INSERM, Imagerie Cérébrale et Handicaps Neurologiques UMR 825, Toulouse Cedex 9, France.
Br J Anaesth. 2010 Aug;105(2):208-13. doi: 10.1093/bja/aeq144. Epub 2010 Jun 8.
The peripheral deafferentation induced by regional anaesthesia (RA) results in misperception of size-shape (S) and posture (P) of the anesthetized limb. During RA, most patients seem to describe motionless 'phantom limbs' fixed in stereotyped illusory positions, suggesting that RA could unmask stable postural patterns. The question of whether movement illusions exist or not after anaesthesia needs a prospective study. This study aimed to describe the phenomenology of RA-induced kinesthetic illusions (K illusions).
We examined prospectively the body image alteration during infraclavicular blocks in 20 patients. Multimodal sensory testing (pinprick, heat-cold, pallesthesia, and arthrokinesia) and assessment of motor function were performed every 5 min for 60 min after administration of the local anaesthetics. Meanwhile, patients described phantom limb sensations (S, P, and K illusions).
We individualized the occurrence of K illusions [44 (8) min] with respect to S illusions [7 (3) min; P<0.005] and P illusions [22 (4) min; P<0.001]. A close relationship between the onset of K illusions and proprioceptive impairment (arthrokinesia: r=0.92, P<0.001; pallesthesia: r=0.89, P<0001) and abolishment of motor activity (r=0.83, P<0.001) was identified. Finally, a principal component analysis showed that S and P illusions were essentially related to the proprioceptive impairment.
This study analyses for the first time the temporal evolution of sensorimotor dysfunction and the onset of K illusions during RA. Our results suggest the involvement of an alteration of proprioception and motor functions in the origin of this phenomenon. These data agree with the motor awareness theory.
区域麻醉（RA）引起的外周去传入导致对麻醉肢体的大小-形状（S）和姿势（P）的错觉。在 RA 期间，大多数患者似乎描述了静止的“幻肢”，固定在刻板的错觉位置，这表明 RA 可以揭示稳定的姿势模式。麻醉后是否存在运动错觉需要前瞻性研究。本研究旨在描述 RA 诱导的运动错觉（K 错觉）的现象学。
我们前瞻性地检查了 20 例患者锁骨下阻滞期间的身体意象改变。在局部麻醉剂给药后 60 分钟内，每 5 分钟进行一次多模态感觉测试（刺痛、冷热、触觉和关节运动觉）和运动功能评估。同时，患者描述了幻肢感觉（S、P 和 K 错觉）。
我们个体化了 K 错觉的发生[44（8）分钟]，与 S 错觉[7（3）分钟；P<0.005]和 P 错觉[22（4）分钟；P<0.001]。K 错觉的发生与本体感觉障碍（关节运动觉：r=0.92，P<0.001；触觉：r=0.89，P<0001）和运动活动的消除（r=0.83，P<0.001）密切相关。最后，主成分分析表明 S 和 P 错觉本质上与本体感觉障碍有关。
本研究首次分析了 RA 期间传感器运动功能障碍和 K 错觉发生的时间演变。我们的结果表明，本体感觉和运动功能的改变参与了这一现象的发生。这些数据与运动意识理论一致。
