Martin R, Dumais R, Cinq-Mars S, Tétrault J P
Département d'Anesthésie-Réanimation, Université de Sherbrooke, Province du Québec, Canada.
Ann Fr Anesth Reanim. 1993;12(3):229-32. doi: 10.1016/s0750-7658(05)80645-8.
The influence of the volume of local anaesthetic solution on axillary blockade was investigated in a prospective randomized double-blind study including 120 patients presenting for upper limb surgery. A peripheral nerve stimulator was used to carry out the axillary block with a multiple injection technique. The musculocutaneous, radial, median and ulnar nerves were routinely stimulated. Four criteria were monitored: quality of sensory blockade, degree of motor blockade, time of onset and duration of anaesthesia. The patients were randomly allocated into two groups (n = 60 each). In the first, patients received 25 ml per m2 of body surface area of carbonated 1% lignocaine, 0.25% bupivacaine or a 1 to 1 mixture of both. Patients in the other group were given the same amount of local anaesthetic in half the volume, i.e. 12.5 ml.m-2 of carbonated 2% lignocaine, 0.5% bupivacaine or a 1 to 1 mixture of both these. Adrenaline (1 in 400,000) was added to half the anaesthetic solutions used in each group. The data demonstrated that, for a same amount of local anaesthetic, the larger volumes provided better quality sensory blockade than the smaller ones (p < 0.03). However, the volume of solution used affected neither the time of onset nor the duration of anaesthesia, nor the degree of motor blockade. It is concluded that, despite the use of a neurostimulator and simultaneous infiltration of several nerve trunks, the volume required to ensure a reliable degree of sensory block with the technique of axillary block is comprised between 40 and 50 ml (25 ml.m-2).
在一项前瞻性随机双盲研究中，对120例接受上肢手术的患者进行了局部麻醉溶液体积对腋路阻滞影响的研究。使用外周神经刺激器采用多点注射技术进行腋路阻滞。常规刺激肌皮神经、桡神经、正中神经和尺神经。监测四项指标：感觉阻滞质量、运动阻滞程度、起效时间和麻醉持续时间。患者被随机分为两组（每组n = 60）。第一组患者每平方米体表面积接受25 ml的碳酸化1%利多卡因、0.25%布比卡因或两者1:1的混合液。另一组患者接受相同量但体积减半的局部麻醉剂，即每平方米12.5 ml的碳酸化2%利多卡因、0.5%布比卡因或两者1:1的混合液。每组使用的半数麻醉溶液中添加了肾上腺素（1:400,000）。数据表明，对于相同量的局部麻醉剂，较大体积的溶液比较小体积的溶液提供了更好的感觉阻滞质量（p < 0.03）。然而，所用溶液的体积既不影响起效时间也不影响麻醉持续时间，也不影响运动阻滞程度。得出的结论是，尽管使用了神经刺激器并同时对多条神经干进行浸润，但采用腋路阻滞技术确保可靠感觉阻滞程度所需的体积在40至50 ml（每平方米25 ml）之间。
