Jindal Seema, Sidhu Gurkaran Kaur, Sood Dinesh, Grewal Anju
Department of Anaesthesiology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India.
Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Saudi J Anaesth. 2016 Oct-Dec;10(4):432-435. doi: 10.4103/1658-354X.179114.
Local anesthetic instillation in close vicinity to nerves anywhere in body blocks sensations in the same order as in central neuraxial blockade. The main purpose of this study was to evaluate the efficacy of vibration sense as criteria to determine the onset of surgical anesthesia following brachial plexus block and its correlation with loss of sensory and motor power.
This prospective study included fifty patients of American Society of Anaesthesiologist physical status I and II, aged between 18 and 45 years, undergoing elective upper limb surgery under brachial plexus block by supraclavicular approach. The baseline values of vibration sense perception using 128 Hz Rydel-Seiffer tuning fork, motor power using formal motor power of wrist flexion and wrist extension, and sensory score by pinprick method were recorded preoperatively and every 5 min after giving block till the onset of complete surgical anesthesia.
The mean ± standard deviation of time (in minutes) for sensory, motor, and vibration block was 13.33 ± 3.26, 21.10 ± 3.26, and 25.50 ± 2.02, respectively ( < 0.05). Although all the patients achieved complete sensory and motor block after 25 min, 14% of the patients still had vibration sensations intact and 100% of the patients achieved complete sensory, motor, and vibration block after 30 min.
Vibration sense serves as a reliable indicator for the onset of surgical anesthesia following brachial plexus block. Vibration sense testing with 128 Hz Rydel-Seiffer tuning fork along with motor power assessment should be used as an objective tool to assess the onset of surgical anesthesia following brachial plexus block.
在身体任何部位靠近神经处注入局部麻醉剂，其阻断感觉的顺序与中枢神经轴索阻滞相同。本研究的主要目的是评估振动觉作为确定臂丛神经阻滞后手术麻醉起效的标准的有效性，及其与感觉和运动功能丧失的相关性。
本前瞻性研究纳入了50例美国麻醉医师协会身体状况分级为Ⅰ级和Ⅱ级、年龄在18至45岁之间、拟行锁骨上入路臂丛神经阻滞下择期上肢手术的患者。术前及给予阻滞药物后每隔5分钟记录使用128赫兹里德尔 - 西弗音叉的振动觉感知基线值、使用腕关节屈曲和伸展的正式运动功能评估的运动功能，以及用针刺法评估的感觉评分，直至完全手术麻醉起效。
感觉、运动和振动阻滞的平均时间（分钟）±标准差分别为13.33±3.26、21.10±3.26和25.50±2.02（<0.05）。尽管所有患者在25分钟后均实现了完全感觉和运动阻滞，但14%的患者仍有完整的振动觉，100%的患者在30分钟后实现了完全感觉、运动和振动阻滞。
振动觉可作为臂丛神经阻滞后手术麻醉起效的可靠指标。应使用128赫兹里德尔 - 西弗音叉进行振动觉测试并结合运动功能评估，作为评估臂丛神经阻滞后手术麻醉起效的客观工具。
