Choudhary Nitin, Kumar Abhijit, Kohli Amit, Wadhawan Sonia, Siddiqui Tabish H, Bhadoria Poonam, Kamat Hemlata
Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India.
Department of Anaesthesiology, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India.
J Anaesthesiol Clin Pharmacol. 2019 Jul-Sep;35(3):373-378. doi: 10.4103/joacp.JOACP_144_18.
This study aims to compare the single-point injection and double-point injection technique of ultrasound-guided supraclavicular block with regard to the success rate, time taken to perform the procedure, onset and duration of sensory and motor block, and complications.
A total of 60 American Society of Anesthesiologists physical status I and II patients between 20 and 50 years of age, with body mass index ≤30 kg/m posted for forearm surgeries, with anticipated surgical duration more than 1 h were randomly divided into two groups: group S (single-point injection) and group D (double-point injection technique). After locating the brachial plexus with ultrasound, needle was inserted from lateral to medial direction to reach the plexus. In group D, 20 ml of inj. bupivacaine 0.5% was deposited as 10 ml each in superior (in the cluster) and inferior pocket (corner pocket) between the plexus and subclavian artery with the help of hydrodissection while in group S the total 20 ml was deposited in the superior (in the cluster) pocket. The onset of sensory and motor block was assessed using pin prick method and modified Bromage scale. Adequacy of block was ensured by assessing the ulnar, radial, and median nerve distribution. Procedural time was defined from the point of scanning the plexus till the drug was injected completely. Total sensory, motor duration, and complications if any were noted.
Group D had higher success rate compared to group S (96.7 vs. 83.3%; < 0.0001). The total procedural time was significantly more in group D compared to group S (14.6 ± 2.7 vs. 10.1 ± 1.7 min; < 0.0001). The onset of sensory and motor block was faster and the duration of sensory and motor block was significantly longer in group D.
The adequacy of block, sensory, and motor duration was significantly high in newer double-point injection technique. However, it requires longer procedural time compared to single-point injection technique.
本研究旨在比较超声引导下锁骨上阻滞的单点注射和双点注射技术在成功率、操作时间、感觉和运动阻滞的起效及持续时间以及并发症方面的差异。
总共60例年龄在20至50岁之间、美国麻醉医师协会身体状况分级为Ⅰ级和Ⅱ级、体重指数≤30kg/m²、拟行前臂手术且预计手术时间超过1小时的患者被随机分为两组：S组（单点注射）和D组（双点注射技术）。用超声定位臂丛神经后，从外侧向内侧进针至神经丛。在D组，借助水分离技术，将20ml 0.5%布比卡因注射液分别以10ml注入神经丛与锁骨下动脉之间的上方（在神经丛内）和下方腔隙（角部腔隙）；而在S组，将20ml全部注入上方（在神经丛内）腔隙。采用针刺法和改良的 Bromage 评分评估感觉和运动阻滞的起效情况。通过评估尺神经、桡神经和正中神经的分布来确保阻滞充分。操作时间定义为从扫描神经丛开始至药物完全注射完毕的时间。记录总的感觉、运动持续时间以及任何并发症。
与S组相比，D组成功率更高（96.7%对83.3%；P<0.0001）。D组的总操作时间显著长于S组（14.6±2.7对10.1±1.7分钟；P<0.0001）。D组感觉和运动阻滞的起效更快，感觉和运动阻滞的持续时间显著更长。
新型双点注射技术在阻滞充分性、感觉和运动持续时间方面显著更高。然而，与单点注射技术相比，其操作时间更长。
