三角肌运动反应用于小儿经肌间沟臂丛神经阻滞的临床观察

目的为三角肌运动反应作为在外周神经刺激器定位下小儿经肌间沟臂丛神经阻滞终点的临床应用提供参考。方法60例拟行上肢手术患儿,在外周神经刺激器定位下行经肌间沟臂丛神经阻滞,随机分为3组:A组(20例),三角肌运动反应终点组;B组(20例),肱二头肌运动反应终点组;C组(20例),三角肌和肱二头肌运动反应终点组。比较各组在刺激域电流、获得终点时间、合作患儿运动阻滞起效时间及神经阻滞效果的差异。结果组间刺激域电流、运动阻滞起效时间、神经阻滞效果差异无统计学意义(P>0.05);A、B组获得终点时间大于C组(P<0.05)。结论三角肌运动反应终点可以作为小儿经肌间沟臂丛神经阻滞穿刺针正确定位的标志。     

神经刺激器辅助肌间沟臂丛阻滞在锁骨手术中的临床应用

目的比较传统的异感法和外周神经刺激器法在锁骨手术时的麻醉效果。方法 60例锁骨手术的患者随机分为传统肌间沟组（A组）和神经刺激器（PNS）组（B组）,每组各30例。A组以传统异感法定位行肌间沟臂丛神经阻滞,再行颈浅丛神经阻滞;B组以PNS定位行肌间沟臂丛神经阻滞,再同A组行颈浅丛神经阻滞。局麻药为1%利多卡因＋0.375%罗哌卡因混合液,臂丛阻滞剂量为20～30 ml,颈浅丛阻滞剂量为5ml,记录并比较两组麻醉起效维持时间、麻醉效果、辅助用药、不良反应。结果 B组感觉消失时间（T1）、运动消失时间（T2）短于A组（P〈0.05）,镇痛时间（T3）、运动阻滞时间（T4）长于A组（P〈0.05）,B组麻醉效果优于A组。结论肌间沟臂丛神经阻滞复合颈浅丛阻滞可以满足锁骨手术麻醉需要,PNS辅助肌间沟臂丛神经阻滞能提高臂丛阻滞效果,延长术后镇痛时间。     

等剂量不同浓度罗哌卡因用于臂丛神经阻滞效果及血药浓度观察

目的探讨罗哌卡因用于肌间沟臂丛神经阻滞效果与血药浓度的关系。方法择期行上肢骨科手术患者60例,随机均分为三组,罗哌卡因150 mg分别配成20 ml(0.75%,A组)、30 ml(0.5%,B组)和40 ml(0.375%,C组),神经刺激仪定位行肌间沟臂丛神经阻滞。观察感觉、运动阻滞情况;高效液相法测定注药后10、15、20、30、60、90、120 min静脉血罗哌卡因浓度。结果感觉和运动阻滞起效时间均为A组相似文献   

1%甲哌卡因与0.5%罗哌卡因用于肌间沟臂丛神经阻滞锁骨骨折术中的比较

目的观察1%甲哌卡因与0.5%罗哌卡因用于肌间沟臂丛神经阻滞锁骨骨折术中麻醉效果的比较。方法择期行肌间沟臂丛神经阻滞锁骨骨折成年患者30例,ASAⅠ~Ⅱ级,随机分为2组(n=15);1%甲哌卡因组(M组)和0.5%罗哌卡因组(R组)。两组均在神经刺激仪引导下,以肌间沟入路行臂丛神经阻滞,M组和R组分别注入1%甲哌卡因25 mL和0.5%罗哌卡因25 mL。观察两组血流动力学,感觉、运动阻滞起效及恢复时间,术后VAS评分,不良反应及麻醉满意度。结果与R组比较,M组感觉、运动阻滞起效时间缩短,阻滞恢复时间缩短(P0.05),术后6 h、12 h的VAS评分增加(P0.05)。结论 1%甲哌卡因与0.5%罗哌卡因行肌间沟臂丛神经阻滞,均能满足锁骨骨折手术。采用1%甲哌卡因较0.5%罗哌卡因起效更快,且感觉、运动恢复更早,利于早期活动,但术后镇痛效果不如0.5%罗哌卡因。     

