Mangal Vandana, Meena Chandrashekhar, Meena Khushboo, Singh Chitra, Mistry Tuhin, Rathore Monika
Anesthesiology, Sawai Man Singh Medical College, Jaipur, IND.
Anesthesiology and Perioperative Care, Ganga Medical Center & Hospitals Pvt Ltd., Coimbatore, IND.
Cureus. 2023 Nov 18;15(11):e49018. doi: 10.7759/cureus.49018. eCollection 2023 Nov.
Background This study investigated the success rate of ultrasonography (USG)-guided supraclavicular block using a single-point injection technique comparing it with multiple-point injection technique, in terms of nerve sparing, time taken to perform the procedure, time taken to onset of sensory and motor block. Materials and methods A total of 204 patients of American Society of Anesthesiologists (ASA) Status I and II, aged 18-60 years, with body mass index (BMI) ≤30 kg/m, posted for upper limb surgeries were given USG-guided supraclavicular brachial plexus block with 15 mL of 0.5% Ropivacaine. The patients were randomly divided into group A (single-point injection) and group B (multiple-point injection), using an out-of-plane technique. Sensory and motor block was assessed for onset and maximum grade achieved, by using pinprick, cold, touch, and movement respectively. The efficacy of the block was tested by assessment in the territories of musculocutaneous, ulnar, radial, median, axillary, and intercostobrachial nerves. Procedural time was calculated from the insertion of the needle till the complete injection of the drug. Results Patients in both groups were comparable in terms of demography and ASA status. The success rate for group A was 60.8%, compared to 98% in group B. In group B, the intercostobrachial nerve was most commonly spared (7.84%), followed by ulnar (1.96%), and radial (0.98%). On the other hand, in group A, the most frequently spared nerves were ulnar and intercostobrachial (23.5% each), followed by radial (12.7%), axillary (10.8%), musculocutaneous (7.8%), and median nerves (6.9%). The onset of sensory and motor block was similar in both groups. The procedure time was longer in the multiple-point group. Conclusion Our observations suggest that nerve sparing is much lesser in the multiple-point injection technique used for USG-guided supraclavicular block. In a good number of patients using this technique, the intercostobrachial nerve gets blocked.
背景 本研究调查了超声引导下锁骨上阻滞采用单点注射技术与多点注射技术的成功率，比较了两者在神经保留、操作所需时间、感觉和运动阻滞起效时间方面的差异。
材料与方法 共有204例美国麻醉医师协会（ASA）分级为Ⅰ级和Ⅱ级、年龄在18至60岁、体重指数（BMI）≤30kg/m²、拟行上肢手术的患者接受了超声引导下锁骨上臂丛神经阻滞，使用15ml 0.5%罗哌卡因。采用平面外技术将患者随机分为A组（单点注射）和B组（多点注射）。分别通过针刺、冷觉、触觉和运动评估感觉和运动阻滞的起效情况及达到的最大分级。通过对肌皮神经、尺神经、桡神经、正中神经、腋神经和肋间臂神经支配区域的评估来测试阻滞效果。操作时间从进针到药物完全注射完毕进行计算。
结果 两组患者在人口统计学和ASA分级方面具有可比性。A组成功率为60.8%，而B组为98%。在B组中，肋间臂神经最常被保留（7.84%），其次是尺神经（1.96%）和桡神经（0.98%）。另一方面，在A组中，最常被保留的神经是尺神经和肋间臂神经（各23.5%），其次是桡神经（12.7%）、腋神经（10.8%）、肌皮神经（7.8%）和正中神经（6.9%）。两组感觉和运动阻滞的起效情况相似。多点注射组的操作时间更长。
结论 我们的观察结果表明，超声引导下锁骨上阻滞采用的多点注射技术在神经保留方面要少得多。在大量使用该技术的患者中，肋间臂神经会被阻滞。
