Department of Anesthesiology, CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.
Can J Anaesth. 2013 Mar;60(3):244-52. doi: 10.1007/s12630-012-9825-2. Epub 2012 Dec 1.
In recent studies on ultrasound-guided infraclavicular block (ICB), the authors have favoured a single injection posterior to the axillary artery rather than multiple injections; however, procedural complications and success rates associated with single-injection ultrasound-guided ICB are not well known. We undertook an observational study to evaluate the success rates of experienced and non-experienced operators performing ICBs and to identify the complications associated with ultrasound-guided single-injection ICB.
We conducted an observational cohort study of all ultrasound-guided single-injection ICBs performed over a two-year period (2008-2010). We identified the subjects for our study using a local database and excluded patients younger than 18 yr and those who received a continuous ICB. Complications (non-neurological and neurological) and ICB success rates were the primary and secondary end points, respectively. We collected the following data from patients' charts: patient demographics, types of complications and their respective frequencies, and the experience of the clinician performing the ICBs, and we identified potential late complications by telephone interview. Using a seven-point Likert scale, two experts in regional anesthesia evaluated the likelihood of a relationship between the identified neurological signs or symptoms and the ICB. A neurologist then evaluated the complications identified as being potentially related to the ICB. Summary data were collated, and 95% confidence intervals (CI) were calculated.
We reviewed 627 ICB procedures, and 496 (79%) patients received telephone interviews. Most patients were males who had undergone either plastic or orthopedic surgery. Mepivacaine 1.5% was used in 96% of cases with a median volume of 30 mL [interquartile range 30-38]. We identified 131 cases of neurological signs or symptoms. Four cases were retained as possible links to the ICB, but they underwent complete resolution of symptoms at the time of evaluation. Two possible cases of local anesthetic toxicity were observed. There was a 93% success rate (95% CI 91 to 95) and the results were comparable between the experienced and the non-experienced operators (94% vs 93%, respectively).
We observed few complications associated with a single-injection ultrasound-guided ICB and a high success rate regardless of the operator's expertise. The technique appears to be reliable, easy to perform, and safe.
在最近的超声引导锁骨下阻滞（ICB）研究中，作者倾向于在腋动脉后行单次注射，而不是多次注射；然而，单次注射超声引导 ICB 相关的程序并发症和成功率尚不清楚。我们进行了一项观察性研究，以评估经验丰富和非经验丰富的操作者行 ICB 的成功率，并确定与超声引导单次注射 ICB 相关的并发症。
我们对两年期间（2008-2010 年）进行的所有超声引导单次注射 ICB 进行了一项观察性队列研究。我们使用本地数据库确定了研究对象，并排除了年龄小于 18 岁的患者和接受连续 ICB 的患者。并发症（非神经和神经）和 ICB 成功率分别是主要和次要终点。我们从患者病历中收集了以下数据：患者人口统计学资料、并发症类型及其相应频率，以及行 ICB 的临床医生的经验，并通过电话访谈确定潜在的迟发性并发症。两位区域麻醉专家使用七点 Likert 量表评估了所识别的神经体征或症状与 ICB 之间的关系的可能性。然后，神经科医生评估了被认为与 ICB 相关的潜在并发症。汇总了摘要数据，并计算了 95%置信区间（CI）。
我们回顾了 627 例 ICB 手术，其中 496 例（79%）患者接受了电话访谈。大多数患者为男性，接受过整形或骨科手术。96%的病例使用 1.5%甲哌卡因，中位数容量为 30mL[四分位间距 30-38]。我们发现了 131 例神经体征或症状。保留了 4 例可能与 ICB 相关的病例，但在评估时症状完全缓解。观察到 2 例可能的局部麻醉毒性病例。成功率为 93%（95%CI 91 至 95），且经验丰富和非经验丰富操作者之间的结果相似（分别为 94%和 93%）。
我们观察到单次注射超声引导 ICB 相关并发症较少，且成功率较高，与操作者的专业水平无关。该技术似乎可靠、易于操作且安全。
