Abe Shingo, Kondo Hiroki, Tomiyama Yohei, Shimada Toshiki, Bun Masayuki, Kuriyama Kohji
Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan.
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
J Exp Orthop. 2023 Apr 20;10(1):48. doi: 10.1186/s40634-023-00611-1.
Ultrasound-guided supraclavicular brachial plexus block (SCBPB) is performed by surgeons for upper limb anesthesia; however, certain patients need additional local anesthesia. This study aimed to identify risk factors for additional local anesthetic injection requirements.
In total, 269 patients receiving ultrasound-guided SCBPB were enrolled. Patient age, sex, body mass index, anesthetic drug dose, surgeon expertise (hand surgeon or resident), tourniquet time, comorbidities (diabetes mellitus and mental disorders), and preoperative blood pressure representing anxiety were compared between the additional local anesthesia and no additional local anesthesia groups matched for background using propensity scores. Receiver operating characteristic analysis was performed to determine risk factor cut-off values with the highest predictive potential.
Of 269 patients, 41 (15.2%) required additional intraoperative local anesthesia. Among surgical sites, elbow surgery showed the highest prevalence of the need for additional local anesthesia (17/41, 41%). A high body mass index and high systolic blood pressure before surgery were identified as risk factors for additional intraoperative local anesthesia requirement. Furthermore, systolic blood pressure > 170 mmHg (area under the curve, 0.66) predicted the need for intraoperative local anesthesia with 36% sensitivity, 89% specificity, 37.5% positive predictive value, and 88.6% negative predictive value. The median systolic blood pressure was significantly greater in patients requiring additional local anesthesia than in those not requiring it [151 (139-171) mmHg vs. 145 (127-155) mmHg; P = 0.026].
Elbow surgery, obesity, and high systolic blood pressure (> 170 mmHg) before surgery are predictive of additional intraoperative local anesthesia requirement.
Prognostic Level III.
超声引导下锁骨上臂丛神经阻滞（SCBPB）由外科医生实施用于上肢麻醉；然而，某些患者需要额外的局部麻醉。本研究旨在确定额外局部麻醉注射需求的危险因素。
总共纳入了269例接受超声引导下SCBPB的患者。使用倾向评分在背景匹配的额外局部麻醉组和无额外局部麻醉组之间比较患者的年龄、性别、体重指数、麻醉药物剂量、外科医生专业水平（手外科医生或住院医生）、止血带使用时间、合并症（糖尿病和精神障碍）以及代表焦虑程度的术前血压。进行受试者操作特征分析以确定具有最高预测潜力的危险因素截断值。
269例患者中，41例（15.2%）术中需要额外的局部麻醉。在手术部位中，肘部手术显示额外局部麻醉需求的发生率最高（17/41，41%）。高体重指数和术前高收缩压被确定为术中额外局部麻醉需求的危险因素。此外，收缩压>170 mmHg（曲线下面积，0.66）预测术中局部麻醉需求的敏感性为36%，特异性为89%，阳性预测值为37.5%，阴性预测值为88.6%。需要额外局部麻醉的患者的收缩压中位数显著高于不需要额外局部麻醉的患者[151（139 - 171）mmHg对145（127 - 155）mmHg；P = 0.026]。
肘部手术、肥胖和术前高收缩压（>170 mmHg）可预测术中额外局部麻醉需求。
预后III级。
