改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉的临床研究

Objective To study the feasibility of subclavicular brachial plexus block with localized puncture at the apex of the axilla.Methods 520 adult patients who underwent upper limb emergency surgery were randomly assigned to receive subclavicular brachial plexus block with localized puncture at the apex of the axilla ( experimental group) and block anesthesia with intraclavicular route ( control group).Patients in both groups received 0.375% ropivacaine, volume (40.0± 2.7)ml.During the 30 minutes after the blockade, the onset and effect of motor and sensory block, the sensory block effect of each nerve branches and integrated effect of nerve block were recorded.The VAS score and acesodyne duration with tourniquet were compared between the two groups at 2, 4, 6 and 8 hours after the drug had been used for 30 minutes.Results Within 30 minutes after the drug was delivered, the onset of motor and sensory block in the experimental group was evidently shorter than that in the control group, while the duration of motor and sensory block was evidently longer ( P ＜ 0.01).There were no statistically significant differences in motor and sensory block score, median nerve block effect and ulnar nerve block effect between the two groups.The musculocutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group ( P ＜ 0.05).After the drug had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the oontrol group ( P ＜0.01).The analgesia duration of tourniquet in the experimental group was significantly longer than that of the control group ( P ＜ 0.01 ).Conclusion The modified subclavicular brachial plexus block with localized puncture at the apex of the axilla can provide perfect blockade, satisfactory anesthetic effect and higher safety in upper limb surgery.     

改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉的临床研究

Objective To study the feasibility of subclavicular brachial plexus block with localized puncture at the apex of the axilla.Methods 520 adult patients who underwent upper limb emergency surgery were randomly assigned to receive subclavicular brachial plexus block with localized puncture at the apex of the axilla ( experimental group) and block anesthesia with intraclavicular route ( control group).Patients in both groups received 0.375% ropivacaine, volume (40.0± 2.7)ml.During the 30 minutes after the blockade, the onset and effect of motor and sensory block, the sensory block effect of each nerve branches and integrated effect of nerve block were recorded.The VAS score and acesodyne duration with tourniquet were compared between the two groups at 2, 4, 6 and 8 hours after the drug had been used for 30 minutes.Results Within 30 minutes after the drug was delivered, the onset of motor and sensory block in the experimental group was evidently shorter than that in the control group, while the duration of motor and sensory block was evidently longer ( P ＜ 0.01).There were no statistically significant differences in motor and sensory block score, median nerve block effect and ulnar nerve block effect between the two groups.The musculocutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group ( P ＜ 0.05).After the drug had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the oontrol group ( P ＜0.01).The analgesia duration of tourniquet in the experimental group was significantly longer than that of the control group ( P ＜ 0.01 ).Conclusion The modified subclavicular brachial plexus block with localized puncture at the apex of the axilla can provide perfect blockade, satisfactory anesthetic effect and higher safety in upper limb surgery.     

右美托咪啶对上肢手术患者罗哌卡因臂丛神经阻滞效果及上肢缺血再灌注损伤的影响

目的 探讨右美托咪啶对上肢手术患者臂丛神经阻滞及上肢缺血再灌注损伤的影响.方法 拟行腋路臂丛神经阻滞的上肢手术患者40例,性别不限,年龄18～55岁,体重45～80kg,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将患者随机分为2组(n=20),对照组(C组):神经阻滞用药为0.5%罗哌卡因30 ml;右美托咪啶组(D组):神经阻滞用药为0.5%罗哌卡因+右美托咪啶8 mg混合液30 ml.评价感觉阻滞和运动阻滞的效果,记录感觉阻滞和运动阻滞的起效时间和维持时间,于麻醉诱导前(T0)、松止血带后1、5和30 min(T1-3)时抽取术侧肘部静脉血样,测定血浆MDA和缺血修饰蛋白(IMA)的浓度,同时取术侧肘部动脉血样,行血气分析.记录术中恶心呕吐、呼吸抑制、头晕、心动过缓等并发症的发生情况.术中主诉疼痛的患者静脉注射舒芬太尼0.2μg/kg,仍因疼痛无法完成手术的患者则改为全身麻醉.结果 无一例患者使用补救用药,无一例患者更改麻醉方式,所有患者均未发生恶心呕吐、呼吸抑制、头晕、心动过缓等并发症.与C组比较,D组感觉阻滞、运动阻滞维持时间明显延长,血浆MDA和IMA的浓度明显降低,PaO2和BE升高(P＜0.05),感觉阻滞和运动阻滞的起效时间差异无统计学意义(P＞0.05);与T0时比较,两组T2、T3时血浆MDA和IMA的浓度升高,C组T1时pH值降低,两组T1时PaO2降低,T1、T2时BE降低(P＜0.05).结论 右美托咪啶不仅可增强上肢手术患者罗哌卡因臂丛神经阻滞效果,还可减轻止血带诱发的上肢缺血再灌注损伤.

