Yu Wei-Ping, Xu Xu-Zhong, Wu Dao-Zhu, Guo Xian-Yang, Huang Pin-Tong
Department of Anesthesiology and Medical Ultrasonics, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou 325027, China.
Zhonghua Yi Xue Za Zhi. 2007 Mar 20;87(11):740-5.
To investigate the clinical effects and safety of the technique of axillary approach brachial plexus blocking by ultrasound-guided four points via one-puncture.
Eighty patients scheduled for elective operation were randomly divided into 2 equal groups to undergo axillary approach brachial plexus blocking by ultrasound-guided four points via one-puncture technique (Group U) or nerve stimulator-guided brachial plexus blocking (Group N). The main branches of brachial plexus (radial, median, ulnar, and musculocutaneous nerves) were localized by ultrasound-guided or nerve stimulator-guided techniques. In Group U 8 ml of mixed anesthetic solution containing isovolumetric 0.75% ropivacaine and 2% lidocaine was injected into the 4 main branches of brachial plexus, with a total volume of 32 ml. The ultrasonic manifestations of the brachial plexus and its surrounding tissues were observed. The values of diameter and depth of the 4 nerves and the distance of the musculocutaneous nerve to the midpoint of axillary artery were measured. The manipulation time, onset time, maintaining time, efficacy of blocking, and incidence of complication were recorded.
The manipulation time of Group U was 5.2 +/- 2.1 min, significantly shorter than that of Group N (14.6 +/- 3.2 min, P = 0.000), The onset times of the median, radial, and ulnar nerves of Group U were 3.3 +/- 1.9 min, 3.0 +/- 1.7 min, and 3.4 +/- 1.9 min respectively, all significantly shorter than those of Group N (4.6 +/- 2.0 min, 7.3 +/- 7.4 min, and 6.4 +/- 6.1 min respectively, P < 0.01 or P < 0.05). The anesthetic success rate of Group U was 100%, significantly higher than that of Group N (77.5%, P = 0.005). The rate of accidental puncture to blood vessel of Group U was 0, significantly lower than that of Group N (40%, P = 0.000).
With significantly higher anesthetic success rate, shorter manipulation time and onset time, and lower complication rate, the technique of axillary approach brachial plexus blocking by ultrasound-guided four points via one-puncture is a safe and reliable blocking method in comparison with the nerve stimulator-guided method.
探讨超声引导下腋路臂丛神经四点一次穿刺阻滞技术的临床效果及安全性。
将80例择期手术患者随机分为两组，每组40例，分别接受超声引导下腋路臂丛神经四点一次穿刺阻滞技术（U组）或神经刺激器引导下臂丛神经阻滞（N组）。采用超声引导或神经刺激器引导技术定位臂丛神经主要分支（桡神经、正中神经、尺神经和肌皮神经）。U组将含等体积0.75%罗哌卡因和2%利多卡因的混合麻醉液8 ml注入臂丛神经4个主要分支，总量32 ml。观察臂丛神经及其周围组织的超声表现，测量4条神经的直径、深度及肌皮神经至腋动脉中点的距离，记录操作时间、起效时间、维持时间、阻滞效果及并发症发生率。
U组操作时间为（5.2±2.1）min，明显短于N组（14.6±3.2）min，P = 0.000；U组正中神经、桡神经和尺神经的起效时间分别为（3.3±1.9）min、（3.0±1.7）min和（3.4±1.9）min，均明显短于N组（分别为4.6±2.0 min、7.3±7.4 min和6.4±6.1 min），P < 0.01或P < 0.05。U组麻醉成功率为100%，明显高于N组（77.5%），P = 0.005。U组血管误穿率为0，明显低于N组（40%），P = 0.000。
与神经刺激器引导法相比，超声引导下腋路臂丛神经四点一次穿刺阻滞技术麻醉成功率明显更高，操作时间和起效时间更短，并发症发生率更低，是一种安全可靠的阻滞方法。
