Shabani Majaliwa, Crespo Sophie, Raingeval Xavier
Health_unit, International Committee of the Red Cross, Bamako, Mali.
Health Unit, International Committee of the Red Cross, Geneva, Switzerland.
Local Reg Anesth. 2025 Jul 26;18:45-55. doi: 10.2147/LRA.S524347. eCollection 2025.
Regional anesthesia for upper extremity surgery in weapon-wounded patients is challenging, particularly in low-resource settings. Existing techniques often require multiple needle entries and ultrasound probe repositioning, increasing complexity and risk. There is a need for a simpler, effective technique providing complete anesthesia from the shoulder to the hand.
We developed a novel ultrasound-guided regional anesthesia technique-the Single-entry Selective Trunk Block (S-SeTB)-which targets the superior trunk (ST), middle trunk (MT), and C8 ventral ramus (C8VR) with local anesthetic diffusion to the inferior trunk (IT). The procedure uses one skin entry point to deliver three injections and is combined with a superficial cervical plexus (SCP) block using the same entry and ultrasound plane. Over 600 procedures were performed in field hospitals operated by the International Committee of the Red Cross, with observations documented.
The S-SeTB consistently achieved full anesthesia of the upper extremity, including the shoulder and clavicle, without the need for conversion to general anesthesia. The technique was well tolerated and effective in complex trauma cases. No major complications were reported. Compared to conventional selective trunk blocks or hybrid brachial plexus approaches, the S-SeTB required lower anesthetic volumes (20-25 mL) and demonstrated reduced procedural complexity and risks (eg, pneumothorax, vascular puncture).
The S-SeTB, combined with SCP and intercostobrachial nerve blocks, offers a reliable, resource-efficient, and safer alternative to traditional brachial plexus block techniques. It is particularly well-suited for austere environments where anesthesia resources and safety margins are limited. Further prospective studies are ongoing to evaluate block dynamics and confirm efficacy.
为武器伤患者进行上肢手术的区域麻醉具有挑战性，尤其是在资源匮乏的环境中。现有技术通常需要多次进针和重新定位超声探头，增加了操作的复杂性和风险。需要一种更简单、有效的技术，能提供从肩部到手部的完全麻醉。
我们开发了一种新型超声引导区域麻醉技术——单入路选择性干阻滞（S-SeTB），该技术以局部麻醉药扩散至下干（IT）的方式，靶向臂丛上干（ST）、中干（MT）和C8前支（C8VR）。该操作使用一个皮肤进针点进行三次注射，并结合使用相同进针点和超声平面的颈浅丛（SCP）阻滞。在红十字国际委员会运营的野战医院进行了600多例手术，并记录了观察结果。
S-SeTB始终能实现上肢包括肩部和锁骨的完全麻醉，无需转为全身麻醉。该技术在复杂创伤病例中耐受性良好且有效。未报告重大并发症。与传统选择性干阻滞或混合臂丛阻滞方法相比，S-SeTB所需麻醉药量更低（20 - 25 mL），且操作复杂性和风险（如气胸、血管穿刺）降低。
S-SeTB联合SCP阻滞和肋间臂神经阻滞，为传统臂丛阻滞技术提供了一种可靠、资源高效且更安全的替代方法。它特别适用于麻醉资源和安全边际有限的严峻环境。正在进行进一步的前瞻性研究以评估阻滞动态并确认疗效。
