Kaye Alan D, Upshaw William C, Holley Caroline, Bailey Paris D, Tassin Joseph P, Frolov Mark V, Sudini Sanjana, Miller Benjamin C, Palowsky Zachary R, Kataria Saurabh, Ahmadzadeh Shahab, Shekoohi Sahar, Robinson Christopher L
Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA.
Curr Pain Headache Rep. 2024 Dec 30;29(1):1. doi: 10.1007/s11916-024-01346-z.
Peripheral nerve blocks are performed using local anesthetics that are commonly performed prior to surgery to either be the sole anesthetic and/or for postoperative pain management. Interscalene blocks are a specific type of nerve block that targets the superior and middle trunks of the brachial plexus inhibiting transmission of pain signals from the upper extremities to the central nervous system making them useful in mitigating pain following surgeries involving the shoulder, upper arm, and elbow.
Previously, interscalene blocks were performed with a nerve stimulator, which is an instrument designed to generate a twitch in surrounding muscles to verify the anesthetic block was placed in the correct location. However, this approach with a nerve stimulator alone is being done less frequently as physicians now often employ ultrasound either by itself or in conjunction with a nerve stimulator to in the block. Several clinical studies have shown that the use of ultrasound leads to improved safety and effectiveness of the interscalene block as compared to performing the block using a nerve stimulator alone. Clinical studies comparing interscalene blocks done with ultrasound versus ultrasound in conjunction with a nerve stimulator have shown the combination to be slightly safer and more efficacious with reduced side effects, though the difference in these metrics between the two is small. Interscalene blocks are highly effective for postoperative pain related to shoulder and upper extremity surgeries. Ultrasound guided blocks are more effective with reduced adverse effects when compared to nerve stimulation alone. The combination of both ultrasound and nerve stimulation allows for increased efficacy and decreaed side effects in limited clinical investigations. Therefore, more studies are needed to further compare and determine best practice interscalene techniques for shoulder and upper extremity surgeries.
外周神经阻滞使用局部麻醉剂进行，通常在手术前实施，作为唯一的麻醉方式和/或用于术后疼痛管理。肌间沟阻滞是一种特定类型的神经阻滞，其目标是臂丛神经的上干和中干，抑制疼痛信号从上肢向中枢神经系统的传递，使其在减轻涉及肩部、上臂和肘部的手术后疼痛方面很有用。
以前，肌间沟阻滞是使用神经刺激器进行的，神经刺激器是一种旨在使周围肌肉产生抽搐以验证麻醉阻滞是否放置在正确位置的仪器。然而，现在医生单独使用神经刺激器进行这种方法的频率越来越低，因为他们现在经常单独使用超声或与神经刺激器结合使用超声来进行阻滞。几项临床研究表明，与仅使用神经刺激器进行阻滞相比，使用超声可提高肌间沟阻滞的安全性和有效性。比较超声引导下的肌间沟阻滞与超声结合神经刺激器进行的肌间沟阻滞的临床研究表明，两者结合使用稍微更安全、更有效，副作用更少，尽管两者在这些指标上的差异很小。肌间沟阻滞对于与肩部和上肢手术相关的术后疼痛非常有效。与单独的神经刺激相比，超声引导下的阻滞更有效，副作用更少。在有限的临床研究中，超声和神经刺激的结合可提高疗效并减少副作用。因此，需要更多的研究来进一步比较和确定用于肩部和上肢手术的最佳肌间沟技术实践。
