背景:前锁骨臂丛神经阻滞是一种新兴的锁骨下入路,目标是腋窝动脉外侧的索,提供感觉运动阻滞的快速发作。然而,半膈麻痹(HDP)的发病率,潜在的并发症,与广泛使用的锁骨上(SC)方法相比,尚不清楚。本研究旨在比较超声引导下前锁骨和SC臂丛神经阻滞的HDP发生率。
目的:比较超声引导下SC和前锁骨臂丛神经阻滞对膈肌偏移的影响,厚度,和收缩性以及肺功能。
方法:这种前瞻性,随机化,观察者盲法对照试验纳入了60例接受肩下手术的患者.患者随机接受超声引导下的SC(S组)或前锁骨(C组)臂丛神经阻滞和0.5%左布比卡因。使用超声检查前后的隔膜厚度和隔膜厚度分数(DTF)评估隔膜功能。肺功能检查(PFTs)(强迫肺活量(FVC),一秒钟用力呼气量(FEV1),阻断前和阻断后两小时进行呼气峰流速(PEFR)。比较了块特征。
结果:与前锁骨组相比,SC组的DTF从阻滞前到阻滞后的降低幅度明显更大(平均ΔDTF:34.38%vs.14.01%,p<0.01)。两组FVC均显著下降,FEV1和PEFR后置块,但是SC组恶化的程度明显更大,在区块特征上没有显着差异。
结论:与SC方法相比,前锁骨臂丛神经阻滞显示出更好的膈肌收缩力保留和较少的PFTs恶化,同时同样有效。这些发现突出了骨锁骨技术在减少膈肌功能障碍和呼吸损害方面的潜在益处。特别是有呼吸道并发症风险的患者。
BACKGROUND: A costoclavicular brachial plexus block is an emerging infraclavicular approach that targets the cords lateral to the axillary artery, providing rapid onset of sensory-motor blockade. However, the incidence of hemi-diaphragmatic paralysis (HDP), a potential complication, remains unclear compared to the widely used supraclavicular (SC) approach. This study aimed to compare the incidence of HDP between ultrasound-guided costoclavicular and SC brachial plexus blocks.
OBJECTIVE: To compare the influence of ultrasound-guided SC and costoclavicular brachial plexus blocks on diaphragmatic excursion, thickness, and contractility along with pulmonary function.
METHODS: This prospective, randomized, observer-blinded controlled trial included 60 patients undergoing below-shoulder surgeries. Patients were randomized to receive either ultrasound-guided SC (Group S) or costoclavicular (Group C) brachial plexus block with 0.5% levobupivacaine. The diaphragmatic function was assessed using ultrasonographic evaluation of diaphragm thickness and diaphragmatic thickness fraction (DTF) pre- and postblock. Pulmonary function tests (PFTs) (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow rate (PEFR)) were performed preblock and two hours postblock. Block characteristics were compared.
RESULTS: The SC group exhibited a significantly larger reduction in DTF from preblock to postblock compared to the costoclavicular group (mean ΔDTF: 34.38% vs. 14.01%, p<0.01). Both groups showed significant declines in FVC, FEV1, and PEFR postblock, but the magnitude of deterioration was significantly greater in the SC group, displaying no significant difference in block characteristics.
CONCLUSIONS: The costoclavicular brachial plexus block demonstrated superior preservation of diaphragmatic contractility and lesser deterioration of PFTs compared to the SC approach while being equally effective. These findings highlight the potential benefits of the costoclavicular technique in minimizing diaphragmatic dysfunction and respiratory impairment, particularly in patients at risk for respiratory complications.