Duggan Edel, Brull Richard, Lai Jacob, Abbas Sherif
Department of Anesthesia and Pain Management, Toronto Western Hospital University Health Network, Toronto, Ontario, Canada.
Reg Anesth Pain Med. 2008 Jan-Feb;33(1):70-3. doi: 10.1016/j.rapm.2007.10.003.
Glomangiomas are rare, vascular tumors consisting of an afferent artery, arteriovenous canal, neuro-reticular elements, collagen, and efferent veins, and are most often located in the soft tissue of the upper extremities. We describe how the use of ultrasound-guided nerve blockade altered the anesthetic management of a patient with multiple glomangiomatosis undergoing elective forearm surgery.
A 32-year-old man was scheduled for excision of painful glomangiomas from the ulnar aspect of his right wrist, with exploration of his ulnar nerve. The anesthetic concerns included (1) morbid obesity, (2) chronic pain syndrome and opioid intolerance, (3) a potentially difficult airway, and (4) obstructive sleep apnea. Ultrasound-guided supraclavicular blockade was the proposed anesthetic of choice. Ultrasound scan of the supraclavicular fossa revealed numerous vascular lesions surrounding the divisions of the brachial plexus. Color Doppler imaging confirmed these pulsatile lesions to be vascular in origin. Even under two-dimensional ultrasound guidance, we believed that the risk of vascular puncture and unintentional intravascular injection of local anesthetic was high, and therefore we abandoned the supraclavicular approach. A successful ultrasound-guided axillary brachial plexus blockade was performed uneventfully.
Although multiple glomangiomatosis is a rare disease, this case illustrates the invaluable contribution that ultrasound has made to modern, regional anesthetic practice, especially for patients with aberrant anatomy in whom traditional nerve-localization techniques could result in serious complications.
血管球瘤是一种罕见的血管性肿瘤，由一条传入动脉、动静脉通道、神经网状成分、胶原蛋白和传出静脉组成，最常位于上肢软组织中。我们描述了超声引导下神经阻滞如何改变了一名患有多发性血管球瘤病的患者在进行择期前臂手术时的麻醉管理。
一名32岁男性计划切除右手腕尺侧疼痛性血管球瘤，并探查其尺神经。麻醉方面的顾虑包括：（1）病态肥胖；（2）慢性疼痛综合征和阿片类药物不耐受；（3）潜在的困难气道；（4）阻塞性睡眠呼吸暂停。拟选择超声引导下锁骨上阻滞作为麻醉方法。锁骨上窝超声扫描显示臂丛神经分支周围有许多血管病变。彩色多普勒成像证实这些搏动性病变起源于血管。即使在二维超声引导下，我们仍认为血管穿刺和意外血管内注射局麻药的风险很高，因此放弃了锁骨上入路。顺利实施了一次成功的超声引导下腋路臂丛神经阻滞。
尽管多发性血管球瘤病是一种罕见疾病，但该病例说明了超声对现代区域麻醉实践所做出的宝贵贡献，特别是对于解剖结构异常的患者，传统神经定位技术可能会导致严重并发症。