Abstract：

Objective To investigate the effect of dexmedetomidine on brachial plexus block with ropivacaine and upper extremity ischemia-reperfusion (I/R) injury in patients undergoing upper extremity surgery. Methods Forty ASA Ⅰ or Ⅱ patients of both sexes, aged 18-55 yr, weighing 45-80 kg, scheduled forupper extremity surgery under brachial plexus block, were randomly divided into 2 groups ( n = 20 each): control group ( group C )and dexmedtomidine group (group D). In group C, brachial plexus block was performed using 0.5% ropivacaine 30 ml. In group D, brachial plexus block was performed with a mixture (30 ml) of 0.5% ropivacaine and 8 mg dexmedetomidine. The efficacy of motor and sensory block was evaluated and the onset time and duration of motor and sensory block were recorded. Venous blood samples were obtained from peripheral vein on the operated side before anesthesia induction (T0), and at 1, 5 and 30 min after tourniquet release (T1-3) to detect the plasma concentrations of MDA and ischemia-modified albumi (IMA). Arterial blood samples were also obtained at the same time points for blood gas analysis. The complications such as nausea and vomiting, respiratory depression, bradycardia and dizziness were recorded. Sufentanil 0.2 μg/kg was given as rescue medication. If the operation could not be completed, general anesthesia was used. Results There was no requirement for rescue analgesics and general anesthesia, and no complications occurred in all the patients. The duration of sensory and motor block was significantly longer, the plasma concentrations of MDA and IMA were significantly lower, and PaO2 and BE were significantly higher in group D than in group C ( P ＜ 0.05). The plasma concentrations of MDA and IMA were significantly higher at T2 and T3 in both groups, the pH value was significantly lower at T1 in group C, PaO2 at T1 and BE at T1 and T2 were significantly lower in both groups than those at T0 ( P ＜ 0.05). Conclusion Dexmedetomidine can not only enhance the efficacy of brachial plexus block with ropivacaine, but also reduce the upper extremity I/R injury caused by tourniquet in patients undergoing upper extremity surgery.     

Experimental study of phrenic nerve transfer for treatment of brachial plexus root avulsion

Objective To investigate the effects ofneurorrhaphy,nerve grafting and nerve im-plantation in phrenic nerve transfer for treat-ment of brachial plexus root avulsion. Methods One hundred and eighty Spra-gue-Dawley rats were divided into threegroups:the neurorrhaphy group,the nervegrafting group and the nerve implantationgroup.Evaluations such as motor nerve laten-cy,amplitude of compound actional poten-     

超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度

Objective To determine the median effective concentration (EC50) of ropivacaine for ultrasound-guided brachial plexus block.Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes, aged 19-72 yr, weighing 45-83 kg, scheduled for upper extremity surgery under brachial plexus block guided by ultrasound, were enrolled in this study. Brachial plexus block was performed under the guidance of ultrasound. After successful location, ropivacaine 30 ml was injected. EC50 of ropivacaine was determined by up-and-down sequential method. The initial concentration was 0.50% . Each time the concentration increased/decreased by 0.05% . EC50 of ropivacaine required for ultrasound-guided brachial plexus block and 95% confidence interval were calculated using Probit analysis.Results The EC50 of ropivacaine resulting in complete block of the brachial plexus nerve was 0.436%(95% confidence interval 0.393%-0.477% ). Conclusion The EC50 of ropivacaine is 0.436% for ultrasoundguided brachial plexus block.     

