Nalini Kadirehally Bheemanna, Bevinaguddaiah Yatish, Thiyagarajan Balaji, Shivasankar Archana, Pujari Vinayak Seenappa
Department of Anaesthesiology, Sapthagiri Institute of Medical Sciences, Bengaluru, Karnataka, India.
Department of Anaesthesiology, M S Ramaiah Medical College, Bengaluru, Karnataka, India.
J Anaesthesiol Clin Pharmacol. 2021 Oct-Dec;37(4):655-660. doi: 10.4103/joacp.JOACP_43_20. Epub 2021 Nov 2.
Brachial plexus is in a very compact state at the costoclavicular space (CCS) when compared to the axilla, where the individual nerves are separate. This study aimed to test the hypothesis that brachial plexus block (BPB) at the CCS would result in a faster onset of block as compared to the axillary approach of BPB.
Fifty patients who underwent surgeries below the level of mid-arm under ultrasound-guided BPB were randomly allocated to any one of the two study groups. Thirty milliliters of local anesthetic (LA), a mixture of 10-mL 2% lidocaine with 5-μg/mL adrenaline and 20-mL 0.5% bupivacaine, was deposited around the axillary artery (25-mL LA) and the musculocutaneous nerve (5-mL LA) or at the CCS, and performance time was noted. Observer blinded to the block procedure recorded the block onset time and success rate.
The mean (SD) onset times were comparable between the costoclavicular (CC) and axillary (AX) groups (12.0 ± 3.2 vs. 11.2 ± 2.9 min, respectively; = 0.367). Group CC demonstrated a reduction in performance time compared to group AX (5.3 ± 1.9 vs. 8.0 ± 3 min, respectively; < 0.05). All blocks were successful in both groups without any complications except for one patient in group AX who required a rescue block for radial nerve.
Costoclavicular and axillary ultrasound-guided BPBs resulted in similar onset times. However, the block performance time was longer for AX group compared to CC group. There were no intergroup differences found in terms of success rates.
与腋部（此处各神经相互分离）相比，臂丛神经在锁胸间隙（CCS）处于非常紧密的状态。本研究旨在验证以下假设：与腋路臂丛神经阻滞（BPB）相比，在CCS进行臂丛神经阻滞（BPB）会导致阻滞起效更快。
50例接受超声引导下BPB且手术部位在臂中部以下的患者被随机分配至两个研究组中的任意一组。将30毫升局部麻醉药（LA），即10毫升2%利多卡因与5微克/毫升肾上腺素的混合物以及20毫升0.5%布比卡因，注射在腋动脉周围（25毫升LA）和肌皮神经周围（5毫升LA）或CCS处，并记录操作时间。对阻滞操作不知情的观察者记录阻滞起效时间和成功率。
锁胸（CC）组和腋路（AX）组的平均（标准差）起效时间相当（分别为12.0±3.2分钟和11.2±2.9分钟；P = 0.367）。与AX组相比，CC组的操作时间缩短（分别为5.3±1.9分钟和8.0±3分钟；P<0.05）。两组所有阻滞均成功，无任何并发症，除AX组有1例患者桡神经需要补救阻滞。
锁胸和腋路超声引导下的BPB起效时间相似。然而，AX组的阻滞操作时间比CC组长。在成功率方面未发现组间差异。
