臂叢神經(jīng)阻滯

1、Handoll HH, et al. Cochrane database of systematic reviews. 2006, (1): CD003842腋鞘中的各支神經(jīng)被分隔腋鞘中的各支神經(jīng)被分隔腋鞘各支神經(jīng)有獨(dú)立的腋鞘各支神經(jīng)有獨(dú)立的“隔離室隔離室”Sadan AY, et al. Clinical Anatomy, 2007, 20: 57-63.10ml 亞甲蘭（亞甲蘭（8/8例）例）40ml 亞甲蘭（亞甲蘭（7/8例）例）Sadan AY, et al. Clinical Anatomy, 2007, 20: 57-63.隔膜隔膜 正常隔膜無孔隙正常隔膜無孔隙 泡沫樣缺陷（泡沫樣

2、缺陷（40ml40ml亞甲蘭）亞甲蘭）Sadan AY, et al. Clinical Anatomy, 2007, 20: 57-63.0.5-2mmHorlocker TT, et al. Anesth Analg, 1999, 88:382-387. Pins, eletric shock, annoying pain腋路四點(diǎn)異感與四點(diǎn)神經(jīng)刺激的比較腋路四點(diǎn)異感與四點(diǎn)神經(jīng)刺激的比較Sia S, et al. Regional Anesthesia and Pain Medicine, 2000, 91: 647-651.Klasstad Q, et al. Anesthesiology

3、, 2002, 96: 1315-1324.動脈上（由淺入深）：正中、肌皮動脈上（由淺入深）：正中、肌皮動脈下（由淺入深）：尺、橈動脈下（由淺入深）：尺、橈肌皮肌皮正中正中橈橈尺尺小魚際區(qū)小魚際區(qū)小指內(nèi)收小指內(nèi)收橈側(cè)手背橈側(cè)手背手腕外展手腕外展大魚際區(qū)大魚際區(qū)曲手曲手前臂外側(cè)前臂外側(cè)屈前臂屈前臂感覺感覺運(yùn)動運(yùn)動尺神經(jīng)尺神經(jīng)橈神經(jīng)橈神經(jīng)正中神經(jīng)正中神經(jīng)Casati A, et al. Anesthesiology, 2007, 106: 992-996.阻滯實(shí)施時間、阻滯成功率、患者的接受程度等方面無顯著性差異阻滯實(shí)施時間、阻滯成功率、患者的接受程度等方面無顯著性差異Perlas A, et a

4、l. Reg Anesth Pain Med, 2006, 31: 455-450.Perlas A, et al. Reg Anesth Pain Med, 2006, 31: 455-450.正中神經(jīng)入路（正中神經(jīng)入路（Q2）Klasstad Q, et al. Anesthesiology, 2002, 96: 1315-1324.擴(kuò)散完全：擴(kuò)散完全：5/13=38.5%Klasstad Q, et al. Anesthesiology, 2002, 96: 1315-1324.正中神經(jīng)入路（正中神經(jīng)入路（Q2）擴(kuò)散不全：擴(kuò)散不全：8/13=62.5%正中神經(jīng)入路（正中神經(jīng)入路（Q2）K

5、lasstad Q, et al. Anesthesiology, 2002, 96: 1315-1324.正中和尺神經(jīng)的擴(kuò)散效果較好正中和尺神經(jīng)的擴(kuò)散效果較好Koscielniak-Nielsen ZL, et al. Eur J Anaesthesiol, 1997, 14: 164-171.多點(diǎn)阻滯明顯提高肌皮和橈神經(jīng)的阻滯成功率多點(diǎn)阻滯明顯提高肌皮和橈神經(jīng)的阻滯成功率Sia S, et al. Reg Anesth Pain Med, 2001, 26: 499-503.2N: 橈和正中橈和正中3N: 肌皮、橈、正中肌皮、橈、正中Sia S. Reg Anesth Pain Med,

6、2006, 31(6): 514-518. Group ULN Group RADSia S. Reg Anesth Pain Med, 2006, 31(6): 514-518.起效時間起效時間阻滯效果阻滯效果Rodriguez J, et al. Reg Anesth Pain Med, 2006,31(3): 202-205.小劑量與小容量能產(chǎn)生良好阻滯效果小劑量與小容量能產(chǎn)生良好阻滯效果極高容量效果與普通容量效果相似極高容量效果與普通容量效果相似質(zhì)疑這一觀點(diǎn)的邏輯推理質(zhì)疑這一觀點(diǎn)的邏輯推理Serradell A, et al. Br J Anaesth, 2003, 91: 519-524.Group A: 1% Mepivacaine 36ml (9ml4)Group B: 1% Mepivacaine 28ml (7ml4)Group C: 1% Mepivacaine 20ml (5ml4)Koscielniak-Nielsen ZJ, et al. Can J Anesth, 1999, 46: 658-664.0.1%，9ml*4 0.1%,18ml*4 0.25%,9ml*4Harper GK, et al. Br J Anaest