Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.02.013
Brazilian Journal of Anesthesiology
Scientific Article

The need for supplemental blocks in single versus triple injections in infraclavicular brachial plexus blocks with a medial approach: a clinical and anatomic study

Bloqueio complementar de nervos no bloqueio de plexo braquial infraclavicular com técnica medial de injeção única versus tripla: estudo anátomo-clínico

Hande G Aytuluk, Tuncay Colak

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Abstract

Background and objectives
To evaluate the single-injection and triple-injection techniques in infraclavicular blocks with an ultrasound-guided medial approach in terms of block success and the need for supplementary blocks.

Methods
This study comprised 139 patients who were scheduled for elective or emergency upper-limb surgery. Patients who received an infraclavicular blocks with a triple-injection technique were included in Group T (n = 68). Patients who received an infraclavicular blocks with a single-injection technique were included in Group S (n = 71). The number of patients who required supplementary blocks or had complete failure, the recovery time of sensory blocks and early and late complications were noted.

Results
The block success rate was 84.5% in Group S, and 94.1% in Group T without any need for supplementary nerve blocks. The blocks were supplemented with distal peripheral nerve blocks in 8 patients in Group S and in 3 patients in Group T. Following supplementation, the block success rate was 95.8% in Group S and 98.5% in Group T. These results were not statistically significant. A septum preventing the proper distribution of local anesthetic was clearly visualized in 4 patients. The discomfort rate during the block was significantly higher in Group T (p < 0.05).

Conclusion
In ultrasound-guided medial-approach infraclavicular blocks, single-injection and triple-injection techniques did not differ in terms of block success rates. The need for supplementary blocks was higher in single injections than with triple injections. The presence of a fascial layer could be the reason for improper distribution of local anesthetics around the cords.

Keywords

Anesthesia;  Brachial plexus;  Infraclavicular block;  Regional anesthesia;  Upper-extremity orthopedic surgery;  Vertical infraclavicular block

Resumo

Justificativa e objetivos
Avaliar as técnicas de injeção única e tripla no bloqueio infraclavicular, empregando-se acesso medial guiado por ultrassonografia, comparando-se o sucesso do bloqueio e a necessidade de bloqueios complementares.

Método
O estudo incluiu 139 pacientes com indicação de cirurgia de membro superior eletiva ou de emergência. O Grupo T (n = 68 pacientes) recebeu bloqueio infraclavicular com técnica de injeção tripla e o Grupo S (n = 71), bloqueio infraclavicular com injeção única. Registrou-se o número de pacientes que necessitaram bloqueio complementar de nervo ou que apresentaram falha completa do bloqueio, o tempo de recuperação do bloqueio sensorial e as complicações precoces e tardias.

Resultados
A taxa de sucesso do bloqueio infraclavicular, sem necessidade de bloqueio complementar de nervo, foi 84,5% e 94,1% para os Grupos S e T, respectivamente. No bloqueio infraclavicular foi necessário bloqueio de nervos periféricos distais em 8 e 3 pacientes dos Grupos S e T, respectivamente. Após a complementação, a taxa de sucesso do bloqueio foi 95,8% e 98,5% para os Grupos S e T, respectivamente. Os resultados não foram estatisticamente significantes. Imagem de septo impedindo a distribuição adequada do anestésico local foi claramente visualizada em quatro pacientes. A taxa de desconforto durante a realização do bloqueio foi estatatisticamente mais alta no Grupo T (p < 0,05).

Conclusões
As técnicas de injeção única e tripla em bloqueio infraclavicular guiado por ultrasonografia com acesso medial não diferiram quanto à taxa de sucesso. A necessidade de bloqueio complementar foi maior com a técnica de injeção simples. A ocorrência de invólucro de fascia poderia justificar a distribuição inadequada do anestésico local ao redor dos fascículos do plexo.

Palavras-chave

Anestesia;  Plexo braquial;  Bloqueio infraclavicular;  Anestesia regional;  Cirurgia ortopédica de membro superior;  Bloqueio infraclavicular vertical

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