在横突平面和关节突平面采用短轴平面内法进行腰丛阻滞的比较：一项随机对照试验。

Comparison of lumbar plexus block using the short axis in-plane method at the plane of the transverse process and at the articular process: a randomized controlled trial.

作者信息

Lu Rui, Shen Chengcheng, Yang Chunyong, Chen Yan, Li Juanjuan, Lu Kaizhi

机构信息

Department of Anesthesia, the First Hospital Affiliated to Army Medical University (Southwest Hospital), Army Medical University, Chongqing, 400038, China.

出版信息

BMC Anesthesiol. 2018 Feb 7;18(1):17. doi: 10.1186/s12871-018-0480-1.

DOI:10.1186/s12871-018-0480-1

PMID:29415656

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5804000/

Abstract

BACKGROUND

Although the safety and effectiveness of the short-axis in-plane method has been confirmed for lumbar plexus block, the operation is difficult and has a high rate of epidural spread at the plane of the articular process. Therefore, we developed a new in-plane technique, called the beach chair method, which displays images from the transverse process. We compared the operative difficulty and incidence of epidural spread of the beach chair method with those of the control method (at the plane of the articular process) in this randomized controlled clinical trial.

METHODS

Sixty patients, aged 18 to 75 years, scheduled for unilateral arthroscopic knee surgery were randomized to receive double-guided lumbar plexus block by the beach chair method (n = 30) or the control method (n = 30) with 30 ml 0.5% ropivacaine hydrochloride; all patients received a sciatic nerve block with 10 ml 1% lidocaine hydrochloride and 10 ml 0.5% ropivacaine hydrochloride.

RESULTS

The incidence of epidural spread after lumbar plexus block was significantly lower in the beach chair group than that in the control group [1 case (3.3%) vs. 9 (30.0%), P = 0.006]. Moreover, the imaging time (34.2 ± 16.7 s vs. 48.9 ± 16.8 s, P = 0.001), needling time (85.0 ± 45.3 s vs. 131.4 ± 88.2 s, P = 0.013) and number of needle punctures (2.7 ± 1.3 vs. 4.5 ± 2.1, P = 0.000) were significantly lower in the beach chair group than those in the control group; the ultrasound visibility score of the beach chair group was better than that of the control group. There were no significant differences in the remaining indicators.

CONCLUSIONS

The beach chair method was easier and was associated with a lower incidence of epidural spread than the control method. Therefore, the beach chair method (at the plane of the transverse process) provides another promising option for lumbar plexus block for the non-obese population.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR), Registration number:ChiCTR-INR-15007505, registered on November 06, 2015.

摘要

背景

尽管短轴平面内法用于腰丛神经阻滞的安全性和有效性已得到证实，但该操作难度大，且在关节突平面硬膜外扩散率高。因此，我们开发了一种新的平面内技术，称为沙滩椅法，该方法可显示横突的图像。在这项随机对照临床试验中，我们比较了沙滩椅法与对照方法（在关节突平面）的操作难度和硬膜外扩散发生率。

方法

将60例年龄在18至75岁、计划行单侧关节镜膝关节手术的患者随机分为两组，分别接受沙滩椅法（n = 30）或对照方法（n = 30）双引导腰丛神经阻滞，均使用30 ml 0.5%盐酸罗哌卡因；所有患者均接受10 ml 1%盐酸利多卡因和10 ml 0.5%盐酸罗哌卡因的坐骨神经阻滞。

结果

腰丛神经阻滞后沙滩椅组硬膜外扩散发生率显著低于对照组[1例（3.3%） vs. 9例（30.0%），P = 0.006]。此外，沙滩椅组的成像时间（34.2±16.7秒 vs. 48.9±16.8秒，P = 0.001）、进针时间（85.0±45.3秒 vs. 131.4±88.2秒，P = 0.013）和进针次数（2.7±1.3次 vs. 4.5±2.1次，P = 0.000）均显著低于对照组；沙滩椅组的超声可视评分优于对照组。其余指标无显著差异。