肌间沟与腋路联合臂丛神经阻滞与单纯肌间沟臂丛神经阻滞的临床比较

目的探讨联合臂丛神经阻滞的有效性和安全性,以改善单纯肌间沟臂丛神经阻滞不全的现象。方法80例前臂和手部手术患者随机分为两组,各40例,采用单纯肌间沟臂丛神经阻滞和联合臂丛神经阻滞的方法,观察、记录麻醉效果。结果臂丛阻滞的完善率分别为82.5%和97.5%。结果肌间沟、腋路联合臂丛神经阻滞完善了麻醉效果,提高了麻醉质量和病人的生活质量。     

腋路-肌间沟联合臂丛神经阻滞的临床麻醉效果观察

臂丛神经阻滞是临床中上肢手术常用的一种麻醉方法,但传统的单纯腋路或者肌间沟臂丛阻滞,经常出现桡侧或尺侧麻醉阻滞不完善。本文采用腋路-肌间沟两点联合臂丛神经阻滞方法,麻醉     

不同浓度罗哌卡因对超声引导下肌间沟臂丛神经阻滞麻醉的效果

目的 探讨不同浓度罗哌卡因对超声引导下肌间沟臂丛神经阻滞的麻醉效果.方法 择期行上肢手术患者100例,ASAⅠ～Ⅲ级,性别不限,年龄20～87岁,BMI 19～24 kg/m2.均在超声引导下行肌间沟臂丛神经阻滞麻醉.应用随机数字表法分为2组,各50例.低浓度组采用0.3％罗哌卡因,高浓度组采用0.5％罗哌卡因.评价麻...     

斜角肌间沟复合腋路法臂丛神经阻滞在上肢手术中的应用

臂丛神经阻滞是一种解剖标志定位简单的临床神经丛阻滞麻醉操作技术,单纯斜角肌间沟或腋路臂丛神经阻滞方法能为患者上肢手术或镇痛等提供较良好的神经阻滞效果,但在使用高浓度或大容量局麻药时有发生某一(膈或喉返)神经分支被阻滞,导致该分支神经功能暂时可逆性丧失,或时有部分(尺或桡)神经分支阻滞效果欠完善,不能满足术中镇痛或止血带需求.     

超声引导下小儿肌间沟臂丛神经阻滞

目的 探讨超声引导下小儿肌间沟臂丛神经阻滞的可行性和安全性.方法 36例拟行肱骨髁部骨折切开复位内固定术患儿,应用高频超声探头扫描肌间沟内臂丛神经的分布,测量神经干的直径和距离皮肤的深度,在超声引导下以0.25%布比卡因行肌间沟臂丛阻滞.结果 超声扫描36例小儿肌间沟内臂丛神经均清晰显示,超声引导下以0.25%布比卡因行肌间沟臂丛阻滞麻醉有效率达100%.结论 超声引导下小儿肌间沟臂丛神经阻滞安全可行.     

小儿肌间沟入路臂丛神经阻滞麻醉

临床工作中我们经常遇到由于先天畸形或外伤需行上肢手术的小儿患者 ,我科 1999年～ 2 0 0 1年对这类患儿实施肌间沟入路臂丛神经阻滞麻醉配合手术 ,取得良好效果 ,报道如下。1　资料与方法1 1　临床资料本组 31例 ,年龄 2～ 7岁 ,平均 4 5岁 ,均行上肢择期手术 ,手术时间 0 5～ 3 5ｈ。1 2　术前准备患儿术前禁食 8ｈ ,禁水 4ｈ ,术前 30ｍｉｎ肌注阿托品0 0 2ｍｇ/ｋｇ ,安定 0 2ｍｇ/ｋｇ ,对于哭闹不合作的患儿进入手术室前肌注氯胺酮 5ｍｇ/ｋｇ作为基础麻醉。1 3　麻醉方法患儿进入手术室后开放静脉 ,取仰卧位 ,头偏向健侧 ,一手…     

神经刺激仪引导肌间沟复合腋路臂丛神经阻滞用于上肢手术

臂丛神经阻滞穿刺传统方法多以解剖定位加异感定位作为穿刺成功的标志,因其缺乏客观性,技术不熟练者操作易引起穿刺点出血、阻滞不全、神经损伤等并发症.我院采用神经刺激仪定位下肌间沟复合腋路臂丛神经阻滞,并与传统方法分析比较,现报道如下.     

硫酸镁在肌间沟臂丛神经阻滞上肢手术中的应用

目的观察超声引导下硫酸镁肌间沟臂丛神经阻滞(ISBPB)对上肢手术麻醉效果和镇痛时间的影响。方法选择ISBPB复合喉罩全麻拟行上肢手术的患者54例,男34例,女20例,年龄37~73岁,ASAⅠ或Ⅱ级,随机均分为两组:硫酸镁组(M组),超声引导下ISBPB,用药0.5%罗哌卡因8ml(40mg)加10%硫酸镁2ml(0.5g);对照组(N组),超声引导下ISBPB,用药0.5%罗哌卡因8ml加生理盐水2ml(40mg)。待神经阻滞完全起效后,静脉诱导插入喉罩通气,术中七氟醚(呼末MAC 0.8)维持。分别记录局麻药注射后感觉和运动阻滞的起效时间和持续时间,术后镇痛时间,术后4、8、12、24h的疼痛视觉模拟评分(VAS)以及术后不良反应。结果两组感觉和运动阻滞起效时间差异无统计学意义,M组的感觉阻滞持续时间和镇痛时间明显长于N组(P0.05)。术后8、12、24h M组的VAS评分明显低于N组(P0.05)。两组的术后补救用镇痛药、芬太尼用量差异无统计学意义。两组恶心呕吐的发生率差异无统计学意义。所有患者均未出现肌力减弱、麻木、瘙痒、寻麻疹等不良反应。结论超声引导下ISBPB注射0.5%罗哌卡因复合硫酸镁能延长感觉阻滞持续时间,降低术后疼痛程度,延长镇痛时间。     

