Department of Anesthesiology, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Reg Anesth Pain Med. 2009 Sep-Oct;34(5):508-13. doi: 10.1097/AAP.0b013e3181ae7306.
Controversy exists regarding the need for nerve stimulation when performing an ultrasound (US)-guided peripheral nerve block. We tested the hypothesis that the quality of a femoral nerve block (FNB) performed with US is equivalent to an FNB performed with US and nerve stimulation.
One hundred seven patients undergoing unilateral total knee arthroplasty were randomized to receive either a US-guided FNB (group US) or a US-guided FNB with nerve stimulation (group USNS). Thirty milliliters of bupivacaine 0.5% was injected in both groups. At 10, 20, 30, and 40 mins after block placement, blinded motor and sensory examinations were conducted. Secondary outcomes included time to perform the block, the number of needle redirections, and 24-hrs intravenously administered morphine equivalent consumption.
There were no significant differences in the proportion of patients with either a partial or complete block. At 40 mins, 95.7% of the USNS subjects had a partial or complete sensory block of the femoral nerve (complete in 71.7% and partial in 24%) compared with 88.1% of US subjects (complete in 69% and partial in 19.1%; odds ratio, 2.97; P = 0.19). There were more needle redirections in group USNS (4.1 vs 1.1, P < 0.001), with a higher percentage of patients requiring 2 or more needle attempts (44.2% vs 18.9%, P < 0.01). The time to perform the block in group USNS was longer (188 vs 148 secs, P = 0.01).
The addition of nerve stimulation to a US-guided FNB did not change preoperative block efficacy.
在进行超声（US）引导下外周神经阻滞时是否需要神经刺激存在争议。我们检验了一个假设，即 US 引导下股神经阻滞（FNB）的质量与 US 引导下结合神经刺激的 FNB 质量相当。
107 例行单侧全膝关节置换术的患者被随机分为接受 US 引导下 FNB（US 组）或 US 引导下 FNB 结合神经刺激（USNS 组）。两组均注射 0.5%布比卡因 30ml。阻滞放置后 10、20、30 和 40 分钟，进行盲法运动和感觉检查。次要结局包括完成阻滞的时间、针的重新定向次数和 24 小时内静脉给予的吗啡等效消耗量。
两组部分或完全阻滞的患者比例无显著差异。在 40 分钟时，95.7%的 USNS 组患者股神经感觉阻滞完全或部分阻滞（完全 71.7%，部分 24%），而 US 组为 88.1%（完全 69%，部分 19.1%；优势比，2.97；P=0.19）。USNS 组需要更多的针重新定向（4.1 次比 1.1 次，P<0.001），需要 2 次或更多针尝试的患者比例更高（44.2%比 18.9%，P<0.01）。USNS 组完成阻滞的时间更长（188 秒比 148 秒，P=0.01）。
在 US 引导下 FNB 中加入神经刺激并没有改变术前阻滞效果。
