Matsuda Hiroaki, Oka Yoshinari, Takatsu Shigeko, Katsube Ryoichi, Yoshida Ryuichi, Oyama Takanori, Takeda Yoshimasa, Miyazaki Masashi
Department of Surgery, Saiwaicho Memorial Hospital, Okayama - Japan.
Department of Internal Medicine, Saiwaicho Memorial Hospital, Okayama - Japan.
J Vasc Access. 2016 May 7;17(3):284-90. doi: 10.5301/jva.5000513. Epub 2016 Feb 8.
The operative field for vascular access (VA) surgery in the forearm is on the volar surface, and motor nerve block is not necessary for regional anesthesia. Therefore, selective block of branches of the brachial plexus may be a more efficient anesthesia technique.
Individual nerve blocks in the axillary brachial plexus and selective blocks of the musculocutaneous and medial antebrachial cutaneous nerves in the upper arm were performed using low doses and concentrations of a local anesthetic mixture of lidocaine and ropivacaine under ultrasound (US) guidance in patients undergoing VA surgery in the forearm. The targeted nerves were identified by continuous US tracing along the upper arm to the axilla in a short-axis view. We performed three VA surgeries in the forearm using an axillary brachial plexus block and four using a selective two-nerve bock in the upper arm. We recorded any additional anesthetic requirement and evaluated intraoperative pain using the Wong-Baker Faces Pain Rating Scale (WBFRS; 0 = no pain; 10 = worst pain).
All of the target nerve branches were clearly identified by US tracing. All patients had satisfactory intraoperative pain control (0 or 2 score on WBFRS). Four patients required small additional doses of local anesthetic.
US-guided block of individual branches of the brachial plexus at the axilla achieved effective anesthesia using small amounts of local anesthetic. An advanced selective nerve block in the upper arm allows minimum necessary anesthesia and provides safe and efficient analgesia for VA surgery in the forearm.
前臂血管通路（VA）手术的术野位于掌侧，区域麻醉时无需进行运动神经阻滞。因此，选择性阻滞臂丛神经分支可能是一种更有效的麻醉技术。
在超声（US）引导下，对接受前臂VA手术的患者使用低剂量和低浓度的利多卡因与罗哌卡因局部麻醉混合剂，分别进行腋部臂丛神经的单支阻滞以及上臂肌皮神经和前臂内侧皮神经的选择性阻滞。在短轴视图下，通过沿上臂至腋窝连续超声追踪来识别目标神经。我们对3例前臂VA手术患者采用腋部臂丛神经阻滞，对4例患者采用上臂选择性双神经阻滞。记录任何额外的麻醉需求，并使用面部表情疼痛评分量表（WBFRS；0 = 无疼痛；10 = 最剧烈疼痛）评估术中疼痛情况。
通过超声追踪可清晰识别所有目标神经分支。所有患者术中疼痛控制均令人满意（WBFRS评分为0或2分）。4例患者需要少量额外的局部麻醉剂。
超声引导下在腋部阻滞臂丛神经的各个分支，使用少量局部麻醉剂即可实现有效的麻醉。上臂先进的选择性神经阻滞可实现最小必要麻醉，并为前臂VA手术提供安全有效的镇痛。
