Brazilian Journal of Anesthesiology
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

Downloads: 0
Views: 749


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.

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.

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.

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.


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


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.


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


1 D. Brenner, G. Iohom, P. Mahon, et al. Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: a randomised trial Eur J Anaesthesiol, 36 (2019), pp. 48-54

2 M.S. Hughes, M.J. Matava, R.W. Wright, et al. Interscalene brachial plexus block for arthroscopic shoulder surgery: a systematic review J Bone Joint Surg Am, 95 (2013), pp. 1318-1324

3 C.M. Brummett, B.A. Williams Additives to local anesthetics for peripheral nerve blockade Int Anesthesiol Clin, 49 (2011), pp. 104-116

4 P. Heath, G. Brownlie, M. Herrick Latency of brachial plexus block. The effect on onset time of warming local anaesthetic solutions Anaesthesia, 45 (1990), pp. 297-301

5 M. Opperer, P. Gerner, S.G. Memtsoudis Additives to local anesthetics for peripheral nerve blocks or local anesthesia: a review of the literature Pain Manag, 5 (2015), pp. 117-128

6 M.A. Kirksey, S.C. Haskins, J. Cheng, S.S. Liu Local anesthetic peripheral nerve block adjuvants for prolongation of analgesia: a systematic qualitative review PLoS One, 10 (10) (2015), Article e0137312

7 F.C. Liu, J.T. Liou, Y.J. Day, et al. Effect of warm lidocaine on the sensory onset of epidural anesthesia: a randomized trial Chang Gung Med J, 32 (2009), pp. 643-649

8 P.M. Mehta, E. Theriot, D. Mehrotra, et al. A simple technique to make bupivacaine a rapid-acting epidural anesthetic Reg Anesth Pain Med, 12 (1987), pp. 135-138

9 B. Nazli, H. Oguzalp, E. Horasanli, et al. The effects on sensorial block, motor block, and haemodynamics of levobupivacaine at different temperatures applied in the subarachnoid space Biomed Res Int, 2014 (2014), Article 132687

10 P. Rosenberg, J. Heavner Temperature-dependent nerve-blocking action of lidocaine and halothane Acta Anaesthesiol Scand, 24 (1980), pp. 314-320

11 H. Sviggum, S. Yacoubian, X. Liu, et al. The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia: a randomized controlled study Int J Obstet Anesth, 24 (2015), pp. 15-21

12 H. Kamaya, J.J. Hayes, I. Ueda Dissociation constants of local anesthetics and their temperature dependence Anesth Analg, 62 (1983), pp. 1025-1030

13 R. Lee, Y.M. Kim, E.M. Choi, et al. Effect of warmed ropivacaine solution on onset and duration of axillary block Korean J Anesthesiol, 62 (2012), pp. 52-56

14 C. Chilvers Warm local anaesthetic—effect on latency of onset of axillary brachial plexus block Anaesth Intensive Care, 21 (1993), pp. 795-798

15 Y. Tomak, B. Erdivanli, A. Sen, et al. Effect of cooled hyperbaric bupivacaine on unilateral spinal anesthesia success rate and hemodynamic complications in inguinal hernia surgery J Anesth, 30 (2016), pp. 26-30

16 N. Dabarakis, A. Tsirlis, N. Parisis, et al. The role of temperature in the action of mepivacaine Anesth Prog, 53 (2006), pp. 91-94

17 P.A. Pappone Voltage-clamp experiments in normal and denervated mammalian skeletal muscle fibres J Physiol, 306 (1980), pp. 377-410

60748e69a95395190769e727 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections