超声引导 SGB 所需的局部麻醉最小容量。

Minimal volume of local anesthetic required for an ultrasound-guided SGB.

机构信息

Departments of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon Dr. Kim's Pain Clinic, Busan, South Korea.

出版信息

Pain Med. 2012 Nov;13(11):1381-8. doi: 10.1111/j.1526-4637.2012.01495.x. Epub 2012 Sep 26.

DOI:10.1111/j.1526-4637.2012.01495.x

PMID:23013477

Abstract

BACKGROUND

Compared with the blind technique, ultrasound-guided stellate ganglion block (SGB) reduces the amount of local anesthetic needed for a successful block. The purpose of this study is to determine the minimal, optimal volume of local anesthetic required for successful ultrasound-guided SGB and to reduce its adverse effects.

METHODS

Thirty-five patients with postherpetic neuralgia and complex regional pain syndrome of the upper extremity and the facial area were selected. For ultrasound-guided SGB by subfacial method, each patient was injected with 0.5% mepivacaine mixed with contrast media in 2 mL, 3 mL, and 4 mL doses at 2-week intervals. After the procedure, the spread of contrast media in the spine was checked by fluoroscopy. Ptosis and conjunctival flushing were rated and recorded. Adverse effects, such as hoarseness, foreign body sensation, swallowing difficulty, and upper arm weakness, were also recorded.

RESULTS

Out of the 35 initial patients, the results for 33 patients who received all three SGBs were included in this study. The contrast media spread to 4.80 ± 0.82, 4.94 ± 0.86, and 5.09 ± 0.97 total spinal segments in the 2 mL, 3 mL, and 4 mL groups, respectively. The cephalad spread of contrast media was 2.16 ± 0.74, 2.23 ± 0.85, and 2.30 ± 0.78 spinal segments for the 2 mL, 3 mL, and 4 mL groups, respectively, and the caudad spread of contrast media was 2.64 ± 0.51, 2.70 ± 0.61, and 2.89 ± 0.64 segments in the 2 mL, 3 mL, and 4 mL groups, respectively. There were no significant statistical differences in any segments for the three groups (P > 0.05). Review of the fluoroscopic images showed spread of the contrast media below the C7-T1 junction in all three groups. Ptosis developed in all three groups after the procedure.

CONCLUSION

In conclusion, when performing an ultrasound-guided SGB, 2 mL dosage was sufficient for a successful block as the previous, conventional volume. Therefore, when performing an ultrasound-guided SGB, we recommend the 2 mL dosage of local anesthetics for a successful block.

摘要

背景

与盲目技术相比，超声引导星状神经节阻滞（SGB）可减少成功阻滞所需的局部麻醉剂用量。本研究的目的是确定用于成功超声引导 SGB 的最小、最佳局部麻醉剂体积，并减少其不良反应。

方法

选择 35 例带状疱疹后神经痛和上肢及面部复杂性区域疼痛综合征患者。对于通过皮下方法进行的超声引导 SGB，每位患者在 2 周的间隔内分别以 2 mL、3 mL 和 4 mL 剂量注射 0.5%甲哌卡因混合对比剂。操作后，通过透视检查检查对比剂在脊柱中的扩散情况。评估并记录上睑下垂和结膜充血情况。还记录了声音嘶哑、异物感、吞咽困难和上臂无力等不良反应。

结果

在最初的 35 名患者中，有 33 名接受了所有 3 次 SGB 的患者的结果被纳入本研究。2 mL、3 mL 和 4 mL 组的对比剂分别扩散到 4.80±0.82、4.94±0.86 和 5.09±0.97 个总脊髓段。2 mL、3 mL 和 4 mL 组的对比剂头侧扩散分别为 2.16±0.74、2.23±0.85 和 2.30±0.78 个脊髓段，对比剂尾侧扩散分别为 2.64±0.51、2.70±0.61 和 2.89±0.64 个脊髓段。三组各节段之间无统计学差异（P>0.05）。透视图像回顾显示三组均有对比剂扩散至 C7-T1 交界处以下。三组患者术后均出现上睑下垂。