Chen Carl P C, Hsu Chih-Chin, Cheng Chih-Hsiu, Huang Shu-Chun, Chen Jean-Lon, Lin Shin-Yi
Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Keelung and College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
J Pain Res. 2021 Jan 18;14:75-82. doi: 10.2147/JPR.S276095. eCollection 2021.
To investigate whether body mass index (BMI) and changes in body positioning have any correlation with the distance from the pleura to the inferior trunk of the supraclavicular brachial plexus.
Twenty stroke patients with upper limb spasticity and complex regional pain syndrome were recruited for this study. Distance from the pleura to the inferior trunk was measured in the supine position, body turned sideways at 45 °, and in the lateral decubitus position. Correlations between BMI and measured distances in these body positions were evaluated. A linear musculoskeletal ultrasound transducer was used to conduct these distance measurements.
The distance from the pleura to the inferior trunk in the supine position was calculated to have an average of 0.42 ± 0.06 cm (D1), 0.44 ±0.05 (D2) when lying sideways at 45 °, and 0.87 ± 0.08 cm (D3) in the lateral decubitus position. The Kruskal-Wallis test revealed significant differences when comparing D3 with D1, and D3 with D2 ( < 0.001). Positive correlations were observed between BMI and D1 (Spearman's rho = 0.62, = 0.004, two-tailed), and between BMI and D2 (Spearman's rho = 0.61, = 0.005, two-tailed). The strongest positive correlation was observed between BMI and D3 (Spearman's rho = 0.78, < 0.001, two-tailed).
In the lateral decubitus body position, the distance from the pleura to the inferior trunk increased significantly by 2-fold and was positively correlated with BMI. The increased distance may improve the safety of the nerve block procedure. As a result, it is recommended that patients be placed in the lateral decubitus body position when performing ultrasound-guided supraclavicular brachial plexus nerve block of the inferior trunk.
探讨体重指数（BMI）及体位变化与胸膜至锁骨上臂丛神经下干距离之间是否存在相关性。
本研究招募了20例患有上肢痉挛和复杂性区域疼痛综合征的中风患者。在仰卧位、身体向一侧转45°以及侧卧位时测量胸膜至下干的距离。评估BMI与这些体位下测量距离之间的相关性。使用线性肌肉骨骼超声换能器进行这些距离测量。
仰卧位时胸膜至下干的距离经计算平均为0.42±0.06厘米（D1），身体向一侧转45°时为0.44±0.05厘米（D2），侧卧位时为0.87±0.08厘米（D3）。Kruskal-Wallis检验显示，比较D3与D1以及D3与D2时存在显著差异（<0.001）。观察到BMI与D1之间存在正相关（Spearman秩相关系数rho = 0.62，P = 0.004，双侧），BMI与D2之间也存在正相关（Spearman秩相关系数rho = 0.61，P = 0.005，双侧）。BMI与D3之间观察到最强的正相关（Spearman秩相关系数rho = 0.78，P < 0.001，双侧）。
在侧卧位时，胸膜至下干的距离显著增加了2倍，且与BMI呈正相关。距离增加可能会提高神经阻滞操作的安全性。因此，建议在进行超声引导下锁骨上臂丛神经下干神经阻滞时将患者置于侧卧位。
