Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington 98101, USA.
Reg Anesth Pain Med. 2013 Jan-Feb;38(1):54-7. doi: 10.1097/AAP.0b013e31826f0a63.
The use of ultrasound for in-plane interscalene block shifts needle insertion to a more posterior approach through the middle scalene muscle, when compared with classic nerve stimulator techniques. Branches from the brachial plexus, including the dorsal scapular and long thoracic nerves, are often anatomically located within the middle scalene muscle. The aim of this study was to use ultrasound to identify and characterize the frequency and position of the dorsal scapular and long thoracic nerves located in the middle scalene muscle.
We recruited 50 subjects who presented for shoulder surgery. Before block placement, ultrasound was used to evaluate the area posterior to the brachial plexus for visible segments of the long thoracic and dorsal scapular nerves. If nerves were identified, a stimulating Tuohy needle was advanced in close proximity. Current was then applied through the needle, and motor response confirmed the visualized nerve as being either the dorsal scapular nerve or long thoracic nerve.
Ninety percent of the subjects had a nerve visible under ultrasound assessment within or superficial to the middle scalene muscle. The nerves were located at similar depth as the perceived C6 nerve root, at 1.1 ± 0.4 cm from skin and 0.7 ± 0.4 cm posterior from the brachial plexus. Stimulation revealed that the nerve identified on ultrasound was the dorsal scapular nerve (77%) or the long thoracic nerve (23%).
This descriptive study revealed that the dorsal scapular and long thoracic nerves routinely could be identified with ultrasound.
与经典神经刺激器技术相比，超声引导下肌间沟入路可使进针点更靠后，针尖更偏向于穿过中斜角肌，从而到达前斜角肌间隙。臂丛分支，包括肩胛背神经和胸长神经，通常在中斜角肌内解剖定位。本研究旨在利用超声识别和描述中斜角肌内肩胛背神经和胸长神经的出现频率和位置。
我们招募了 50 名拟行肩部手术的患者。在进行阻滞前，我们使用超声评估臂丛神经后方区域，以发现可见的胸长神经和肩胛背神经节段。如果发现神经，将刺激 Tuohy 针推进至接近神经的位置。然后通过针施加电流，观察运动反应，以确定可视化神经为肩胛背神经或胸长神经。
90%的受试者在中斜角肌内或其浅层下的超声评估中可发现神经。这些神经的位置与感知的 C6 神经根相似，距皮肤 1.1±0.4cm，距臂丛后 0.7±0.4cm。刺激显示，超声识别的神经为肩胛背神经（77%）或胸长神经（23%）。
本描述性研究表明，肩胛背神经和胸长神经通常可通过超声识别。
