Tantry Thrivikrama Padur, Shetty Pramal, Shetty Rithesh, Shenoy Sunil P
Department of Anaesthesiology, A J Institute of Medical Sciences, Kuntikana, Mangalore, Karnataka, India.
Department of Urology, A J Institute of Medical Sciences, Kuntikana, Mangalore, Karnataka, India.
Anesth Essays Res. 2015 May-Aug;9(2):276-80. doi: 10.4103/0259-1162.156369.
Regional anesthesia is favored in patients who undergo emergency extremity (limb) surgery, and specifically so in the absence of fasting status. In the absence of ultrasonic guidance, the nerve stimulator still remains a valuable tool in performing a brachial block, but its use is difficult in an emergency surgical patient and greater cautious approach is essential. We identified the supraclavicular plexus by the nerve stimulation-motor response technique as follows. Anterior chest muscles contractions, diaphragmatic contraction, deltoid contractions, and posterior shoulder girdle muscle contractions when identified were taken as "negative response" with decreasing stimulating current. A forearm muscle contraction, especially "wrist flexion" and "finger flexion" at 0.5 mA of current was taken as "positive response." If no positive response was identified, the "elbow flexion" was considered as the final positive response for successful drug placement. The series of patients had difficulty for administering both general and regional anesthesia and we considered them as complex scenarios. The risk of the block failure was weighed heavily against the benefits of its success. The described series includes patients who had successful outcomes in the end and the techniques, merits, and risks are highlighted.
区域麻醉在接受急诊肢体手术的患者中更受青睐，尤其是在未禁食的情况下。在没有超声引导的情况下，神经刺激器在进行臂丛阻滞时仍然是一种有价值的工具，但在急诊手术患者中使用困难，必须采取更谨慎的方法。我们通过神经刺激-运动反应技术确定锁骨上神经丛如下。当识别出前胸肌肉收缩、膈肌收缩、三角肌收缩和后肩胛带肌肉收缩时，随着刺激电流减小，将其视为“阴性反应”。当前臂肌肉收缩，特别是在0.5 mA电流时出现“腕部屈曲”和“手指屈曲”时，将其视为“阳性反应”。如果未识别出阳性反应，则将“肘部屈曲”视为药物成功注入的最终阳性反应。该系列患者在实施全身麻醉和区域麻醉时均遇到困难，我们将其视为复杂情况。阻滞失败的风险与成功的益处进行了权衡。所描述的系列包括最终取得成功结果的患者，并突出了技术、优点和风险。
