Estudo radiológico da dispersão de diferentes volumes de anestésico local no bloqueio de plexo braquial pela via posterior

Marcos Guilherme Cunha Cruvinel; Carlos Henrique Viana de Castro; Yerkes Pereira Silva; Flávio de Oliveira França; Flávio Lago

doi:10.1590/S0034-70942005000500005

Scientific Article

Estudo radiológico da dispersão de diferentes volumes de anestésico local no bloqueio de plexo braquial pela via posterior

Radiological evaluation of the spread of different local anesthetic volumes during posterior brachial plexus block

Marcos Guilherme Cunha Cruvinel; Carlos Henrique Viana de Castro; Yerkes Pereira Silva; Flávio de Oliveira França; Flávio Lago

http://dx.doi.org/10.1590/S0034-70942005000500005 Braz J Anesthesiol, vol.55, n5, p.508-516, 2005

PDF

Downloads: 1

Resumo

JUSTIFICATIVA E OBJETIVOS: A dispersão do anestésico local no bloqueio interescalênico foi bem estudada, porém no bloqueio pela via posterior são poucos os estudos. O objetivo deste estudo foi determinar a dispersão de diferentes volumes de anestésico local nesta técnica através de exame radiológico contrastado. MÉTODO: Dezesseis pacientes submetidos a bloqueio do plexo braquial pela via posterior, 15 foram divididos aleatoriamente em três grupos de cinco: Grupo 1: volume de 20 mL; Grupo 2: volume de 30 mL; Grupo 3: volume de 40 mL. Em um paciente, submetido a bloqueio contínuo do plexo braquial pela via posterior, a administração de um volume de 10 mL foi estudada. Em todos, o anestésico usado foi a ropivacaína a 0,375% associada a solução radiopaca. Foram feitas radiografias da região cervical imediatamente após o bloqueio que foi avaliado através da pesquisa de sensibilidade térmica utilizando-se algodão embebido em álcool, 30 minutos após a sua realização e na sala de recuperação pós-anestésica. RESULTADOS: O comportamento radiológico e clínico do bloqueio de plexo braquial pela via posterior é muito semelhante aquele descrito com a técnica de Winnie (interescalênico). Invariavelmente há envolvimento do plexo cervical e das raízes mais altas (C5-C7) do plexo braquial. CONCLUSÕES: Este estudo mostra que a dispersão do anestésico local no bloqueio do plexo braquial pela via posterior se dá primariamente nas raízes responsáveis pela inervação do ombro.

Palavras-chave

ANESTÉSICOS, ANESTÉSICOS, CIRURGIA, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Local anesthetic spread during interscalenic block has been thoroughly studied, however there are few studies on posterior block. This study aimed at evaluating the spread of different local anesthetic volumes during posterior brachial plexus block using contrasted X-rays. METHODS: Participated in this study 16 patients submitted to posterior brachial plexus block, 15 of whom were randomly divided in three groups of five patients: Group 1: 20 mL; Group 2: 30 mL.; Group 3 40 mL. The volume of 10 mL was studied in one patient submitted to continuous posterior brachial plexus block. All patients received 0.375% ropivacaine associated to radio-opaque solution. X-rays of the cervical region were obtained immediately after blockade that were evaluated by thermal sensitivity using cotton soaked in alcohol 30 minutes after being performed and in the PACU. RESULTS: Radiological and clinical behavior of posterior brachial plexus block is very similar to Winnies technique (interscalenic). There is always involvement of cervical plexus and of higher brachial plexus roots (C5-C7). CONCLUSIONS: This study has shown that local anesthetic spread during posterior brachial plexus block is seen primarily in shoulder innervating roots.

Keywords

ANESTHETICS, ANESTHETICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, SURGERY

References

Singelyn FJ, Lhotel L, Fabre B. Pain relief after arthorscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block. Anesth Analg. 2004;99:589-592.

Ritchie E, Tong D, Chung F. Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality?. Anesth Analg. 1997;84:1306-1312.

Al-Kaisy A, McGuire G, Chan V. Analgesic effect of interscalene block using low-dose bupivacaine for outpatient arthroscopic shoulder surgery. Reg Anesth Pain Med. 1998;23:469-473.

DAlessio JG, Rosenblum M, Shea K. A retrospective comparison of interscalene block and general anesthesia for ambulatory shoulder arthroscopy. Reg Anesth Pain Med. 1995;20:62-68.

Brown A, Weiss R, Greenberg C. Interscalene block for shoulder arthroscopy: comparison with general anesthesia. Arthroscopy. 1993;9:295-300.

