Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942009000500007
Brazilian Journal of Anesthesiology
Scientific Article

Estudo comparativo entre ultrassom e neuroestimulação no bloqueio do plexo braquial pela via axilar

A comparative study between ultrasound and neurostimulation guided axillary brachial plexus block

Diogo Brüggemann da Conceição; Pablo Escovedo Helayel; Getúlio Rodrigues de Oliveira Filho

http://dx.doi.org/10.1590/S0034-70942009000500007 Braz J Anesthesiol, vol.59, n5, p.585-591, 2009
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Resumo

JUSTIFICATIVA E OBJETIVOS: O uso do ultrassom em Anestesia Regional vem crescendo. Existem poucos estudos comparando o uso do ultrassom com a neuroestimulação. O objetivo deste estudo foi comparar a execução do bloqueio do plexo braquial pela via axilar guiado por neuroestimulação com dupla injeção e guiado por ultrassonografia em procedimentos cirúrgicos na mão. Para isto, foram comparados o tempo de realização, a taxa de sucesso e complicações. MÉTODO: Após a aprovação do Comitê de Ética em Pesquisa do Hospital Governador Celso Ramos foram selecionados 40 pacientes escalados para operações eletivas na mão com bloqueio de plexo braquial via axilar. Os pacientes foram distribuídos aleatoriamente eletronicamente em dois grupos de 20 pacientes: Grupo Neuroestimulação (NE) e Grupo Ultrassonografia (US). Foram comparados tempo de realização, taxa de sucesso e taxa de complicações. RESULTADOS: As taxas de bloqueio completo, falha parcial e falha total não apresentaram diferença estatística significativa entre os grupos US e NE. O tempo médio para realização do procedimento no grupo US (354 segundos) não apresentou diferença estatística significativa quando comparado ao grupo NE (381 segundos). Pacientes do grupo NE apresentaram maior taxa de punção vascular (40%) quando comparados ao grupo US (10%, p < 0,05). A taxa de presença de parestesia durante a realização do bloqueio foi igual entre os dois grupos (15%). CONCLUSÕES: A taxa de sucesso e tempo para a realização foram semelhantes entre o bloqueio de plexo braquial via axilar guiado por ultrassom quando comparado com o guiado por neuroestimulação com dois estímulos em operações sobre a mão. Maior taxa de punção vascular ocorreu no bloqueio guiado por neuroestimulação.

Palavras-chave

ANESTESIA, Regional, EQUIPAMENTOS, EQUIPAMENTOS

Abstract

Conceição DB, Helayel PE, Oliveira Filho GR - A Comparative Study between Ultrasound- and Neurostimulation-Guided Axillary Brachial Plexus Block. BACKGROUND AND OBJECTIVES: The use of ultrasound in Regional Blocks is increasingly more frequent. However, very few studies comparing ultrasound and neurostimulation have been conducted. The objective of this study was to compare neurostimulation-guided axillary brachial plexus block with double injection and ultrasound-guided axillary plexus block for hand surgeries. The time to perform the technique, success rate, and complications were compared. METHODS: After approval by the Ethics on Research Committee of the Hospital Governador Celso Ramos, 40 patients scheduled for elective hand surgeries under axillary plexus block were selected. Patients were randomly divided into two groups with 20 patients each: Neurostimulation (NE) and Ultrasound (US) groups. The time to perform the technique, success rate, and complication rate were compared. RESULTS: Complete blockade, partial failure, and total failure rates did not show statistically significant differences between the US and NE groups. The mean time to perform the technique in the US group (354 seconds) was not statistically different than that of the NE group (381 seconds). Patients in the NE group had a higher incidence of vascular punctures (40%) when compared with those in the US group (10%, p < 0.05). The rate of paresthesia during the blockade was similar in both groups (15%). CONCLUSIONS: The success rate and time to perform the blockade were similar in ultrasound- and neurostimulation-guided axillary plexus block for hand surgeries. The rate of vascular puncture was higher in neurostimulation-guided axillary plexus block.

Keywords

ANESTHESIA, Regional, EQUIPMENT, EQUIPMENT

References

Brull R, Perlas A, Chan VW. Ultrasound-guided peripheral nerve blockade. Curr Pain Headache Rep. 2007;11:25-32.

Neal JM, Gerancher JC, Hebl JR. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009;34:134-170.

Sia S, Lepri A, Ponzecchi P. Axillary brachial plexus block using peripheral nerve stimulator: a comparison between double- and triple-injection techniques. Reg Anesth Pain Med. 2001;26:499-503.

Marhofer P, Chan VW. Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg. 2007;104:1265-1269.

Sites BD, Brull R. Ultrasound guidance in peripheral regional anesthesia: philosophy, evidence-based medicine, and techniques. Curr Opin Anaesthesiol. 2006;19:630-639.

Conceição DB, Helayel PE, Carvalho FAE. Imagens ultrasonográficas do plexo braquial na região axilar. Rev Bras Anestesiol. 2007;57:684-689.

Helayel PE, Conceição DB, Nascimento BS. Curva de aprendizado da sonoanatomia do plexo braquial na região axilar. Rev Bras Anestesiol. 2009;59:187-193.

Helayel PE, Conceição DB, Oliveira Filho GR. Bloqueios nervosos guiados por ultra-som. Rev Bras Anestesiol. 2007;57:106-123.

Abrahams MS, Aziz MF, Fu RF. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009;102:408-417.

Liu SS, Ngeow JE, Yadeau JT. Ultrasound-guided regional anesthesia and analgesia: a qualitative systematic review. Reg Anesth Pain Med. 2009;34:47-59.

Casati A, Danelli G, Baciarello M. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology. 2007;106:992-996.

Chan VW, Perlas A, McCartney CJ. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. 2007;54:176-182.

Sites BD, Beach ML, Spence BC. Ultrasound guidance improves the success rate of a perivascular axillary plexus block. Acta Anaesthesiol Scand. 2006;50:678-684.

Rucci FS, Barbagli R, Pippa P. The optimal dose of local anaesthetic in the orthogonal two-needle technique: Extent of sensory block after the injection of 20, 30 and 40 mL of anaesthetic solution. Eur J Anaesthesiol. 1997;14:281-286.

Nakagawa M, Mammoto T, Hazama A. Midazolam premedication reduces propofol requirements for sedation during regional anesthesia. Can J Anaesth. 2000;47:47-49.

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