Yamamoto K, Tsubokawa T, Ohmura S, Kobayashi T
Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Kanazawa University, Japan.
Reg Anesth Pain Med. 1999 Jan-Feb;24(1):36-42. doi: 10.1016/s1098-7339(99)90163-3.
Spread of local anesthetic solution in axillary brachial plexus block is thought to be influenced by the position of the arm and the use of compression maneuvers. We investigated how these two factors affected central local anesthetic spread and block quality.
Radiographic spread of local anesthetic was studied in 80 adult patients. They received mepivacaine mixed with contrast agent through an indwelling catheter with the arm abducted to either 0 or 90 degrees , and with or without local digital compression. Central and peripheral spread of the contrast agent was evaluated with anteroposterior radiographs of the axilla. Block quality was studied in a separate series of 70 adult patients. They received mepivacaine with the arm abducted 0 degrees or 90 degrees . The degree of sensory and motor block was assessed 20 minutes after the injection.
Arm position at 0 degrees abduction promoted central spread of the contrast agent. Although digital compression suppressed peripheral spread effectively, it did not improve the central spread of the solution. Sensory block was comparable in all terminal nerves of the arm in both arm positions, whereas motor block of the radial nerve was promoted with no abduction.
The central spread of local anesthetics is facilitated by injection without abduction of the arm but not by the use of compression at the injection site. This, however, did not alter the quality of the block.
局部麻醉药溶液在腋路臂丛神经阻滞中的扩散被认为受手臂位置和压迫手法使用的影响。我们研究了这两个因素如何影响局部麻醉药的中心扩散及阻滞质量。
对80例成年患者的局部麻醉药影像学扩散情况进行了研究。他们通过留置导管接受混有造影剂的甲哌卡因，手臂外展至0度或90度，且有无局部手指压迫。通过腋窝前后位X线片评估造影剂的中心和外周扩散情况。在另一组70例成年患者中研究阻滞质量。他们接受甲哌卡因，手臂外展0度或90度。注射后20分钟评估感觉和运动阻滞程度。
手臂外展0度的位置促进了造影剂的中心扩散。虽然手指压迫有效地抑制了外周扩散，但并未改善溶液的中心扩散。在两种手臂位置下，手臂所有终末神经的感觉阻滞相当，而桡神经的运动阻滞在无外展时更明显。
不使手臂外展进行注射可促进局部麻醉药的中心扩散，但在注射部位使用压迫手法则不能。然而，这并未改变阻滞质量。
