运动反应阈电流强于或弱于0．5mA在超声引导下行肌问沟神经阻滞均可产生良好效果  

作　　者：SanjayK.Sinha Jonathan H.Abrams Robert S. Weller 姚凤珍(译) 崔苏扬(校) 

机构地区：[1]Department of Anesthesiology, Saint Francis Hospital and Medical Center, Hartford, Connecticut [2]Department of Anesthesiology,Wake Forest University School of Medicine, Winston-Salem, North Carolina [3]不详

出　　处：《麻醉与镇痛》2008年第3期18-23,共6页Anesthesia & Analgesia

摘　　要：背景对超声引导下行肌间沟阻滞时神经电刺激的运动反应进行定量，并比较运动反应阈电流强于或弱于0．5mA时的阻滞情况。方法选择61例在肌间沟阻滞和全身麻醉下行非住院肩部手术的患者，进行前瞻性观察研究。手术前超声引导下在肌问沟放置一绝缘穿刺针，测定能诱发运动反应的最小电流值，并注射含肾上腺素的0．5％布比卡因30ml。测定上干（uppertrunk）支配区感觉和运动神经阻滞情况15分钟，然后开始全麻诱导。手术后记录麻醉后恢复室（PACU）中上干阻滞成功率和疼痛评分，并记录阻滞持续时间和手术后当晚镇痛药使用剂量。诱发运动反应的电流阈值≤0．5mA者编入A组，〉0．5mA者编入B组，并比较2组上述指标间的差异。结果诱发运动反应的电流阂值范围在0．14～1．7mA间，其中≤0．5mA者即A组病例占42％。所有患者均获得满意的上千感觉和运动阻滞，并且在PACU中无一例患者需要应用阿片类药物。两组的平均阻滞时问为17．8±4．9小时，手术后镇痛药物用量无差异。两组感觉阻滞起效时间相同，但15分钟时运动神经阻滞不全率B组（37％）高于A组（12％）（P=0．03）。结论超声引导下使用神经刺激仪行肌间沟神经阻滞时，出现运动反应的电流强度大于或小于Q5InA对上干阻滞成功率和持续时间无影响。BACKGROUND： We quantified the motor response after ultrasound （U-S） -guided needle placement for interscalene block （ISB）. We then compared block characteristics based on motor response above or below 0. 5 mA. METHODS： Sixty-one patients scheduled for ambulatory shoulder surgery under ISB and general anesthesia were included in this prospective, observational study. Preoperatively, an insulated needle was positioned by U-S in the interscalene groove. The lowest current producing motor response was determined, and 30 ml 0. 5% bupivacaine with epinephrine was injected. Motor and sensory block were tested in the upper trunk distribution for 15 rain until general anesthesia was induced. Postop- eratively, the success of upper trunk block, pain score in the postanesthesia care unit and block duration, and analgesic tablet consumption overnight were recorded. Patients were divided a priori into Group A （current ≤0. 5 mA） and Group B （current 〉0. 5 mA）, and results were compared between groups. RESULTS： The observed current range was 0. 14 - 1.7 mA, with current ≤0.5 mA in 42% of patients （Group A）. All patients had complete sensorimotor upper trunk block and none required narcotics in the postanesthesia care unit. Block duration （both groups： 17.8 ±4.9 h, mean ±SD） and home analgesic use were equivalent. Sensory block onset was equivalent between groups, but incomplete motor block at 15 min was more likely in Group B： 37% vs 12% in Group A （P = 0. 03）. CONCLUSIONS： During U-S-guided ISB using nerve stimulation, the observed motor response below or above 0. 5 mA had no impact on success or duration of upper trunk block.

关 键 词：运动神经阻滞 肌间沟阻滞 运动反应 超声引导 电流值 反应阈 0.5%布比卡因 手术后镇痛 

分 类 号：R971.2[医药卫生—药品] R614.4[医药卫生—药学]