在有监督的受训者指导下进行神经刺激器引导和超声引导的外周神经阻滞的不良结果：单站点数据库更新。
Adverse outcomes associated with nerve stimulator-guided and ultrasound-guided peripheral nerve blocks by supervised trainees: update of a single-site database.
机构信息
Department of Anesthesiology, University of Pittsburgh School of Medicine, UPMC-Southside/Mercy Ambulatory Surgical Center, 2000 Mary Street, Pittsburgh, PA 15203, USA.
出版信息
Reg Anesth Pain Med. 2012 Nov-Dec;37(6):577-82. doi: 10.1097/AAP.0b013e318263d396.
BACKGROUND
We previously published a retrospective review of complications related to peripheral nerve blocks performed by supervised trainees, from our quality assurance and billing data, guided by either ultrasound, with nerve stimulator confirmation, or landmark-based nerve stimulator techniques. This report updates our results, for the period from May 2008 through December 2011, representing ongoing transition to near-complete combined ultrasound/nerve stimulator guidance in a block-oriented, outpatient orthopedic anesthesia practice.
METHODS
We queried our deidentified departmental quality improvement electronic database for adverse outcomes associated with peripheral nerve blocks. Billing records were also deidentified and used to provide the denominator of total number of blocks using each technique of neurolocation. The types of blocks considered in this analysis were interscalene, axillary, femoral, sciatic, and popliteal-sciatic blocks. Nerve block complications based on each type of guidance were then compared for the entire recent 30-month time period, as well as for the 6-year period of this report.
RESULTS
There were 9062 blocks performed by ultrasound/nerve stimulator, and 5436 by nerve stimulator alone over the entire 72-month period. Nerve injuries lasting longer than 1 year were rare, but similar in frequency with both nerve guidance techniques. The incidence of local anesthetic systemic toxicity was found to be higher with landmark-nerve stimulator technique than with use of ultrasound-guided nerve blocks (6/5436 vs 0/9069, P = 0.0061).
CONCLUSIONS
We report a large series of combined ultrasound/nerve stimulator nerve blocks by supervised trainees without major local anesthetic systemic toxicity. While lacking the compelling evidence of randomized controlled trials, this observational database nonetheless allows increased confidence in the safety of using combined ultrasound/nerve stimulator in the setting of anesthesiologists-in-training.
背景
我们之前发表了一篇回顾性研究，分析了由监督培训生进行的外周神经阻滞相关并发症，这些数据来自我们的质量保证和计费数据，这些操作由超声引导、神经刺激器确认或基于标志的神经刺激器技术指导。本报告更新了我们的结果，涵盖了 2008 年 5 月至 2011 年 12 月期间的数据，代表了在以阻滞为导向的门诊骨科麻醉实践中，向近乎完全结合超声/神经刺激器引导的持续转变。
方法
我们从我们部门的去识别电子数据库中查询与外周神经阻滞相关的不良事件。计费记录也被去识别，并用于提供使用每种神经定位技术进行的总神经阻滞数量的分母。本分析中考虑的阻滞类型包括肌间沟、腋路、股神经、坐骨神经和腘窝-坐骨神经阻滞。然后，根据每种引导类型比较了整个最近 30 个月的时间以及本报告 6 年的时间内的神经阻滞并发症。
结果
在整个 72 个月的时间内，有 9062 例采用超声/神经刺激器进行的神经阻滞，5436 例采用单独的神经刺激器进行的神经阻滞。持续超过 1 年的神经损伤很少见，但在两种神经引导技术中频率相似。与使用超声引导神经阻滞相比，使用标志神经刺激器技术的局部麻醉全身毒性发生率更高（6/5436 比 0/9069，P=0.0061）。
结论
我们报告了一系列由监督培训生进行的联合超声/神经刺激器神经阻滞，没有出现重大局部麻醉全身毒性。虽然缺乏随机对照试验的有力证据，但这种观察性数据库仍然增加了在麻醉医师培训中使用联合超声/神经刺激器的安全性的信心。
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