Selander D, Edshage S, Wolff T
Acta Anaesthesiol Scand. 1979 Feb;23(1):27-33. doi: 10.1111/j.1399-6576.1979.tb01417.x.
Seeking paresthesiae when performing a peripheral nerve block may increase the risk of post-anesthetic neurological sequelae. To test this hypothesis, we prospectively followed two groups of patients who underwent hand surgery with an axillary block. In one group, the axillary plexus was located by actively seeking paresthesiae; in the other, pulsations of the axillary artery indicated an adequate position of the injection needle. Mepivacaine 10 mg/ml, with or without adrenaline, was used. The study included 533 patients, 290 in the paresthesia group and 243 in the artery group. Although unintentional, paresthesiae were elicited in 40% of patients in the artery group. Postanesthetic nerve lesions were seen in ten patients, eight in the paresthesia group and two in the artery group, all of whom had been blocked by mepivacaine with adrenaline. Symptoms varied between light paresthesiae lasting a few weeks, and severe paresthesiae, ache and paresis lasting more than 1 year. The etiology suspected was needle and perhaps injection trauma to the nerves during blocking. We conclude that whenever possible nerve blocks should be performed without searching for paresthesiae.
在进行周围神经阻滞时寻找感觉异常可能会增加麻醉后神经后遗症的风险。为了验证这一假设，我们前瞻性地跟踪了两组接受腋路阻滞手部手术的患者。一组通过主动寻找感觉异常来定位腋神经丛；另一组则通过腋动脉搏动来确定注射针的合适位置。使用了含或不含肾上腺素的10mg/ml甲哌卡因。该研究纳入了533例患者，感觉异常组290例，动脉组243例。尽管是无意的，但动脉组40%的患者引出了感觉异常。10例患者出现了麻醉后神经损伤，感觉异常组8例，动脉组2例，所有这些患者均接受了含肾上腺素的甲哌卡因阻滞。症状从持续数周的轻度感觉异常到持续超过1年的严重感觉异常、疼痛和轻瘫不等。怀疑的病因是阻滞过程中针以及可能的注射对神经造成的创伤。我们得出结论，只要有可能，神经阻滞应在不寻找感觉异常的情况下进行。
