Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021, USA.
Anesth Analg. 2010 Sep;111(3):617-23. doi: 10.1213/ANE.0b013e3181ea5f5d. Epub 2010 Aug 4.
There is a lack of clinical registries to document efficacy and safety of ultrasound-guided regional anesthesia. Interscalene blocks are effective for shoulder arthroscopy, and ultrasound guidance may reduce risk. Furthermore, ultrasound-guided supraclavicular block is a novel approach for shoulder anesthesia that may have less risk for neurological symptoms than interscalene block.
One thousand one hundred sixty-nine patients undergoing ultrasound-guided regional anesthesia for ambulatory shoulder arthroscopy were enrolled in our prospective registry. Standardized perioperative data were collected including a preoperative neurological screening tool. Either interscalene or supraclavicular block was performed at the discretion of the clinical team. Standardized follow-up was performed in the postanesthesia care unit and at 1 week. Postoperative neurological symptoms (PONS) were assessed at the 1-week follow-up with the same screening tool by a blinded neurologist.
Ultrasound-guided interscalene (n = 515) and supraclavicular (n = 654) blocks had excellent anesthetic success (99.8%; 95% confidence interval [CI], 99.4%-99.9%) with 0% (95% CI, 0%-0.3%) incidence of vascular puncture or intravascular injection. The incidence of hoarseness in the postanesthesia care unit was significantly less with supraclavicular (22% with 95% CI, 19%-26%) than interscalene block (31% with 95% CI, 27%-35%). The incidence of dyspnea was similar (7% for supraclavicular vs 10% with interscalene). No patient had a clinically apparent pneumothorax. The incidence of PONS was very low (0.4% with 95% CI, 0.1%-1%), and there was a 0% (95% CI, 0%-0.3%) incidence of permanent nerve injury.
Ultrasound-guided interscalene and supraclavicular blocks are effective and safe for shoulder arthroscopy. Temporary and permanent PONS is uncommon.
目前缺乏临床注册来记录超声引导下区域麻醉的疗效和安全性。肌间沟阻滞对肩关节镜检查有效，而超声引导可能会降低风险。此外，锁骨上阻滞是一种新的肩关节麻醉方法，其发生神经症状的风险可能低于肌间沟阻滞。
我们前瞻性注册了 1169 例行超声引导下区域麻醉的门诊肩关节镜检查患者。收集了包括术前神经筛查工具在内的标准化围手术期数据。临床团队根据需要进行肌间沟或锁骨上阻滞。在麻醉后恢复室和 1 周时进行标准化随访。由一名盲法神经科医生在 1 周随访时使用相同的筛查工具评估术后神经症状（PONS）。
超声引导下肌间沟（n=515）和锁骨上（n=654）阻滞的麻醉成功率非常高（99.8%；95%置信区间[CI]，99.4%-99.9%），血管穿刺或血管内注射的发生率为 0%（95%CI，0%-0.3%）。锁骨上阻滞在麻醉后恢复室发生声音嘶哑的比例明显低于肌间沟阻滞（22%，95%CI，19%-26%比 31%，95%CI，27%-35%）。呼吸困难的发生率相似（锁骨上阻滞 7%，肌间沟阻滞 10%）。没有患者发生明显气胸。PONS 的发生率非常低（0.4%，95%CI，0.1%-1%），且永久性神经损伤的发生率为 0%（95%CI，0%-0.3%）。
超声引导下肌间沟和锁骨上阻滞对肩关节镜检查有效且安全。暂时性和永久性 PONS 并不常见。
