Krebs P
Reg Anaesth. 1987 Jan;10(1):1-15.
High axillary brachial plexus anaesthesia was performed in 25 patients. This technique employs simple, straight forward axillary access, and produces an infraclavicular brachial plexus block which is adequate for anaesthesia of the entire arm. The technique and the equipment required are described in the text and illustrated by the figures. Twenty patients who received high axillary brachial plexus anaesthesia were compared with 20 patients who received conventional axillary brachial plexus anaesthesia. The arm anaesthesia attained was classified as being of the analgesic or the anaesthetic stage by pin-prick testing at 4-min intervals, and the motor block, as paretic or the paralytic stage. Five incorrect catheter placements (i.e., 20%) were observed in the group with high axillary brachial plexus anaesthesia; however, they could be revised to produce conventional axillary brachial plexus blocks. Blood mepivacaine level determinations performed over a 90-min period showed that the relatively high dosage used (with average 7.29 gm/kg body weight) did not result in toxic blood levels. This technique involves advancing the catheter 8.3-20 cm (mean 13.9 cm) beyond the puncture site. In 11 cases, it was necessary to overcome resistance when advancing the needle. The site of placement was determined by electrostimulation and cold-temperature-testing. Comparison of both groups revealed that the block is faster and more complete, and the nerves which are usually difficult to block with plexus anaesthesia are anaesthetized better with the high axillary block than with the conventional technique. The anaesthesia of the axillary and musculocutaneous nerves showed an impressive improvement. Whereas the usually difficult block of the radial nerve in the hand was greatly improved, the median and ulnar nerves were blocked equally well using either method. The only complication that occurred was an intravenous catheter placement, which was diagnosed and corrected. No other early or late complications were observed following the use of this technique in a large group of patients. This new technique is simple and easy to master.
对25例患者实施了高位腋路臂丛神经麻醉。该技术采用简单、直接的腋路进针，可产生锁骨下臂丛神经阻滞，足以麻醉整个手臂。文中描述了该技术及所需设备，并配有插图说明。将20例接受高位腋路臂丛神经麻醉的患者与20例接受传统腋路臂丛神经麻醉的患者进行比较。每隔4分钟通过针刺测试将获得的手臂麻醉分为镇痛期或麻醉期，运动阻滞分为轻瘫期或麻痹期。在高位腋路臂丛神经麻醉组中观察到5例导管放置错误（即20%）；然而，可以将其调整为传统腋路臂丛神经阻滞。在90分钟内进行的甲哌卡因血药浓度测定表明，所使用的相对高剂量（平均体重7.29克/千克）并未导致血药浓度达到中毒水平。该技术包括将导管从穿刺部位推进8.3 - 20厘米（平均13.9厘米）。在11例病例中，进针时需要克服阻力。放置部位通过电刺激和冷温测试确定。两组比较显示，该阻滞起效更快、更完全，与传统技术相比，通常用丛神经麻醉难以阻滞的神经在高位腋路阻滞时麻醉效果更好。腋神经和肌皮神经的麻醉效果有显著改善。虽然通常难以阻滞的手部桡神经阻滞有了很大改善，但正中神经和尺神经使用两种方法的阻滞效果相同。唯一发生的并发症是静脉导管误置，已被诊断并纠正。在一大组患者中使用该技术后，未观察到其他早期或晚期并发症。这项新技术简单且易于掌握。
