Öztürk Ömür, Tezcan Aysu Hayriye, Bilge Ali, Erdem Esref, Yağmurdur Hatice, Dost Burhan
Department of Anaesthesiology and Reanimation, Kafkas University School of Medicine, Kars, Turkey.
Department of Ortopedics and Traumatology, Kafkas University School of Medicine, Kars, Turkey.
Turk J Anaesthesiol Reanim. 2017 Jun;45(3):164-168. doi: 10.5152/TJAR.2017.33349. Epub 2017 Feb 1.
Our aim was to determine the ideal position of upper extremities during ultrasonography guidance for axillary block. The position that provides the shortest distance between the median and musculocutaneous nerves was assumed to be the most appropriate position for axillary block.
In this cross-sectional study, 120 (45 female and 75 male) patients were placed in a position with a shoulder at 90° / elbow 90° (position 1) and a shoulder 90° / elbow 0° (position 2). The intersection point of the biceps brachii muscle with the lower border of the pectoralis major muscle is defined as the proximal level (P). Distal level (D) is reffered as 5 cm below the proximal level. In the positions described above, the distance between median and musculocutaneous nerves was measured proximal (positions 1P and 2P) and distal levels (positions 1D and 2D). It was investigated whether these measurements differed between the groups and whether the body mass index or the gender.
The shortest mean distance (10.24±3.95 mm) between the two nerves was determined when the shoulder position 90°/elbow position 0° at the distal level (1D) and the longest mean distance (13.41±4.26 mm) was determined when shoulder position 90°/elbow position 90° at the proximal level (2P). In all four cases, there was no difference in the results between men and women. There was no relationship between the measurement results and the body mass indexes and age of the patients.
Appropriate positioning of the upper extremities is important for achieving optimal position during axillary block. Thereby, the procedure can be safely and effectively performed with lesser amounts of local anaesthetic solution and a decreased number of manoeuvres with needle during infiltration.
我们的目的是确定在超声引导下腋路阻滞时上肢的理想位置。假定能使正中神经和肌皮神经之间距离最短的位置是腋路阻滞的最合适位置。
在这项横断面研究中，120例患者（45例女性和75例男性）被置于肩部90°/肘部90°（位置1）和肩部90°/肘部0°（位置2）的体位。肱二头肌与胸大肌下缘的交点定义为近端水平（P）。远端水平（D）指近端水平以下5厘米处。在上述体位下，测量近端（位置1P和2P）和远端水平（位置1D和2D）处正中神经和肌皮神经之间的距离。研究这些测量值在组间是否存在差异，以及是否与体重指数或性别有关。
在远端水平（1D）肩部位置90°/肘部位置0°时，确定两条神经之间最短平均距离为（10.24±3.95毫米），在近端水平（2P）肩部位置90°/肘部位置90°时，确定最长平均距离为（13.41±4.26毫米）。在所有四种情况下，男性和女性的结果均无差异。测量结果与患者的体重指数和年龄之间无相关性。
上肢的适当定位对于在腋路阻滞期间获得最佳位置很重要。由此，该操作可以使用较少的局部麻醉溶液并在浸润期间减少进针操作次数而安全有效地进行。
