Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, South Korea.
Department of Anesthesiology and Pain Medicine, College of Medicine, Jeju National University, Jeju, Korea.
Pain Physician. 2021 Jan;24(1):E15-E21.
The brachial plexus courses along the lateral to posterior aspect of the subclavian artery located within the supraclavicular region as a trunk or division. Therefore we hypothesized that 2 injections, one along the lateral and one along the posterior aspect of the brachial plexus, could be performed by changing the angle of the ultrasound probe, thereby achieving a 3-dimensional (3-D) even distribution of local anesthetics. Previously, we confirmed the efficacy of this type of approach with that of a single cluster approach. These findings represent a subsequent study.
This study was conducted to confirm the superiority of block quality achieved by 2 injections from 2 planes (control group; group C) over 2 injections in one plane (experimental group; group E).
A randomized, controlled trial.
Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center.
In group C (n = 35), the brachial plexus sheath was penetrated in 2 planes by anteriorly altering the angle of the ultrasound probe without changing its position. In group E (n = 35), the upper and lower portions of the brachial plexus sheath were penetrated in one plane. A total of 15 mL of lidocaine 1.5% containing epinephrine (1:200,000) was injected at each point in both groups. The ultrasound-guided supraclavicular brachial plexus block was evaluated every 5 minutes for 30 minutes. The main outcome variables were rates of blockage of all 4 nerves and ulnar nerve sparing.
The rate of blockage of all 4 nerves (median, ulnar, radial, and musculocutaneous nerves) was not significantly different between the 2 groups (94% in group C vs. 86% in group E, respectively; P = 0.232). The number of spared ulnar nerves was similar (1 vs. 5, respectively; P = 0.088). Group procedure times, onset times, and Visual Analog Scale scores for the blocks were similar.
For the 2 plane, 2 injection approach, only 2-D imaging was performed rather than 3-D imaging.
Two injections performed in one plane offered similar benefits to 2 injections performed in 2 planes. The 2 techniques provided comparable block qualities and could be viewed as equally effective alternatives.
臂丛神经位于锁骨下区域内的锁骨下动脉的外侧至后侧，作为干或分支走行。因此，我们假设通过改变超声探头的角度，可以进行两次注射，一次在臂丛神经的外侧，一次在臂丛神经的后侧，从而实现局部麻醉剂的三维（3-D）均匀分布。之前，我们已经通过单次集群方法证实了这种方法的有效性。这些发现代表了后续研究。
本研究旨在通过 2 个平面的 2 次注射（对照组；C 组）与 1 个平面的 2 次注射（实验组；E 组）比较，证实阻滞质量的优势。
随机对照试验。
加图立大学Gil 医疗中心麻醉与疼痛医学系。
在 C 组（n = 35）中，通过在不改变探头位置的情况下向前改变超声探头的角度，在 2 个平面上穿透臂丛神经鞘。在 E 组（n = 35）中，在上部和下部臂丛神经鞘中在一个平面上穿透。两组均在每个点注射 15 毫升含肾上腺素（1:200,000）的 1.5%利多卡因。在 30 分钟内每 5 分钟评估一次超声引导锁骨上臂丛神经阻滞。主要观察指标为所有 4 根神经和尺神经阻滞率。
两组所有 4 根神经（尺神经、正中神经、桡神经和肌皮神经）的阻滞率无显著差异（C 组分别为 94%和 E 组 86%；P = 0.232）。保留的尺神经数量相似（分别为 1 和 5；P = 0.088）。组间手术时间、起效时间和阻滞的视觉模拟评分相似。
对于 2 个平面、2 次注射方法，仅进行了 2-D 成像，而不是 3-D 成像。
在一个平面上进行 2 次注射与在 2 个平面上进行 2 次注射具有相似的益处。这两种技术提供了相似的阻滞质量，可以被视为同样有效的替代方法。
