Jochum D, Roedel R, Gleyze P, Balliet J M
Service d'anesthésie-réanimation, clinique du Diaconat, Colmar, France.
Ann Fr Anesth Reanim. 1997;16(2):114-9. doi: 10.1016/s0750-7658(97)87191-2.
To determine the relationship between minimal stimulating current and success rate of interscalene brachial plexus block (IBPB), to assess the quality of anaesthesia and postoperative analgesia, and to evaluate the benefits and drawbacks of this technique in shoulder surgery.
Prospective study of a continuous series of clinical cases.
Series of 167 patients undergoing shoulder surgery under IBPB, obtained with Winnie's technique, in 1995.
The plexus was located with a nerve stimulator and an insulated needle, 25 mm long and with a short 30 degrees bevel (Stimuplex, Braun). Data were collected with questionnaires, filled in by the anaesthetists, the surgeon and patients.
Shoulder surgery was performed either under IBPB alone in 51.5% of cases (group A), or under IBPB associated with sedation (midazolam: 1-3 mg) in 31.7% (group B), or under IBPB associated with general anaesthesia either on the patient's request (11.4% = group C) or due to IBPB failure (5.4% = group D). The success rate was 94.6% and the efficiency of postoperative analgesia obtained in 100% of cases (no pain at admission in the recovery room). For the nerve location a minimal stimulating current of 0.08 to 1 mA (mean minimal stimulating current 0.42 +/- 0.17 mA) had been required, with a significant difference (P = 0.0001) between group A (0.38 +/- 0.14 mA) and the others (0.43 +/- 0.15 mA in group B, 0.50 +/- 0.21 mA in group C, 0.59 +/- 0.23 mA in group D).
The correlation between minimal stimulating current and success rate has clearly shown the benefit of the nerve stimulation. IBPB, which provides a successful and efficient anaesthesia with minimal risk and satisfactory postoperative analgesia, has become the standard technique for shoulder surgery.
确定最小刺激电流与肌间沟臂丛神经阻滞（IBPB）成功率之间的关系，评估麻醉质量和术后镇痛效果，并评价该技术在肩部手术中的利弊。
对一系列连续临床病例的前瞻性研究。
1995年采用温妮技术接受IBPB下肩部手术的167例患者。
使用神经刺激器和一根25毫米长、带有30度短斜面的绝缘针（Stimuplex，贝朗）定位神经丛。数据通过麻醉医生、外科医生和患者填写的问卷收集。
51.5%的病例仅在IBPB下进行肩部手术（A组），31.7%在IBPB联合镇静（咪达唑仑：1 - 3毫克）下进行（B组），11.4%因患者要求（C组）或因IBPB失败（5.4% = D组）在IBPB联合全身麻醉下进行。成功率为94.6%，100%的病例获得了有效的术后镇痛（恢复室入院时无疼痛）。神经定位时所需的最小刺激电流为0.08至1毫安（平均最小刺激电流0.42±0.17毫安），A组（0.38±0.14毫安）与其他组（B组0.43±0.15毫安、C组0.50±0. twenty - one毫安、D组0.59±0.23毫安）之间存在显著差异（P = 0.0001）。
最小刺激电流与成功率之间的相关性清楚地显示了神经刺激的益处。IBPB提供了成功且有效的麻醉，风险最小且术后镇痛效果令人满意，已成为肩部手术的标准技术。