超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度

Objective To determine the median effective concentration (EC50) of ropivacaine for ultrasound-guided brachial plexus block.Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes, aged 19-72 yr, weighing 45-83 kg, scheduled for upper extremity surgery under brachial plexus block guided by ultrasound, were enrolled in this study. Brachial plexus block was performed under the guidance of ultrasound. After successful location, ropivacaine 30 ml was injected. EC50 of ropivacaine was determined by up-and-down sequential method. The initial concentration was 0.50% . Each time the concentration increased/decreased by 0.05% . EC50 of ropivacaine required for ultrasound-guided brachial plexus block and 95% confidence interval were calculated using Probit analysis.Results The EC50 of ropivacaine resulting in complete block of the brachial plexus nerve was 0.436%(95% confidence interval 0.393%-0.477% ). Conclusion The EC50 of ropivacaine is 0.436% for ultrasoundguided brachial plexus block.     

Nerve transfer for treatment of brachial plexus injury：comparison study between the transfer of partial median and ulnar nerves and that of phrenic and spinal accessary nerves

Objective:To compare the effect of using partial median and ulnar nerves for treatment of C5-6 orC5-7 avulsion of the brachial plexus with that of using phrenic and spinal accessary nerves.Methods:The patients were divided into 2groups randomly according to different surgical procedures.Twelve cases were involved in the first group.The phrenic nerve was transferred to the musculocutaneous nerve or through a sural nerve graft,and the spinal accessary nerve was to the suprascapular nerve.Eleven cases were classified into the second group.A part of the fascicles of median nerve was transferred to be coapted with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to the axillary nerve.The cases were followed up from 1to 3years and the clinical outcome was compared between the two groups.     

超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度

目的 超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度.方法 择期上肢手术患者50例,年龄19～72岁,体重45～83 ks,身高150～181 cm,ASA分级Ⅰ或Ⅱ级.超声引导下行臂丛神经阻滞,定位成功后注入罗哌卡因30 ml,初始浓度0.50%,浓度变化梯度为O.05%,阻滞有效则下一例采用低一级浓度,阻滞无效,则下一例采用高一级浓度.采用Prebit法计算超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度及其95%可信区间.结果 超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度为0.436%,95%可信区间为0.393%～0.477%.结论 超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度为0.436%.

Abstract：

Objective To determine the median effective concentration (EC50) of ropivacaine for ultrasound-guided brachial plexus block.Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes, aged 19-72 yr, weighing 45-83 kg, scheduled for upper extremity surgery under brachial plexus block guided by ultrasound, were enrolled in this study. Brachial plexus block was performed under the guidance of ultrasound. After successful location, ropivacaine 30 ml was injected. EC50 of ropivacaine was determined by up-and-down sequential method. The initial concentration was 0.50% . Each time the concentration increased/decreased by 0.05% . EC50 of ropivacaine required for ultrasound-guided brachial plexus block and 95% confidence interval were calculated using Probit analysis.Results The EC50 of ropivacaine resulting in complete block of the brachial plexus nerve was 0.436%(95% confidence interval 0.393%-0.477% ). Conclusion The EC50 of ropivacaine is 0.436% for ultrasoundguided brachial plexus block.     

Glinical study about low epidural block efficacy of ropivacaine and bupivacaine at the equivalent concentrations

