Wenger Andrea, Rothenberger Jens, Hakim-Meibodi Lara-Elena, Notheisen Thomas, Schaller Hans-Eberhard
Clinic for Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Baden-Wurttemberg, Germany.
Clinic for Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Baden-Wurttemberg, Germany.
J Surg Res. 2017 May 15;212:153-158. doi: 10.1016/j.jss.2017.01.009. Epub 2017 Jan 27.
Axillary plexus block is a common method for regional anesthesia, especially in hand and wrist surgery. Local anesthetics (e.g., mepivacaine) are injected around the peripheral nerves in the axilla. A vasodilatory effect due to sympathicolysis has been described, but not quantified.
In a prospective controlled study between October 2012 and July 2013, we analyzed 20 patients with saddle joint arthritis undergoing trapeziectomy under axillary plexus block. Patients received a mixture of mepivacaine 1% and ropivacaine 0.75% in a 3:1 ratio. The measurements were carried out on the plexus side and the contralateral hand, which acted as the control. Laser-Doppler spectrophotometry (oxygen to see [O2C] device) was used to measure various perfusion factors before and after the plexus block, after surgery and in 2-h intervals until 6 h postoperatively.
Compared with the contralateral side, the plexus block produced an enhancement of tissue oxygen saturation of 117.35 ± 34.99% (cf. control SO: 92.92 ± 22.30%, P < 0.010) of the baseline value. Furthermore, blood filling of microvessels (rHb: 131.36 ± 48.64% versus 109.12 ± 33.25%, P < 0.0062), peripheral blood flow (219.85 ± 165.59% versus 129.55 ± 77.12%, P < 0.018), and velocity (163.86 ± 58.18% versus 117.16 ± 45.05%, P < 0.006) showed an increase of values.
Axillary plexus block produces an improvement of peripheral tissue oxygen saturation of the upper extremity over the first 4 h after the inception of anesthesia.
腋神经丛阻滞是一种常用的区域麻醉方法，尤其在手和腕部手术中。局部麻醉药（如甲哌卡因）被注射到腋窝周围的外周神经周围。已有文献报道了交感神经阻滞引起的血管舒张效应，但未进行量化。
在2012年10月至2013年7月的一项前瞻性对照研究中，我们分析了20例在腋神经丛阻滞下接受大多角骨切除术的鞍状关节关节炎患者。患者接受了1%甲哌卡因和0.75%罗哌卡因按3:1比例混合的药物。测量在神经丛侧和作为对照的对侧手部进行。使用激光多普勒分光光度法（氧监测[O2C]设备）在神经丛阻滞前、后、手术后以及术后6小时内每2小时测量各种灌注因子。
与对侧相比，神经丛阻滞使组织氧饱和度较基线值提高了117.35±34.99%（对照侧氧饱和度：92.92±22.30%，P<0.010）。此外，微血管血容量（相对血红蛋白：131.36±48.64%对109.12±33.25%，P<0.0
062）、外周血流量（219.85±165.59%对129.55±77.12%，P<0.018）和血流速度（163.86±58.18%对117.16±45.05%，P<0.006）均显示值增加。
腋神经丛阻滞在麻醉开始后的前4小时内可改善上肢外周组织的氧饱和度。