改良式肌间沟臂丛神经阻滞麻醉的临床观察

目的:观察和分析改良式肌间沟臂丛神经阻滞麻醉的效果。方法:80例前臂和手部手术患者,随机分为2组。第1组(40例)采用改良式肌间沟阻滞。第2组(40例)采用传统的肌间沟阻滞法,两组使用的局麻药量和浓度相同。分别记录其麻醉起效时间,阻滞完善时间。根据尺神经、桡神经、正中神经、腋神经和肌皮神经的阻滞情况评定麻醉效果,观察记录可能出现的并发症。结果:采用改良式肌间沟阻滞麻醉的麻醉效果明显优于肌间沟阻滞麻醉,P<0.01。结论:改良式肌间沟臂丛神经阻滞的麻醉效果明显,臂丛神经阻滞完善,运动阻滞效果好。     

改良臂丛阻滞在手部手术应用的可行性

目的：观察改良臂丛阻滞在手部手术的应用效果。方法180例拟行手部手术的患者，随机分成E、F组，每组9b例。E组采用肌间沟、外加腕部正中神经、尺神经阻滞；F组为对照组，行肌间沟阻滞加腋路阻滞。比较两组患者感觉、运动神经阻滞起效及维持时间，有无局麻药毒性反应，麻醉效果评定（按完全、基本完全、部分阻滞和失败4级标准评定）。结果感觉、运动阻滞维持时间两组间差异无显著性（ P〉0．05），E组感觉、运动阻滞起效时间快于F组（P〈0．05），局麻药毒性反应E组少于F组（P〈0．01），E组阻潍效果完全率高于F组（P〈0．01）。结论肌间沟阻滞加腕部正中神经、尺神经阻滞，麻醉起效时间迅速，效果完全，局麻药毒性反应少，是手部手术较理想的麻醉方法。     

小儿经肌间沟臂丛神经阻滞刺激域电流分析

目的在外周神经刺激器(PNS)定位下小儿经肌间沟臂丛神经阻滞中,对刺激域电流进行分析。方法 78例拟行上肢手术患儿,PNS 定位下行经肌间沟臂从神经阻滞,根据刺激域电流对样本行 Q 型分层聚类分析,比较类间性别、年龄、体重、身高、刺激域电流、获得终点时间及神经阻滞效果。结果将样本分成2类:第1类35例,刺激域电流范围0.38～0.50 mA;第2类43例,刺激域电流范围0.20～0.37 mA。类间刺激域电流差异有统计学意义(P<0.05)。结论在 PNS 定位下小儿经肌间沟臂从神经阻滞中,刺激域电流在0.20～0.50 mA 范围内,可获得满意的神经阻滞。     

甲磺酸罗哌卡因和盐酸罗哌卡因肌间沟臂丛神经阻滞的比较

目的 观察0.596%甲磺酸罗哌卡因和0.5%盐酸罗哌卡因在超声引导下行肌间沟臂丛神经阻滞的效果.方法 60例上肢手术行肌间沟臂丛麻醉的患者,随机均分成两组:A组给予0.596%甲磺酸罗哌卡因30 ml;B组给予0.5%盐酸罗哌卡因30 ml.比较两组感觉及运动阻滞起效时间、阻滞程度、运动恢复时间、镇痛持续时间和不良反应.结果 A组尺神经感觉阻滞起效时间显著快于B组[(38.30±14.65)min vs.(48.03±22.34)min](P<0.05).注药60 min A组尺神经感觉完全阻滞29例(96.7%),显著多于B组的20例(66.7%)(P<0.05).结论 0.596%甲磺酸罗哌卡因的尺神经感觉阻滞优于0.5%盐酸罗哌卡因.     