Objective：The purpose of this prospective, randomized, double-blind study was to compare the low epidural block efficacy of ropivacaine and bupivacaine at the equivalent concentrations. Methods Eighty patients （44 male and 36 female patients） undergoing selective lower abdominal or lower extremity surgery were allocated randomly to four groups with 20 in each, receiving 0.5% bupivacaine （group B0.5）, 0.5% ropivacaine （group R0.5）, 0.75% bupivacaine （group B0.75） and 0.75% ropivacaine （group R0.75）, respectively. Prior to surgery, with double blind method, 0.5%, 0.75% ropivacaine, or 0.5%, 0.75% bupivacaine as local anesthetic solutions were injected respectively via epidural catheters at interspace of L2-3 or L3-4. Patients received the experimental drug 4 ml as a catheter test dose in order to avoid the catheter being improperly placed into the subarechnoid space. Ropivacaine or bupivacaine 3-5ml was administered at five minutes intervals until anesthetic effect had met surgery demand. （The segmental level of sensory block by pinpricking had extended above the top of surgery incision.） During the procedure, no additional study drug was injected into the epidurel space while the patients were being recorded, including onset time, the efficacy of sensory moter block, duration, cardiovascular effects, the quality of analgesia and neuromuscular block, adverse reactions and complications. All subjects were continuously monitored non-invasion blood pressure, heart rate（HR）, oxygen saturation measured by pulse oximetry（SpO2） and electrocardiogram（EEG） throughout surgery. Results：The anesthesia of all subjects was appropriate for surgery. With 0.5%, 0.75% ropivacaine, or 0.5%, 0.75% bupivacaine in the equivalent dosages, onset time, duration of sensory block, and the efficacy of motor block（mostly Bromage 3） was not significantly different between the groups（P 〉0.05）. Increasing the concentration of ropivacaine could leaded to a longer duration of motor block, especially in group R0.75（P〈0.01）. The cephalad dermatomal level of analgesia accessed by pinpricking was mostly T8-T10 for all groups. Because the difference between the peak or the valley ,and the baseline ,of SpO2, HR, BP, and PP was not statistically significant（P 〉 0.05）, the study drug didn＇t show obvious effects on haemodynamics. The minority of the patients, distributed among the four groups, complained of udnary retention after the operation.
Conclusions：The data from the patients undergoing lower abdominal or lower extremity surgery, who received lower anesthesia with 0.5%, 0.75% ropivacaine or 0.5%, 0.75% bupivacaine in the equivalent volumes respectively revealed that anesthetic efficiency could meet surgery demand. Onset time of the tow drugs, ropivacaine and bupivacaine, was similar at the equivalent concentrations, there was no difference in duration and efficacy of sensory and motor block, and in the cephalad spread degree of epidurel anesthetics, between ropivacaine and bupivacaine at the equal dosages. The higher concentrations of ropivacaine appeared to be obviously associated with a more prolonged duration of sensory block.     

不同浓度的罗哌卡因对糖尿病大鼠坐骨神经电生理的影响

Objective To observe the effects of clinical routine dasages 0.375% and 0.5% ropivacaine on electrophysiologic of changes of the sciatic nerve in diabetic rats. Methods Twelve healthy rsts and 12 rats with streptozotocin (STZ) induced diabetic peripheral,neuropathy were:used and further divided to 2 groups.Both sciatic nerves were exposed under general anesthesia.0.5 ml of either 0.375% or 0.5% ropivacaine was iniected in close proximity to the right seiatic nerve which was the experimental side.0.5 ml of 0.9% sodium chloride was iniected in close proximity to the left sciatic nerve which served as control.Motor nerve conduction velocity(MNCV),amplitude (AMP) and latency (LAT) of compound muscle action potential were recorded before injection,at the moment of injection,at one minute intervals for to 15 minutes and 48 hours after the injection. Results MNCV,AMP and LAT didn't change at all the observed time points of the 0.9% sodium chloride iniected control side in either healthy rats or diabetic rats.MNCV and AMP in normal rats injected with 0.375% ropivaeaine began to decrease at average 4 minutes and became zero at 10 minutes,while they began to decrease at average 3 minutes and dropled to zero at average 9 minutes while injected with 0.5% ropivacaine.These parameters returned to baseline levels after 48 hours.MNCV and AMP in diabetic rats injected with 0.375% ropivacaine began to decrease at average one minute and became zero at 7 minutes,while they began to decrease at average one minute and dropped to zero at 6 minutes with 0.5% ropivacaine injection.The time course had statistically significant difference between diabetic and normal rats.LAT had the same change pattern as MNCV and AMP.After 48 hours.MNCV in 0.375% ropivacaine diabetic group was not different from baseline value(P＜0.05),but AMP and LAT Were still significantly different from baseline levels.MNCV, AMP and LAT in 0.5% ropivacaine diabetic group had significant difference comparing to baseline levels and levels of 0.375% ropivaeaine diabetic group(P＜0.05). Conclusion Either 0.375% or 0.5% ropivacaine may deteriorate the diabetic peripheral nerve injury,the latter more remarkable.     

