Department of Anesthesiology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
Acta Anaesthesiol Scand. 2010 Feb;54(2):241-5. doi: 10.1111/j.1399-6576.2009.02110.x. Epub 2009 Sep 7.
Both multiple injection and single posterior cord injection techniques are associated with extensive anesthesia of the upper limb after an infraclavicular coracoid block (ICB). The main objective of this study was to directly compare the efficacy of both techniques in terms of the rates of completely anesthetizing cutaneous nerves below the elbow.
Seventy patients undergoing surgery at or below the elbow were randomly assigned to receive an ICB after the elicitation of either a single radial nerve-type response (Radial group) or of two different main nerve-type responses of the upper limb, except for the radial nerve (Dual group). Forty milliliters of 1.5% mepivacaine was given in a single or a dual dose, according to group assignment. The sensory block was assessed in each of the cutaneous nerves at 10, 20 and 30 min. Block performance times and the rates of complete anesthesia below the elbow were also noted.
Higher rates of sensory block of the radial nerve were found in the Radial group at 10, 20 and 30 min (P<0.05). The rates of sensory block of the ulnar nerve at 30 min were 97% and 75% in the Radial and in the Dual groups, respectively (P<0.05). The rate of complete anesthesia below the elbow was also higher in the Radial group at 30 min (P<0.05).
Injection of a local anesthetic after a single stimulation of the radial nerve fibers produced more extensive anesthesia than using a dual stimulation technique under the conditions of our study.
锁骨下喙突旁肌间沟阻滞（ICB）后，多次注射和单次后索注射技术均与上肢广泛麻醉有关。本研究的主要目的是直接比较这两种技术在肘以下皮神经完全麻醉率方面的效果。
70 例肘以下手术患者随机分为两组，一组在单次桡神经型反应（桡神经组）后接受 ICB，另一组在两种不同的上肢主要神经型反应（除桡神经外）后接受 ICB（双神经组）。根据分组情况，40 毫升 1.5%甲哌卡因单次或双剂量给药。在 10、20 和 30 分钟时评估每个皮神经的感觉阻滞情况。还记录阻滞性能时间和肘以下完全麻醉的发生率。
桡神经组在 10、20 和 30 分钟时桡神经感觉阻滞率较高（P<0.05）。桡神经组和双神经组在 30 分钟时尺神经感觉阻滞率分别为 97%和 75%（P<0.05）。30 分钟时，桡神经组肘以下完全麻醉率也较高（P<0.05）。
在本研究条件下，与使用双刺激技术相比，单次刺激桡神经纤维后注射局部麻醉剂可产生更广泛的麻醉效果。
