Wu T J, Lin S Y, Liu C C, Chang H C, Lin C C
Department of Anesthesiology, Taipei Municipal Chung-Shiao Hospital.
Ma Zui Xue Za Zhi. 1993 Jun;31(2):83-6.
Infraclavicular approach to the brachial plexus provides adequate anesthesia of the entire arm. Local anesthetics can be deposited over cords and branches of brachial plexus above the formation of musculocutaneous and axillary nerves. The approach can also easily block ulnar segment of medial cord and intercostobrachial nerve, which helps preventing tourniquet pain. However, distance to the plexus is deeper than the other approaches so that current blind method using anatomical landmarks requires anesthesiologists' delicate manipulation and experience. Through ultrasonography, the location of subclavian artery, as an anatomical landmark, can be easily identified. It is then very easy and safe to perform infraclavicular brachial plexus block. Our new method showed 89% (n = 9) successful rate. The time for the block was 4.2 +/- 1.5 min and there was an average of 3.2 +/- 0.6 needle penetrations. Thirty three percent (n = 3) had subclavian artery been punctured without formation of hematoma clinically. No patient had clinical postoperative pneumothorax.
锁骨下臂丛神经阻滞法可为整个手臂提供充分的麻醉。局部麻醉药可注射在肌皮神经和腋神经形成上方的臂丛神经束和分支上。该方法还可轻松阻滞内侧束的尺侧段和肋间臂神经，有助于预防止血带疼痛。然而，与其他方法相比，该方法距神经丛的深度更深，因此目前使用解剖标志的盲法需要麻醉医生进行精细操作并具备经验。通过超声检查，可轻松识别作为解剖标志的锁骨下动脉的位置。然后进行锁骨下臂丛神经阻滞就非常容易且安全。我们的新方法成功率为89%（n = 9）。阻滞时间为4.2 +/- 1.5分钟，平均进针3.2 +/- 0.6次。33%（n = 3）的患者锁骨下动脉被穿刺，但临床上未形成血肿。无患者术后出现临床气胸。
