Department of Anesthesiology, Hôpital Foch, Université of Versailles SQY (UniverSud Paris), Suresnes, France.
Anesth Analg. 2012 Sep;115(3):728-33. doi: 10.1213/ANE.0b013e31825fa37d. Epub 2012 Jun 28.
Ultrasound-guided perineural peripheral nerve block using a hydrodissection technique may reduce the risk of accidental intravascular local anesthetic (LA) injection. In this prospective randomized double-blind study, we tested the hypothesis that median nerve block effectiveness is not reduced when circumferential perineural hydrodissection with dextrose 5% in water (D5W) precedes LA injection.
Patients scheduled for hand surgery were randomized to receive an ultrasound-guided median nerve block at the elbow to achieve circumferential perineural spread with either 6 mL of D5W followed by 6 mL of LA (lidocaine 1.5% with epinephrine 1:200,000) (D5W-LA group) or with 6 mL of LA alone (LA group). The primary outcome was onset time of successful anesthesia defined by a complete abolition of light touch sensation for the index finger.
Data from 95 patients were analyzed: 43 in the D5W-LA group and 52 in the LA group. Noninferiority tests were significant (all P < 0.05) for a critical limit of 7 minutes between D5W-LA and LA groups for onset time of the primary criterion, light touch block at index finger (mean ± SD, respectively: 23.9 ± 7.4 and 22.0 ± 7.9 minutes; 95% confidence interval [CI], -5.9 to 2.1 minutes), and for cold block at index fingertip, sensory blocks at thenar eminence, and motor block. Success rate at 30 minutes (defined as complete abolition for cold and light touch at index finger) was noted in 100% and 98.1% (95% CI, -6% to 10%) and 95.2% and 96.2% (95% CI, -13% to 9%) of patients for the D5W-LA and the LA groups.
Performing an ultrasound-guided perineural circumferential hydrodissection with D5W into which LA is injected leaves nerve block outcome unchanged. The assumption that this procedure may reduce the risk of intravascular injection and systemic toxicity remains to be demonstrated.
超声引导下经皮神经周围神经阻滞采用水分离技术可能会降低意外血管内局部麻醉药（LA）注射的风险。在这项前瞻性随机双盲研究中，我们检验了以下假设，即当在 LA 注射前进行周围神经环行水分离（D5W）时，正中神经阻滞的效果不会降低。
计划接受手部手术的患者被随机分为接受超声引导下肘正中神经阻滞，以实现周围神经的环行神经周围扩散，分别用 6 毫升的 D5W 加 6 毫升的 LA（利多卡因 1.5%加肾上腺素 1:200000）（D5W-LA 组）或仅用 6 毫升的 LA（LA 组）。主要结局是成功麻醉的起始时间，定义为食指的轻触感觉完全消失。
对 95 名患者的数据进行了分析：D5W-LA 组 43 例，LA 组 52 例。非劣效性检验均为阳性（所有 P < 0.05），对于 D5W-LA 和 LA 组之间起始时间的主要标准（食指轻触阻滞），即 7 分钟的临界限值，有统计学意义（分别为 23.9 ± 7.4 和 22.0 ± 7.9 分钟；95%置信区间[CI]，-5.9 至 2.1 分钟），对于指尖冷觉阻滞、大鱼际区感觉阻滞和运动阻滞也有统计学意义。30 分钟时的成功率（定义为食指的冷觉和轻触完全消失）分别为 100%和 98.1%（95%CI，-6%至 10%）和 95.2%和 96.2%（95%CI，-13%至 9%），在 D5W-LA 和 LA 组。
进行超声引导下的周围神经环行水分离术，然后注入 LA，不会改变神经阻滞的效果。这一程序可能会降低血管内注射和全身毒性的风险，这一假设仍有待证实。
Zotero 插件