腕管松解术中超声或神经刺激引导下腕部神经阻滞的前瞻性随机对照研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：牛振瑛 编辑：潘志军 审校：曹莹
我们推测，与神经刺激引导的腕部阻滞相比，超声引导的腕部阻滞可能执行得更快，并且可以提高成功率。
将60例行腕管松解术的患者随机分为正中神经和尺神经阻滞两组，分别采用感觉运动神经刺激法(n？30)和超声引导法(n？30)。每条神经周围注射1.5%甲哌卡因4毫升。评估完全感觉阻滞的执行时间和起效时间。
超声引导组正中神经阻滞(超声，55[48-60]vs神经刺激，100[65-150]秒，P=0.02)和尺神经(超声，57[50-70]vs神经刺激，80[60-105]秒，P=0.02)的中位时间均显著缩短。超声引导组正中神经感觉阻滞完全起效时间(超声，370[278-459]vs神经刺激，254[230-300]秒，P=0.02)及尺神经感觉阻滞完全起效时间（超声，367[296-420]vs神经刺激，241[210-300]秒，P=0.01）较神经刺激组短。两组成功率均为93%。
这项随机前瞻性研究表明，超声引导的腕部神经阻滞与神经刺激一样有效。
Macaire P, et al. Ultrasound- or Nerve Stimulation-Guided Wrist Blocks for Carpal Tunnel Release: A Randomized Prospective Comparative Study[J].Reg Anesth Pain Med. Jul-Aug 2008;33(4):363-8.
Ultrasound- or Nerve Stimulation-Guided Wrist Blocks for Carpal Tunnel Release: A Randomized Prospective Comparative Study
Abstract
Background and Objectives: We hypothesized that ultrasound-guided wrist blocks may be faster to perform,and may increase success rate, compared with nerve stimulation-guided wrist blocks.
Methods: Sixty patients undergoing ambulatory endoscopic carpal tunnel release were randomly allocated to receive median and ulnar nerve blocks using either sensory-motor nerve stimulation (n =30) or ultrasound guidance (n =30). Four mL of mepivacaine 1.5% was injected around each nerve. Performance time and onset time of complete sensory block were assessed.
Results: Median time to perform both median (ultrasound, 55 [48-60] vs. nerve stimulation, 100 [65-150] seconds, P=0.02) and ulnar (ultrasound, 57 [50-70] vs. nerve stimulation, 80 [60-105] seconds, P =0 .02) nerve
blocks were significantly shorter in the ultrasound group. Onset time of complete sensory block in the median (ultrasound, 370 [278-459] vs. nerve stimulation, 254 [230-300] seconds, P =0.02) and ulnar (ultrasound, 367 [296-420] vs. nerve stimulation, 241 [210-300] seconds, P = 0.01) nerve areas were shorter in the nerve stimulation group. The success rate was 93% in both groups.
Conclusions: This randomized prospective study demonstrates that ultrasound-guided wrist nerve blocks are as efficient as those performed with nerve stimulation.
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