超声引导下臂丛神经阻滞在上肢手术中的应用

目的观察超声引导下臂丛神经阻滞在上肢手术中的应用效果。方法 40例急诊或择期行上肢或手部手术的患者,ASAⅠ~Ⅲ级,随机均分为超声引导组(US组)和传统解剖定位组(NS组),两组均合并使用神经刺激器,局麻药均为0.4%罗哌卡因,US组为30 ml,NS组为40 ml。观察两组麻醉操作完成时间、感觉阻滞起效时间、运动起效时间、感觉恢复时间、运动恢复时间。结果 US组麻醉完成时间、感觉阻滞起效时间、运动阻滞起效时间明显短于NS组(P<0.05或P<0.01)。结论超声引导合并神经刺激器行臂丛神经阻滞可缩短麻醉完成时间,减少局麻药用药量,延长麻醉作用时间,减少并发症的发生。     

超声引导下臂丛神经阻滞在上肢手术中的临床观察和经验

目的　研究超声引导臂丛神经阻滞相对于传统盲探下臂丛神经阻滞的优越性和实践经验。方法　选取我院采用超声引导臂丛神经阻滞上肢手术20例（超声引导组）,同时选择同期采用盲探异感法臂丛神经阻滞（盲探臂丛阻滞组）20例,比较两组患者各生理指标、生命体征变化、神经阻滞效应和并发症。结果　超声引导组患者的麻醉起效时间、镇痛维持时间、成功率均优于盲探臂丛阻滞组,两组比较差异有统计学意义（P<0.05）;盲探臂丛阻滞组的并发症高于超声引导组,但其差异没有统计学意义（P>0.05）。结论　超声引导下臂丛神经阻滞有助于使麻药准确注入至最佳位置,提高麻醉质量。     

超声引导喙突处锁骨下臂丛神经阻滞与逆行锁骨下臂丛神经阻滞的比较

目的 比较超声引导喙突处锁骨下臂丛神经阻滞与逆行锁骨下臂丛神经阻滞的临床麻醉效果.方法 拟行前臂或手部手术患者60例,随机分为两组,分别行超声引导下喙突处锁骨下臂丛神经阻滞(观察组)和超声引导逆行锁骨下臂丛神经阻滞(对照组),每组30例.记录麻醉成功率、麻醉操作时间、持续时间及并发症发生例数、各臂丛神经的起效时间.结果 对照组尺神经、前臂内侧皮神经起效时间较观察组短(P＜0.05).对照组有5例Homer's综合征,1例误入血管.结论 超声引导喙突处锁骨下臂丛神经阻滞和逆行锁骨下臂丛神经阻滞均是可行有效的区域麻醉方法.     

超声引导下臂丛神经再次阻滞在长时间上肢骨科手术中的应用

目的探讨超声引导下臂丛神经再次阻滞在长时间上肢骨科手术中的应用。方法将90例行长时间上肢骨科手术患者随机分三组,每组30例,首次麻醉为神经刺激仪引导下臂丛神经阻滞,再次麻醉时随机分为神经刺激组、超声引导下神经阻滞组和全麻组。记录再次麻醉后、术毕、术后4小时和术后6小时的VAS评分及并发症情况。结果再次麻醉后超声引导组、全麻组术中麻醉效果优于神经刺激组,比较差异有统计学意义(P0.05);术后4、6小时超声引导组术后镇痛的效果优于全麻组和神经刺激组,比较差异有统计学意义(P0.05),麻醉后并发症比较超声组和全麻组优于神经阻滞组,比较差异有统计学意义(P0.05)。结论超声引导下臂丛神经再次阻滞在长时间上肢骨科手术中尤为适用,是一种安全、有效的临床技术,值得临床推广应用     

