Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.044
Brazilian Journal of Anesthesiology
Clinical Research

Does local anesthetic temperature affect the onset and duration of ultrasound-guided infraclavicular brachial plexus nerve block?: a randomized clinical trial

A temperatura do anestésico local afeta o início e a duração do bloqueio do plexo braquial guiado por ultrassom?

Ilker Ince, Muhammed Ali Arı, Aysenur Dostbil, Esra Kutlu Yalcin, Ozgur Ozmen, M. Zafeer Khan, Tetsuya Shimada, Mehmet Aksoy, Kutsi Tuncer

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Abstract

Background
Infraclavicular brachial plexus nerve block is a commonly performed anesthesiology technique in the upper extremity. Local anesthetics may be administered at different temperatures for both neuraxial and peripheral nerve blocks. We aimed to evaluate the effects of the temperature of the local anesthetic at the time of administration on the onset and duration of sensory and motor blocks in infraclavicular brachial plexus nerve block.

Methods
A total of 80 patients undergoing elective upper extremity surgery were randomly assigned to one of the following groups using a computer-based randomization software; low temperature (4 °C) (Group L, n = 26), room temperature (25 °C) (Group R, n = 27) and warmed (37 °C) (Group W, n = 27). A 1:1 mixture of 2% lidocaine and 0.5% bupivacaine was used as local anesthetic. Infraclavicular brachial plexus nerve block was performed under ultrasound guidance in all patients preoperatively. The onset and duration of sensory and motor blocks were recorded.

Results
Each group had different onset of motor (p < 0.001) and sensory (p < 0.001) blocks. The duration of motor block was similar between groups (p = 221). However, a significant difference was found in the duration of sensory block between group L (399.1 ± 40.8 min) and group R (379.6 ± 27.6 min) (p = 0.043). There was no complication related to nerve block procedure.

Conclusions
The administration of the local anesthetic at lower temperatures may prolong the onset of both motor and sensory blocks in infraclavicular brachial plexus nerve block.

Keywords

Local anesthetic,  Temperature,  Nerve block,  Brachial plexus,  Interventional ultrasonography

Resumo

Justificativa: O bloqueio do nervo do plexo braquial infraclavicular é uma técnica anestesiológica comumente realizada na extremidade superior. Os anestésicos locais podem ser administrados em temperaturas diferentes para bloqueios de nervos neuroaxiais e periféricos. Nosso objetivo foi avaliar os efeitos da temperatura do anestésico local no momento da administração sobre o início e a duração dos bloqueios sensorial e motor no bloqueio do plexo braquial infraclavicular. Metodologia: Um total de 80 pacientes submetidos à cirurgia eletiva da extremidade superior foram aleatoriamente designados para um dos seguintes grupos usando um software de randomização baseado em computador; temperatura baixa (4°C) (Grupo L, n = 26), temperatura ambiente (25°C) (Grupo R, n = 27) e aquecida (37°C) (Grupo W, n = 27). Uma mistura 1: 1 de lidocaína a 2% e bupivacaína a 0,5% foi usada como anestésico local. O bloqueio do nervo do plexo braquial infraclavicular foi realizado sob orientação de ultrassom em todos os pacientes no pré-operatório. O início e a duração dos bloqueios sensoriais e motores foram registrados. Resultados: Cada grupo teve início de bloqueio motor (p <0,001) e sensorial (p <0,001) diferente. A duração do bloqueio motor foi semelhante entre os grupos (p = 221). No entanto, foi encontrada diferença significativa na duração do bloqueio sensorial entre o grupo L (399,1 ± 40,8 min) e o grupo R (379,6 ± 27,6 min) (p = 0,043). Não houve complicações relacionadas ao procedimento de bloqueio do nervo. Conclusões: A administração de anestésico local em baixas temperaturas pode prolongar o início dos bloqueios motor e sensorial no bloqueio do plexo braquial infraclavicular.

Palavras-chave

Anestésico local; Temperatura; Bloqueio nervoso; Plexo braquial; Ultrassonografia intervencionista.

References

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