Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
Faculty of Medicine, Section for Physiology, University of Oslo, Oslo, Norway.
Anaesthesia. 2019 Nov;74(11):1389-1396. doi: 10.1111/anae.14795. Epub 2019 Aug 7.
We evaluated the effect of adrenaline on human skin microcirculation (nutritive and sub-papillary) and systemic cardiovascular variables after it was added to lidocaine in infraclavicular brachial plexus blocks. Twelve healthy, non-smoking male volunteers were included, each attending two study sessions 2 weeks apart, and they were studied using a crossover design. In both sessions, they received an ultrasound-guided infraclavicular brachial plexus block in the non-dominant arm with 0.4 ml.kg lidocaine, 15 mg.ml with or without adrenaline 5 μg.ml . Microcirculation was assessed by laser Doppler fluxmetry (sub-papillary blood flow), capillary video microscopy (nutritive blood flow) and continuous temperature measurements. Heart rate and arterial pressure were recorded continuously and non-invasively. Median (IQR [range]) sub-papillary blood flow increased substantially 30 min after the brachial plexus block, from 8.5 (4.4-13.5 [2.9-28.2]) to 162.7 (111.0-197.8 [9.5-206.7]) arbitrary units with adrenaline (p = 0.017), and from 6.9 (5.3-28.5 [1.8-42.1] to 133.7 (16.5-216.7 [1.0-445.0] arbitrary units without adrenaline (p = 0.036). Nutritive blood flow (functional capillary density, capillaries.mm , measured at the dorsal side of the hand) decreased in the blocked extremity when adrenaline was used as adjuvant, from median (IQR [range]) 45 (36-52 [26-59]) to 38 (29-41 [26-42]), p = 0.028, whereas no significant change occurred without adrenaline. Median finger skin temperature (°C) increased by 44% (data pooled) with no significant differences between the groups. No significant changes were found in the systemic cardiovascular variables with or without adrenaline. We conclude that lidocaine infraclavicular brachial plexus blocks caused an increase in skin sub-papillary blood flow. The addition of adrenaline produced stronger and longer lasting blocks, but decreased the nutritive blood flow.
我们评估了在锁骨下臂丛阻滞中加入肾上腺素后对人体皮肤微循环（营养和亚真皮）和全身心血管变量的影响。 纳入了 12 名健康、不吸烟的男性志愿者，他们在 2 周的间隔内分别参加了 2 次研究，采用交叉设计进行研究。 在两次会议中，他们在非优势臂上接受超声引导的锁骨下臂丛阻滞，使用 0.4ml.kg 利多卡因，15mg.ml 加或不加肾上腺素 5μg.ml 。 通过激光多普勒通量测量（亚真皮血流）、毛细血管视频显微镜（营养血流）和连续温度测量来评估微循环。 连续无创记录心率和动脉压。 锁骨下丛阻滞后 30 分钟，亚真皮血流明显增加，肾上腺素组从 8.5（4.4-13.5[2.9-28.2]）增加至 162.7（111.0-197.8[9.5-206.7]）任意单位（p=0.017），而无肾上腺素组从 6.9（5.3-28.5[1.8-42.1]增加至 133.7（16.5-216.7[1.0-445.0]任意单位（p=0.036）。 当使用肾上腺素作为佐剂时，营养血流（功能毛细血管密度，在手背测量的毛细血管.mm）在阻滞侧减少，从中位数（IQR[范围]）45（36-52[26-59]）减少至 38（29-41[26-42]），p=0.028，而无肾上腺素时无显著变化。 中位数手指皮肤温度（°C）升高 44%（数据汇总），两组之间无显著差异。 无论是否使用肾上腺素，全身心血管变量均无显著变化。 我们得出结论，锁骨下臂丛阻滞引起皮肤亚真皮血流增加。 肾上腺素的加入产生了更强和更持久的阻滞，但降低了营养血流。
