定位臂丛神经后束对锁骨下臂丛神经阻滞效果的影响

目的比较锁骨下臂丛神经阻滞定位臂丛后束与外侧束的阻滞成功率。方法选择70例择期行上肢手术的患者,随机分成外侧束组和后束组,采用Wilson提出的喙突人路,通过神经刺激器分别引发臂丛神经的外侧束或后束所支配的远端运动反应后给予0．5％罗哌卡因30ml。在给药后5min、10min、20min、30min分别记录上肢5支终末神经（正中神经,肌皮神经,桡神经,尺神经,前臂内侧皮神经）的阻滞情况。结果外侧束组阻滞成功率为53．1％,后束组阻滞成功率为78．9％,后束组成功率显著高于外侧束组（P〈0．05）。结论引发后束所支配的运动反应后给药,阻滞成功率要高于引发外侧束所支配的运动反应后给药的阻滞成功率。

Influence of stimulating different cords on the efficacy of infraclavicular brachial plexus block

OBJECTIVE: Stimulating lateral or posterior cord may produce different anesthesia extent because of different anatomical position of the two plexus at the infraclavicular region. We To explore the difference in the efficacy of infraclavicular brachial plexus block by stimulating different cords of the infraclavicular brachial plexus. METHODS: 70 patients of the ASA physical status class I - II, aged 14 - 64, scheduled for elective surgical procedures below elbow underwent infraclavicular brachial plexus block with the Wilson's approach via the point 2 cm medial and caudal to the coracoid process guided by nerve stimulator, to simulate the lateral cord (n = 32) or posterior cord (n = 38). 30 ml of 0.5% ropivacaine was injected after the stimulation of the lateral or posterior cords. Anesthesia was assessed 5, 10, 20, and 30 min after the local anesthetic injection. A successful blockade was defined as analgesia in all dermatomes of the five nerves (median nerve, musculocutaneous nerve, radial nerve, ulnar nerve, and medial antebrachial cutaneous nerve). RESULTS: Stimulating the posterior cord provided complete blockade in 30 patients (78.9%) and stimulating the lateral cord provided complete blockade in 17 patients (53.1%). CONCLUSION: Stimulating the posterior cord guided by nerve stimulator increases the efficacy of infraclavicular brachial plexus block compared with stimulating the lateral cord.