Strid Jennie Maria Christin, Pedersen Erik Morre, Al-Karradi Sinan Naseer Hussain, Bendtsen Mathias Alrø Fichtner, Bjørn Siska, Dam Mette, Daugaard Morten, Hansen Martin Sejr, Linnet Katrine Danker, Børglum Jens, Søballe Kjeld, Bendtsen Thomas Fichtner
Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
Department of Radiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
Biomed Res Int. 2017;2017:1873209. doi: 10.1155/2017/1873209. Epub 2017 Mar 15.
Fused real-time ultrasound and magnetic resonance imaging (MRI) may be used to improve the accuracy of advanced image guided procedures. However, its use in regional anesthesia is practically nonexistent. In this randomized controlled crossover trial, we aim to explore effectiveness, procedure-related outcomes, injectate spread analyzed by MRI, and safety of ultrasound/MRI fusion versus ultrasound guided Suprasacral Parallel Shift (SSPS) technique for lumbosacral plexus blockade. Twenty-six healthy subjects aged 21-36 years received two SSPS blocks (20 mL 2% lidocaine-epinephrine [1 : 200,000] added 1 mL diluted contrast) guided by ultrasound/MRI fusion versus ultrasound. Number (proportion) of subjects with motor blockade of the femoral and obturator nerves and the lumbosacral trunk was equal (ultrasound/MRI, 23/26 [88%]; ultrasound, 23/26 [88%]; = 1.00). Median (interquartile range) preparation and procedure times (s) were longer for the ultrasound/MRI fusion guided technique (686 [552-1023] versus 196 [167-228], < 0.001 and 333 [254-439] versus 216 [176-294], = 0.001). Both techniques produced perineural spread and corresponding sensory analgesia from L2 to S1. Epidural spread and lidocaine pharmacokinetics were similar. Different compartmentalized patterns of injectate spread were observed. Ultrasound/MRI fusion guided SSPS was equally effective and safe but required prolonged time, compared to ultrasound guided SSPS. This trial is registered with EudraCT (2013-004013-41) and ClinicalTrials.gov (NCT02593370).
融合实时超声与磁共振成像（MRI）可用于提高高级图像引导手术的准确性。然而，其在区域麻醉中的应用实际上并不存在。在这项随机对照交叉试验中，我们旨在探讨超声/MRI融合与超声引导骶上平行移位（SSPS）技术用于腰骶丛阻滞的有效性、与手术相关的结果、通过MRI分析的注射剂扩散情况以及安全性。26名年龄在21 - 36岁的健康受试者接受了两次SSPS阻滞（20毫升2%利多卡因 - 肾上腺素[1∶200,000]加1毫升稀释造影剂），分别由超声/MRI融合引导与超声引导。股神经、闭孔神经和腰骶干运动阻滞的受试者数量（比例）相等（超声/MRI，23/26[88%]；超声，23/26[88%]；P = 1.00）。超声/MRI融合引导技术的中位（四分位间距）准备和手术时间（秒）更长（686[552 - 1023]对比196[167 - 228]，P < 0.001；333[254 - 439]对比216[176 - 294]，P = 0.001）。两种技术均产生了从L2到S1的神经周围扩散及相应的感觉镇痛效果。硬膜外扩散和利多卡因药代动力学相似。观察到了注射剂扩散的不同分区模式。与超声引导的SSPS相比，超声/MRI融合引导的SSPS同样有效且安全，但需要更长时间。该试验已在欧洲临床试验数据库（EudraCT，2013 - 004013 - 41）和美国国立医学图书馆临床试验注册库（ClinicalTrials.gov，NCT02593370）注册。
