Xu C S, Zhao X L, Zhou H B, Qu Z J, Yang Q G, Wang H J, Wang G
Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing 100035, China.
Zhonghua Yi Xue Za Zhi. 2017 Oct 17;97(38):3005-3009. doi: 10.3760/cma.j.issn.0376-2491.2017.38.012.
To explore the efficacy and safety of bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator. From February 2012 to April 2014, 120 patients undergoing bilateral hand/forearm surgery in Beijing Jishuitan Hospital were enrolled and anaesthetized with bilateral axillary brachial plexus block. All patients were divided into two groups randomly using random number table: the ultrasound-guided group (group U, =60) and the neurostimulator-guidedgroup (group N, =60). The block was performed with 0.5% ropivacaine. Patients' age, sex and operation duration were recorded. Moreover, success rate, performance time, onset of sensor and motor block, performance pain, patient satisfaction degree and the incidence of related complications were also documented. Venous samples were collected at selected time points and the total and the plasma concentrations of ropivacaine were analyzed with HPLC. The performance time, the onset of sensor block and the onset of motor block of group U were (8.2±1.5), (14.2± 2.2)and (24.0±3.5)min respectively, which were markedly shorter than those in group N( (14.6±3.9), (19.9±3.8), (28.8±4.2)min, respectively), and the differences were statistically significant(=11.74, 10.09, 6.73, respectively, all <0.01). The performance pain score of group N was (25.5± 13.2), which was obviously more serious than group U (31.7± 11.2) and a significant statistical difference was detected (=2.856, <0.05). The patient satisfaction degree of group U was 95.0%, which was significantly higher than group N (83.3%) and a markedly statistical difference was detected (χ(2)=4.227, <0.05). Fifty min after performance, the total plasma concentration of ropivacaine of group U was(1.76±0.48)mg/L, which was significantly lower than group N (1.88±0.53)mg/L and a significant statistical difference was detected (=2.43, <0.05), while no significant differences were detected at the other time points between two groups (>0.05). No analgesic was superadded and no other anesthesia methods were applied. No complications were detected perioperatively. The bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator are both effective and safe for bilateral hand/forearm surgery. However, the ultrasound-guided block may be more clinically beneficial because of its shorter performance time, rapid onset and higher patient satisfaction degree.
探讨超声引导或神经刺激器引导下双侧腋路臂丛神经阻滞的有效性和安全性。2012年2月至2014年4月，选取在北京积水潭医院行双侧手部/前臂手术的120例患者，采用双侧腋路臂丛神经阻滞麻醉。所有患者使用随机数字表法随机分为两组：超声引导组（U组，n = 60）和神经刺激器引导组（N组，n = 60）。采用0.5%罗哌卡因进行阻滞。记录患者的年龄、性别及手术时长。此外，还记录成功率、操作时间、感觉和运动阻滞起效时间、操作时疼痛、患者满意度及相关并发症的发生率。在选定时间点采集静脉血样，采用高效液相色谱法分析罗哌卡因的总量及血浆浓度。U组的操作时间、感觉阻滞起效时间和运动阻滞起效时间分别为（8.2±1.5）、（14.2±2.2）和（24.0±3.5）分钟，明显短于N组（分别为（14.6±3.9）、（19.9±3.8）、（28.8±4.2）分钟），差异有统计学意义（分别为11.74、10.09、6.73，均P<0.01）。N组的操作时疼痛评分为（25.5±13.2），明显重于U组（31.7±11.2），差异有统计学意义（t = 2.856，P<0.05）。U组患者满意度为95.0%，明显高于N组（83.3%），差异有统计学意义（χ(2)=4.227，P<0.05）。操作后50分钟，U组罗哌卡因的血浆总浓度为（1.76±0.48）mg/L，明显低于N组（1.88±0.53）mg/L，差异有统计学意义（t = 2.43，P<0.05），而两组在其他时间点差异无统计学意义（P>0.05）。未追加镇痛药物，未应用其他麻醉方法。围手术期未发现并发症。超声引导或神经刺激器引导下的双侧腋路臂丛神经阻滞用于双侧手部/前臂手术均有效且安全。然而，超声引导下的阻滞可能在临床上更具优势，因为其操作时间短、起效快且患者满意度更高。
