Gandy C L
Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Hand Clin. 1991 Nov;7(4):695-704; discussion 705-6.
Despite the potential complications of brachial plexus blockade, it remains a reliable and safe form of anesthesia for surgery of the upper extremity. The site of the surgery dictates which of the four approaches to the brachial plexus should be used. When the choice matches the site of surgery, the blocks should be successful in approximately 80% of cases. When supplemented with an additional peripheral block, the success rate is greater than 90% using the axillary and supraclavicular approaches. The duration of the blocks varies from 1 to 12 hours, depending on the choice of anesthetic agent. The addition of epinephrine to the anesthetic agent decreases the rate of tissue uptake of the drug, thereby both lengthening the duration of the block and decreasing the toxicity of the agent. Alkalinizing lidocaine with sodium bicarbonate decreases the latency time and increases the intensity and spread of the block. Surgeons should be aware of the advantages and capabilities of regional anesthesia and should discuss anesthesia options with patients and anesthesiologists.
尽管臂丛神经阻滞存在潜在并发症，但它仍是上肢手术一种可靠且安全的麻醉方式。手术部位决定应采用臂丛神经的四种入路中的哪一种。当选择与手术部位匹配时，大约80%的病例阻滞应会成功。当辅以额外的外周神经阻滞时，采用腋路和锁骨上路入路的成功率超过90%。阻滞的持续时间从1至12小时不等，这取决于麻醉剂的选择。在麻醉剂中加入肾上腺素可降低药物的组织摄取率，从而既延长阻滞持续时间又降低该药剂的毒性。用碳酸氢钠碱化利多卡因可缩短起效时间并增加阻滞的强度和范围。外科医生应了解区域麻醉的优势和能力，并应与患者及麻醉医生讨论麻醉选择。