超声引导下臂丛神经阻滞麻醉的应用

临床上肢手术多采用区域阻滞麻醉方式,而臂丛神经阻滞是最主要的麻醉方法.传统的臂丛神经区域阻滞法,依据体表的解剖标志进行穿刺定位,属于盲探式操作,成功率较低,且易损伤血管、神经而引起严重的并发症.近年,利用可视超声显像技术,可直观地分辨出局部解剖结构,在其引导下可将穿刺针准确地置于臂丛神经旁,使局部麻醉药得以充分地浸润靶神经[1],可保证一举成功.我们自2009年将此技术应用于肌间沟臂丛神经阻滞麻醉,取得良好效果. 一、临床资料 行上肢整形手术患者50例,其中上臂手术11例,前臂手术16例,手部手术23例,全部患者依据美国麻醉医师协会(American Societyof Anesthesiologists,ASA)分级均为Ⅰ、Ⅱ级[2].年龄18～55岁,体质量40～85 kg,无神经系统疾患,无肝、肾功能不全,颈部进针部位无感染病灶.随机将患者平均分为超声引导组(US组)和传统解剖定位组(NS组)两组.     

超声引导下肋锁间隙和喙突入路锁骨下臂丛神经阻滞在前臂或手部术中效果的比较

目的比较超声引导下肋锁间隙(CCS)臂丛神经阻滞与超声引导下喙突入路锁骨下臂丛神经阻滞在前臂或手部术中临床麻醉效果。方法选取拟行前臂或手部手术患者58例,男33例,女25例,年龄18~70岁,ASAⅠ~Ⅲ级,随机分为超声引导下CCS臂丛神经阻滞组(A组)和超声引导下喙突入路锁骨下臂丛神经阻滞组(B组)。分别给予0.5%罗哌卡因20 ml,记录臂丛神经深度,神经阻滞操作时间,注射局麻药后5、10、20、30 min臂丛神经分支(正中神经、尺神经、桡神经、肌皮神经)感觉阻滞和运动阻滞情况,神经阻滞持续时间,以及麻醉相关不良反应等。结果 A组臂丛神经深度(2.0±1.2)cm,明显浅于B组(3.5±1.8)cm(P0.05);A组神经阻滞操作时间(2.0±1.5)min,明显短于B组(4.0±1.5)min(P0.05);注射局麻药后5、10 min A组正中神经、尺神经、桡神经、肌皮神经的感觉阻滞率均明显高于B组(P0.05);注药后10 min A组尺神经、桡神经、肌皮神经的运动阻滞率明显高于B组(P0.05),其余时点两组运动阻滞率差异无统计学意义。两组无一例呼吸困难、恶心呕吐、耳鸣等不良反应。结论超声引导下肋锁间隙臂丛神经阻滞较喙突入路锁骨下臂丛神经阻滞深度浅,神经阻滞穿刺操作时间更短,其感觉阻滞和运动阻滞起效更快。     

超声引导臂丛麻醉在锁骨内固定术的应用

[目的]探讨超声引导臂丛麻醉在锁骨内固定术中的应用.[方法]将57例锁骨骨折患者按术中麻醉方法不同分为超声组(采用超声引导进行臂丛麻醉,30例)和传统组(采用臂丛联合颈浅丛神经阻滞麻醉,27例).比较两组患者实施麻醉一般指标、手术区域阻滞效果、术中疼痛程度、肌松效果及患者满意度.[结果]超声组在操作时间、起效时间、恢复...     

超声引导下肌间沟联合腋路臂丛神经阻滞麻醉效果的临床研究

目的探讨超声引导下肌间沟联合腋路臂丛神经阻滞麻醉的效果与安全性。方法随机将48例拟在超声引导下行臂丛麻醉的上肢手术患者分为2组,各24例。M组使用0.5%的罗哌卡因30 m L行单纯肌间沟臂丛阻滞;U组各使用0.5%的罗哌卡因15 mL行肌间沟联合腋路臂丛阻滞。行腋路臂丛阻滞时,各用5 mL局麻药依次注射在尺神经、正中神经和桡神经周围。记录2组神经阻滞操作时间,评估2组主要神经的痛觉阻滞情况、运动阻滞程度。评价麻醉效果,记录操作相关并发症。结果注药30 min后,U组正中神经、尺神经完全阻滞例数显著多于M组,2、3、4、5级运动阻滞程度均显著高于M组,麻醉效果优良率(100%)显著高于M组(75.0%),差异均有统计学意义(P0.05)。M组发生Horner综合征2例、声音嘶哑1例,U组未发生相关并发症。结论超声引导下肌间沟联合腋路臂丛神经阻滞麻醉用于上肢手术,安全可行,麻醉效果良好。     

