Department of Anesthesiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Reg Anesth Pain Med. 2009 Nov-Dec;34(6):595-9. doi: 10.1097/aap.0b013e3181bfbd83.
Supraclavicular brachial plexus block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular brachial plexus block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis.
In a prospective randomized observer-blinded controlled trial, 60 patients scheduled for elective elbow, forearm, wrist, or hand surgery under supraclavicular brachial plexus block without sedation were included. Supraclavicular brachial plexus block was performed with 20 mL of 0.75% ropivacaine using either ultrasound or nerve stimulation guidance. Ventilatory function was assessed by ultrasound examination of hemidiaphragmatic movement and spirometry.
None of the 30 patients in the ultrasound group showed complete or partial paresis of the hemidiaphragm (95% confidence interval, 0.00-0.14), whereas in the nerve stimulation group, 15 patients showed complete paresis of the hemidiaphragm and 1 patient showed partial paresis of the hemidiaphragm (0% versus 53%, respectively; P < 0.0001). Ventilatory function (forced expiratory volume 1, forced vital capacity, peak expiratory flow) was significantly reduced in the nerve stimulation group compared with the ultrasound-guided group (P < 0.05). Two block failures occurred in the nerve stimulation group compared with none in the ultrasound group (P = 0.49). No adverse effects occurred in either group.
Ultrasound-guided supraclavicular brachial plexus block, using 20 mL of 0.75% ropivacaine with the described technique, is not associated with hemidiaphragmatic paresis.
锁骨上臂丛神经阻滞会导致膈神经阻滞，膈神经阻滞的发生率为 50%至 67%，进而导致膈肌部分或完全麻痹。我们研究了在锁骨上臂丛神经阻滞中，与神经刺激引导相比，超声引导使用 0.75%罗哌卡因是否会降低膈神经阻滞的发生率。
在一项前瞻性、随机、观察者设盲、对照临床试验中，纳入了 60 例拟在锁骨上臂丛神经阻滞下接受择期肘部、前臂、腕部或手部手术且未镇静的患者。使用 0.75%罗哌卡因 20mL 行锁骨上臂丛神经阻滞，采用超声或神经刺激引导。通过超声检查膈肌运动和肺量测定评估呼吸功能。
在超声组的 30 例患者中，均未出现完全或部分膈肌麻痹（95%置信区间，0.00 至 0.14），而在神经刺激组，15 例患者出现完全膈肌麻痹，1 例患者出现部分膈肌麻痹（分别为 0%和 53%；P<0.0001）。与超声引导组相比，神经刺激组的呼吸功能（1 秒用力呼气量、用力肺活量、呼气峰流速）显著降低（P<0.05）。与超声组相比，神经刺激组有 2 例阻滞失败，而超声组无阻滞失败（P=0.49）。两组均未发生不良反应。
在锁骨上臂丛神经阻滞中，使用 20mL0.75%罗哌卡因，并采用描述的技术进行超声引导，不会导致膈肌麻痹。
