Maga Joni M, Cooper Lebron, Gebhard Ralf E
Department of Anesthesiology, University of Miami Hospital, Miami, Florida, USA.
Int Anesthesiol Clin. 2012 Winter;50(1):47-55. doi: 10.1097/AIA.0b013e31821a00a8.
Multiple different approaches to the brachial plexus are available for the regional anesthesiologist to provide successful anesthesia and analgesia for ambulatory surgery of the upper extremity. Although supraclavicular and infraclavicular blocks are faster to perform than axillary blocks, the operator needs to keep in mind that blocks performed around the clavicle carry the risk for specific side effects and complications, no matter whether ultrasound or nerve stimulation is the chosen modality for neurolocation. Owing to the ambulatory nature of the planned surgical intervention, even significant side effects may not become clinically symptomatic until the patient is discharged from the facility. For example, due to pneumothorax risks, axillary or mid-humeral blocks remain the most logical approaches for ambulatory surgical procedures at and below the elbow, while reserving infra-clavicularor supraclavicular approaches for surgery from the proximal humerus to above the elbow. Smaller interventions such as carpal tunnel release or trigger finger release can be performed under elbow, wrist, or digital blocks. The regional anesthesiologist should strive to develop a tailored plan for each individual case to provide the most effective and safest nerve block technique for their patients.
区域麻醉医生有多种不同的臂丛神经阻滞方法可供选择，以便为上肢门诊手术提供成功的麻醉和镇痛。虽然锁骨上和锁骨下阻滞比腋路阻滞实施起来更快，但操作者需要记住，无论选择超声还是神经刺激作为神经定位方式，在锁骨周围进行的阻滞都有特定副作用和并发症的风险。由于计划中的手术干预具有门诊性质，即使是严重的副作用在患者出院前可能也不会出现临床症状。例如，由于气胸风险，腋路或肱骨中段阻滞仍然是肘部及以下门诊手术最合理的方法，而锁骨下或锁骨上阻滞方法则保留用于从肱骨近端到肘部以上的手术。较小的手术，如腕管松解或扳机指松解，可以在肘部、腕部或指部阻滞下进行。区域麻醉医生应努力为每个病例制定个性化计划，为患者提供最有效、最安全的神经阻滞技术。
