Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.
Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
Korean J Anesthesiol. 2021 Dec;74(6):522-530. doi: 10.4097/kja.21028. Epub 2021 Apr 12.
The corner pocket (CP) approach for supraclavicular block (SCB) prevents ulnar nerve (UN) sparing due to needle proximity to the lower trunk. Improved ultrasound resolution has suggested that the intertruncal (IT) approach is a suitable alternative method. We compared efficiency of these two approaches on the UN blockade.
Sixty patients were randomized to undergo SCB using the ultrasound-guided CP or IT approach. For lower trunk blockade, 10 ml of local anesthetic agents (1 : 1 mixture of 0.75% ropivacaine and 1% lidocaine) were injected in the CP (CP approach) or between the lower and middle trunks (IT approach). Additional 15 ml was injected identically to block the middle and upper trunks in both groups. Sensory and motor blockade was evaluated after intervention.
Complete sensory blockade (75.9% [22/29] vs. 43.3% [13/30], P = 0.023) and complete motor blockade (82.8% [24/29] vs. 50.0% [15/30], P = 0.017) of the UN at 15 min after SCB were significantly more frequent in the IT than in the CP group. Sensory block onset time of the UN was significantly shorter in the IT compared to the CP group (15.0 [10.0, 15.0] min vs. 20.0 [15.0, 20.0] min, P = 0.012).
The IT approach provided a more rapid onset of UN blockade than the CP approach. These results suggest that the IT approach is a suitable alternative to the CP approach and can provide faster surgical readiness.
锁骨上阻滞（SCB）的角囊（CP）入路由于针靠近下干，因此无法避免尺神经（UN）的保留。超声分辨率的提高表明，椎间（IT）入路是一种合适的替代方法。我们比较了这两种方法在 UN 阻滞中的效率。
60 名患者随机分为超声引导 CP 或 IT 入路行 SCB。对于下干阻滞，在 CP（CP 入路）或中下干之间（IT 入路）注射 10ml 局部麻醉剂（0.75%罗哌卡因和 1%利多卡因 1:1 混合）。两组均在相同部位注射另外 15ml 以阻滞中、上干。干预后评估感觉和运动阻滞。
术后 15min，IT 组完全感觉阻滞（75.9%[22/29]比 43.3%[13/30]，P=0.023）和完全运动阻滞（82.8%[24/29]比 50.0%[15/30]，P=0.017）的 UN 明显多于 CP 组。IT 组 UN 感觉阻滞起效时间明显短于 CP 组（15.0[10.0,15.0]min 比 20.0[15.0,20.0]min，P=0.012）。
与 CP 入路相比，IT 入路可更快地引起 UN 阻滞。这些结果表明，IT 入路是 CP 入路的一种合适替代方法，可以更快地准备手术。
