Department of Anesthesia and Perioperative Medicine, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada.
Anesth Analg. 2010 Apr 1;110(4):1222-6. doi: 10.1213/ANE.0b013e3181cb6791. Epub 2010 Feb 8.
In this prospective, randomized, double-blind study, we compared the effectiveness and time efficiency of perioperative axillary blocks performed via 2 different techniques, 1 involving 2 and the other 4 separate skin punctures.
One hundred twenty patients undergoing upper limb surgery were randomized to receive either (1) an axillary brachial plexus block involving 2 injections, with 30 mL local anesthetic injected posterior to the axillary artery (with redirection, as needed, to achieve circumferential spread), plus 10 mL local anesthetic to the musculocutaneous nerve, guided by ultrasound (group 1, n = 56); or (2) 4 separate 10-mL injections to the median, ulnar, radial, and musculocutaneous nerves, using a combined ultrasound and neurostimulation technique (group 2, n = 58). All patients received 40 mL of 0.5% ropivacaine with 1:400,000 epinephrine. The primary outcome was the success rate of the block, defined as anesthesia adequate for surgery. Secondary outcomes were the time to administer the block, time to the onset of motor-sensory block, time to surgical readiness, and incidence of adverse events.
The 2-injection technique was slightly faster to administer (8 vs 11 minutes, P = 0.003). The mean nerve block score was slightly higher for the 4-injection group at the 10-, 15-, 20-, and 30-minute time points, but the cumulative percentages of blocks having taken effect were not significantly different over these time points, at 0.0%, 5.4%, 12.5%, and 37.5% among those who had received a 2-injection block versus 6.9%, 10.4%, 19.0%, and 48.3%, respectively, with the 4-injection block (P = 0.20). There was no difference in the percentage of patients with complete block by 30 minutes (32.1% vs 37.5%, P = 0.55) or in final block success rates (89.3% vs 87.9%, P = 0.99).
An ultrasound-guided 2-injection axillary block may be as effective as, and more time efficient than, a 4-injection technique.
在这项前瞻性、随机、双盲研究中，我们比较了两种不同技术进行的腋窝阻滞的有效性和时间效率，一种技术涉及 2 次注射，另一种技术涉及 4 次单独的皮肤穿刺。
120 例接受上肢手术的患者随机分为两组：（1）接受包含 2 次注射的腋路臂丛神经阻滞，30 毫升局部麻醉药在腋动脉后注射（必要时重新定向以实现环形扩散），外加 10 毫升局部麻醉药至肌皮神经，超声引导（组 1，n=56）；或（2）采用超声联合神经刺激技术对正中神经、尺神经、桡神经和肌皮神经进行 4 次单独的 10 毫升注射（组 2，n=58）。所有患者均接受 0.5%罗哌卡因+1:400,000 肾上腺素 40 毫升。主要结局是阻滞成功率，定义为手术所需的麻醉效果。次要结局是阻滞给药时间、运动感觉阻滞起效时间、手术准备时间和不良事件发生率。
2 次注射技术给药速度略快（8 分钟与 11 分钟，P=0.003）。在 10、15、20 和 30 分钟时，4 次注射组的神经阻滞评分略高，但在这些时间点，起效的阻滞百分比没有显著差异，接受 2 次注射的患者分别为 0.0%、5.4%、12.5%和 37.5%，接受 4 次注射的患者分别为 6.9%、10.4%、19.0%和 48.3%（P=0.20）。在 30 分钟时完全阻滞的患者比例（32.1%与 37.5%，P=0.55）或最终阻滞成功率（89.3%与 87.9%，P=0.99）方面，两组间无差异。
超声引导下 2 次注射腋路阻滞可能与 4 次注射技术一样有效，且更节省时间。