不同注药方法在超声引导下肌间沟臂丛神经阻滞中的临床观察

目的比较多点注射和单点注射用于超声引导下肌间沟臂丛神经阻滞中的麻醉效果。方法选取2018年7月至2019年7月于本院行肩关节镜手术患者共计80例。使用随机数字表法将患者随机分为D组和Y组,每组各40例。D组采用超声引导下肌间沟臂丛多点注射法,Y组采用超声引导下肌间沟臂丛单点注射法。结果在麻醉作用方面,D组在感觉、运动阻滞起效时间上明显快于Y组(P0.001),并且在持续时间上长于Y组(P0.05),两组差异具有统计学意义。在操作所需时间上D组长于Y组,差异具有统计学意义(P0.001)。D组在麻醉效果上优于Y组,差异具有统计学意义(P0.05)。两组患者与麻醉相关的并发症发生情况差异不大,不存在统计学意义。结论多点注射用于超声引导下肌间沟臂丛神经阻滞可使麻醉效果起效快,持续时间久,患者满意度高,可供临床麻醉医生参考使用。     

低浓度罗哌卡因两种给药途径在肌腱粘连松解术中疗效比较

目的探讨低浓度罗哌卡因两种给药途径在臂丛神经阻滞麻醉后感觉与运动分离疗效差异,评价低浓度罗哌卡因臂丛神经阻滞在屈肌腱粘连松解手术中的应用价值。方法 2008年3月-2012年3月,对76例肌腱粘连患者,随机分为两组,36例低浓度(0.15%20 mL)罗哌卡因在超声引导下用于臂丛神经阻滞麻醉(A组);40例低浓度(0.15%20 mL)罗哌卡因按传统方法用于臂丛神经阻滞麻醉(B组)。麻醉阻滞完成后采取VAS评分、Bromage改良法和肌力Lovett分级记录两组平均起效时间、感觉和运动阻滞情况,并在术中通过松解手指的主动活动来判断肌腱松解效果。结果 A组起效时间明显短于B组(P0.05),A组感觉神经阻滞时间长于B组(P0.05);两组注药后10min,30min,1h的VAS评分,A组明显低于B组(P0.05),运动神经阻滞A组与B组比较无统计学意义(P0.05)。结论低浓度罗哌卡因超声引导给药途径较传统给药途径麻醉后产生感觉与运动分离效果好,可有效地判断术中屈肌腱松解的效果,为手术医师提供一定的参考。     

Ultrasound‐guided catheterisation of the subclavian vein: freehand vs needle‐guided technique

The objective of this prospective, randomised study was to examine the impact of a multi‐angle needle guide for ultrasound‐guided, in‐plane, central venous catheter placement in the subclavian vein. One hundred and sixty patients were randomly allocated to two groups, freehand or needle‐guided, and then 159 catheterisations were analysed. Cannulation of the first examined access site was successful in 96.9% of cases with no significant difference between groups. There were three arterial punctures and no other severe injuries. Catheter misplacements did not differ between the groups. Higher success rates within the first and second attempts in the needle‐guided group were observed (p = 0.041 and p = 0.019, respectively). Use of the needle guide reduced the access time from a median (IQR [range]) of 30 (18–76 [6–1409]) s to 16 (10–30 [4–295]) s; p = 0.0001, and increased needle visibility from 31.8% (9.7%–52.2% [0–96.67]) to 86.2% (62.5%–100% [0–100]); p < 0.0001. A multi‐angle needle guide significantly improved aligning the needle and ultrasound plane compared with the freehand technique when cannulating the subclavian vein. Use of the guide resulted in faster access times and increased success at the first and second attempts.     

