Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, 400030, China.
Curr Med Sci. 2020 Dec;40(6):1182-1190. doi: 10.1007/s11596-020-2307-9. Epub 2021 Jan 11.
A nerve stimulation-guided lumbar plexus block is a well-established technique. It is not clear whether ultrasound guidance has additional value for this deep block technique. This study aimed to examine whether ultrasound guidance using a paramedian transverse scan through the intertransverse space (PMTS-ITS) approach in combination with nerve stimulation reduces the onset time of a complete sensory block. Forty-four patients who were scheduled to undergo arthroscopic knee surgery with an ultrasound visibility score (UVS) of ≥10 for the lumbar plexus were enrolled and randomly allocated to the ultrasound guidance with nerve stimulation group (group U-N) or nerve stimulation group (group N) in this prospective, randomized, parallel-group, active-controlled study. The primary outcome was the onset time of a complete sensory block. The results showed that the onset time of a complete sensory block to pinprick and cold was 10 (10-40) min and 10 (10-40) min in group U-N, respectively, and 30 (10-40) min and 20 (10-40) min in group N (P=0.005, P=0.004), respectively. The performance time was 658±87 s in group U-N and 528±97 s in group N (P<0.001). There was no (0%) patient who required 5 or more needle passes in group U-N and 6 (27.3%) in group N (P=0.028). The block failure rate was 9.1% in group U-N and 31.8% in group N (P>0.05). In conclusion, ultrasound guidance using the PMTS-ITS approach in combination with nerve stimulation led to a faster onset of a complete sensory block than nerve stimulation alone for a lumbar plexus block in patients with a UVS ≥10. Ultrasound guidance with nerve stimulation significantly decreased the number of patients who required 5 or more needle passes.
神经刺激引导下的腰丛阻滞是一种成熟的技术。目前尚不清楚超声引导对这种深部阻滞技术是否有额外的价值。本研究旨在探讨经椎间横突间隙旁正中横向扫描（PMTS-ITS）联合神经刺激的超声引导是否能缩短完全感觉阻滞的起效时间。本前瞻性、随机、平行组、主动对照研究共纳入 44 例拟行膝关节镜手术的患者，这些患者的腰椎超声可视评分（UVS）≥10，将其随机分为超声引导联合神经刺激组（U-N 组）和神经刺激组（N 组）。主要结局是完全感觉阻滞的起效时间。结果显示，U-N 组的针刺痛觉和冷觉完全阻滞的起效时间分别为 10（10-40）min 和 10（10-40）min，N 组分别为 30（10-40）min 和 20（10-40）min（P=0.005，P=0.004）。U-N 组的操作时间为 658±87 s，N 组为 528±97 s（P<0.001）。U-N 组中没有（0%）患者需要 5 次或更多次进针，而 N 组中则有 6 例（27.3%）（P=0.028）。U-N 组的阻滞失败率为 9.1%，N 组为 31.8%（P>0.05）。总之，对于 UVS≥10 的患者，与单纯神经刺激相比，超声引导下经 PMTS-ITS 联合神经刺激可更快地产生完全感觉阻滞。神经刺激联合超声引导显著减少了需要 5 次或更多次进针的患者数量。
