Marhofer P, Schrögendorfer K, Koinig H, Kapral S, Weinstabl C, Mayer N
Department of Anesthesiology and General Intensive Care Medicine, University of Vienna, Austria.
Anesth Analg. 1997 Oct;85(4):854-7. doi: 10.1097/00000539-199710000-00026.
The use of ultrasound reduces the onset time, improves the quality of sensory block, and minimizes the risks associated with the supraclavicular approach for brachial plexus and stellate ganglion blockade. The present study was designed to evaluate whether ultrasound also facilitates the approach for 3-in-1 blocks. Forty patients (ASA physical status II or III) undergoing hip surgery after trauma were randomly assigned to two groups. In the ultrasound (US) group, 20 mL bupivacaine 0.5% was administered under US guidance, whereas in the control group, the same amount and concentration of local anesthetic was administered with the assistance of a nerve stimulator (NS). After US- or NS-based identification of the femoral nerve, the local anesthetic solution was administered, and the distribution of the local anesthetic solution was visualized and recorded on videotape in the US group. The quality and the onset of the sensory block was assessed by using the pinprick test in the central sensory region of each of the three nerves and compared with the same stimulation on the contralateral leg every 10 min for 60 min. The rating was performed using a scale from 100% (uncompromised sensibility) to 0% (no sensory sensation). Heart rate, noninvasive blood pressure, and oxygen saturation were measured at short intervals for 60 min. The onset of sensory blockade was significantly shorter in Group US compared with Group NS (US 16 +/- 14 min, NS 27 +/- 16 min, P < 0.05). The quality of the sensory block after injection of the local anesthetic was also significantly better in Group US compared with Group NS (US 15% +/- 10% of initial value, NS 27% +/- 14% of initial value, P < 0.05). A good analgesic effect was achieved in 95% of the patients in the US group and in 85% of the patients in the NS group. In the US group, visualization of the cannula tip, the femoral nerve, the major vessels, and the local anesthetic spread was possible in 85% of patients. Incidental arterial puncture (n = 3) was observed only in the NS group. We conclude that an US-guided approach for 3-in-1 block reduces the onset time, improves the quality of the sensory block and minimizes the risks associated with this regional anesthetic technique.
The onset time and the quality of a regional anesthetic technique for the lower extremity is improved by ultrasonographic nerve identification compared with older techniques.
超声的使用可缩短起效时间，提高感觉阻滞质量，并将与锁骨上臂丛神经和星状神经节阻滞相关的风险降至最低。本研究旨在评估超声是否也有助于三合一阻滞的操作。40例（ASA身体状况II或III级）创伤后接受髋关节手术的患者被随机分为两组。在超声（US）组中，在超声引导下给予20 mL 0.5%布比卡因，而在对照组中，在神经刺激器（NS）辅助下给予相同剂量和浓度的局部麻醉药。在通过超声或神经刺激器识别股神经后，给予局部麻醉药溶液，并在超声组中通过录像观察并记录局部麻醉药溶液的分布情况。使用针刺试验在三条神经各自的中央感觉区域评估感觉阻滞的质量和起效情况，并在60分钟内每10分钟与对侧腿部相同刺激进行比较。使用从100%（感觉未受损）到0%（无感觉）的量表进行评分。在60分钟内短时间间隔测量心率、无创血压和血氧饱和度。与NS组相比，US组感觉阻滞的起效明显更短（US组1十六条1十四条分钟，NS组27十六条1十六条分钟，P < 0.05）。与NS组相比，US组注射局部麻醉药后感觉阻滞的质量也明显更好（US组为初始值的15%十六条10%，NS组为初始值的27%十六条14%，P < 0.05）。US组95%的患者和NS组85%的患者获得了良好的镇痛效果。在US组中，85%的患者能够看到套管尖端、股神经、主要血管和局部麻醉药的扩散情况。仅在NS组观察到意外动脉穿刺（n = 3）。我们得出结论，超声引导下的三合一阻滞操作可缩短起效时间，提高感觉阻滞质量，并将与这种区域麻醉技术相关的风险降至最低。
与传统技术相比，超声识别神经可改善下肢区域麻醉技术的起效时间和质量。
