Büttner J, Kemmer A, Argo A, Klose R, Forst R
Abteilung für Anaesthesie und Intensivmedizin der Berufsgenossenschaftlichen Unfallklinik, Ludwigshafen.
Reg Anaesth. 1988 Jan;11(1):7-11.
The results of 1133 axillary catheter brachial blocks are reported. Effectiveness and side-effects were monitored in a prospective manner over a period of 1 year.
The puncture was performed with an 18-gauge plastic cannula fitted with a solid steel stylet. The stylet has a 45 degrees, short bevel with rounded edges. When puncturing the axillary neurovascular sheath, no attempt was made to elicit paresthesias with the needle. A distinct "click" and very easy advancement of the plastic cannula were signs of being well inside the neurovascular sheath. To confirm the correct positioning, 0.5-3 ml refrigerated saline solution were injected. If no paresthesias could be produced, a new puncture was performed using a nerve stimulator. The plastic cannula was fixed to the skin. For long-lasting operations or if postoperative analgesia or sympatholysis was required, a more flexible catheter was introduced through the plastic cannula. As an initial dose 40 ml 1% mepivacaine was injected via the cannula. If there was an insufficient block after 20 min, another 20 ml 1% mepivacaine was given. For long-lasting operations, 40 ml 1% mepivacaine was injected every 2 h.
Surgery was completed in 72% of patients; 24% required some form of supplementation including 17.2% of patients who received a "top-up" after 20 min (Table 1). In 3.8% of cases the technique was considered to be a complete failure, meaning that patients needed some type of general anesthesia including the use of i.v. ketamine.(ABSTRACT TRUNCATED AT 250 WORDS)
报告了1133例腋路导管臂丛阻滞的结果。在1年的时间里对其有效性和副作用进行了前瞻性监测。
采用配有实心钢针芯的18号塑料套管进行穿刺。针芯有一个45度的短斜面，边缘呈圆形。穿刺腋神经血管鞘时，不试图用针引出异感。塑料套管明显的“咔哒”声和非常容易推进是已进入神经血管鞘内的迹象。为确认正确位置，注入0.5 - 3毫升冷藏生理盐水。如果未引出异感，则使用神经刺激器重新进行穿刺。将塑料套管固定于皮肤上。对于长时间手术或如果需要术后镇痛或交感神经阻滞，通过塑料套管插入一根更柔韧的导管。作为初始剂量，经套管注入40毫升1%的甲哌卡因。如果20分钟后阻滞效果不佳，再给予20毫升1%的甲哌卡因。对于长时间手术，每2小时注入40毫升1%的甲哌卡因。
72%的患者手术得以完成；24%的患者需要某种形式的补充，包括17.2%的患者在20分钟后接受了“追加剂量”（表1）。在3.8%的病例中，该技术被认为完全失败，这意味着患者需要某种类型的全身麻醉，包括使用静脉注射氯胺酮。（摘要截短于250字）