改良喙突入路臂丛神经阻滞的效果观察

目的 观察改良喙突人路臂丛神经阻滞的可行性.方法 60例ASA Ⅰ或Ⅱ级上肢手术患者随机均分为喙突法组(A组)和腋路法组(B组),A组在喙突尖向内下2 cm处绝缘针垂直于皮肤进入,B组取腋动脉上方搏动最强处进针.将神经刺激仪设置为电流1 mA、频率2 Hz.当电流减小到0.3 mA时仍可见到正中、尺、桡神经任一神经支配区肌肉颤搐时,固定刺激针,回吸无血后注入0.5%罗哌卡因 1%利多卡因混合液30 ml.比较两组的人针深度、止血带痛发生率、感觉及运动阻滞的成功率及时间.结果 A组人针深度明显深于B组(P＜0.05).A组止血带痛发生率明显短于B组(P＜0.05).A组中正中、桡、肌皮、腋、臂内侧皮神经感觉完全阻滞的成功率明显高于B组(P＜0.05),桡、肌皮、腋神经感觉达到完全阻滞的时间也明显短于B组(P＜0.01).A组运动完全阻滞的成功率明显高于B组(P＜0.05),达到最大运动阻滞的时间也明显短于B组(P＜0.01).结论 改良喙突人路法臂丛操作简便,阻滞成功率高,阻滞效果好.     

Facilitating needle alignment in-plane to an ultrasound beam using a portable laser unit

OBJECTIVE: Ultrasound guidance can increase success with peripheral nerve blocks. Accurate anesthetic injection is optimized with both clear visualization and fine adjustment of the needle tip at the target area. Good needle alignment with the ultrasound beam and using a freehand technique are both desirable for these conditions. The purpose of this report is to describe how a unique, in-plane laser guide may be used to improve the alignment of injection needles with ultrasound beams in order to promote best needle tip visualization. ILLUSTRATION IMAGES: By using a small, battery-operated laser unit mounted onto an ultrasound transducer, a method to align the ultrasound scanning plane and laser-line projection plane was developed. Such alignment was further demonstrated and illustrated in a water bath model. Ultrasound was then used to show how clearly the needle shaft and tip can be visualized after needle alignment to the ultrasound beam using the laser line shining on the shaft of the needle. CONCLUSION: This in vitro demonstration describes the potential use of a readily available laser-line unit to assist with in-plane needle alignment with the ultrasound plane in order to ultimately improve needle visibility during ultrasound-guided peripheral nerve block. It requires minimum specialized training and may allow for maximum flexibility with freehand needle insertions in a sterile fashion.     

Novel 3D ultrasound system for midline single-operator epidurals: a feasibility study on a porcine model

BackgroundWe developed a real-time 3D ultrasound thick slice rendering technique and innovative Epiguide needle-guide as an adjunct to single-operator midline epidural needle insertions. Study goals were to determine feasibility of the technique in a porcine model and compare the visibility of standard and echogenic needles.MethodsThirty-four lumbar needle insertions were performed on six intact porcine spines ex vivo. Ultrasound scanning identified the insertion site and, using an Epiguide, the needle was guided into the epidural space through the ligamentum flavum in the midline plane, watched in real-time on the 3D ultrasound. Entry into the epidural space was judged by a loss-of-resistance technique. Needle visibility was rated by the anesthesiologist performing the technique using a 4-point scale; (0=cannot see, 1=poor, 2=satisfactory, 3=excellent), and later by an independent assessor viewing screenshots. The procedure was repeated at all lumbar levels using either the standard or echogenic needle.ResultsSuccessful loss-of-resistance to fluid was achieved in 76% of needle insertions; needle visibility with echogenic needles (94.2% rated satisfactory/excellent) was significantly better than with standard needles (29.4% satisfactory/excellent, P <0.0001). Successful loss-of-resistance was 93% when mean needle visibility was rated as ‘excellent’. Inter-observer agreement between assessors was ‘near-perfect’ (weighted kappa=0.83).ConclusionIt is feasible to perform 3D ultrasound-guided real-time single-operator midline epidural insertions, in a porcine model. Echogenic needles were found to consistently improve needle visibility; and improved needle visibility tended to increase successful entry into epidural space.     