Magnesium added to prilocaine prolongs the duration of axillary plexus block

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the effect of the addition of magnesium to prilocaine on the duration of sensory and motor-nerve block. METHODS: After institutional approval, 60 ASA physical status I and II patients, between 18 and 60 years of age and scheduled for forearm and hand surgery under axillary brachial plexus block, were included in the study. Patients were randomly assigned to 1 of 4 groups. All of the patients received 5 mg/kg of 2% prilocaine and isotonic sodium chloride solution in 35 mL total volume for axillary brachial plexus block. Group I received intravenous saline, and group II received 150 mg intravenous magnesium at the same time as local anesthetic administration. In group III, 100 mg of magnesium, and in group IV, 150 mg of magnesium, were added to local anesthetic solution. Sensory block and motor block of musculocutaneous, radial, median, and ulnar nerves were recorded at 5-minute intervals. RESULTS: The duration of motor block was significantly longer in group IV than in other groups (167 +/- 30, 177 +/- 17, 180 +/- 20, and 250 +/- 19 minutes in groups I to IV, respectively) (P < .01). Mean duration of sensory block in both of the perineural magnesium groups was statistically different than in groups I and II (P < .001). Duration of sensory block in group IV (304 +/- 30 minutes) was significantly longer than in group III (253 +/- 23 minutes) (P < .001). CONCLUSION: The admixture of magnesium to prilocaine for axillary brachial plexus block provided a pronounced prolongation of sensory and motor block without side effects.     

左旋布比卡因与罗哌卡因应用于臂丛神经阻滞的临床对比研究

目的 比较左旋布比卡因和罗哌卡因用于肌间沟臂丛神经阻滞的效果及不良反应。方法 本组自2007年5月～12月对60例行上肢手术患者，ASAI～Ⅱ级，分为罗哌卡因（R）组和左旋布比卡因（L）组，每组30例，采用肌间沟法行臂丛神经阻滞，观察感觉／运动神经阻滞的起效时间及持续时间、患者对神经阻滞满意度、不良反应。结果 两组间感觉神经和运动神经阻滞起效时间的差异无显著性（P〉0．05）；L组的感觉和运动神经阻滞持续时间显著长于R组（P〈0．05），神经阻滞优良率均为100％。结论 左旋布比卡因与罗哌卡因均可安全用于临床肌间沟臂丛神经阻滞，二者有相似的药效学特性，但左旋布比卡因在术后镇痛方面略优于罗哌卡因。     

Comparison of clonidine and tramadol added to prilocaine brachial plexus block - analgesia, sensory and motor block

In a randomized, double-blind study we investigated the effect of clonidine and tramadol added to prilocaine on duration of analgesia, sensory and motor brachial plexus block. 60 patients were randomized in three groups. Group A received 40 ml prilocaine 1,5 % with tramadol 1,5 mg/kg KG, group B 40 ml prilocaine 1,5 % plus clonidine 1,5 microg/kg KG and group C 40 ml prilocaine 1,5 % without any additional medication. We recorded heart rate, blood pressure, oxygen saturation and sedation score at regular intervals. The onset of sensory and motor block was tested every five minutes for thirty minutes. The duration of analgesia, sensory and motor block were evaluated by using a questionnaire. There was no difference between the three groups concerning onset of brachial plexus block and duration of analgesia. But there was a significant prolongation of the duration of sensory and motor block in group B. Haemodynamic parameters remained stable in all patients, there were no significant changes in blood pressure and sedation.     

罗哌卡因混合碳酸利多卡因与等效浓度罗哌卡因用于逆行锁骨下臂丛神经阻滞效果的比较

目的 比较罗哌卡因混合碳酸利多卡因与等效浓度罗哌卡因用于逆行锁骨下臂丛神经阻滞的效果.方法 择期行上肢手术患者60例,ASA分级Ⅰ或Ⅱ级,年龄18～64岁,体重49～ 98 kg,均在超声引导下行逆行锁骨下臂丛神经阻滞.采用随机数字表法,将患者随机分为2组(n＝30),A组应用0.35％罗哌卡因30ml,B组应用0.233％罗哌卡因和0.346％碳酸利多卡因混合液30 ml.于麻醉给药后每隔5 min记录臂丛神经各分支的阻滞效果(感觉阻滞效果评估采用针刺法,运动阻滞效果评估采用Bromage分级),记录感觉和运动阻滞起效时间、麻醉给药后30 min时感觉与运动阻滞有效情况和并发症的发生情况.结果 两组臂丛神经各分支的感觉和运动阻滞起效时间及阻滞有效率比较差异无统计学意义(P＞0.05).两组均未见严重并发症发生.结论 罗哌卡因混合碳酸利多卡因与等效浓度罗哌卡因行逆行锁骨下臂丛神经阻滞效果相似,提示碳酸利多卡因不能增强罗哌卡因的臂丛神经阻滞效应.     