超声引导肌间沟臂丛神经阻滞的临床应用

目的 比较超声引导联合神经刺激器(US)定位与单纯神经刺激器(NS)定位行肌间沟臂丛神经阻滞的效果及安全性.方法 选择拟行上肢手术的患者40例,ASA Ⅰ或Ⅱ级,随机均分为US组和NS组.两组均给予0.5%的罗哌卡因30ml.记录寻找目标神经所需时间和完成操作所需时间、感觉神经阻滞起效和持续时间;评价各神经支配区域的感觉阻滞程度、手术区域麻醉效果(优、良、失败);观察并记录并发症.结果 US组完成操作所需时间(3.7±1.1)min,明显短于NS组的(7.2±3.5)min(P<0.01).US组感觉阻滞起效时间(12.0±2.4)min,明显快于NS组(15.2±3.0)min(P<0.05).麻醉效果优等率US组为85%,NS组为70%,差异无统计学意义.US组未出现并发症;NS组有3例患者出现与神经阻滞相关的并发症.结论 超声引导下行肌间沟臂丛神经阻滞操作时间短,阻滞起效快,效果好,并发症少.     

三种常用定位方法肌间沟臂丛阻滞的比较

目的 比较筋膜突破(facial pop,FP)、异感(paresthesia,PAR)、外周神经刺激(peripheral nerve stimulation,PNS)3种定位法应用于肌间沟臂丛阻滞的临床效果以及局麻药在臂丛鞘内的分布与扩散状况.方法 90例拟行上肢手术的患者,采用随机数字表法分为筋膜突破组(FP组)、异感组(PAR组)和外周神经刺激组(PNS组),每组30例.评估感觉和运动神经的阻滞程度、手术过程中的麻醉效果,观察和记录并发症的发生情况,每组6例行C_4～T_3的横断面及注药侧肌问沟的冠、矢状面计算机体层摄影(computed tomography,CT).结果 3组患者中腋神经、肌皮神经、正中神经、桡神经的感觉及运动评分差异均无统计学意义;前臂内侧皮神经的感觉评分和尺神经的感觉及运动评分FP组明显高于PAR组(P<0.05)和PNS组(P<0.01),PAR组明显高于PNS组(P<0.05);损伤血管发生率PAR组明显高于FP组(P<0.01)和PNS组(P<0.05). CT结果显示局麻药在臂从鞘内呈不均匀扩散,仅在肌间沟水平似乎有鞘的特征,其以下有明显的分隔及囊袋,并有伪足.PNS组的总体麻醉效果高于FP组(P<0.05);尺侧手术麻醉效果FP组低于PAR组(P<0.05)和PNS组(P<0.01).结论 上臂及前臂桡侧手术采用3种定位均可,但FP法更安全简便;偏向尺侧的手术宜采用PAR或PNS定位法,以PNS定位为佳.     

Successful interscalene block with a nerve stimulator may also result after a pectoralis major motor response

BACKGROUND AND OBJECTIVES: Interscalene block of the brachial plexus is a well-established anesthetic and analgesia technique for shoulder surgery. The endpoint for successful block using the nerve stimulator has been described by previous authors as a bicep motor response (twitch) and recently by a deltoid motor response. This retrospective observational case study of regular clinical practice examined the efficacy of using the pectoralis major motor response as an endpoint for a successful block. METHODS: A total of 120 patients who were scheduled for elective ambulatory shoulder surgery were retrospectively studied. All interscalene blocks were performed with aid of a nerve stimulator. Patients were categorized into 3 groups of 40 patients. Group 1 (biceps twitch), group 2 (deltoid twitch), and group 3 (pectoralis major twitch) were compared on success of the block. This retrospective study was conducted by reviewing interscalene block data sheets from the last 40 patients consecutively receiving interscalene block from either a bicep, deltoid, or pectoralis major motor response. A successful block was defined by the inability of the patient to raise their arm against gravity 20 minutes after injection of the local anesthetic. RESULTS: Pectoralis major motor response as an endpoint for local anesthetic injection was examined. Of 40 patients studied in this group, 38/40 were judged successful. This was comparable to the success rate in biceps (38/40 successful) and deltoid groups (37/40 successful). CONCLUSIONS: This retrospective observational case study of regular clinical practice suggests that a pectoralis major motor response can be a satisfactory endpoint for interscalene block.     

