Demirelli Gokhan, Baskan Semih, Karabeyoglu Isil, Aytac Ismail, Ornek Dilsen Hatice, Erdogmus Alper, Baydar Mustafa
Anesthesiology Department, Ankara Numune Training and Research Hospital, Ankara, Turkey.
Anesthesiology Department, Ankara Numune Training and Research Hospital, Ankara, Turkey. .
J Pak Med Assoc. 2017 Apr;67(4):508-512.
To evaluate the characteristics of axillary plexus blockade applied using ultrasound only and using ultrasound together with nerve stimulator in patients undergoing planned forearm, wrist or hand surgery.
This randomised, prospective, double-blinded, single-centre study was conducted at Ankara Numune Training and Research Hospital, Ankara, Turkey, from November 2014 to August 2015, and comprised patients undergoing forearm, wrist or hand surgery. Participants were separated into 2 groups. In Group 1, the nerve roots required for the surgical site were located one by one and local anaesthetic was applied separately to each nerve for the block. In Group 2, the vascular nerve bundle was located under ultrasound guidance and a total block was achieved by administering all the local anaesthetic within the nerve sheath. In the operating room, standard monitorisation was applied. Following preparation of the skin, the axillary region nerve roots and branches and vascular structures were observed by examination with a high-frequency ultrasound probe. In both groups, a 22-gauge, 5cm block needle was entered to the axillary region with visualisation of the whole needle on ultrasound and 20ml local anaesthetic of 0.5% bupivacaine was injected. SPSS 19 was used for data analysis.
Of the 60 participants, there were 30(50%) in each group. The mean age was 39.1±15 years in the group 1 which was the ultrasound nerve stimulation group, and 41.5±14.3 years in group 2. The duration of the procedure was longer in group I than in group 2 (p<0.05). Patient satisfaction values during the procedure were higher in group 2(p<0.05). In the ulnar sensory examination, the values of the patients in group 1were higher at 10, 15, 20 and 25 minutes (p<0.05). In the median, radial and ulnar motor examination, the values of the patients in group 1were higher at 15 and 20 minutes (p<0.05).
Brachial plexus blockade via axillary approach guided by ultrasound offered excellent quality of sensory and motor block equivalent to that of the nerve stimulator-guided technique.
评估仅使用超声以及超声联合神经刺激器对计划进行前臂、腕部或手部手术的患者实施腋路臂丛神经阻滞的特点。
本随机、前瞻性、双盲、单中心研究于2014年11月至2015年8月在土耳其安卡拉努姆内培训和研究医院进行，纳入前臂、腕部或手部手术患者。参与者被分为2组。第1组，逐一确定手术部位所需的神经根，并分别对每条神经进行局部麻醉阻滞。第2组，在超声引导下定位血管神经束，并通过在神经鞘内注入所有局部麻醉药实现完全阻滞。在手术室，进行标准监测。皮肤准备后，用高频超声探头检查观察腋窝区域的神经根、分支和血管结构。两组均使用22G、5cm的阻滞针，在超声下全程可视化进针至腋窝区域，并注入20ml 0.5%布比卡因局部麻醉药。采用SPSS 19进行数据分析。
60名参与者中，每组各30名（50%）。超声神经刺激的第1组平均年龄为39.1±15岁，第2组为41.5±14.3岁。第1组手术时间比第2组长（p<0.05）。第2组术中患者满意度更高（p<0.05）。在尺神经感觉检查中，第1组患者在10、15、20和25分钟时的值更高（p<0.05）。在正中神经、桡神经和尺神经运动检查中，第1组患者在15和20分钟时的值更高（p<0.05）。
超声引导下经腋路臂丛神经阻滞提供了与神经刺激器引导技术相当的优良感觉和运动阻滞质量。
