儿科患者超声引导下肋锁臂丛神经阻滞外侧与内侧的比较 :随机临床试验。

Die Anaesthesiologie Pub Date : 2024-02-01 Epub Date: 2024-01-16 DOI:10.1007/s00101-023-01365-2
Mehmet F Cosgun, Emine A Salviz, Emre S Bingul, Mehmet Guzel, Emre Senturk, Merve O Dinc, Salih Aktas, Meltem Savran-Karadeniz
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引用次数: 0

摘要

背景和目的:肋锁神经臂丛阻滞因其应用简便而越来越受欢迎。最近定义了肋锁关节外侧和内侧方法。在本研究中,我们旨在调查这些方法在儿科人群中的程序执行情况:在这项研究中,55 名 2 至 10 岁的儿童在全身麻醉诱导后随机接受外侧(LC 组)或内侧(MC 组)肋锁臂丛阻滞,以进行术后镇痛。所有患者均在脊髓群中心接受布比卡因(1 毫克/千克,0.25%)。记录的主要结果是针刺操作次数。作为次要结果,比较了阻滞执行特征(理想的超声引导臂丛神经索可视化、针道规划时间、针尖和针杆可视化难度、因局麻药分布不足而需要额外的针操作、阻滞执行时间、总手术难度)和术后疼痛相关数据(阻滞强度、疼痛评分和镇痛需求):结果:LC 组患者所需的超声观察时间更短(中位数 14 秒,范围 11-23 秒;中位数 42 秒,范围 15-67 秒,P 0.05):结论:外侧入路比内侧入路所需的进针操作更少。两种方法都具有良好的安全性和镇痛效果。
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Comparison of ultrasonography-guided lateral versus medial costoclavicular brachial plexus block in pediatric patients : A randomized clinical trial.

Background and aims: Costoclavicular brachial plexus block is gaining popularity due to its ease of application. Lateral and medial costoclavicular approaches have recently been defined. In the current study, we aimed to investigate the procedural execution of these approaches in the pediatric population.

Methods: In this study 55 children aged between 2 and 10 years were randomized to receive lateral (LC group) or medial (MC group) costoclavicular brachial plexus block after induction of general anesthesia for postoperative analgesia. All patients received bupivacaine (1 mg/kg, 0.25%) within the center of the cord cluster. The number of needle maneuvers was recorded as primary outcome. Block performing features (ideal ultrasound-guided brachial plexus cords visualization, needle pathway planning time, needle tip and shaft visualization difficulty, requirement of extra needle maneuver due to insufficient local anesthetic distribution, block performance time, total procedure difficulty) and postoperative pain-related data (block intensities, pain scores and analgesic requirements) were all compared as secondary outcomes.

Results: The LC group patients required less ultrasound visualization time (median 14 s, range 11-23 s vs. median 42 s, range 15-67 s, p < 0.001) and fewer needle maneuvers (median 1, range 1-2 vs. median 3, range 2-4, p < 0.001) compared to the MC group. Similarly, the median block performance duration was shorter (median 67 s, range 47-94 s vs. median 140s, 90-204 s, p < 0.01) and procedures were perceived as easier (median 4, range 4-5 vs. median 3, range 2-5, p = 0.04) in the LC group. All other parameters were comparable (p > 0.05).

Conclusion: The lateral approach required less needle maneuvers than the medial approach. Both techniques represented a good safety profile with favorable analgesic features.

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