Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2009 Nov;56(11):812-8. doi: 10.1007/s12630-009-9170-2.
The success rate for infraclavicular brachial plexus block using nerve stimulation reportedly ranges from 60 to 80%. Ultrasound guidance may be associated with greater success. This study compared ultrasound guided infraclavicular block with a dual motor endpoint nerve stimulation technique.
One hundred three hand surgery patients were randomized to receive either ultrasound-guided (ultrasound group) or dual motor endpoint nerve stimulation (stimulation group) infraclavicular block using 2% lidocaine 15 mL and 0.5% bupivacaine 15 mL with epinephrine. Block success was defined as loss of sensation to pinprick in each of the radial, ulnar, median, and musculocutaneous nerve distributions when measured 20 min after block performance. Block performance time, readiness for surgery (no supplemental block, skin infiltration, or general anesthesia), and complications were also assessed.
Patient characteristics were similar between groups. Success rate was 92% in the ultrasound group and 80% in the stimulation group (P = 0.18). Block performance time was shorter in the ultrasound group (median 5 min) compared with the stimulation group (median 10.5 min) (P < 0.001). Paresthesiae were more frequent in the stimulation group (45%) than in the ultrasound group (6%) (P < 0.001). After final injection, more patients were ready for surgery in the ultrasound group (85%) than in the stimulation group (65%) (P = 0.04). At 1 week postoperatively, complications were minor and transient and did not differ between groups.
There was no statistically significant difference in the success rate between ultrasound guidance and dual motor endpoint stimulation for infraclavicular block. However, ultrasound guidance shortens performance time and improves readiness for surgery compared with dual motor endpoint stimulation.
据报道，使用神经刺激的锁骨下臂丛阻滞的成功率范围为 60%至 80%。超声引导可能与更高的成功率相关。本研究比较了超声引导锁骨下阻滞与双电机端神经刺激技术。
103 例手部手术患者随机分为接受超声引导（超声组）或双电机端神经刺激（刺激组）锁骨下阻滞，使用 2%利多卡因 15 mL 和 0.5%布比卡因 15 mL 加肾上腺素。阻滞成功定义为阻滞后 20 分钟测量时，每个桡神经、尺神经、正中神经和肌皮神经分布的刺痛感丧失。还评估了阻滞性能时间、手术准备（无补充阻滞、皮肤浸润或全身麻醉）和并发症。
两组患者的特征相似。超声组成功率为 92%，刺激组为 80%（P = 0.18）。超声组的阻滞性能时间（中位数 5 分钟）明显短于刺激组（中位数 10.5 分钟）（P < 0.001）。刺激组感觉异常的发生率（45%）明显高于超声组（6%）（P < 0.001）。最后一次注射后，超声组（85%）准备手术的患者多于刺激组（65%）（P = 0.04）。术后 1 周，并发症轻微且短暂，两组间无差异。
超声引导与双电机端刺激锁骨下阻滞的成功率无统计学差异。然而，与双电机端刺激相比，超声引导可缩短操作时间并提高手术准备情况。
