Seeberger M D, Urwyler A
Department of Anaesthesia, University of Basel, Kantonsspital, Switzerland.
Acta Anaesthesiol Scand. 1995 Aug;39(6):769-73. doi: 10.1111/j.1399-6576.1995.tb04168.x.
The goal of this prospective randomized study was to assess the extension of the "three-in-one" paravascular lumbar plexus block after femoral nerve stimulation and injection of 20 vs. 40 ml mepivacaine 10 mg/ml. Three-in-one blocks were achieved in 12 of 39 (31%) patients given 20 ml of 1% mepivacine (group 1), and 17 of 41 (41%) patients given 40 ml (Group 2) of the same solution (n.s.). The level of successful blockade at each nerve did not differ between groups. The femoral nerve was blocked in 92% vs. 93% of patients in groups 1 and 2, respectively; the obturator nerve in 62% vs. 78%; and the lateral cutaneous femoral nerve in 41% vs. 44%. We conclude that femoral nerve stimulation is effective in faciliating blockade in the femoral nerve but not the obturator or lateral cutaneous femoral nerve with the tested solution and volumes, and therefore not particularly effective for achieving complete 3-in-1 blockade. Within the clinically relevant range of 20-40 ml, the volume of mepivacaine 10 mg/ml does not appear to influence the extent of blockade.
这项前瞻性随机研究的目的是评估在股神经刺激后注射20毫升与40毫升10毫克/毫升甲哌卡因时“三合一”血管旁腰丛阻滞的范围。在给予20毫升1%甲哌卡因的39例患者中的12例（31%）（第1组）以及给予40毫升相同溶液的41例患者中的17例（41%）（第2组）实现了三合一阻滞（无显著差异）。两组之间每条神经的成功阻滞水平无差异。第1组和第2组分别有92%和93%的患者股神经被阻滞；闭孔神经分别为62%和78%；股外侧皮神经分别为41%和44%。我们得出结论，在所测试的溶液和容量下，股神经刺激有助于股神经的阻滞，但对闭孔神经或股外侧皮神经无效，因此对实现完全的三合一阻滞不是特别有效。在20 - 40毫升的临床相关范围内，10毫克/毫升甲哌卡因的容量似乎不影响阻滞范围。
