Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2017.07.001
Brazilian Journal of Anesthesiology
Scientific Article

Randomized prospective study of three different techniques for ultrasound-guided axillary brachial plexus block

Estudo prospectivo randomizado de três diferentes técnicas para o bloqueio do plexo braquial via axilar guiado por ultrassom

Leonardo Henirque Cunha Ferraro; Alexandre Takeda; Paulo César Castello Branco de Sousa; Fernanda Moreira Gomes Mehlmann; Jorge Kiyoshi Mitsunaga Junior; Luiz Fernando dos Reis Falcão

http://dx.doi.org/10.1016/j.bjane.2017.07.001 Braz J Anesthesiol, vol.68, n1, p.62-68, 2018
PDF English
PDF Português
Downloads: 0
Views: 962

Abstract

Abstract Introduction Randomized prospective study comparing two perivascular techniques with the perineural technique for ultrasound-guided axillary brachial plexus block (US-ABPB). The primary objective was to verify if these perivascular techniques are noninferior to the perineural technique. Method 240 patients were randomized to receive the techniques: below the artery (BA), around the artery (AA) or perineural (PN). The anesthetic volume used was 40 mL of 0.375% bupivacaine. All patients received a musculocutaneous nerve blockade with 10 mL. In BA technique, 30 mL were injected below the axillary artery. In AA technique, 7.5 mL were injected at 4 points around the artery. In PN technique, the median, ulnar, and radial nerves were anesthetized with 10 mL per nerve. Results Confidence interval analysis showed that the perivascular techniques studied were not inferior to the perineural technique. The time to perform the blockade was shorter for the BA technique (300.4 ± 78.4 s, 396.5 ± 117.1 s, 487.6 ± 172.6 s, respectively). The PN technique showed a lower latency time (PN - 655.3 ± 348.9 s; BA - 1044 ± 389.5 s; AA - 932.9 ± 314.5 s), and less total time for the procedure (PN - 1132 ± 395.8 s; BA - 1346.2 ± 413.4 s; AA - 1329.5 ± 344.4 s). BA technique had a higher incidence of vascular puncture (BA - 22.5%; AA - 16.3%; PN - 5%). Conclusion The perivascular techniques are viable alternatives to perineural technique for US-ABPB. There is a higher incidence of vascular puncture associated with the BA technique.

Keywords

Axillary brachial plexus block, Ultrasound, Perineural technique, Perivascular technique, Vascular puncture

Resumo

Resumo Introdução Estudo prospectivo randomizado, compara duas técnicas perivasculares com a técnica perineural para o bloqueio do plexo braquial via axilar guiado por ultrassom (BPVA-USG). Objetivo primário foi verificar se essas técnicas perivasculares são não inferiores à técnica perineural. Método Foram randomizados 240 pacientes para receber as técnicas: abaixo da artéria (TA), ao redor da artéria (TR) ou perineural (PN). O volume de anestésico usado foi 40 ml de bupivacaína 0,375%. Em todos os pacientes, fez-se o bloqueio do nervo musculocutâneo com 10 ml. Na técnica TA, injetaram-se 30 ml abaixo da artéria axilar. Na técnica TR, injetaram-se 7,5 ml em quatro pontos ao redor da artéria. Na técnica PN, os nervos mediano, ulnar e radial foram anestesiados com 10 ml por nervo. Resultados Análise dos intervalos de confiança mostrou que as técnicas perivasculares estudadas não são inferiores à técnica perineural. A técnica TA apresentou menor tempo para o bloqueio (300,4 ± 78,4 seg; 396,5 ± 117,1 seg; 487,6 ± 172,6 seg; respectivamente). A técnica PN apresentou menor tempo de latência (PN - 655,3 ± 348,9 seg; TA - 1044 ± 389,5 seg; TR - 932,9 ± 314,5 seg) e menor tempo total de procedimento (PN - 1132 ± 395,8 seg; TA -1346,2 ± 413,4 seg; TR 1329,5 ± 344,4 seg). A técnica TA apresentou maior incidência de punção vascular (TA - 22,5%, TR - 16,3%; PN - 5%). Conclusão As técnicas perivasculares são opções viáveis à técnica perineural para o BPVA-USG. Ressalta-se maior incidência de punção vascular associada à técnica TA.

Palavras-chave

Bloqueio plexo braquial via axilar, Ultrassom, Técnica perineural, Técnica perivascular, Punção vascular

References

O'Donnell BD, Iohom G. An estimation of the minimum effective anesthetic volume of 2% lidocaine in ultrasound-guided axillary brachial plexus block. Anesthesiology. 2009;111:25-9.

Ferraro LHC, Takeda A, Rezende AH. Determination of the minimum effective volume of bupivacaine 0.5% for ultrasound-guided axillary brachial plexus block. Rev Bras Anestesiol. 2014;64:49-53.

Takeda A, Ferraro LH, Rezende AH. Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound. Rev Bras Anestesiol. 2015;65:163-9.

Wong DM, Gledhill S, Thomas R. Sonographic location of the radial nerve confirmed by nerve stimulation during axillary brachial plexus blockade. Reg Anesth Pain Med. 2009;34:503-7.

Imasogie N, Ganapathy S, Singh S. A prospective, randomized, double-blind comparison of ultrasound-guided axillary brachial plexus blocks using 2 versus 4 injections. Anesth Analg. 2010;110:1222-6.

Bernucci F, Gonzalez AP, Finlayson RJ. A prospective, randomized comparison between perivascular and perineural ultrasound-guided axillary brachial plexus block. Reg Anesth Pain Med. 2012;37:473-7.

Cho S, Kim YJ, Baik HJ. Comparison of ultrasound-guided axillary brachial plexus block techniques: perineural injection versus single or double perivascular infiltration. Yonsei Med J. 2015;56:838-44.

Sasse AD, Wada CY, Andrade JML. Requerimentos mínimos para o planejamento e análise de estudos clínicos de não inferioridade. Rev Bras Clin Med. 2010;8:538-41.

Tran DQ, Pham K, Dugani S. A prospective, randomized comparison between double-, triple-, and quadruple-injection ultrasound-guided axillary brachial plexus block. Reg Anesth Pain Med. 2012;37:248-53.

Neal JM. Ultrasound-guided regional anesthesia and patient safety: update of an evidence-based analysis. Reg Anesth Pain Med. 2016;41:195-204.

Kutiyanawala MA, Stotter A, Windle R. Anatomical variants during axillary dissection. Br J Surg. 1998;85:393-4.

Orebaugh SL, Williams BA. Brachial plexus anatomy: normal and variant. Sci World J. 2009;9:300-12.

González AP, Bernucci F, Pham K. Minimum effective volume of lidocaine for double-injection ultrasound-guided axillary block. Reg Anesth Pain Med. 2013;38:16-20.

5dcc5d2a0e88252421bf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections