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超声引导下锁骨上臂丛神经阻滞在上肢手术中的内侧入路与外侧入路比较：一项随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：赵游霄 编辑：赵游霄 审校：曹莹
背景：
肋锁臂丛神经阻滞已成为上肢手术麻醉或镇痛的首选手术方式。该技术尚未标准化，目前采用两种方法：内侧法和外侧法。我们的研究旨在比较这两种方法的执行时间和患者特定的临床结果。
方法：
评估的主要结果是操作时间。次要结果是成像时间、针刺时间、阻滞起效时间、总麻醉时间、麻醉成功和执行者难度评分。
结果：
在 59 名患者中，30 名患者被随机分配到 M 组，29 名患者被随机分配到 L 组。我们使用改良的意向治疗方法进行了统计分析。 M 组的操作时间（分钟）的平均值 ± SD 为 11.9 ± 3.8，L 组为 9.4 ± 4.1，平均值之间的差异 (95% CI) 为 2.4（0.3 至 4.5）（P < 0.05）。 M 组的中位针刺时间（四分位距）为 9.5 分钟（5-16），而 L 组为 7 分钟（4-19）（P = 0.035）。在患者中，M 组中 40%、26.67%、33.3% 的操作者难度为 3、2、1 级，而 L 组中分别有 10.3%、37.9%、51.7% 的操作者难度为 3、2、1 级（P = 0.032） ）。体重指数 (BMI) < 25 的患者的平均操作时间为 9.95 分钟，而 BMI > 25 的患者的平均操作时间为 12.68 分钟 (P = 0.0243)。
结论：
我们的研究表明，在操作时间、成像时间、进针时间和操作者难度方面，内侧入路与外侧入路相比没有显着优势。操作时间和操作者难度都随着体重指数和深度的增加而增加，其中内侧入路的差异更大。
原始文献：
Am, S., Patel, N., Kumar, R., Ranjith, K. R., Muthiah, T., Ayub, A., Singh, A. K., Khanna, P., & Ray, B. R. (2024). Medial versus lateral approach in ultrasound-guided costoclavicular brachial plexus block for upper limb surgery: a randomized control trial. Anaesthesiology Intensive Therapy, 56(3), 199–205.
英文原文：
Medial versus lateral approach in ultrasound-guided costoclavicular brachial plexus block for upper limb surgery: a randomized control trial
Background: Costoclavicular brachial plexus block has become a procedure of choice for surgical anaesthesia or analgesia in upper limb surgery. The technique is not standardised yet, and two approaches are currently employed: the medial and lateral approach. Our study aims to compare the two approaches in terms of performance time and patient-specific clinical outcomes.
Methods: The primary outcome assessed was performance time. The secondary outcomes were imaging time, needling time, block onset time, total anaesthesia time, anaesthesia success, and performer difficulty score.
Results: Of 59 patients, 30 patients were randomized to Group M and 29 patients were randomized to Group L. We conducted statistical analysis using a modified intentionto-treat approach. The mean ± SD for performance time (in minutes) was 11.9 ± 3.8 in Group M and 9.4 ± 4.1 in Group L with a difference between means (95% CI) of 2.4 (0.3 to 4.5) (P < 0.05). The median (interquartile range) needling time of Group M was 9.5 minutes (5–16) vs. 7 (4–19) in Group L (P = 0.035). Among patients, 40%, 26.67%, 33.3% in Group M had grade 3, 2, 1 performer difficulty whereas 10.3%, 37.9%, 51.7% in Group L had grade 3, 2, 1 performer difficulty, respectively (P = 0.032). The mean performance time was 9.95 minutes in patients with body mass index (BMI) < 25 vs. 12.68 minutes in BMI > 25 (P = 0.0243).
Conclusions: Our study revealed that the medial approach has no significant advantage over the lateral approach with regards to performance time, imaging time, needling time, and performer difficulty. Both performance time and performer difficulty increase with BMI and depth of the cords, with a larger difference in the medial approach.
