Liu Spencer S, Zayas Victor M, Gordon Michael A, Beathe Jonathan C, Maalouf Daniel B, Paroli Leonardo, Liguori Gregory A, Ortiz Jaime, Buschiazzo Valeria, Ngeow Justin, Shetty Teena, Ya Deau Jacques T
Department of Anesthesiology, Hospital for Special Surgery, Weill College of Medicine of Cornell University, 535 East 70th St., New York City, NY 10021, USA.
Anesth Analg. 2009 Jul;109(1):265-71. doi: 10.1213/ane.0b013e3181a3272c.
Visualization with ultrasound during regional anesthesia may reduce the risk of intraneural injection and subsequent neurological symptoms but has not been formally assessed. Thus, we performed this randomized clinical trial comparing ultrasound versus nerve stimulator-guided interscalene blocks for shoulder arthroscopy to determine whether ultrasound could reduce the incidence of postoperative neurological symptoms.
Two hundred thirty patients were randomized to a standardized interscalene block with either ultrasound or nerve stimulator with a 5 cm, 22 g Stimuplex insulated needle with 1.5% mepivacaine with 1:300,000 epinephrine and NaCO3 (1 meq/10 mL). A standardized neurological assessment tool (questionnaire and physical examination) designed by a neurologist was administered before surgery (both components), at approximately 1 wk after surgery (questionnaire), and at approximately 4-6 weeks after surgery (both components). Diagnosis of postoperative neurological symptoms was determined by a neurologist blinded to block technique.
Two hundred nineteen patients were evaluated. Use of ultrasound decreased the number of needle passes for block performance (1 vs 3, median, P < 0.001), enhanced motor block at the 5-min assessment (P = 0.04) but did not decrease block performance time (5 min for both). No patient required conversion to general anesthesia for failed block, and patient satisfaction was similar in both groups (96% nerve stimulator and 92% ultrasound). The incidence of postoperative neurological symptoms was similar at 1 wk follow-up with 11% (95% CI of 5%-17%) for nerve stimulator and 8% (95% CI of 3%-13%) for ultrasound and was similar at late follow-up with 7% (95% CI of 3%-12%) for nerve stimulator and 6% (95% CI of 2%-11%) for ultrasound. The severity of postoperative neurological symptoms was similar between groups with a median patient rating of moderate. Symptoms were primarily sensory and consisted of pain, tingling, or paresthesias.
Ultrasound reduced the number of needle passes needed to perform interscalene block and enhanced motor block at the 5 min assessment; however, we did not observe significant differences in block failures, patient satisfaction or incidence, and severity of postoperative neurological symptoms.
区域麻醉期间使用超声进行可视化操作可能会降低神经内注射及后续神经症状的风险，但尚未得到正式评估。因此，我们开展了这项随机临床试验，比较超声引导与神经刺激器引导下的肌间沟阻滞用于肩关节镜手术的效果，以确定超声是否能降低术后神经症状的发生率。
230例患者被随机分为两组，分别接受超声引导或神经刺激器引导下的标准化肌间沟阻滞，使用5 cm、22 g的Stimuplex绝缘针，注射含1:300,000肾上腺素和碳酸氢钠（1 meq/10 mL）的1.5%甲哌卡因。由神经科医生设计的标准化神经评估工具（问卷和体格检查）在手术前（两者均进行）、术后约1周（问卷）以及术后约4 - 6周（两者均进行）使用。术后神经症状的诊断由对阻滞技术不知情的神经科医生确定。
对219例患者进行了评估。使用超声减少了阻滞操作时的进针次数（中位数：1次对3次，P < 0.001），在5分钟评估时增强了运动阻滞效果（P = 0.04），但未缩短阻滞操作时间（两组均为5分钟）。没有患者因阻滞失败而需要转为全身麻醉，两组患者的满意度相似（神经刺激器组为96%，超声组为92%）。术后1周随访时，神经刺激器组术后神经症状的发生率为11%（95%CI为5% - 17%），超声组为8%（95%CI为3% - 13%），两者相似；晚期随访时，神经刺激器组为7%（95%CI为3% - 12%），超声组为6%（95%CI为2% - 11%），两者也相似。两组术后神经症状的严重程度相似，患者评分中位数为中度。症状主要为感觉异常，包括疼痛、刺痛或感觉异常。
超声减少了肌间沟阻滞所需的进针次数，并在5分钟评估时增强了运动阻滞效果；然而，我们未观察到在阻滞失败、患者满意度或术后神经症状的发生率及严重程度方面存在显著差异。
