腋路意外血管穿刺明显更频繁（P<0.05）。
经锁骨下途径进行臂丛神经阻滞与腋路一样安全有效。当上臂活动受限或不需要时，锁骨下途径可能比腋路更可取。