右旋美托咪啶加入到左旋布比卡因中可延长臂丛神经阻滞的持续时间

背景和目的我们针对右旋美托咪啶添加到左旋布比卡因中对腋路臂丛神经阻滞效果的影响加以评估。主要观察指标为起效时间、感觉和运动神经阻滞时间及镇痛时间。方法选择60例择期行前臂和手部手术的患者,采用随机双盲试验方法将患者分成两组。通过神经刺激的方法定位腋下4条主要神经（肌皮神经、桡神经、正中神经、尺神经）。将患者随机分配到两组中的任一组。给予L组（n=30）0．5％左旋布比卡因40ml（200mg）＋生理盐水1ml;给予LD组（n=30）0．5％左旋布比卡因40ml（200mg）＋右旋美托咪啶1ml。记录运动和感觉阻滞起效时间、阻滞持续时间和镇痛持续时间。结果两组中的患者基本资料和手术特点都相似。感觉和运动阻滞起效时间LD组比L组明显缩短（P〈0．05）。感觉和运动阻滞持续时间LD组比L组明显延长（P〈0．01）。镇痛持续时间LD组比L组长（P〈0．05）。分别于10、15、30、45、60、90、120分钟记录收缩压,LD组明显低于L组（P〈O．05）。60、90、120分钟记录舒张压,LD组明显低于L组（P〈0．05）。除基础值外,LD组心率明显低于L组（P〈0．05）。在LD组有7例心动过缓患者,L组无心动过缓者（P〈0．05）。结论右旋美托咪啶加入左旋布比卡因用于腋路臂丛神经阻滞,可缩短起效时间,延长持续时间和镇痛时间。但右旋美托咪啶可能导致心动过缓。     

Mépivacaïne à 1 % et bloc axillaire: durée du bloc sensitif et moteur

ObjectivesTo assess the duration of both sensory and motor blockade of brachial plexus with 40 mL 1% mepivacaine after axillary or midhumeral approach.Study designProspective, open, non-comparative, multicentric study.PatientsOne hundred and eighty patients, ASA physical class 1 and 2, scheduled for hand or forearm surgery under brachial plexus block were included.MethodsA midhumeral or axillary brachial plexus block using a nerve stimulator was performed with 40 mL of 1% mepivacaine. Sensory blockade was tested for each cutaneous area (median, radial, ulnar, musculocutaneous and medial cutaneous nerve of the forearm) using pin-prick. Motor blockade was assessed by grip strengh of the hand. Incidence and duration of analgesia, anaesthesia and motor blockade were assessed. The incidence of tourniquet pain and the time when pain occurred were determined.ResultsAccording to the nerve area tested, analgesia and anaesthesia were obtained in 98% and 85% of cases respectively; duration of anaesthesia was between 150 ± 40 to 167 ± 49 minutes and duration of analgesia was from 184 ± 50 to 205 ± 51 minutes. Duration of paralysis was 144 ± 40 minutes and duration of paresis was 190 ± 51 minutes. Pain occurred in three out of 138 patients at tourniquet inflation and in six patients after completion of surgery.ConclusionsMid humeral or axillary block with 40 mL of 1% mepivacaine is highly successful and provides efficient surgical anaesthesia for various surgical procedures of intermediary duration.     

Infraclavicular block with lateral approach and nerve stimulation: extent of anesthesia and adverse effects.

