First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
Chin Med J (Engl). 2012 May;125(10):1811-6.
The use of traditional techniques (such as landmark techniques, paresthesia and peripheral nerve stimulator) for upper-limb anesthesia has often been restricted to the expert or enthusiast, which was blind. Recently, ultrasound (US) has been applied to differ blood vessel, pleura and nerve, thus may reduce the risk of complications while have a high rate of success. The aim of this study was to determine if the use of ultrasound guidance (vs. peripheral nerve stimulator, (PNS)) decreases risk of vascular puncture, risk of hemi-diaphragmatic paresis and risk of Horner syndrome and improves the success rate of nerve block.
A search strategy was developed to identify randomized control trials (RCTs) reporting on complications of US and PNS guidance for upper-extremity peripheral nerve blocks (brachial plexus) in adults available through PubMed databases, the Cochrane Central Register of Controlled Trials, Embase databases, SinoMed databases and Wanfang data (date up to 2011-12-20). Two independent reviewers appraised eligible studies and extracted data. Risk ratios (OR) were calculated for each outcome and presented with 95% confidence intervals (CI) with the software of Review Manager 5.1.0 System (Cochrane Library).
Sixteen trials involving 1321 adults met our criteria were included for analysis. Blocks performed using US guidance were more likely to be successful (risk ratio (RR) for block success 0.36, 95%CI 0.23 - 0.56, P < 0.00001), decreased incidence of vascular puncture during block performance (RR 0.13, 95%CI 0.06 - 0.27, P < 0.00001), decreased the risk of complete hemi-diaphragmatic paresis (RR 0.09, 95%CI 0.03 - 0.52, P = 0.0001).
US decreases risks of complete hemi-diaphragmatic paresis or vascular puncture and improves success rate of brachial plexus nerve block compared with techniques that utilize PNS for nerve localization. Larger studies are needed to determine whether or not the use of US can decrease risk of neurologic complications.
传统技术（如体表标志技术、感觉异常和周围神经刺激器）在上肢麻醉中的应用往往局限于专家或爱好者，而且是盲法的。最近，超声（US）已被用于区分血管、胸膜和神经，从而降低了并发症的风险，同时提高了成功率。本研究的目的是确定超声引导（与周围神经刺激器（PNS）相比）是否降低血管穿刺风险、膈神经麻痹风险和霍纳综合征风险，并提高神经阻滞的成功率。
制定了一种搜索策略，以确定通过 PubMed 数据库、Cochrane 中心对照试验注册、Embase 数据库、SinoMed 数据库和万方数据（截至 2011 年 12 月 20 日）检索到的报告成人上肢周围神经阻滞（臂丛）中 US 和 PNS 引导并发症的随机对照试验（RCTs）。两名独立的评审员评估合格的研究并提取数据。使用 Review Manager 5.1.0 系统（Cochrane 图书馆）计算每个结果的风险比（OR），并呈现 95%置信区间（CI）。
纳入了 16 项涉及 1321 名成人的试验进行分析。使用 US 引导进行的阻滞更有可能成功（阻滞成功率的风险比（RR）为 0.36，95%CI 为 0.23 - 0.56，P < 0.00001），降低了阻滞过程中血管穿刺的发生率（RR 0.13，95%CI 为 0.06 - 0.27，P < 0.00001），降低了完全膈神经麻痹的风险（RR 0.09，95%CI 为 0.03 - 0.52，P = 0.0001）。
与使用 PNS 进行神经定位的技术相比，US 降低了完全膈神经麻痹或血管穿刺的风险，并提高了臂丛神经阻滞的成功率。需要更大的研究来确定 US 是否可以降低神经并发症的风险。