Ultrasound visibility of needles used for regional nerve block: an in vitro study

BACKGROUND AND OBJECTIVES: Ultrasound visibility of regional block needles is a critical component for safety and success of regional anesthetic procedures. The aim of the study was to formally assess factors that influence ultrasound visibility of needles used in regional anesthesia. METHODS: Regional block needles between 17- and 22-G diameter were inserted in a tissue equivalent phantom at angles from 0 degrees to 65 degrees relative to the phantom surface. For visibility enhancement, the needles were primed with air or water in combination with stylets and different size guide wires. Ultrasound measurements of needle tips and shafts were performed using transversal and longitudinal imaging with a linear 15-MHz transducer. Univariate and multivariate statistical analyses were performed on 719 visibility measurements. RESULTS: Hustead tip needles exhibited best ultrasound visibility. Ultrasound visibility of the needle tip was increased by insertion of a medium size guide wire. Water or air priming of the needle, insulation, and the insertion of a stylet did not influence needle visibility. Long axis imaging of the needle for shallow insertion angles (<30 degrees in relation to the phantom surface) and short-axis imaging for steep angles (>60 degrees ) provided the best ultrasound visibility of the needle tips. Needle visibility decreased linearly with steeper insertion angles ( P <.001) and smaller needle diameters ( P <.001). CONCLUSIONS: The results of our in-vitro study suggest a number of factors enhancing ultrasound visibility of regional block needles. The use of needles in the largest possible size inserted with a medium-size guide wire provides the best ultrasound visibility. Analysis of the approach angle favors needle insertion parallel to the transducer. The consideration of these factors may improve safety and success of ultrasound-guided regional blocks.     

Ultrasound characteristics of needles for regional anesthesia

BACKGROUND AND OBJECTIVES: Needle visibility is a crucial requirement for successful and safe ultrasound-guided peripheral nerve blocks. We performed a prospective study on the ultrasonic imaging quality of various commercially available needles. We tested the hypothesis that different nerve block needles would have different ultrasonic appearances. Furthermore, we examined the influence of needle angle with regard to the ultrasound plane, 2 types of media surrounding the needle, and the impact of 3 different ultrasound machines. METHODS: Twelve needles were prospectively tested for 3 ultrasound planes (longitudinal, axial tip, and axial shaft) at 2 different angles (0 degrees and 45 degrees). Quality of needle visibility and ultrasound scans were described by using 6 criteria (visibility score range 0-10): (1) visibility of needle; (2) visibility of surrounding media; (3) consistency of needle surface; (4) formation of artifacts; (5) degree of shadowing; and (6) detection and distinction of the needle from the surrounding media. Additionally, every ultrasound scan was performed in 2 media (water bath and animal model) with 3 ultrasound devices and evaluated by 2 investigators. Evaluation of the ultrasound scans was blinded with regard to needle but not to the ultrasound machine and media. RESULTS: In the animal model, visibility was good at 0 degrees (visibility score greater than 6) but was decreased for all needles at a 45 degree angle (criterion 6). In this setting, 2 needles were difficult to identify (score less than 3; criterion 6) and only 3 of 12 reached a score of 7 or more (criterion 6). Depiction quality for all 3 planes was significantly lower in the animal model when compared with the water bath (P < .001) and at an angle of 45 degrees when compared with 0 degrees (P < .001). There was no significant impact of the ultrasound machine on image quality. CONCLUSIONS: In a tissue-equivalent model we found significant differences among different types of needles at a 45 degree angle. In clinical use, angles between 30 degrees and 60 degrees are required. Because visibility of the needle is a keystone of ultrasound-guided peripheral nerve blocks, our results suggest the need to optimize the echogenicity of needles used for ultrasound-guided nerve blocks.     

Technique of renal biopsy by ultrasound guided percutaneous puncture with a spring loaded "gun".

The study consisted of 89 consecutive patients (mean age = 41.5, range = 16-82, 64 men, 25 women) referred for renal biopsy because of clinical suspicion of renal parenchymal disease. Neither transplant kidneys nor tumour evaluation were included. A biopsy "gun" (Biopty) and 14 (2.0 mm) and 18 (1.2 mm) gauge needles were used with ultrasound guidance. Sixtyseven renal biopsies were guided using a freehand technique 42 using a fixed angle guide attachment. The mean glomerular yield was 9.4 glomeruli. Almost 25% of the 18 gauge needle biopsies (n = 57) had to be repeated and 29.3% of the 14 gauge needle biopsies (n = 75). The yield difference was not statistically significant (Chi-squared = 0.37, p = 0.54). There was no statistically significant difference between the distributions of failure to obtain a significant material for evaluation caused by the biopsy technique used (Chi-squared = 0.08, p = 0.78). When analysing cases of single successful pass the thinner needle produced 6.7 glomeruli (n = 36, SD = 5.08) and the thicker needle 13.8 glomeruli (n = 18, SD = 6.82). No serious complications occurred.     

