Prevalência de paralisia diafragmática após bloqueio de plexo braquial pela via posterior com ropivacaína a 0,2%

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

doi:10.1590/S0034-70942006000500004

Scientific Article

Prevalência de paralisia diafragmática após bloqueio de plexo braquial pela via posterior com ropivacaína a 0,2%

Prevalence of diaphragmatic paralysis after brachial plexus blockade by the posterior approach with 0.2% ropivacaine

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

http://dx.doi.org/10.1590/S0034-70942006000500004 Braz J Anesthesiol, vol.56, n5, p.461-469, 2006

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Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio de plexo braquial pela via interescalênica descrita por Winnie é uma das técnicas mais eficazes para promover analgesia pós-operatória de intervenções cirúrgicas no ombro. Uma de suas conseqüências é a paralisia diafragmática. Esta paralisia pode levar, em pacientes com algum grau de disfunção pulmonar prévia, à insuficiência respiratória. A abordagem do plexo braquial por via posterior tem conquistado espaço. O objetivo deste estudo foi determinar a prevalência de paralisia diafragmática, após o bloqueio de plexo braquial interescalênico pela via posterior com o uso de ropivacaína a 0,2%. MÉTODO: Vinte e dois pacientes submetidos ao bloqueio do plexo braquial interescalênico pela via posterior com ropivacaína a 0,2%, foram avaliados no pós-operatório com o objetivo de identificar sinais radiológicos de elevação da cúpula diafragmática sugestivos de paralisia hemidiafragmática. Em 20 pacientes utilizou-se 40 mL de ropivacaína a 0,2%, nestes foi realizada radiografia de tórax em inspiração. Em dois foram utilizados 20 mL de ropivacaína a 0,2%, com subseqüente avaliação fluoroscópica. RESULTADOS: Não houve complicações relacionadas à realização do bloqueio. Em todos os pacientes, o bloqueio foi efetivo e proporcionou boa analgesia pós-operatória. Foi observada elevação da cúpula diafragmática compatível com paralisia hemidiafragmática em todos os casos estudados. CONCLUSÕES: Nas condições deste estudo observou-se que o bloqueio do plexo braquial pela via posterior é uma técnica que está associada à alta prevalência de paralisia diafragmática, mesmo utilizando-se baixas concentrações de anestésico local.

Palavras-chave

ANESTÉSICOS, Local, CIRURGIA, Ortopédica, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Brachial plexus blockade by the interscalene approach, described by Winnie, is one of the most effective techniques in promoting postoperative analgesia in surgeries of the shoulder. Diaphragmatic paralysis is one of the consequences of this technique. This paralysis can cause respiratory failure in patients with prior lung dysfunction. Brachial plexus blockade by the posterior approach has become increasingly more popular. The objective of this study was to determine the prevalence of diaphragmatic paralysis after interscalene brachial plexus blockade by the posterior approach with 0.2% ropivacaine. METHODS: Twenty-two patients who underwent interscalene brachial plexus blockade by the posterior approach with 0.2% ropivacaine were evaluated in the postoperative period to identify radiological signs of elevation of the hemidiaphragm that could suggest hemidiaphragmatic paralysis. Forty mL of 0.2% ropivacaine were used in 20 patients; inspiratory chest X-rays were done in these patients. Twenty mL of 0.2% ropivacaine were used in two patients, with posterior fluoroscopic evaluation. RESULTS: There were no complications related to the procedure. The anesthesia was effective in every patient, providing good postoperative analgesia. Every patient in this study presented elevation of the diaphragm compatible with hemidiaphragmatic paralysis. CONCLUSIONS: We observed that brachial plexus blockade by the posterior approach is associated with a high prevalence of diaphragmatic paralysis, even with low concentrations of local anesthetics.

Keywords

ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional, COMPLICATIONS, SURGERY, Orthopedic

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Prevalência de paralisia diafragmática após bloqueio de plexo braquial pela via posterior com ropivacaína a 0,2%

Prevalence of diaphragmatic paralysis after brachial plexus blockade by the posterior approach with 0.2% ropivacaine

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

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