腋路臂丛神经阻滞-解剖与临床

腋路臂丛神经阻滞因其操作简便、不良反应发生率低而被广泛地用于肘部以下的手术.它的穿刺点既不像肌间沟臂丛神经阻滞那样靠近中枢神经,也不似锁骨上入路那样接近肺尖,更适合于非住院病人的麻醉.对解剖的良好认识和理解有助于麻醉医师更好地实施臂丛神经阻滞.本文旨在对腋路臂丛神经阻滞的解剖基础和临床应用作一综述.     

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。     

Ultrasound-guided infraclavicular brachial plexus block

Background. Peripheral nerve blocks are almost always performedas blind procedures. The purpose of this study was to test thefeasibility of seeing individual nerves of the brachial plexusand directing the block needle to these nerves with real timeimaging. Methods. Using ultrasound guidance, infraclavicular brachialplexus block was performed in 126 patients. Important aspectsof this standardized technique included (i) imaging the axillaryartery and the three cords of the brachial plexus posteriorto the pectoralis minor muscle, (ii) marking the position ofthe ultrasound probe before introducing a Tuohy needle, (iii)maintaining the image of the entire length of the needle atall times during its advancement, (iv) depositing local anaestheticaround each of the three cords and (v) placing a catheter anteriorto the posterior cord when indicated. Results. In 114 (90.4%) patients, an excellent block permittedsurgery without a need for any supplemental anaesthetic or conversionto general anaesthesia. In nine (7.2%) patients local or perineuraladministration of local anaesthetic, and in three (2.4%) conversionto general anaesthesia, was required. Mean times to administerthe block, onset of block and complete block were 10.0 (SD 4.4),3.0 (1.3) and 6.7 (3.2) min, respectively. Mean lidocaine dosewas 695 (107) mg. In one patient, vascular puncture occurred.In 53 (42.6%) patients, an indwelling catheter was placed, butonly three required repeat injections, which successfully prolongedthe block. Conclusion. The use of ultrasound appears to permit accuratedeposition of the local anaesthetic perineurally, and has thepotential to improve the success and decrease the complicationsof infraclavicular brachial plexus block. Br J Anaesth 2002; 89: 254–9     

Ultrasound-guided supraclavicular brachial plexus block

In this study, we evaluated state-of-the-art ultrasound technology for supraclavicular brachial plexus blocks in 40 outpatients. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. The block technique we describe aligned the needle path with the ultrasound beam. The block was successful after one attempt in 95% of the cases, with one failure attributable to subcutaneous injection and one to partial intravascular injection. Pneumothorax did not occur. Our preliminary data suggest that a high-resolution ultrasound probe can reliably identify the brachial plexus and its neighboring structures in the supraclavicular region. The technique of real-time guidance during needle advancement can quickly localize nerves. Distinct patterns of local anesthetic spread observed on ultrasound can further confirm accurate needle location. IMPLICATIONS: Real-time ultrasound imaging during supraclavicular brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern of local anesthetic spread.     

Continuous axillary brachial plexus block

Continuous axillary brachial plexus block was performed in 597 patients undergoing prolonged operations on the hand. The technique required placement of a 5 cm 23 gauge teflon intravenous catheter in the axillary perivascular sheath. Lidocaine 1.5 per cent or mepivicaine 1.5 per cent (20-40 ml) were used for the initial block dose. Surgery was completed in 77.2 per cent of patients (460) with the axillary block alone while in 19.1 per cent of patients (114) supplementary narcotic administration or additional regional blocks were required. In 3.7 per cent of patients (22) the technique was considered a complete failure. Complications included local anaesthetic toxic reactions (2.85 per cent, 17 cases), nerve injury (0.50 per cent, three cases) and one case of major haematomaformation. The advantages of this technique and the possible complications are discussed.     

Ultrasound-guided nerve block: brachial plexus block

Ultrasonographic guidance has been introduced as an aid to nerve localization, for brachial plexus blockade in the interscalene and infraclavicular regions. Ultrasound-guided interscalene approach and infraclavicular approach were established as an excellent method to provide good analgesia during surgery and relieve post-surgical pain after shoulder or upper arm surgery and forearm or hand surgery respectively. Single shot injection and continuous catheter approach in both nerve blocks were described together with clinical key points based on the ultrasound images.     

Quality of axillary brachial plexus block

A perivascular catheter technique (PVT) and a nerve stimulator technique (NST) for axillary brachial plexus block were compared in terms of quality: complete, incomplete or failed blocks. In a randomised series, 30 PVT blocks and 30 NST blocks were performed by three staff anaesthetists. In the NST group, surgical anaesthesia was always achieved, whereas in the PVT group, four blocks required supplementation with general anaesthesia. In both groups eight patients needed supplementation with additional conduction blocks of 1-3 peripheral nerves. It is concluded that a nerve stimulator technique may increase the success rate of axillary brachial plexus block to some extent.