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

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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

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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

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