Brattwall Metha, Jildenstål Pether, Warrén Stomberg Margareta, Jakobsson Jan G
Department of Anaesthesiology and Intensive Care, Unit of Day Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
F1000Res. 2016 May 18;5. doi: 10.12688/f1000research.7292.1. eCollection 2016.
Upper extremity blocks are useful as both sole anaesthesia and/or a supplement to general anaesthesia and they further provide effective postoperative analgesia, reducing the need for opioid analgesics. There is without doubt a renewed interest among anaesthesiologists in the interscalene, supraclavicular, infraclavicular, and axillary plexus blocks with the increasing use of ultrasound guidance. The ultrasound-guided technique visualising the needle tip and solution injected reduces the risk of side effects, accidental intravascular injection, and possibly also trauma to surrounding tissues. The ultrasound technique has also reduced the volume needed in order to gain effective block. Still, single-shot plexus block, although it produces effective anaesthesia, has a limited duration of postoperative analgesia and a number of adjuncts have been tested in order to prolong analgesia duration. The addition of steroids, midazolam, clonidine, dexmedetomidine, and buprenorphine has been studied, all being off-label when administered by perineural injection, and the potential neurotoxicity needs further study. The use of perineural catheters is an effective option to improve and prolong the postoperative analgesic effect. Upper extremity plexus blocks have an obvious place as a sole anaesthetic technique or as a powerful complement to general anaesthesia, reducing the need for analgesics and hypnotics intraoperatively, and provide effective early postoperative pain relief. Continuous perineural infusion is an effective option to prolong the effects and improve postoperative quality.
上肢阻滞作为单独的麻醉方法和/或全身麻醉的辅助手段都很有用，还能提供有效的术后镇痛，减少对阿片类镇痛药的需求。随着超声引导技术的日益普及，麻醉医生无疑对肌间沟、锁骨上、锁骨下和腋路臂丛神经阻滞重新产生了兴趣。超声引导技术可清晰显示针尖及注射的溶液，降低了副作用、意外血管内注射的风险，也可能减少了对周围组织的损伤。超声技术还减少了获得有效阻滞所需的药物剂量。尽管单次臂丛神经阻滞能产生有效的麻醉效果，但术后镇痛时间有限，人们已对多种辅助药物进行了试验，以延长镇痛时间。已对添加类固醇、咪达唑仑、可乐定、右美托咪定和丁丙诺啡进行了研究，经神经周围注射给药时这些药物均属于超说明书用药，其潜在的神经毒性需要进一步研究。使用神经周围导管是改善和延长术后镇痛效果的有效选择。上肢臂丛神经阻滞作为单独的麻醉技术或全身麻醉的有力补充具有明显的优势，可减少术中对镇痛药和催眠药的需求，并能有效缓解术后早期疼痛。连续神经周围输注是延长镇痛效果和改善术后质量的有效选择。
