Wang Huaijiang, Li Liandi, Xu Chengshi, Qu Xiangdong, Qu Zhijun, Wang Geng
Department of Anesthesiology, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
Department of Anesthesiology, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, Heilongjiang, China.
J Anesth. 2016 Aug;30(4):596-602. doi: 10.1007/s00540-016-2193-2. Epub 2016 Jun 2.
This study was designed to investigate the risk of local anesthetic toxicity and efficacy of simultaneous bilateral axillary brachial plexus block performed under the guidance of ultrasound or a neurostimulator.
One hundred and twenty patients who were anesthetized with bilateral axillary plexus block simultaneously between February 2012 and March 2014 were enrolled in the study. The patients were anesthetized under the guidance of a neurostimulator (group N, n = 60) or ultrasound (group U, n = 60). The block performance time, procedure-related pain, adverse events, total and free plasma concentrations of ropivacaine, and other data were recorded. The comparison was analyzed statistically.
The block performance time, and onset of the sensory and motor block, of group N was longer than that of group U (p < 0.001). The procedure-related pain of group N was more serious than that of group U (p < 0.05). The patient satisfaction rate of group U was higher than that of group N (p < 0.05). The total plasma concentrations of ropivacaine in group N were comparable to those of group U, except for the value at 50 min after injection (p < 0.05). The free plasma concentrations of ropivacaine of group N at 5 min were significantly higher than that of group U (p < 0.001). No apparent serious adverse events were observed perioperatively in both groups.
Simultaneous bilateral axillary brachial plexus block guided by neurostimulator or ultrasound in bilateral distal upper extremity surgery seems to have a low risk of local anesthetic toxicity and to be effective. The ultrasound-guided block is superior in terms of providing the same degree of anesthesia with shorter duration, less pain, and faster onset of sensory and motor blockades, which is important in clinical practice.
本研究旨在探讨在超声或神经刺激器引导下进行双侧腋路臂丛神经阻滞时局部麻醉药毒性风险及疗效。
纳入2012年2月至2014年3月期间同时接受双侧腋路臂丛神经阻滞麻醉的120例患者。患者在神经刺激器引导下（N组，n = 60）或超声引导下（U组，n = 60）接受麻醉。记录阻滞操作时间、与操作相关的疼痛、不良事件、罗哌卡因的总血浆浓度和游离血浆浓度以及其他数据。进行统计学比较分析。
N组的阻滞操作时间以及感觉和运动阻滞的起效时间均长于U组（p < 0.001）。N组与操作相关的疼痛比U组更严重（p < 0.05）。U组患者的满意度高于N组（p < 0.05）。N组罗哌卡因的总血浆浓度与U组相当，但注射后50分钟时的值除外（p < 0.05）。N组罗哌卡因在5分钟时的游离血浆浓度显著高于U组（p < 0.001）。两组围手术期均未观察到明显严重不良事件。
在双侧上肢远端手术中，神经刺激器或超声引导下的双侧腋路臂丛神经阻滞似乎局部麻醉药毒性风险较低且有效。超声引导下的阻滞在提供相同程度麻醉的情况下具有持续时间更短、疼痛更少以及感觉和运动阻滞起效更快的优势，这在临床实践中很重要。
