Orlowski O, Bullmann V, Vieth V, Filler T, Osada N, Van Aken H, Weber T P
Department of Anaesthesiology and Intensive Care, University of Münster, Germany.
Anaesthesia. 2006 Jun;61(6):528-34. doi: 10.1111/j.1365-2044.2006.04618.x.
The aim of this study was to examine the effect of a 20 degrees Trendelenburg position on the blockade of nerves that exit the brachial plexus proximally in patients undergoing single-injection axillary brachial plexus block. After a pilot study of eight cadavers suggested that a head-down and lateral position would encourage the proximal spread of local anaesthetic, 72 patients undergoing elective surgery were divided into two equal groups: a Supine group and a Modified Position group (lateral position, 20 degrees head-down tilt). Patients were left in the allocated position for 30 min after an axillary block had been performed with alkalinised mepivacaine 1% 49.5 ml. Sensory and motor blockade evaluation showed that there was a significantly higher proportion of axillary nerve (76% vs. 0%, p < 0.001), thoracodorsal nerve (86% vs. 0%, p < 0.001) and subscapular nerve (89% vs. 0%, p < 0.001) blockade in the Modified Position group. Sensory block of the radial nerve was also improved by the modified position (100% vs. 86%, p < 0.05).
本研究的目的是探讨在接受单次注射腋路臂丛神经阻滞的患者中，20度头低脚高位对臂丛神经近端穿出神经的阻滞效果。在对8具尸体进行的初步研究表明头低脚高位和侧卧位会促进局部麻醉药向近端扩散后，72例择期手术患者被分为两组，每组人数相等：仰卧位组和改良体位组（侧卧位，头向下倾斜20度）。在用49.5毫升1%的碱化甲哌卡因进行腋路阻滞术后，让患者保持在指定体位30分钟。感觉和运动阻滞评估显示，改良体位组中腋神经（76%对0%，p<0.001）、胸背神经（86%对0%，p<0.001）和肩胛下神经（89%对0%，p<0.001）阻滞的比例显著更高。改良体位也改善了桡神经的感觉阻滞（100%对86%，p<0.05）。