Dynamic ultrasound‐guided short‐axis needle tip navigation technique vs. landmark technique for difficult saphenous vein access in children: a randomised study

Dynamic ultrasound‐guided short‐axis needle tip navigation is a novel technique for vascular access. After venipuncture, the needle and catheter are further advanced within the vessel lumen under real‐time ultrasound guidance with constant visualisation of the needle tip in the short‐axis view. This can minimise the risk of transfixing the cannulated vessel. We compared two techniques for non‐visible saphenous vein cannulation under general anaesthesia in children weighing ≥ 3 kg and less than four years of age: dynamic ultrasound‐guided short‐axis needle tip navigation technique (ultrasound group) vs. landmark technique. Venous cannulation was performed by three experienced anaesthetists. The primary outcome measure was first‐attempt success rate. Success rate within 10 min was a secondary outcome. A total of 102 patients were randomly allocated to either the ultrasound group or the landmark group. First‐attempt success rate was 90% in the ultrasound group compared with 51% in the landmark group, p<0.001, difference 39%, 95% confidence interval (CI) of the difference 23–55%. Success rate within 10 min was 92% in the ultrasound group compared with 63% in the landmark group, p = 0.001, difference 29%, 95%CI of the difference 14–45%. We conclude that, when performed by experienced anaesthetists, the dynamic ultrasound‐guided short‐axis needle tip navigation technique improved non‐visible saphenous vein cannulation in children compared with the landmark technique.     

A prospective randomized study to compare ultrasound-guided with nonultrasound-guided double lumen internal jugular catheter insertion as a temporary hemodialysis access

Internal jugular venous catheters (IJVC) for hemodialysis are a commonly employed temporary vascular access for hemodialysis. Most hospitals still follow the use of blind technique, which uses anatomical landmarks. Even in the most experienced hands this procedure has a variable success rate. Ultrasound guidance can decrease the incidence of periprocedural complications and improve the success rate. In this randomized study we compared the procedure success rate and periprocedural complications in patients undergoing ultrasound guided vs. nonultrasound guided IJVC insertion for a temporary hemodialysis access. METHODS: All patients subjected to insertion of an IJVC between March 2004 and June 2004 were enrolled into the study, randomized to either the blind (group A) or ultrasound guided (group B) procedure, which uses a portable ordinary ultrasound machine without a needle guide. The aseptic Saldinger technique was used for catheterization in both the groups. Baseline characteristics of patient and periprocedural events were recorded. RESULTS: A total of 60 patients were randomized, 30 patients each in two groups. First attempt venous cannulation success rate was 56.7% in group A compared to 86.7% in group B. Chance of occurrence of adverse outcome was significantly more in the blind procedure (P=0.020). A post-procedure chest radiograph done in all patient showed no complications. CONCLUSION: Ultrasound guided procedure for internal jugular vein catheter insertion using an ordinary ultrasound machine was significantly safer and more successful as compared to the blind technique.     

Ultrasound‐guided needle handling using a guidance positioning system in a phantom

The SonixGPS? needle guidance positioning system provides navigation assistance to facilitate needle handling during ultrasound‐guided procedures. Each of 20 inexperienced nurse anaesthetists performed 12 different ultrasound‐guided tasks in a porcine phantom. Using both in‐plane and out‐of‐plane approaches, they inserted a needle and made contact with metal rods at depths of 2, 4 and 6 cm. We compared their performances without and with navigation as paired observations. Using the out‐of‐plane approach, navigation yielded shorter execution times (26 s vs 14 s, respectively; p = 0.01) and fewer needle repositionings (8 vs 3, respectively; p = 0.001). Using the in‐plane approach, the needle was more visible with navigation assistance: 24% vs 52% of execution time, respectively (95% CI: 44%–12%; p = 0.0025). Better needle visibility was associated with shorter execution times and fewer needle repositionings. Combining ultrasound‐guided techniques with the needle guidance positioning system may reduce tissue manipulation, thus improving patient comfort and safety.