Halil Sivgin Cubuk State Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey.
Ankara City Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey.
Medicine (Baltimore). 2022 Jun 10;101(23):e29241. doi: 10.1097/MD.0000000000029241.
The development of ultrasonography technology and its widespread application have increased peripheral nerve block applications, especially in limb surgeries, since it reduces complication rates and increases success rates in peripheral nerve block applications. However, even experienced physicians need to direct a large number of needles and injections for adequate local anesthetic spread, which can cause accidental vascular puncture and local anesthetic systemic toxicity. Such complications can be prevented by hydrodissection and a safer and successful anesthesia can be provided to patients in this study, it was aimed to investigate the effects of hydrodissection on anesthesia characteristics in the infraclavicular brachial plexus blockade.
Ninety patients were included in our study after approval by the Ethics Committee. These patients were randomly divided into 2 groups (Group I: Infraclavicular brachial plexus blockade with normal method and Group II: infraclavicular brachial plexus blockade with hydrodissection). After obtaining patient consent, monitoring and vascular access were provided. Group I patients were mixed with 30 mL of local anesthetic mixture (15 mL of distilled water and 15 mL of 0.5% bupivacaine), and Group II patients were treated with 15 mL of distilled water by hydrodissection and 15 mL of 0.5% bupivacaine anesthesia resident. Block characteristics were evaluated and recorded every 5 minutes for the first 30 minutes by a blinded observer. The sensory block score was 7, the total score was 14 or above, and the block was considered successful, and the patient was ready for surgery. Postoperative block removal times, analgesia, and complications were evaluated and recorded.
A significant difference was found between the sensory and motor block onset times and postoperative VAS scores between the normal and hydrodissection groups (P < .05). There were no significant differences in terms of block application times, postoperative block removal times, and complications between the groups.
In this study, it has been shown that hydrodissection in peripheral nerve blocks does not lag in terms of block success and characteristics compared to normal methods, whereas anesthetists with less experience in peripheral nerve block experience obtain safer and more successful results in practice.
超声技术的发展及其广泛应用增加了周围神经阻滞的应用，特别是在四肢手术中，因为它降低了并发症的发生率，并提高了周围神经阻滞的成功率。然而，即使是经验丰富的医生也需要引导大量的针和注射以实现充分的局部麻醉扩散，这可能导致意外的血管穿刺和局部麻醉全身毒性。通过水分离可以预防此类并发症，并且可以为患者提供更安全和成功的麻醉。本研究旨在探讨水分离对锁骨下臂丛神经阻滞麻醉特性的影响。
经伦理委员会批准后，本研究纳入了 90 例患者。这些患者被随机分为 2 组（I 组：采用常规方法进行锁骨下臂丛神经阻滞，II 组：采用水分离进行锁骨下臂丛神经阻滞）。在获得患者同意后，提供监测和血管通路。I 组患者混合 30ml 局部麻醉混合物（15ml 蒸馏水和 15ml0.5%布比卡因），II 组患者用 15ml 蒸馏水进行水分离，并用 15ml0.5%布比卡因进行麻醉。由一名盲法观察者每 5 分钟评估和记录前 30 分钟的阻滞特征。感觉阻滞评分达到 7 分，总评分达到 14 分或以上，认为阻滞成功，患者即可准备手术。评估并记录术后阻滞去除时间、镇痛和并发症。
正常组和水分离组之间感觉和运动阻滞起效时间以及术后 VAS 评分有显著差异（P<0.05）。两组之间阻滞应用时间、术后阻滞去除时间和并发症无显著差异。
在这项研究中，与常规方法相比，水分离在周围神经阻滞的阻滞成功率和特征方面没有滞后，而在周围神经阻滞方面经验较少的麻醉师在实践中获得了更安全、更成功的结果。
