Wang Quanguang, Li Zhengqian, Xu Shihao, Li Yu, Zhang Xuezheng, Liu Qimin, Xia Yun, Papadimos Thomas J, Xu Xuzhong
Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Zhejiang, China.
Department of Anesthesiology, Peking University Third Hospital, Beijing, China.
BMC Anesthesiol. 2015 Jan 19;15(1):4. doi: 10.1186/1471-2253-15-4. eCollection 2015.
We evaluated the efficacy of a new anesthetic technique termed ultrasound-guided capsule-sheath space block (CSSB) combined with anterior cervical cutaneous nerve block (CCNB) for thyroidectomy.
The study included two parts: Part one was an imaging study to determine technique feasibility. The CSSB was performed on five healthy volunteers by introducing the needle 0.5 cm lateral to the probe under in-plane needle ultrasound guidance. After puncture of the false capsule and its subsequent contraction with the true capsule of thyroid, 10 mL of contrast medium was deposited slowly in the capsule-sheath space. The CCNB was performed bilaterally as follows: Under ultrasound guidance, a subcutaneous injection was made along the sternocleidomastoid using 10 mL of contrast medium which was followed by a girdle-shaped picchu raised from the cricoid cartilage to supraclavicular region. The spreading pattern of contrast medium was imaged using computed tomographic scanning. In part two (a clinical case series) the technique efficacy was evaluated. Seventy-eight patients undergoing thyroidectomy had ultrasound-guided CSSB and CCNB with local anesthetics. The sensory onset of CCNB, intraoperative hemodynamic parameters, and analgesic effect were assessed and complications were noted.
The distribution of contrast medium was well defined. In part two the onset time of CCNB was 2.2 ± 0.7 min, and the hemodynamic parameters remained stable intraoperatively. The recall of visual analogue scale scores during surgery was 2 [1-4] for median (range). The patients' and surgeons' satisfaction scores were 2 [1-4] and 1 [1-3] for median (range). No serious complications occurred.
Combining ultrasound-guided CSSB and CCNB is a feasible, effective and safe technique for thyroidectomy.
Current Controlled Trials ChiCTR-ONC-12002025. Registered 19 March 2012.
我们评估了一种名为超声引导下甲状腺被膜-鞘间隙阻滞（CSSB）联合颈前皮神经阻滞（CCNB）的新型麻醉技术用于甲状腺切除术的疗效。
本研究包括两个部分：第一部分是一项影像学研究，以确定技术的可行性。在平面内超声引导下，于五名健康志愿者的探头外侧0.5 cm处进针，进行CSSB。在穿刺甲状腺假被膜并使其与真被膜收缩后，将10 mL造影剂缓慢注入被膜-鞘间隙。双侧进行CCNB如下：在超声引导下，沿胸锁乳突肌进行皮下注射，使用10 mL造影剂，随后从环状软骨至锁骨上区域形成一个环形皮丘。使用计算机断层扫描对造影剂的扩散模式进行成像。在第二部分（临床病例系列）中，评估该技术的疗效。78例行甲状腺切除术的患者接受了超声引导下使用局部麻醉剂的CSSB和CCNB。评估CCNB的感觉起效时间、术中血流动力学参数和镇痛效果，并记录并发症。
造影剂的分布清晰明确。在第二部分中，CCNB的起效时间为2.2±0.7分钟，术中血流动力学参数保持稳定。手术期间视觉模拟量表评分的中位数为2[1-4]（范围）。患者和外科医生的满意度评分中位数分别为2[1-4]和1[1-3]（范围）。未发生严重并发症。
超声引导下CSSB和CCNB联合应用是一种用于甲状腺切除术的可行、有效且安全的技术。
中国临床试验注册中心ChiCTR-ONC-12002025。2012年3月19日注册。
