上肢手术中超声与外周神经刺激器引导技术用于锁骨上阻滞的比较：一项随机对照试验
Comparison of Ultrasound with Peripheral Nerve Stimulator-guided Technique for Supraclavicular Block in Upper Limb Surgeries: A Randomized Controlled Trial.
作者信息
Alfred Vinu Mervick, Srinivasan Gnanasekaran, Zachariah Mamie
机构信息
Department of Anesthesiology and Intensive Care, Pondicherry Institute of Medical Sciences, Puducherry, India.
出版信息
Anesth Essays Res. 2018 Jan-Mar;12(1):50-54. doi: 10.4103/aer.AER_211_17.
BACKGROUND
The supraclavicular approach is considered to be the easiest and most effective approach to block the brachial plexus for upper limb surgeries. The classical approach using the anatomical landmark technique was associated with higher failure rates and complications. Ultrasonography (USG) guidance and peripheral nerve stimulator (PNS) have improved the success rates and safety margin.
AIMS
The aim of the present study is to compare USG with PNS in supraclavicular brachial plexus block for upper limb surgeries with respect to the onset of motor and sensory blockade, total duration of blockade, procedure time, and complications.
SETTINGS AND DESIGN
Prospective, randomized controlled study.
SUBJECT AND METHODS
Sixty patients aged above 18 years scheduled for elective upper limb surgery were randomly allocated into two groups. Group A patients received supraclavicular brachial plexus block under ultrasound guidance and in Group B patients, PNS was used. In both groups, local anesthetic mixture consisting of 15 ml of 0.5% bupivacaine and 10 ml of 2% lignocaine with 1:200,000 adrenaline were used.
STATISTICAL ANALYSIS
Independent -test used to compare mean between groups; Chi-square test for categorical variables.
RESULTS
The procedure time was shorter with USG (11.57 ± 2.75 min) compared to PNS (21.73 ± 4.84). The onset time of sensory block (12.83 ± 3.64 min vs. 16 ± 3.57 min) and onset of motor block (23 ± 4.27 min vs. 27 ± 3.85 min) were significantly shorter in Group A compared to Group B ( < 0.05). The duration of sensory block was significantly prolonged in Group A (8.00 ± 0.891 h) compared to Group B (7.25 ± 1.418 h). None of the patients in either groups developed any complications.
CONCLUSION
The ultrasound-guided supraclavicular brachial plexus block can be done quicker, with a faster onset of sensory and motor block compared to nerve stimulator technique.
背景
锁骨上入路被认为是上肢手术中阻滞臂丛神经最简单、最有效的方法。使用解剖标志技术的传统方法失败率和并发症较高。超声（USG）引导和外周神经刺激器（PNS）提高了成功率和安全系数。
目的
本研究的目的是比较在锁骨上臂丛神经阻滞用于上肢手术时，超声引导与外周神经刺激器在运动和感觉阻滞起效时间、总阻滞时间、操作时间及并发症方面的差异。
设置与设计
前瞻性、随机对照研究。
对象与方法
60例年龄18岁以上择期行上肢手术的患者被随机分为两组。A组患者在超声引导下行锁骨上臂丛神经阻滞，B组患者使用外周神经刺激器。两组均使用由15 ml 0.5%布比卡因、10 ml 2%利多卡因和1:200,000肾上腺素组成的局部麻醉混合液。
统计学分析
采用独立样本t检验比较组间均值；分类变量采用卡方检验。
结果
与外周神经刺激器组（21.73±4.84分钟）相比，超声引导组的操作时间更短（11.57±2.75分钟）。A组的感觉阻滞起效时间（12.83±3.64分钟对16±3.57分钟）和运动阻滞起效时间（23±4.27分钟对27±3.85分钟）明显短于B组（P<0.05）。与B组（7.25±1.418小时）相比，A组的感觉阻滞持续时间明显延长（8.00±0.891小时）。两组患者均未出现任何并发症。
结论
与神经刺激器技术相比，超声引导下锁骨上臂丛神经阻滞操作更快，感觉和运动阻滞起效更快。
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