Samerchua Artid, Supphapipat Kittitorn, Leurcharusmee Prangmalee, Lapisatepun Panuwat, Thammasupapong Pornpailin, Lorsomradee Sratwadee
Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Reg Anesth Pain Med. 2024 Oct 24. doi: 10.1136/rapm-2024-105973.
Ultrasound-guided proximal and distal approaches of the intercostobrachial nerve (ICBN) blocks facilitate analgesia for upper arm and axillary surgery, though success rates vary and lack clinical comparison. This study compared their anesthetic and analgesic efficacy as an adjunct to the supraclavicular brachial plexus block for upper arm arteriovenous access surgery.
60 end-stage renal disease patients undergoing upper arm arteriovenous access were randomly assigned to receive either proximal or distal ICBN block using 10 mL of a mixture of levobupivacaine and lidocaine with epinephrine. The primary outcome was a successful ICBN block, defined as a cutaneous sensory blockade at both the medial upper arm and axilla 30 min after the block. Secondary outcomes included block performance, block-related complications, rate of surgical anesthesia, and postoperative analgesia.
The proximal approach had a higher percentage of sensory blockade at the axilla (96.7% vs 73.3%, p=0.03), but comparable rates at the medial upper arm (96.7% vs 96.7%, p=1.00). Consequently, the proximal approach had a higher overall success rate (96.7% vs 73.3%, difference: 23.3%; 95% CI: 6.3%, 40.4%; p=0.03). Both groups had similar surgical anesthesia rates of 93.3%. No significant differences were found in performance time, procedural pain, or postoperative pain intensity.
Proximal ICBN block consistently reduced sensation in the medial upper arm and axilla, while one-quarter of distal blocks spared the axilla. Both approaches, in combination with a supraclavicular brachial plexus block, were effective for upper arm arteriovenous access procedures. However, the proximal approach may be preferable for axillary surgery.
TCTR20200730006.
超声引导下肋间臂神经（ICBN）近端和远端阻滞有助于上臂和腋窝手术的镇痛，尽管成功率有所不同且缺乏临床比较。本研究比较了它们作为锁骨上臂丛神经阻滞辅助手段用于上臂动静脉通路手术的麻醉和镇痛效果。
60例接受上臂动静脉通路手术的终末期肾病患者被随机分配，使用10毫升左旋布比卡因、利多卡因与肾上腺素的混合液接受ICBN近端或远端阻滞。主要结局是ICBN阻滞成功，定义为阻滞后30分钟上臂内侧和腋窝均出现皮肤感觉阻滞。次要结局包括阻滞操作、阻滞相关并发症、手术麻醉率和术后镇痛情况。
近端阻滞方法在腋窝的感觉阻滞百分比更高（96.7%对73.3%，p = 0.03），但在上臂内侧的阻滞率相当（96.7%对96.7%，p = 1.00）。因此，近端阻滞方法的总体成功率更高（96.7%对73.3%，差值：23.3%；95%可信区间：6.3%，40.4%；p = 0.03）。两组的手术麻醉率均为93.3%。在操作时间、操作疼痛或术后疼痛强度方面未发现显著差异。
ICBN近端阻滞持续降低上臂内侧和腋窝的感觉，而四分之一的远端阻滞未累及腋窝。两种方法与锁骨上臂丛神经阻滞联合使用时，对上臂动静脉通路手术均有效。然而，近端阻滞方法可能更适合腋窝手术。
TCTR20200730006。
