Kolny Michał, Stasiowski Michał J, Zuber Marek, Marciniak Radosław, Chabierska Ewa, Pluta Aleksandra, Jałowiecki Przemysław, Byrczek Tomasz
Department of Anaesthesiology and Intensive Therapy, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland, St. Barbara's.
Anaesthesiol Intensive Ther. 2017;49(1):47-52. doi: 10.5603/AIT.2017.0009.
Interscalene brachial plexus block is an effective regional anesthesia technique for shoulder surgeries. The superiority of the popular ultrasound-guided blocks over peripheral nerve stimulator-confirmed blocks remains unclear. In this study the efficacy of these different block techniques was compared.
This prospective, randomized, clinical study included 109 patients (ASA grades I-III) who receive 20 mL 0.5% ropivacaine with ultrasound-guided blocks (U group), peripheral nerve stimulator-confirmed blocks (N group), or ultrasound-guided and peripheral nerve stimulator-confirmed blocks (dual guidance; NU group) for elective shoulder arthroscopy. Block onset time, duration, and effectiveness on the Lovett rating scale were assessed.
There was no statistically significant intergroup difference in duration of block performance, irrespective of the technique (P = 0.232). Onset time of complete warmth sensation loss (P < 0.001) and muscle strength abolition (P < 0.001) was significantly longer and mean Lovett rating scale score distribution was significantly higher in the N group than in the other groups (P < 0.001). These findings show a statistically significant correlation between the performance of the used block technique and the necessity of conversion to general anesthesia because of insufficient block in the N group (58.54%) than in the U (24.44%) and NU (19.57%) groups.
Peripheral nerve stimulator-confirmed needle placement is not necessary to ensure effectiveness of ultrasound-guided blocks, which is expressed as a lack of necessity of conversion to general anesthesia. Nevertheless, the dual guidance technique is recommended to reduce the risk of complications and might be considered the regional anesthesia of choice for shoulder surgery.
肌间沟臂丛神经阻滞是一种用于肩部手术的有效的区域麻醉技术。流行的超声引导阻滞相对于外周神经刺激器定位阻滞的优势仍不明确。在本研究中，对这些不同阻滞技术的疗效进行了比较。
这项前瞻性、随机、临床研究纳入了109例美国麻醉医师协会（ASA）分级为I-III级的患者，他们接受20毫升0.5%罗哌卡因，采用超声引导阻滞（U组）、外周神经刺激器定位阻滞（N组）或超声引导联合外周神经刺激器定位阻滞（双重引导；NU组）进行择期肩关节镜检查。评估阻滞起效时间、持续时间以及Lovett肌力评级量表的效果。
无论采用何种技术，组间阻滞操作持续时间均无统计学显著差异（P = 0.232）。N组完全热感丧失的起效时间（P < 0.001）和肌肉力量消失的起效时间（P < 0.001）明显更长，且平均Lovett肌力评级量表评分分布显著高于其他组（P < 0.001）。这些结果表明，与U组（24.44%）和NU组（19.57%）相比，N组因阻滞不足而转为全身麻醉的必要性与所采用的阻滞技术之间存在统计学显著相关性（58.54%）。
外周神经刺激器定位的针放置对于确保超声引导阻滞的有效性并非必要，这表现为无需转为全身麻醉。然而，推荐双重引导技术以降低并发症风险，并且可被视为肩部手术区域麻醉的首选。
