Tran De Quang Hieu, Russo Gianluca, Muñoz Loreto, Zaouter Cedrick, Finlayson Roderick J
Department of Anesthesia, Montreal General Hospital, 1650 Ave Cedar, D10-144 Montreal, Quebec H3G-1A4, Canada.
Reg Anesth Pain Med. 2009 Jul-Aug;34(4):366-71. doi: 10.1097/AAP.0b013e3181ac7d18.
This prospective, randomized, observer-blinded study compared ultrasound-guided supraclavicular (SCB), infraclavicular (ICB), and axillary (AXB) brachial plexus blocks for upper extremity surgery of the elbow, forearm, wrist, and hand.
One hundred twenty patients were randomly allocated to receive an ultrasound-guided SCB (n = 40), ICB (n = 40), or AXB (n = 40). Performance time (defined as the sum of imaging and needling times) and the number of needle passes were recorded during the performance of the block. Subsequently, a blinded observer recorded the onset time, block-related pain scores, success rate (surgical anesthesia), and the incidence of complications. The main outcome variable was the total anesthesia-related time, defined as the sum of performance and onset times.
No differences were observed between the 3 groups in terms of total anesthesia-related time (23.1-25.5 mins), success rate (95%-97.5%), block-related pain scores, vascular puncture, and paresthesia. Compared with the supraclavicular and infraclavicular approaches, ultrasound-guided AXBs required a higher number of needle passes (6.1 [SD, 2.0] vs 2.0-2.6 [SD, 1.1-1.8]; both P < or = 0.001), a longer needling time (7.4 mins [SD, 2.2 mins] vs 4.9-5.5 mins [SD, 1.9-4.2 mins]; both P < or = 0.016), and a longer performance time (8.5 mins [SD, 2.3 mins] vs 6.0-6.2 mins [SD, 2.1-4.5 mins]; both P < or = 0.008). Supraclavicular blocks resulted in a higher rate of Horner syndrome (37.5% vs 0%-5%; both P < 0.001).
Adjunctive ultrasonography results in similar success rates, total anesthesia-related times, and block-related pain scores for the SCB, ICB, and AXB.
这项前瞻性、随机、观察者盲法研究比较了超声引导下锁骨上（SCB）、锁骨下（ICB）和腋路（AXB）臂丛神经阻滞用于肘部、前臂、腕部和手部的上肢手术。
120例患者被随机分配接受超声引导下的SCB（n = 40）、ICB（n = 40）或AXB（n = 40）。在进行阻滞过程中记录操作时间（定义为成像和进针时间之和）和进针次数。随后，由一名盲法观察者记录起效时间、与阻滞相关的疼痛评分、成功率（手术麻醉）和并发症发生率。主要结局变量是总麻醉相关时间，定义为操作时间和起效时间之和。
三组在总麻醉相关时间（23.1 - 25.5分钟）、成功率（95% - 97.5%）、与阻滞相关的疼痛评分、血管穿刺和感觉异常方面未观察到差异。与锁骨上和锁骨下途径相比，超声引导下的AXB进针次数更多（6.1[标准差，2.0]对2.0 - 2.6[标准差，1.1 - 1.8]；P均≤0.001），进针时间更长（7.4分钟[标准差，2.2分钟]对4.9 - 5.5分钟[标准差，1.9 - 4.2分钟]；P均≤0.016），操作时间更长（8.5分钟[标准差，2.3分钟]对6.0 - 6.2分钟[标准差，2.1 - 4.5分钟]；P均≤0.008）。锁骨上阻滞导致霍纳综合征发生率更高（37.5%对0% - 5%；P均<0.001）。
辅助超声检查时，SCB、ICB和AXB的成功率、总麻醉相关时间以及与阻滞相关的疼痛评分相似。
