Trivedi Saurabh, Gupta Srishti, Bhardwaj Hemendra, Sahoo Tapan Kumar, Gupta Seema, Trivedi Gaurav
Department of Anaesthesia and Critical Care, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India.
Department of Emergency Medicine, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India.
Indian J Anaesth. 2023 Sep;67(9):778-784. doi: 10.4103/ija.ija_45_23. Epub 2023 Sep 6.
The incidence of ulnar nerve sparing has declined with the corner-pocket approach of the supraclavicular block (SCB), however, it continues to persist. A recent technique of SCB, the intertruncal approach, separately blocks each trunk of the brachial plexus. Thus, we hypothesised that the intertruncal approach results in a complete ulnar nerve blockade.
Eighty-eight patients were randomised to undergo SCB using an ultrasound (USG)-guided corner-pocket or intertruncal approach and were compared primarily regarding the complete sensory and motor blockade of the ulnar nerve and all four nerves (ulnar, radial, median and musculocutaneous nerves) at 15 min. Secondary objectives included time required for block performance, patient discomfort score, time to readiness for surgery and duration of sensory blockade of the ulnar nerve. Continous data were compared using an independent -test, and categorical data were compared using the Chi-square test.
The proportion of participants with complete sensory (30/44 vs. 14/44, < 0.001) and complete motor (22/44 vs. 7/44, < 0.001) blocks in the ulnar nerve and all four nerves at 15 min was significantly higher in the intertruncal group. Block performance time and patient discomfort score were higher in the intertruncal group ( < 0.001). The total duration of sensory blockade in the ulnar nerve was more in the corner-pocket group ( < 0.001).
USG-guided intertruncal approach is superior to the corner-pocket approach of SCB regarding a complete ulnar nerve blockade.
锁骨上阻滞（SCB）的角袋法导致尺神经保留的发生率有所下降，然而，这种情况仍持续存在。SCB的一种最新技术——干间入路，可分别阻滞臂丛神经的每一束。因此，我们推测干间入路可实现完全的尺神经阻滞。
88例患者被随机分为两组，分别接受超声（USG）引导下的角袋法或干间入路进行SCB，并主要比较两组在15分钟时尺神经以及所有四条神经（尺神经、桡神经、正中神经和肌皮神经）的完全感觉和运动阻滞情况。次要目标包括阻滞操作所需时间、患者不适评分、手术准备就绪时间以及尺神经感觉阻滞的持续时间。连续数据采用独立样本t检验进行比较，分类数据采用卡方检验进行比较。
在15分钟时，干间入路组尺神经和所有四条神经完全感觉阻滞（30/44 vs. 14/44，P<0.001）和完全运动阻滞（22/44 vs. 7/44，P<0.001）的参与者比例显著更高。干间入路组的阻滞操作时间和患者不适评分更高（P<0.001）。角袋法组尺神经感觉阻滞的总持续时间更长（P<0.001）。
在完全尺神经阻滞方面，超声引导下的干间入路优于锁骨上阻滞的角袋法。
