Nowakowski Piotr, Bieryło Andrzej, Duniec Larysa, Kosson Dariusz, Łazowski Tomasz
1st Department of Anaesthesiology and Intensive Therapy, Medical University of Warsaw, Poland.
Anaesthesiol Intensive Ther. 2013 Oct-Dec;45(4):223-9. doi: 10.5603/AIT.2013.0043.
Ultrasound-guided (US-guided) regional anaesthesia has gained worldwide popularity in recent years owing to the benefits the method offers to patients. The 1st Department of Anaesthesiology and Intensive Care of Warsaw Medical University was one of the first centres in Poland to employ US-guided peripheral nerve blocks (PNB) on a routine basis. The technique was incorporated into the institution's clinical practice from 2007. The purpose of this study was to retrospectively assess changes in the clinical practice of US-guided versus non US-guided PNBs over six years of experience with the technique.
Retrospective analysis assessing the prevalence of PNB methods, local anaesthetic (LA) injection techniques (i.e. single injection vs. multiple), LA volumes used, success rates and the incidence of complications.
This study included 4,066 PNBs performed between January 2006 and June 2012. The results showed systematic growth in the prevalence of US-guided blocks in the total number of PNBs, from 8.6% in 2007 up to 53.3% in 2012. The mean LA volume used in PNB was significantly lower in US-guided blocks compared to traditional PNB techniques (respectively, 21.83 mL vs. 31.41 mL, P < 0.05) without a decrease in the success rate (respectively, 76% vs. 74%, P > 0.05). A shift in the prevailing block technique from single injection to multiple injections was observed, regardless of the nerve location technique employed (from 29% up to 84% of PNBs performed using multiple injection technique).
The use of ultrasound optimizes the technique of peripheral blocks and the amount of local anaesthetic used. Ultrasonography does not affect the safety of peripheral blocks.
近年来，超声引导下区域麻醉因其给患者带来的益处而在全球范围内受到广泛欢迎。华沙医科大学麻醉与重症监护一科是波兰最早常规采用超声引导下外周神经阻滞（PNB）的中心之一。该技术自2007年起被纳入该机构的临床实践。本研究的目的是回顾性评估在六年的技术应用经验中，超声引导与非超声引导下PNB临床实践的变化。
回顾性分析评估PNB方法的流行率、局部麻醉药（LA）注射技术（即单次注射与多次注射）、所用LA体积、成功率及并发症发生率。
本研究纳入了2006年1月至2012年6月期间进行的4066例PNB。结果显示，在PNB总数中，超声引导下阻滞的流行率呈系统性增长，从2007年的8.6%升至2012年的53.3%。与传统PNB技术相比，超声引导下阻滞中PNB所用的平均LA体积显著更低（分别为21.83 mL对31.41 mL，P<0.05），而成功率未降低（分别为76%对74%，P>0.05）。无论采用何种神经定位技术，均观察到主要阻滞技术从单次注射向多次注射的转变（采用多次注射技术进行的PNB从29%增至84%）。
超声的使用优化了外周阻滞技术及局部麻醉药的用量。超声检查不影响外周阻滞的安全性。
