Fredrickson M J, Patel A, Young S, Chinchanwala S
Auckland City Hospital, University of Auckland, Auckland, New Zealand.
Anaesthesia. 2009 Jul;64(7):738-44. doi: 10.1111/j.1365-2044.2009.05918.x.
This prospective, randomised, observer blinded study compared the onset time of brachial plexus block using 2% lidocaine 25-30 ml with adrenaline 5 microg.ml(-1) into the 'corner pocket' inferolateral/lateral to the subclavian artery (supraclavicular, n = 30) or to a triple point injection around the axillary artery (infraclavicular, n = 30). Mean (SD) onset time for complete pinprick sensory blockade assessed by a blinded observer in all four distal nerves was similar in both groups: supraclavicular = 22 (9.4) min, infraclavicular = 21 (7.1) min, p = 0.59. Complete sensory blockade in all four nerve territories at 30 min was achieved in 57% in group supraclavicular and 70% in group infraclavicular (p = 0.28). Painless surgery without the requirement for block supplementation was higher in group infraclavicular (28/30, 93%) compared with group supraclavicular (19/30, 67%; p = 0.01). Of the 11 failures in group supraclavicular, nine were due to incomplete ulnar nerve territory anaesthesia. These results do not support the concept of rapid onset successful supraclavicular block via a simple ultrasound-guided local anaesthetic injection inferolateral to the subclavian artery.
这项前瞻性、随机、观察者盲法研究比较了使用2%利多卡因25 - 30 ml加5μg.ml(-1)肾上腺素，在锁骨下动脉下外侧/外侧的“角袋”处（锁骨上，n = 30）或在腋动脉周围进行三点注射（锁骨下，n = 30）时臂丛神经阻滞的起效时间。由盲法观察者评估的所有四条远端神经完全针刺感觉阻滞的平均（标准差）起效时间在两组中相似：锁骨上组 = 22（9.4）分钟，锁骨下组 = 21（7.1）分钟，p = 0.59。锁骨上组57%、锁骨下组70%在30分钟时实现了所有四个神经区域的完全感觉阻滞（p = 0.28）。与锁骨上组（19/30，67%；p = 0.01）相比，锁骨下组（28/30，93%）无需补充阻滞即可进行无痛手术的比例更高。在锁骨上组的11例失败病例中，9例是由于尺神经区域麻醉不完全。这些结果不支持通过在锁骨下动脉下外侧进行简单的超声引导局部麻醉注射来实现快速起效的成功锁骨上阻滞这一概念。
