Baytar Çağdaş, Köksal Bengü Gülhan
Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University Medicine Faculty, Zonguldak, Türkiye.
Ann Med. 2025 Dec;57(1):2451765. doi: 10.1080/07853890.2025.2451765. Epub 2025 Jan 11.
Although both the lateral sagittal and costoclavicular approaches are applied at the cord level in the infraclavicular region, there is a major difference between the distributions of the two approaches. We aimed to investigate the effects of this different distribution on tissue perfusion and oxygenation.
Sixty patients undergoing elective elbow, forearm, wrist and hand surgery under infraclavicular brachial plexus block were included in the study. Patients were divided into two groups: group CC (costoclavicular approach, = 30) and group LS (lateral sagittal approach, = 30). The primary outcomes of this study were increased perfusion index (PI) and tissue oxygen saturation (StO) rate. Secondary outcomes were the duration of block application, sensory and motor block onset time, time to first analgesic need and duration of motor block.
The PI and StO increased significantly from baseline to each time point in both groups; however, there were no significant differences between the groups. The time to reach the sensory block stage was shorter with the costoclavicular approach. The duration of block application was shorter when using the costoclavicular approach. There were no differences between the approaches in terms of the time to the first analgesic requirement or need for additional analgesics.
The different distributions of the two different approaches to infraclavicular brachial plexus block, costoclavicular and lateral sagittal, did not have an additional effect on tissue perfusion and oxygenation. Both approaches can be preferred especially in surgeries in which an increase in tissue perfusion is desired owing to perfusion-enhancing properties.
CLINICALTRIALS.GOV IDENTIFIER: NCT04764591.
尽管在锁骨下区域的臂丛神经水平均应用了外侧矢状径路和肋锁径路，但两种径路的分布存在显著差异。我们旨在研究这种不同分布对组织灌注和氧合的影响。
本研究纳入了60例行锁骨下臂丛神经阻滞的择期肘部、前臂、腕部和手部手术患者。患者分为两组：CC组（肋锁径路，n = 30）和LS组（外侧矢状径路，n = 30）。本研究的主要结局指标为灌注指数（PI）增加和组织氧饱和度（StO）率。次要结局指标为阻滞应用时间、感觉和运动阻滞起效时间、首次需要镇痛的时间以及运动阻滞持续时间。
两组从基线到各时间点PI和StO均显著增加；然而，两组之间无显著差异。肋锁径路达到感觉阻滞阶段的时间更短。使用肋锁径路时阻滞应用时间更短。在首次需要镇痛的时间或额外镇痛需求方面，两种径路之间无差异。
锁骨下臂丛神经阻滞的两种不同径路，即肋锁径路和外侧矢状径路的不同分布，对组织灌注和氧合没有额外影响。由于具有增强灌注的特性，在希望增加组织灌注的手术中，两种径路均可优先选择。
NCT04764591。
