From the Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR, China (RKS, WS, JP, BS, MKK).
Eur J Anaesthesiol. 2022 Oct 1;39(10):801-809. doi: 10.1097/EJA.0000000000001736. Epub 2022 Aug 11.
Selectively locating and blocking the individual trunks of the brachial plexus with small volumes of local anaesthetic, a selective trunk block (SeTB), may produce anaesthesia of the entire upper extremity except for the T2 dermatome.
This study aimed to evaluate the effects of an ultrasound-guided (USG) SeTB on ipsilateral sensorimotor block dynamics, hemidiaphragmatic function, and efficacy as an all-purpose regional anaesthetic technique for upper extremity surgery.
Prospective cohort study.
Single-centre, university hospital in Hong Kong, China from February 2021 to July 2021.
Thirty patients (aged 53.2 ± 14.8 years and BMI 23.8 ± 3.6 kg m - 2 ), ASA physical status I to III, scheduled for upper extremity surgery under a brachial plexus block.
USG SeTB with 25 ml (7, 8 and 10 ml to the superior, middle and inferior trunks, respectively) of a 1 : 1 mixture of 2% lidocaine with 1 : 200 000 epinephrine and 0.5% levobupivacaine.
Ipsilateral sensorimotor blockade of the suprascapular (only motor), axillary, radial, ulnar, median and musculocutaneous nerves were assessed at regular intervals for 45 min. Ipsilateral hemidiaphragmatic excursion was also measured, at 30 min after the SeTB, using M-mode ultrasound. The SeTB was considered a success if it was possible to complete surgery without any rescue analgesia or conversion to general anaesthesia.
Complete motor blockade of the suprascapular nerve was achieved in median [range] 5 [5 to 15] min. Complete sensory and motor blockade were achieved in all the other 5 nerves in 17.5 [10 to 30] and 15 [10 to 30] min respectively. The SeTB was successful in 93% and ipsilateral hemidiaphragmatic paresis (HDP) was present in 82%, of patients.
SeTB produces sensorimotor blockade of the entire upper extremity, causes ipsilateral HDP, and is effective as the sole anaesthetic for surgery from the proximal humerus to the hand.
ClinicalTrials.gov, Trial Registration No: NCT04752410, Date submitted for Registration: 09 February 2021, Date first posted: 12 February 2021, Dates of patient enrolment: 19 February 2021 to 27 July 2021 ( https://clinicaltrials.gov/ct2/show/NCT04752410 ).
通过小容量局部麻醉剂选择性定位和阻滞臂丛神经的各个干，选择性干阻滞（SeTB）可以产生整个上肢的麻醉，除了 T2 皮区。
本研究旨在评估超声引导（USG）SeTB 对同侧感觉运动阻滞动力学、半膈肌功能和作为上肢手术全身局部麻醉技术的效果。
前瞻性队列研究。
2021 年 2 月至 2021 年 7 月在中国香港的一家单中心大学医院。
30 名患者（年龄 53.2±14.8 岁，BMI 23.8±3.6kg/m 2 ），ASA 身体状况 I 至 III，拟行臂丛神经阻滞下的上肢手术。
USG SeTB，用 25ml（分别为 7、8 和 10ml 至上、中、下干）的 2%利多卡因与 1:200000 肾上腺素和 0.5%左旋布比卡因混合。
在 45 分钟的时间内，每隔一段时间评估同侧肩胛上（仅运动）、腋、桡、尺、正中、肌皮神经的感觉运动阻滞情况。在 SeTB 后 30 分钟，使用 M 模式超声测量同侧膈肌的运动幅度。如果可以不使用任何解救镇痛或转为全身麻醉完成手术，则认为 SeTB 成功。
肩胛上神经的完全运动阻滞中位时间为 5[5 至 15]min。其他 5 条神经的完全感觉和运动阻滞分别在 17.5[10 至 30]min 和 15[10 至 30]min 时达到。93%的患者 SeTB 成功，82%的患者出现同侧膈肌麻痹（HDP）。
SeTB 可产生整个上肢的感觉运动阻滞，引起同侧 HDP，并有效作为从肱骨近端到手的手术的唯一麻醉剂。
ClinicalTrials.gov，试验注册编号：NCT04752410，登记日期：2021 年 2 月 9 日，首次提交日期：2021 年 2 月 12 日，患者入组日期：2021 年 2 月 19 日至 2021 年 7 月 27 日（https://clinicaltrials.gov/ct2/show/NCT04752410）。
