超声引导下腋路筋膜周围平面入路阻滞与神经周围入路阻滞的比较:最简单的？

超声引导下腋路筋膜周围平面入路阻滞与神经周围入路阻滞的比较:最简单的？ 

贵州医科大学     麻醉与心脏电生理课题组

翻译：李奕 编辑：陈锐  审核：曹莹

罂 粟 摘 要 

背景：超声引导腋路阻滞广泛应用于上肢矫形外科的日常手术中。一个简单，安全，有效和省时的技术是必须性的，以优化手术周转和成本。从这个角度来看，我们在一项随机、单盲研究中比较了标准化筋膜周围技术和选择性神经周围技术。 

方法：42例择期手外科手术患者被随机分配接受10mg/mL甲哌卡因20mL，或选择性地围绕每个桡神经、正中神经、尺神经和肌皮神经(神经周围组)或沿背阔肌和腋浅筋膜(筋膜周围组)。主要结果是两组的手术时间。次要目标是针通过的次数、在视觉模拟标度上0-10范围内的每个操作的性能评价、成功率和不良事件的发生率。

结果：筋膜周围组的操作时间显著减少(3.6vs6.5min，P<0.001)，针刺次数更少(3vs6，P<0.001)，操作更简单(8.5vs7.6min，P=0.02)。没有血管穿刺或神经功能缺损的报告。手术麻醉(两组均为95%)和完全麻醉成功率(筋膜周围81%vs神经周围95%)相似。

结论：我们报道了超声引导下的腋路筋膜周围阻滞比传统的神经周围阻滞更容易实施并节省手术时间。考虑到两组麻醉成功率相同，筋膜周围平面技术应被视为日常练习技术和腋路阻滞的第一级学习程序。

原始文献来源： Lucie Beylacq , Elodie Baer , Olivier Choquet , Henri-Louis Dupre , Xavier Capdevila, et al. Perifascial plane versus perineural approaches for ultrasound-guided axillary block: go to the simplest.[J]. Minerva Anestesiol. 2020 Jan;86(1):23-29.

英文原文

l  

Perifascial plane versus perineural approaches for ultrasound-guided axillary block: go to the simplest?

Abstract

Background: Ultrasound-guided axillary block is widely used in daily practice for upper limb orthopedic surgery. A simple, safe, efficacious and time-saving technique is mandatory to optimize surgical turnover and costs. In this perspective, we compared, in a randomized, single-blinded study, a standardized perifascial technique and the selective perineural technique.

Method:  Forty-two patients scheduled for elective hand surgery were randomly assigned to receive 20 mL of 10 mg/mL mepivacaine, either selectively around each of the radial, median, ulnar and musculocutaneous nerves (perineural group) or along the latissimus dorsi and superficial axillary fascia (perifascial group). The primary outcome was the procedure performance time in both groups. Secondary goals were the number of needle passes, a per-procedure evaluation of the performance on a visual analogue scale ranging from 0 to 10, the success rate and the incidence of adverse events.

Results: Performance time was significantly reduced in the perifascial group (3.6 vs. 6.5 min, P<0.001), with fewer needle passes (3 vs. 6, P<0.001) and a simpler procedure performance (8.5 vs. 7.6, P=0.02). No vascular punctures or neurologic deficits were reported. Surgical anesthesia (95% in both groups) and complete anesthetic success (perifascial 81% vs. perineural 95%) were similar.

Conclusion: We reported that the ultrasound-guided axillary perifascial block is easier to perform and saves procedural time compared to the classic perineural technique. Considering the same anesthetic success rate in both groups, the perifascial plane technique should be considered a daily practice technique and the first level of learning procedure for axillary block.

打赏