Department of Anesthesiology, Centre Hospitalier de la Côte Basque, 64109, Bayonne, France.
Department of Anesthesiology, Hopital Privé de l'Ouest Parisien, 78190, Trappes, France.
Sci Rep. 2022 Jan 7;12(1):52. doi: 10.1038/s41598-021-03660-7.
Ultrasound-guided hydrodissection with 5% dextrose in water (DW5) creates a peri-nervous compartment, separating the nerve from the neighboring anatomical structures. The aim of this randomized study was to determine the minimum volume of lidocaine 2% with epinephrine 1:200,000 required when using this technique to achieve an effective median nerve block at the elbow in 95% of patients (MEAV95). Fifty-two patients scheduled for elective hand surgery received an ultrasound-guided circumferential perineural injection of 4 ml DW5 and an injection of local anesthetic (LA) following a biased coin up-and-down sequential allocation method. A successful block was defined as a light touch completely suppressed on the two distal phalanges of the index finger within a 30-min evaluation period. The MEAV95 of lidocaine 2% with epinephrine was 4 ml [IQR 3.5-4.0]. Successful median nerve block was obtained in 38 cases (82.6%) with median onset time of 20.0 [10.0-21.2] minutes (95% CI 15-20). The analgesia duration was 248 [208-286] minutes (95% CI 222-276). Using an ultrasound-guided hydrodissection technique with DW5, the MEAV95 to block the median nerve at the elbow with 2% lidocaine with epinephrine was 4 ml [IQR 3.5-4.0]. This volume is close to that usually recommended in clinical practice.Trial registration clinicaltrials.gov. NCT02438657, Date of registration: May 8, 2015.
超声引导下用水（DW5）进行的水分离在神经周围形成一个间隙，将神经与相邻的解剖结构分开。本随机研究的目的是确定在这种技术下使用时，需要多少体积的 2%利多卡因加肾上腺素 1:200000 （LA），才能在 95%的患者中达到有效的肘正中神经阻滞（MEAV95）。52 名计划接受择期手部手术的患者接受了超声引导下的环形神经周围注射 4ml DW5，并根据偏倚硬币上下顺序分配方法，注射局部麻醉剂（LA）。成功的阻滞定义为在 30 分钟的评估期内，食指的两个远节指骨的轻触感觉完全消失。含肾上腺素的 2%利多卡因的 MEAV95 为 4ml [IQR 3.5-4.0]。38 例（82.6%）获得了正中神经阻滞，中位起效时间为 20.0 [10.0-21.2]分钟（95%CI 15-20）。镇痛持续时间为 248 [208-286]分钟（95%CI 222-276）。使用 DW5 超声引导下水分离技术，含肾上腺素的 2%利多卡因阻滞肘部正中神经的 MEAV95 为 4ml [IQR 3.5-4.0]。这个体积接近临床实践中通常推荐的体积。试验注册临床Trials.gov。NCT02438657，注册日期：2015 年 5 月 8 日。