Interscalene block with a nerve stimulator: a deltoid motor response is a satisfactory endpoint for successful block

BACKGROUND AND OBJECTIVES: The interscalene brachial plexus block (ISB) is an effective and well-established anesthetic technique for shoulder surgery. Using nerve stimulation as an aid in block placement, a motor response (twitch) in the biceps or a more distal upper limb muscle has been recommended to indicate accurate needle placement. Our clinical experience, as well as anatomic reasoning, suggests that a deltoid twitch may be just as effective as one in the biceps for predicting successful block. This prospective clinical study was undertaken to compare a deltoid with a biceps twitch with respect to onset and success of motor block. METHODS: A total of 160 patients scheduled for shoulder surgery were studied prospectively. Interscalene blocks were performed using neurostimulation according to our standard technique. Twitches of the deltoid or biceps or both, whichever appeared first, were accepted and used as the endpoint for needle placement and injection of local anesthetic. Motor block success, i.e., patient inability to lift the arm against gravity, and minutes to motor block onset were recorded. RESULTS: There was 1 failed motor block in the deltoid group and none in the other groups (not a statistically significant difference). When the same local anesthetic was used, there were no statistically significant differences in onset times between the biceps, deltoid, or biceps/deltoid groups. CONCLUSIONS: A deltoid twitch is as effective as a biceps twitch in determining accurate needle placement for ISB and in predicting successful motor block. Acceptance of a deltoid twitch during ISB eliminates the need for further probing and may translate into better patient acceptance and in a smaller risk of needle-induced nerve damage.     

对臂丛神经节前损伤后行神经移位肌内种植术的评价

对移位神经肌内种植术治疗臂丛节前损伤的疗效作一评价。方法：１９９０年间共手术治疗臂丛神经损伤３０２例。其中１０例，术中发现不仅臂丛神经根性撕脱，而且神经远瑞缺损；选用膈、副、肋间、颈丛运动支作为移位神经，经神经移植种植于三角肌５块，肱二头肌４块，肱三头肌１块，胸大肌１块。术后４年进行随访，检测其有关肌肉肌力的恢复程度。结果：肌力恢复２度６块，１度３块，０度２块。结论：该法的治疗效果欠佳，有待进一步提高     

Analgesic effect of interscalene block using low-dose bupivacaine for outpatient arthroscopic shoulder surgery

Background and Objectives. Although interscalene brachial plexus block (ISBPB) is often used to provide anesthesia for arthroscopic shoulder surgery, its selective analgesic effect, provided by low-dose local anesthetic, has not been studied. We hypothesized that ISBPB using a low volume and low concentration of bupivacaine can provide effective postoperative analgesia for shoulder surgery without producing significant sensory or motor block elsewhere. Methods. In this double-blind study, 30 outpatients scheduled to undergo shoulder arthroscopy were randomly assigned to receive either an ISBPB with 10 mL 0.125% bupivacaine with epinephrine 1:400,000 (n = 15) or 10 mL of normal saline (n = 15). The block was performed preoperative, prior to a standardized general anesthetic. Postoperative pain scores, morphine and oral analgesic consumption, recovery profile, and patient satisfaction were recorded. Results. In the ISBPB group, verbal analog pain scores within 120 minutes after surgery were lower, morphine consumption in the postanesthesia care unit was significantly lower (2.7 ± 2.6 mg vs 9.5 ± 5.2 mg), the time to postoperative administration of the first systemic or oral analgesic was significantly longer (141 ± 182 minutes vs 13 ± 10 minutes), the degree of motor and sensory block 120 minutes after surgery was minimal, time to reach hospital discharge criteria was earlier, and patient satisfaction with postoperative analgesia at 24-hour follow-up was greater. Thirty-three percent of the patients receiving ISBPB did not require any analgesic prior to hospital discharge. Conclusions. Interscalene brachial plexus block with low-dose bupivacaine is a useful and selective analgesic technique for outpatient shoulder arthroscopic surgery.     

