刺激导管尖端最小电荷与臂丛神经阻滞外周神经阻滞导管疗效之间无相关性：一项前瞻性盲法队列研究。

No correlation between minimal electrical charge at the tip of the stimulating catheter and the efficacy of the peripheral nerve block catheter for brachial plexus block: a prospective blinded cohort study.

作者信息

Schoenmakers Karin Pw, Heesterbeek Petra Jc, Jack Nigel Tm, Stienstra Rudolf

机构信息

Department of Anesthesiology, Sint Maartenskliniek, Postbox 9011, 6500 GM Nijmegen, The Netherlands.

出版信息

BMC Anesthesiol. 2014 Apr 11;14:26. doi: 10.1186/1471-2253-14-26.

DOI:10.1186/1471-2253-14-26

PMID:24725473

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3991872/

Abstract

BACKGROUND

Stimulating catheters offer the possibility of delivering an electrical charge via the tip of the catheter. This may be advantageous as it allows verifying if the catheter tip is in close proximity to the target nerve, thereby increasing catheter performance. This prospective blinded cohort study was designed to investigate whether there is a correlation between the minimal electrical charge at the tip of the stimulating catheter, and the efficacy of the peripheral nerve block (PNB) catheter as determined by 24 h postoperative morphine consumption.

METHODS

Forty adult patients with ASA physical health classification I-III scheduled for upper extremity surgery under combined continuous interscalene block and general anesthesia were studied. Six patients were excluded from analysis.After inserting a stimulating catheter as if it were a non-stimulating catheter for 2-5 cm through the needle, the minimal electrical charge necessary to obtain an appropriate motor response was determined. A loading dose of 20 mL ropivacaine 0.75% ropivacaine was then administered, and postoperative analgesia was provided by a continuous infusion of ropivacaine 0.2% 8 mL.h-1 via the brachial plexus catheter, and an intravenous morphine patient-controlled analgesia (PCA) device.Main outcome measures include the minimal electrical charge (MEC) at the tip of the stimulating catheter necessary to elicit an appropriate motor response, and the efficacy of the PNB catheter as determined by 24 h postoperative PCA morphine consumption.

RESULTS

Mean (SD) [range] MEC at the tip of the stimulating catheter was 589 (1414) [30 - 5000] nC. Mean (SD) [range] 24 h morphine consumption was 8.9 (9.9) [0-29] mg. The correlation between the MEC and 24 h postoperative morphine consumption was Spearman's Rho rs = -0.26, 95% CI -0.56 to 0.09.

CONCLUSION

We conclude that there is no proportional relation between MEC at the tip of the blindly inserted stimulating catheter and 24 h postoperative morphine consumption.

TRIAL REGISTRATION

Trialregister.nl identifier: NTR2328.

摘要

背景

刺激导管提供了通过导管尖端输送电荷的可能性。这可能具有优势，因为它可以验证导管尖端是否靠近目标神经，从而提高导管性能。这项前瞻性盲法队列研究旨在调查刺激导管尖端的最小电荷量与术后24小时吗啡消耗量所确定的周围神经阻滞（PNB）导管疗效之间是否存在相关性。

方法

对40例计划在连续肌间沟阻滞联合全身麻醉下行上肢手术的ASA身体健康分级为I-III级的成年患者进行研究。6例患者被排除在分析之外。将刺激导管像非刺激导管一样通过穿刺针插入2-5厘米后，确定获得适当运动反应所需的最小电荷量。然后给予20毫升0.75%罗哌卡因的负荷剂量，通过臂丛导管持续输注0.2%罗哌卡因8毫升·小时-1以及静脉吗啡患者自控镇痛（PCA）装置提供术后镇痛。主要观察指标包括引发适当运动反应所需的刺激导管尖端的最小电荷量（MEC），以及术后24小时PCA吗啡消耗量所确定的PNB导管疗效。