BACKGROUND AND OBJECTIVES: The infraclavicular approach to the brachial plexus is little used despite theoretical advantages of the technique. Using a vertical paracoracoid approach, we assessed the extent of the sensory block and the incidence of adverse effects. METHODS: After obtaining informed consent, 100 patients undergoing surgical procedures distal to the elbow were evaluated. The block was performed using a peripheral nerve stimulator. The puncture site was located in the infraclavicular fossa; the direction of the insulated needle was perpendicular to the skin. Motor response was sought in the hand or wrist at < or = 0.6 mA. A total of 40 mL of 1.5% mepivacaine was administered as a single injection. The sensory block was evaluated every 5 minutes for 30 minutes before surgery in the cutaneous distribution of terminal branches of the brachial plexus. RESULTS: When one considers the cutaneous distributions of the median, ulnar, radial, and musculocutaneous nerves, the success rate was 89% for surgery without need for additional peripheral nerve blocks or general anesthesia. In contrast, cutaneous areas innervated by the axillary and medial cutaneous nerves were rarely anesthetized. We were unable to demonstrate a correlation between the intensity of the stimulation and the success of the block. On the other hand, a correlation was found between tourniquet sensation and the absence of anesthesia of the medial cutaneous nerve of the arm. Local anesthetic toxicity, Horner's syndrome, and vascular puncture were respectively observed in 1%, 4%, and 5% of cases. The depth of the needle introduction was correlated with the body mass index (P <.001; r =.63). CONCLUSION: Single injection infraclavicular block, using a vertical paracoracoid approach, appears suitable for surgery distal to the elbow. Selective anesthesia of the medial cutaneous nerve is useful in improving tolerance of the tourniquet.     

Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade

Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and duration of axillary brachial plexus block. Sixty patients scheduled for elective hand and forearm surgery under axillary brachial plexus block were randomly allocated to receive either 34 mL lidocaine 1.5% with 2 mL of isotonic saline chloride (control group, n = 30) or 34 mL lidocaine 1.5% with 2 mL of dexamethasone (8 mg) (dexamethasone group, n = 30). Neither epinephrine nor bicarbonate was added to the treatment mixture. We used a nerve stimulator and multiple stimulations technique in all of the patients. After performance of the block, sensory and motor blockade of radial, median, musculocutaneous, and ulnar nerves were recorded at 5, 15, and 30 min. The onset time of the sensory and motor blockade was defined as the time between last injection and the total abolition of the pinprick response and complete paralysis. The duration of sensory and motor blocks were considered as the time interval between the administration of the local anesthetic and the first postoperative pain and complete recovery of motor functions. Sixteen patients were excluded because of unsuccessful blockade. The duration of surgery and the onset times of sensory and motor block were similar in the two groups. The duration of sensory (242 +/- 76 versus 98 +/- 33 min) and motor (310 +/- 81 versus 130 +/- 31 min) blockade were significantly longer in the dexamethasone than in the control group (P < 0.01). We conclude that the addition of dexamethasone to lidocaine 1.5% solution in axillary brachial plexus block prolongs the duration of sensory and motor blockade.     

不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果

目的 探讨不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果.方法 择期上肢手术患者90例,ASA分级Ⅰ～Ⅲ级,年龄16～75岁,体重40～85 kg.均在超声引导联合神经刺激器辅助定位下行腋路臂丛神经阻滞,根据不同罗哌卡因浓度分为3组(n=30):0.15%罗哌卡因组(A组),0.10%罗哌卡因组(B组),0.05%罗哌卡因组(C组).于注射局麻药后10、30、60、240 min(T1～4)时记录感觉与运动分离阻滞情况、感觉阻滞完善情况和臂丛神经阻滞成功情况,术毕时评定麻醉效果.记录手术时间、镇痛时间.结果 与A组比较,B组T1.2时感觉阻滞完善率较低(P＜0.05),T3.4时感觉阻滞完善率差异无统计学意义(P＞0.05),感觉与运动分离阻滞率较高(P＜0.01),C组T1.2时感觉与运动分离阻滞率较低(P＜0.01),T3.4时感觉与运动分离阻滞率差异无统计学意义(P＞0.05),各时点感觉阻滞完善率较低(P＜0.01).与B组比较,C组各时点感觉阻滞完善率、感觉与运动分离阻滞率均较低(P＜0.01).A组麻醉效果优于B组,B组麻醉效果优于C组(P＜0.01),与A组和B组比较,C组臂丛神经阻滞成功率较低(P＜0.01),A组与B组差异无统计学意义(P＞0.05).结论 0.10%罗哌卡因用于臂丛神经阻滞可产生感觉与运动分离阻滞效果.