与单独锁骨下阻滞相比，同时行锁骨下加远端正中、桡侧和尺侧神经阻滞可加速上肢麻醉，并提高阻滞的一致性。
Concomitant infraclavicular plus distal median, radial, and ulnar nerve blockade accelerates upper extremity anaesthesia and improves block consistency compared with infraclavicular block alone.
机构信息
Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Epsom, Auckland, New Zealand.
出版信息
Br J Anaesth. 2011 Aug;107(2):236-42. doi: 10.1093/bja/aer101. Epub 2011 May 15.
BACKGROUND
This prospective, randomized, observer-blinded study tested the hypothesis that a combined ultrasound-guided block of the infraclavicular brachial plexus plus distal median, radial, and ulnar nerves would accelerate upper extremity anaesthesia compared with infraclavicular block alone.
METHODS
Elective wrist and hand surgery patients were randomly assigned to receive 42 ml infraclavicular lidocaine 1.5% with epinephrine 1/200,000 ('infraclavicular only'; n=30) or 30 ml lidocaine 1.5% with epinephrine 1/200,000 followed by a distal median, radial, and ulnar nerve block using 12 ml 50:50 lidocaine 2%+ropivacaine 0.75% ('combined'; n=31). A blinded observer assessed pinprick sensory and motor block in the four distal nerve territories at 10 and 15 min (each nerve/parameter: no block, 3, to complete block, 0).
RESULTS
Total aggregate block score (sensory+motor) was reduced in the combined group at 15 min [mean (95% confidence interval)=6.7 (5.3-8.1) vs. 9.9 (7.9-11.9), mean difference (95% confidence interval)=3.2 (0.81-5.6), P=0.01], and corresponded to an estimated onset effect time benefit of 6 min (∼40% treatment effect). The combined group also demonstrated reduced variance about the mean (sd=3.7 vs. 5.4, P=0.046). Mean (sd) total block score (sensory+motor) was significantly reduced at 15 min in the combined group for each individual nerve [median, radial, ulnar, respectively: 1.4 (1.1) vs. 2.4 (1.5), P=0.005; 1.2 (1.1) vs. 2.0 (1.5), P=0.03; 1.6 (1.3) vs. 2.5 (1.6), P=0.03].
CONCLUSIONS
At an approximately equivalent total local anaesthetic dose, a combined infraclavicular block plus distal median, radial, and ulnar nerve blockade accelerates anaesthesia onset time and improves block consistency compared with an infraclavicular block alone.
CLINICAL TRIALS REGISTRY
ANZCTR: ACTRN12610000155099. https://www.anzctr.org.au/registry/trial_review.aspx?ID=335162.
背景
本前瞻性、随机、观察者盲法研究旨在检验以下假设，即与单纯锁骨下神经阻滞相比，联合超声引导下锁骨下臂丛神经加远端正中神经、桡神经和尺神经阻滞可加速上肢麻醉。
方法
择期腕关节和手部手术患者被随机分配接受 42ml 含 1/200000 肾上腺素的 1.5% 利多卡因（“单纯锁骨下阻滞”组，n=30）或 30ml 含 1/200000 肾上腺素的 1.5% 利多卡因，然后进行远端正中神经、桡神经和尺神经阻滞，使用 12ml 50:50 利多卡因 2%+罗哌卡因 0.75%（“联合阻滞”组，n=31）。盲法观察者在 10 分钟和 15 分钟评估四个远端神经区域的针刺痛觉和运动阻滞情况（每个神经/参数：无阻滞，3 分；完全阻滞，0 分）。
结果
联合阻滞组在 15 分钟时的总综合阻滞评分（感觉+运动）降低[平均（95%置信区间）=6.7（5.3-8.1）vs. 9.9（7.9-11.9），平均差异（95%置信区间）=3.2（0.81-5.6），P=0.01]，这与估计的起效时间优势 6 分钟相对应（约 40%的治疗效果）。联合阻滞组的平均差异也较小（标准差=3.7 对 5.4，P=0.046）。联合阻滞组在 15 分钟时每个单独神经的总阻滞评分（感觉+运动）均显著降低[分别为：正中神经、桡神经、尺神经：1.4（1.1）vs. 2.4（1.5），P=0.005；1.2（1.1）vs. 2.0（1.5），P=0.03；1.6（1.3）vs. 2.5（1.6），P=0.03]。
结论
在等效的局部麻醉剂总剂量下，与单纯锁骨下阻滞相比，锁骨下联合阻滞加远端正中神经、桡神经和尺神经阻滞可加速麻醉起效时间，并改善阻滞的一致性。
临床试验注册
澳大利亚新西兰临床试验注册中心：ACTRN12610000155099。https://www.anzctr.org.au/registry/trial_review.aspx?ID=335162。
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