Geiser T, Lang D, Neuburger M, Ott B, Augat P, Büttner J
Abteilung für Anästhesiologie und Intensivmedizin, Berufsgenossenschaftliche Unfallklinik Murnau, Prof. Küntscher-Strasse 8, Murnau am Staffelsee, Germany.
Anaesthesist. 2011 Jul;60(7):617-24. doi: 10.1007/s00101-011-1850-y. Epub 2011 Jan 28.
Optimizing the needle position using ultrasound (US) instead of electrical nerve stimulation (NSt) is increasingly common for perivascular brachial plexus block. These two methods were compared in a prospective, randomized, single-blinded controlled trial regarding effectiveness and time of onset of peripheral nerve blockade.
After puncture (penetration of neurovascular sheath and complete insertion of needle) 56 patients were randomly assigned to either the US group (finding the needle tip in transpectoral section, short axis, correction of needle position if local anesthetic spread was insufficient) or the NSt group (target impulse reaction in median, ulnar or radial nerve of 0.3 mA/0.1 ms, if necessary correction of position before injection of local anesthetic) to verify the needle position. All patients received 500 mg 1% mepivacaine. Sensory and motor blocks were tested by single nerve measurements (SNM) 5, 10 and 20 min after finishing the injection, where 0 represents minimal and 2 maximal success of the block.
Single nerve measurements were analyzed using repeated measures ANOVA. The mean results of cumulative SNMs were significantly higher in the US group at all measurement times. Sensitivity US/NSt: 5 min: 3.36±2.32/2.63±1.87; 10 min: 5.45±2.41/4.21±2.45; 20 min: 7.30±2.02/6.43±2.43, p=0.015, motor function US/NSt: 5 min: 3.91±1.81/3.02±1.67; 10 min: 5.27±1.66/4.05±1.70; 20 min: 6.64±1.37/5.50±1.90, p<0.001. At the beginning of surgery complete nerve blockade was achieved in 89% in the US group and 68% in the NSt group (p=0.006), 3 (US) versus 7 (NSt) patients needed supplementation and 3 (US) versus 11 (NSt) patients needed general anesthesia (p=0.022). To achieve the nerve block took approximately 1 min more in the US group (p=0.003).
The use of ultrasound in perivascular brachial plexus blocks leads to significantly higher success rates and shorter times of onset.
在血管周围臂丛神经阻滞中，使用超声（US）而非电神经刺激（NSt）来优化针的位置越来越普遍。在一项前瞻性、随机、单盲对照试验中，对这两种方法在外周神经阻滞的有效性和起效时间方面进行了比较。
56例患者穿刺（穿透神经血管鞘并完全插入针）后，随机分为超声组（在经胸切面短轴找到针尖，若局部麻醉药扩散不足则校正针的位置）或电神经刺激组（正中神经、尺神经或桡神经的目标冲动反应为0.3 mA/0.1 ms，必要时在注射局部麻醉药前校正位置）以确认针的位置。所有患者均接受500 mg 1%的甲哌卡因。注射结束后5、10和20分钟通过单神经测量（SNM）测试感觉和运动阻滞情况，其中0表示阻滞最不成功，2表示最成功。
使用重复测量方差分析对单神经测量结果进行分析。在所有测量时间点，超声组累积单神经测量的平均结果均显著更高。感觉功能超声组/电神经刺激组：5分钟：3.36±2.32/2.63±1.87；10分钟：5.45±2.41/4.21±2.45；20分钟：7.30±2.02/6.43±2.43，p = 0.015；运动功能超声组/电神经刺激组：5分钟：3.91±1.81/3.02±1.67；10分钟：5.27±1.66/4.05±1.70；20分钟：6.64±1.37/5.50±1.90，p < 0.001。手术开始时，超声组89%的患者实现了完全神经阻滞，电神经刺激组为68%（p = 0.006），3例（超声组）与7例（电神经刺激组）患者需要补充麻醉，3例（超声组）与11例（电神经刺激组）患者需要全身麻醉（p = 0.022）。超声组实现神经阻滞大约多花1分钟（p = 0.003）。
在血管周围臂丛神经阻滞中使用超声可显著提高成功率并缩短起效时间。