A low approach to interscalene brachial plexus block results in more distal spread of sensory-motor coverage compared to the conventional approach

A low approach to the interscalene block (LISB) deposits local anesthetic farther caudad on the brachial plexus compared with the conventional interscalene block (ISB). We compared the efficacy of LISB and ISB in achieving anesthesia of the distal extremity in 254 patients having upper extremity surgery. The most frequent elicited motor response was the deltoid for ISB and wrist for LISB. There was significantly greater sensory-motor block of regions below the elbow with the LISB compared with ISB (P < 0.001 for both sensory and motor coverage). Our data indicate that LISB results in a higher incidence of distal elicited motor response and greater sensory-motor blockage of the wrist and hand.     

A comparison of proximal and distal radial nerve motor responses in axillary block using triple stimulation

BACKGROUND AND OBJECTIVES: Stimulation of the radial nerve at the axilla may cause either a proximal movement (forearm extension) or distal movements (supination, wrist or finger extension). In the most recent studies on axillary block, only a distal twitch was accepted as valid. However, this approach was based only on clinical experience. The aim of this study was to verify if a proximal motor response can be considered a satisfactory endpoint. METHODS: This was a prospective, randomized, double-blinded study. One hundred fifty patients received a triple-injection axillary brachial plexus block in which the radial nerve was located by a proximal (group PROX) or a distal motor response (group DIST). Patients were assessed for sensory and motor block of the branches of the radial nerve by a blinded investigator at 5-minute intervals over 30 minutes. RESULTS: An 81% success rate for anesthetizing the sensory distal branches of the radial nerve was seen in group PROX; a significantly higher success rate was recorded in group DIST (95%). The onset time of sensory block for the distal branches of the radial nerve was significantly shorter in group DIST (9.9 +/- 6 v 15.4 +/- 7 minutes). The time to perform the block was slightly shorter and the localization of the nerve simpler in group PROX. The overall block success rate was not significantly different in the 2 groups. CONCLUSIONS: Local anesthetic injection at the proximal radial twitch significantly reduces the efficacy and prolongs the onset time of the radial nerve block. Searching for distal response is significantly more difficult and time consuming than searching for proximal response. However, it does not significantly increase patient discomfort or adverse effects.     

Electrostimulation with or without ultrasound-guidance in interscalene brachial plexus block for shoulder surgery

In a prospective controlled trial to compare conventional interscalene brachial plexus block (ISBPB) using anatomic landmarks and electro-stimulation with a combined technique of ultrasound guidance followed by nerve stimulation, 60 patients were randomized into 2 matched equal groups: Group A using nerve stimulation (NS) alone and Group B using the combination of ultrasound and NS. The time to detect the plexus (3.9 ± 4 min in Group A and 3.3 ± 1.4 min in Group B) was not significantly different. We needed to reposition the needle once (n = 13) or twice (n = 4) in Group B. First-shot motor response was achieved in all but one patient in Group A; here we were only able to locate the plexus by use of ultrasound. None of the patients needed general anaesthesia. There were no significant differences between postoperative pain, motor power, or patient’s satisfaction. ISBPB seems similarly effective using electro-stimulation and ultrasound if performed by experienced anesthesiologists.