Department of Anesthesia, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
Reg Anesth Pain Med. 2012 Sep-Oct;37(5):473-7. doi: 10.1097/AAP.0b013e3182576b6f.
This prospective, randomized, observer-blinded study compared perivascular (PV) and perineural (PN) ultrasound-guided axillary brachial plexus block (AXB) for upper extremity surgery.
Fifty patients were randomly allocated to receive a PV (n = 25) or PN (n = 25) ultrasound-guided AXB. The local anesthetic agent (lidocaine 1.5% with epinephrine 5 μg/mL) and total volume (32 mL) were identical in all subjects. For both groups, the musculocutaneous nerve was first located and then anesthetized using 8 mL. Subsequently, in the PV group, 24 mL was deposited dorsal to the axillary artery (6-o'clock position). In contrast, for the PN group, the median, ulnar, and radial nerves were individually anesthetized with volumes of 8 mL. During the performance of the block, the performance time, number of needle passes, and complications (vascular puncture, paresthesia) were recorded. Subsequently, a blinded observer assessed the onset time, block-related pain scores, and success rate (surgical anesthesia). The main outcome variable was the total anesthesia-related time (sum of performance and onset times).
No differences were observed between the 2 groups in terms of success rate (92%-96%), total anesthesia-related time (27.1-29.0 min), and block-related pain scores. However, the PV technique required fewer needle passes (3.5 [SD, 1.0] vs 8.2 [SD, 2.2]; P = 0.000) as well as a shorter performance time (8.2 [SD, 2.3] vs 15.7 [SD, 3.2] min; P = 0.000) and was associated with a lower incidence of paresthesia (8 vs 52%; P = 0.001). In contrast, the PN technique resulted in a quicker onset time (13.8 [SD, 7.0] vs 18.9 [SD, 7.0] min; P = 0.021) and a decreased incidence of vascular puncture (0 vs 24%; P = 0.01).
Perivascular and PN ultrasound-guided AXBs result in comparable success rates and total anesthesia-related times. Because of fewer needle passes and a shorter performance time, the PV technique provides a simple alternative for ultrasound-guided AXB.
本前瞻性、随机、观察者盲法研究比较了血管周围（PV）和神经周围（PN）超声引导腋路臂丛阻滞（AXB）用于上肢手术。
50 名患者被随机分配接受 PV（n=25）或 PN（n=25）超声引导 AXB。所有患者均使用相同的局部麻醉剂（含肾上腺素 5μg/mL 的 1.5%利多卡因）和总容量（32mL）。对于两组，首先找到肌皮神经，然后用 8mL 进行麻醉。随后，在 PV 组中，将 24mL 置于腋动脉（6 点钟位置）背侧。相比之下，对于 PN 组，分别用 8mL 麻醉正中神经、尺神经和桡神经。在阻滞过程中，记录操作时间、进针次数和并发症（血管穿刺、感觉异常）。随后，一名盲法观察者评估起效时间、阻滞相关疼痛评分和成功率（手术麻醉）。主要结局变量是总麻醉相关时间（操作时间和起效时间之和）。
两组在成功率（92%-96%）、总麻醉相关时间（27.1-29.0min）和阻滞相关疼痛评分方面无差异。然而，PV 技术需要的进针次数更少（3.5[SD，1.0] vs 8.2[SD，2.2]；P=0.000），操作时间更短（8.2[SD，2.3] vs 15.7[SD，3.2]min；P=0.000），感觉异常发生率更低（8% vs 52%；P=0.001）。相比之下，PN 技术起效更快（13.8[SD，7.0] vs 18.9[SD，7.0]min；P=0.021），血管穿刺发生率更低（0% vs 24%；P=0.01）。
血管周围和 PN 超声引导 AXB 成功率和总麻醉相关时间相当。由于进针次数更少、操作时间更短，PV 技术为超声引导 AXB 提供了一种简单的替代方法。
