School of Medicine, Kocaeli University, Kocaeli, Turkey.
Acta Anaesthesiol Scand. 2009 Nov;53(10):1262-7. doi: 10.1111/j.1399-6576.2009.02085.x. Epub 2009 Aug 13.
The objective of this study was to evaluate the influence of single vs. dual control during an ultrasound-guided lateral sagittal infraclavicular block on the efficacy of sensory block and the time of block onset.
In a prospective manner, 60 adult patients scheduled for distal upper limb surgery were randomly allocated to single (Group S) or double stimulation (Group D) groups. A local anesthetic (LA) mixture of 20 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml with 5 microg/ml epinephrine (total 40 ml) was administered in both groups. In the Group S following a median, an ulnar or a radial nerve response, the entire LA was administered at a single site. In Group D 10 ml of LA was administered following the electrolocation of the musculocutaneous nerve and 30 ml LA was injected following median, ulnar or radial nerves. A successful block was defined as analgesia or anesthesia of all five nerves distal to the elbow. Sensory and motor blocks were tested at 5-min intervals for 30 min.
The block was successful in 27 patients in Group S and 28 patients in Group D. The time from starting the block until satisfactory anesthesia was significantly shorter in Group D than in Group S (19.3 vs. 23.2 min) (P<0.05). Total sensory scores were significantly higher in the double stimulation group at 20 and 30 min after the block performance (P<0.05).
Although the block performance time was longer in the double stimulation group, block onset time and extent of anesthesia were more favorable in the double stimulation group.
本研究旨在评估在超声引导下锁骨外侧矢状位阻滞中，单刺激与双刺激对感觉阻滞效果和阻滞起效时间的影响。
前瞻性地将 60 例拟行上肢远端手术的成年患者随机分为单刺激（S 组）或双刺激（D 组）组。两组均给予 20ml 左旋布比卡因 5mg/ml 和 20ml 利多卡因 20mg/ml 加 5μg/ml 肾上腺素（共 40ml）的混合局麻药。S 组在正中神经、尺神经或桡神经出现反应后，于单一部位注入全部局麻药。D 组在电定位肌皮神经后给予 10ml 局麻药，然后再注入正中神经、尺神经或桡神经。成功的阻滞定义为肘以下 5 个神经的痛觉或感觉消失。在 30 分钟内，每隔 5 分钟测试感觉和运动阻滞。
S 组 27 例、D 组 28 例阻滞成功。D 组从开始阻滞到满意麻醉的时间明显短于 S 组（19.3 分钟比 23.2 分钟）（P<0.05）。在阻滞后 20 分钟和 30 分钟，双刺激组的总感觉评分明显高于单刺激组（P<0.05）。
虽然双刺激组的阻滞起效时间较长，但双刺激组的阻滞起效时间和麻醉程度更为有利。
