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腋前线锯齿肌平面阻滞作为一种麻醉肋间臂神经以进行上臂动静脉内瘘创建手术的新方法——三例报告

Axillary serratus anterior plane block as a novel approach to anesthetizing the intercostobrachial nerve for upper arm arteriovenous fistula creation surgery -three case reports.

作者信息

Chan Chi Ho, Lim Jia Yin, Mathews Abey M V

机构信息

Department of Anesthesiology, Sengkang General Hospital, Singapore.

出版信息

Korean J Anesthesiol. 2025 Jun;78(3):279-284. doi: 10.4097/kja.24893. Epub 2025 Mar 6.

DOI:10.4097/kja.24893
PMID:40049147
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12142488/
Abstract

BACKGROUND

Current regional anesthesia techniques used to anesthetize the intercostobrachial nerve (ICBN) for upper arm surgery either lack reliability or have increased procedural risks. Safer and more reliable regional anesthetic techniques are required to block the ICBN effectively. Here, we introduce a novel "axillary serratus anterior plane (A-SAP) block" for anesthetizing the ICBN to allow surgical anesthesia for upper arm arteriovenous fistula (UA-AVF) creation.

CASES

We present 3 cases involving a 79-year-old Chinese male, a 73-year-old Malay female, and a 38-year-old Chinese male, in which the A-SAP block was utilized in UA-AVF creation surgeries. In all 3 cases, the A-SAP block was performed in combination with a supraclavicular brachial plexus block. None of the patients required local anesthetic supplementation intraoperatively.

CONCLUSIONS

The A-SAP block reliably and safely anesthetized the ICBN for UA-AVF creation surgery and is a reliable alternative to higher-risk block techniques, such as paravertebral block or neuraxial block.

摘要

背景

目前用于上臂手术中麻醉肋间臂神经（ICBN）的区域麻醉技术要么缺乏可靠性，要么手术风险增加。需要更安全、更可靠的区域麻醉技术来有效阻滞ICBN。在此，我们介绍一种新型的“腋前线平面（A-SAP）阻滞”，用于麻醉ICBN，以便在上臂动静脉内瘘（UA-AVF）创建手术中实现手术麻醉。

病例

我们报告3例病例，分别为一名79岁中国男性、一名73岁马来女性和一名38岁中国男性，在UA-AVF创建手术中采用了A-SAP阻滞。在所有3例病例中，A-SAP阻滞均与锁骨上臂丛阻滞联合进行。所有患者术中均无需补充局部麻醉药。

结论

A-SAP阻滞在上臂动静脉内瘘创建手术中能可靠、安全地麻醉肋间臂神经，是椎旁阻滞或神经轴阻滞等高风险阻滞技术的可靠替代方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97ad/12142488/9965dddca4d0/kja-24893f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97ad/12142488/8a635fce8f2d/kja-24893f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97ad/12142488/9965dddca4d0/kja-24893f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97ad/12142488/8a635fce8f2d/kja-24893f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97ad/12142488/9965dddca4d0/kja-24893f2.jpg

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引用本文的文献

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Comment on "Axillary serratus anterior plane block as a novel approach to anesthetizing the intercostobrachial nerve for upper arm arteriovenous fistula creation surgery -three case reports-".关于《腋前线锯齿肌平面阻滞作为一种在上臂动静脉内瘘创建手术中麻醉肋间臂神经的新方法——三例报告》的评论
Korean J Anesthesiol. 2025 Aug;78(4):396-397. doi: 10.4097/kja.25252. Epub 2025 May 2.
2
Response to "Comment on Axillary serratus anterior plane block as a novel approach to anesthetizing the intercostobrachial nerve for upper arm arteriovenous fistula creation surgery -three case reports-".对《关于腋前锯肌平面阻滞作为一种在上臂动静脉内瘘创建手术中麻醉肋间臂神经的新方法——三例报告》的评论的回应
Korean J Anesthesiol. 2025 Aug;78(4):397-398. doi: 10.4097/kja.25275. Epub 2025 May 2.

本文引用的文献

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Beyond the Brachial Plexus: Reapplication of the Thoracic Paravertebral Block for Upper Arm Fistula Surgery.超越臂丛神经：胸椎旁阻滞在肱动脉内瘘手术中的再次应用
Cureus. 2023 Aug 2;15(8):e42863. doi: 10.7759/cureus.42863. eCollection 2023 Aug.
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Reg Anesth Pain Med. 2020 Nov;45(11):853-859. doi: 10.1136/rapm-2020-101783. Epub 2020 Sep 14.
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Reg Anesth Pain Med. 2019 Aug 26. doi: 10.1136/rapm-2019-100689.
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Serratus Plane Block: A Cadaveric Study to Evaluate Optimal Injectate Spread.锯肌平面阻滞：评估最佳注射剂扩散的尸体研究。
Reg Anesth Pain Med. 2018 Nov;43(8):854-858. doi: 10.1097/AAP.0000000000000848.
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Ultrasound-Guided Selective Versus Conventional Block of the Medial Brachial Cutaneous and the Intercostobrachial Nerves: A Randomized Clinical Trial.超声引导下选择性与常规肱二头肌皮神经和肋间臂神经阻滞：一项随机临床试验。
Reg Anesth Pain Med. 2018 Nov;43(8):832-837. doi: 10.1097/AAP.0000000000000823.
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JA Clin Rep. 2018;4(1):10. doi: 10.1186/s40981-018-0147-4. Epub 2018 Jan 22.
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Adding a PECS II block for proximal arm arteriovenous access - a randomised study.添加 PECS II 块以建立近端上肢动静脉通路 - 一项随机研究。
Acta Anaesthesiol Scand. 2018 May;62(5):677-686. doi: 10.1111/aas.13073. Epub 2018 Jan 22.
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