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常规腋路臂丛阻滞有神经血管并发症及作用不全、时间短等缺点,Selander报告的连续腋路臂丛阻滞20％作用不全或失败,24％损伤动脉,根据临床观察与新鲜尸体解剖Ang提出改进的连续臂丛阻滞方法。让病人仰卧位,上臂外展,屈肘,前臂外旋,在上臂内侧,距腋窝顶40mm很容易摸到二头肌内侧与正中神经之间定为穿刺点,取50mm长19号针头与皮肤成20°角,向腋窝顶方向平行正中神经进针。进入5～10mm达肱动脉周围间隙,进此间隙不一定有突破感,回抽无血注入2％利多卡因5ml,如无皮下浸润且可见针头搏动,表示针的位置正确,否则再进针5mm,从针孔插入一根240mm长的导引钢丝,插入100～150mm直至遏阻力感为止,退出穿刺针,再将一根80mm长18号导管从导丝外插入,导管进入腋窝后退出导丝固定导管,在穿刺点远端先扎好止血带然后注入2％利多卡因20ml和0.5％布匹卡因20m11:2×10~5肾上腺素。
Conventional axillary brachial plexus neurovascular complications and shortcomings, shortcomings, Selander reported continuous axillary brachial plexus block 20% failure or failure, 24% of the arteries damaged, according to clinical observation and fresh autopsy Ang proposed improved continuous brachial plexus block. The patient supine, upper arm abduction, elbow flexion, forearm external rotation, inside the upper arm, 40mm from the armpit very easily touched the medial biceps and median nerve as a puncture point, take 50mm long 19 needle and skin Into a 20 ° angle, parallel to the direction of the axillary medial nerve into the needle. Into the 5 ~ 10mm up to the brachial artery gap, into the gap does not necessarily have a sense of breakthrough, pumping back into the blood injection of 2% lidocaine 5ml, such as no subcutaneous infiltration and visible needle beats, indicating the correct position of the needle, or else into the needle 5mm, insert a 240mm long guide wire from the pinhole, insert 100 ~ 150mm until the sense of resistance so far, exit the needle, and then a 18mm 18mm length catheter inserted from the guide wire, the catheter into the armpit and exit the guide Wire fixation catheter, the distal puncture site first tourniquet tourniquet and then injected into 2% lidocaine 20ml and 0.5% of the 20mg of clothine: 2 × 10 ~ 5 epinephrine.