Savoie F, Field L, Jenkins R. The pain control infusion pump for postoperative pain control in shoulder surgery. Arthroscopy. 2000;16:339-342.

Niiyama Y, Omote K, Sumita S. The effect of continuous intra-articular and intra-bursal infusion of lidocaine on postoperative pain following shoulder arthroscopic surgery. Masui. 2001;50:251-255.

Henn P, Fischer M, Steuer K. Effectiveness of morphine by periarticular injections after shoulder arthroscopy. Anaesthesist. 2000;49:721-724.

Scoggin JF 3rd, Mayfield G, Awaya DJ. Subacromial and intraarticular morphine versus bupivacaine after shoulder arthroscopy. Arthroscopy. 2002;18:464-468.

Muittari P, Nelimarkka O, Seppala T. Comparison of the analgesic effects of intrabursal oxycodone and bupivacaine after acromioplasty. J Clin Anesth. 1999;11:11-16.

Rodola F, Vagnoni S, DAvolio S. Intra-articular analgesia following arthroscopic surgery of the shoulder. Eur Rev Med Pharmacol Sci. 2001;5:143-146.

Park J, Lee G, Kim Y. The efficacy of continuous intrabursal infusion with morphine and bupivacaine for postoperative analgesia after subacromial arthroscopy. Reg Anesth Pain Med. 2002;27:145-149.

Axelsson K, Nordenson U, Johanzon E. Patient controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression. Acta Anaesthesiol Scand. 2003;47:993-1000.

Klein SM, Nielsen KC, Martin A. Interscalene brachial plexus block with continuous intraarticular infusion of ropivacaine. Anesth Analg. 2001;93:601-605.

Klein SM, Greengrass RA, Steele SM. A comparison of 0. 5% bupivacaine, 0.5% ropivacaine, and 0.75% ropivacaine for interscalene brachial plexus block. Anesth Analg. 1998;87:1316-1319.

Eroglu A, Uzunlar H, Sener M. A clinical comparison of equal concentration and volume of ropivacaine and bupivacaine for interscalene brachial plexus anesthesia and analgesia in shoulder surgery. Reg Anesth Pain Med. 2004;29:539-543.

Neal JM, McDonald SB, Larkin KL. Suprascapular nerve block prolongs analgesia after nonarthroscopic shoulder surgery but does not improve outcome. Anesth Analg. 2003;96:982-986.

Laurila PA, Lopponen A, Kanga-Saarela T. Interscalene brachial plexus block is superior to subacromial bursa block after arthroscopic shoulder surgery. Acta Anaesthesiol Scand. 2002;46:1031-1036.

Krone SC, Chan VW, Regan J. Analgesic effects of low-dose ropivacaine for interscalene brachial plexus block for outpatient shoulder surgery - a dose-finding study. Reg Anesth Pain Med. 2001;26:439-443.

Pippa P, Cominelli E, Marinelli C. Brachial plexus block using the posterior approach. Eur J Anaesthesiol. 1990;7:411-420.

Boezaart AP, Koorn R, Rosenquist RW. Paravertebral approach to the brachial plexus: an anatomic improvement in technique. Reg Anesth Pain Med. 2003;28:241-244.

Boezaart AP, de Beer JF, du Toit. A new technique of continuous interscalene nerve block. Can J Anesth. 1999;46:275-281.

Winnie AP. Interscalene brachial plexus block. Anesth Analg. 1970;49:455-466.

Beato L, Camocardi G, Imbelloni LE. Bloqueio de plexo braquial pela via posterior com uso de neuroestimulador e ropivacaína a 0,5%. Rev Bras Anestesiol. 2005;45:4 (completar).

Urmey W, Gloeggler P. Pulmonery function changes during interscalene brachial plexus block: effects of decreasing local anesthetic injection volume. Reg Anesth. 1993;18:244-249.

Winnie AP. Plexus Anesthesia: Perivascular Techniques of Brachial Plexus Block. 1990:180-181.

Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991;72:498-503.

Estudo radiológico da dispersão de diferentes volumes de anestésico local no bloqueio de plexo braquial pela via posterior

Radiological evaluation of the spread of different local anesthetic volumes during posterior brachial plexus block

Marcos Guilherme Cunha Cruvinel; Carlos Henrique Viana de Castro; Yerkes Pereira Silva; Flávio de Oliveira França; Flávio Lago

Resumo

Palavras-chave

Abstract

Keywords

References

Links

Share

Braz J Anesthesiol