Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942007000500005
Brazilian Journal of Anesthesiology
Scientific Article

Estudo comparativo da eficácia analgésica pós-operatória de 20, 30 ou 40 mL de ropivacaína no bloqueio de plexo braquial pela via posterior

A comparative study on the postoperative analgesic efficacy of 20, 30, or 40 mL of ropivacaine in posterior brachial plexus block

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

http://dx.doi.org/10.1590/S0034-70942007000500005 Braz J Anesthesiol, vol.57, n5, p.500-513, 2007
PDF Português
PDF English
Downloads: 0
Views: 1057

Resumo

JUSTIFICATIVA E OBJETIVOS: As intervenções cirúrgicas por via artroscópica no ombro estão relacionadas com a dor pós-operatória de grande intensidade. Dentre as técnicas de analgesia, o bloqueio do plexo braquial é a que oferece os melhores resultados. O objetivo deste estudo foi determinar qual volume de anestésico local no bloqueio de plexo braquial pela via posterior propicia analgesia pós-operatória para essas operações de maneira mais eficiente. MÉTODO: Noventa pacientes submetidos a bloqueio do plexo braquial pela via posterior foram divididos aleatoriamente em três grupos de 30. Grupo 1 - volume de 20 mL; Grupo 2 - volume de 30 mL; e Grupo 3 - volume de 40 mL. Em todos os grupos, o anestésico usado foi a ropivacaína a 0,375%. O bloqueio foi avaliado por meio da pesquisa de sensibilidade térmica utilizando-se algodão embebido em álcool e a dor pós-operatória foi avaliada seguindo-se uma escala numérica verbal (ENV) nas primeiras 24 horas. RESULTADOS: Nos três grupos a analgesia pós-operatória foi similar segundo os parâmetros avaliados; ENV de dor média, tempo até a primeira queixa de dor e consumo de opióides no pós-operatório. No grupo de 20 mL houve um maior consumo de analgésicos não-opióides após a 12ª hora de pós-operatório. Nos grupos de 30 e 40 mL a extensão do bloqueio foi muito maior. CONCLUSÕES: Este estudo mostrou que o bloqueio do plexo braquial pela via posterior é uma técnica que promove analgesia eficaz para intervenções cirúrgicas no ombro. Os três diferentes volumes estudados promoveram analgesia similar. A maior extensão do bloqueio com volumes maiores não se traduziu em melhor analgesia.

Palavras-chave

ANESTÉSICOS, Local, CIRURGIA, Ortopédica, DOR, pós-operatória, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Arthroscopic surgeries of the shoulder are accompanied by severe postoperative pain. Among the analgesic techniques, brachial plexus block offers the best results. The objective of this study was to determine which volume of local anesthetic in the posterior brachial plexus block offers more adequate analgesia for those procedures. METHODS: Ninety patients undergoing posterior brachial plexus block were randomly divided in three groups of 30 patients: Group 1 – volume of 20 mL; Groups 2 – volume of 30 mL; Group 3 – volume of 40 mL. In all groups 0.375% ropivacaine was the anesthetic used. The blockade was evaluated by testing thermal sensitivity using a cotton ball embedded in alcohol, while postoperative pain was evaluated according to a verbal numeric scale (VNS) in the first 24 hours. RESULTS: Postoperative analgesia was similar in all three groups according to the parameters evaluated: VNS of moderate pain, length of time until the first complaint of pain, and consumption of opioids. Consumption of non-opioid analgesics was greater in the 20 mL group after the 12th postoperative hour. In the 30 and 40 mL groups, the extension of the blockade was significantly greater. CONCLUSIONS: This study demonstrated that posterior brachial block promotes effective analgesia for surgeries of the shoulder. The three different volumes studied promoted similar analgesia. The greater extension of the blockade with larger doses did not translate into better analgesia.

Keywords

ANESTHETIC TECHNIQUES, Regional, ANESTHETICS, Local, PAIN, postoperative, SURGERY, Orthopedic

References

Bonica JJ. Postoperative Pain. The Management of Pain. 1990:461-480.

Capdevila X, Barthelet Y, Biboulet P. Effects of perioperative analgesic technique on the surgery outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91:8-15.

Singelyn FS, Lhotel L, Fabre B. Pain relief after arthroscopic 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 VW. Analgesic effect of interscalene block using low-dose bupivacaine for outpatient arthroscopic shoulder surgery. Reg Anesth Pain Med. 1998;23:469-473.

D'Alessio JG, Rosenblum M, Shea KP. A retrospective comparison of interscalene block and general anesthesia for ambulatory shoulder arthroscopy. Reg Anesth. 1995;20:6268.

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

Laurila PA, Löppönen 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.

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 C. A new technique of continuous interscalene nerve block. Can J Anesth. 1999;46:275-281.

Dagli G, Guzeldemir ME, Volkan Acar H. The effects and side effects of interscalene brachial plexus block by posterior approach. Reg Anesth Pain Med. 1998;23:87-91.

Sandefo I, Iohom G, Van Elstraete A. Clinical efficacy of the brachial plexus block via the posterior approach. Reg Anesth Pain Med. 2005;30:238-242.

Vrancken JH, van der Vegt MH, Zuurmond WW. Continuous brachial plexus block at the cervical level using a posterior approach in the management of neuropathic pain. Reg Anesth Pain Med. 2001;26:572-575.

Bonica JJ. Anatomic, Physiologic Basis of Nociception and Pain. The Management of Pain. 1990:28-94.

Pirec V, Laurito CE, Lu Y. The combined effects of N-type calcium channel blockers and morphine on A delta versus C fiber mediated nociception. Anesth Analg. 2001;92:239-43.

Azar FM, Wright PE. Arthroplasty of Shoulder and Elbow. Campbell's Operative Orthopedics. 2003:483-506.

Netter FH. Membro Superior. Atlas de Anatomia Humana. 2003:401-446.

Winnie AP. Plexus Anesthesia. Perivascular techniques of brachial plexus block.. 1990:180-181.

Wedel DJ. Peripheral Nerve Blocks. Orthopedic Anesthesia. 1993:255-262.

Cruvinel MGC, Castro CVH, Silva YP. Estudo radiológico da dispersão de diferentes volumes de anestésico local no bloqueio de plexo braquial pela via posterior. Rev Bras Anestesiol. 2005;55:508-516.

5dd8207f0e88259e0113f286 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