Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942001000300007
Brazilian Journal of Anesthesiology
Miscellaneous

Bloqueio do plexo braquial por via infraclavicular: abordagem ântero-posterior

Infraclavicular brachial plexus block: antero posterior approach

Luiz Eduardo Imbelloni; Lúcia Beato; M. A Gouveia

http://dx.doi.org/10.1590/S0034-70942001000300007 Braz J Anesthesiol, vol.51, n3, p.235-243, 2001
PDF Português
PDF English
Downloads: 1
Views: 1192

Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo braquial é a técnica preferida pelos anestesiologistas para cirurgias nos membros superiores. Embora o acesso infraclavicular seja menos utilizado, ele pode oferecer algumas vantagens. O objetivo deste estudo prospectivo é mostrar os resultados observados em 50 pacientes submetidos a bloqueio do plexo braquial pela via infraclavicular, usando estimulador de nervo periférico e abordagem ântero-posterior. MÉTODO: Cinqüenta pacientes, com idades entre 17 e 87 anos, estado físico ASA I e II, escalados para cirurgias ortopédicas da extremidade superior foram anestesiados com bloqueio do plexo braquial pela via infraclavicular. Todos os bloqueios foram realizados com estimulador de nervo periférico, a partir de 1 mA. Quando se obtinha uma adequada contração muscular na mão, no antebraço ou músculos do braço, a amperagem era diminuída até desaparecimento da resposta. Se a resposta desaparecesse com estímulo superior a 0,6 mA, a agulha poderia ser movimentada a procura de melhor resposta. Se a resposta não desaparecesse com estímulo menor que 0,5 mA, injetavam-se 50 ml de lidocaína a 1,6% com epinefrina 1:200.000. Foram avaliados o tempo de latência, duração da cirurgia, tolerância ao uso do torniquete, duração dos bloqueios sensitivo e motor, complicações e efeitos adversos. RESULTADOS: O bloqueio foi efetivo em 94% dos pacientes, o tempo médio da latência foi de 8,78 min, a duração média da cirurgia foi de 65,52 min e a tolerância ao torniquete foi observada em todos os pacientes. A média de duração do bloqueio sensitivo foi de 195,56 min e do bloqueio motor de 198,86 min. Ocorreu uma punção vascular. Não foram observados sinais e sintomas clínicos de toxicidade do anestésico local ou do vasoconstritor. Nenhum paciente apresentou efeitos adversos do bloqueio. CONCLUSÕES: O bloqueio infraclavicular do plexo braquial proporciona uma anestesia efetiva para cirurgias dos membros superiores. Acreditamos que a técnica utilizando o estimulador de nervos periféricos proporciona um alto índice de sucesso e demonstrou ser segura. Não foi observado nenhum caso de pneumotórax ou qualquer outro tipo de complicação. A solução do anestésico utilizada proporcionou uma anestesia adequada e segura.

Palavras-chave

ANESTÉSICOS, Local: lidocaína, CIRURGIA, Ortopédica, TÉCNICAS ANESTÉSICAS, Regional: plexo braquial

Abstract

BACKGROUND AND OBJECTIVES: Brachial plexus block is the preferred anesthetic technique for upper limb surgery. Although less commonly used, the infraclavicular brachial block may have some advantages. In this study we present the results of 50 patients submitted to infraclavicular plexus block by the antero posterior approach with the aid of a nerve stimulator. METHODS: Fifty patients, aged 17 to 87 years, physical status ASA I and II, scheduled for upper limb orthopedic surgery, were submitted to brachial plexus block by the infraclavicular approach. All blocks were performed with the help of a peripheral nerve stimulator starting at 1 mA. When an adequate hand, forearm or arm muscle contraction was obtained the current was decreased until the disappearance of the response. If there was no response with a stimulus above 0.6 mA, the needle was relocated in search for a better response. If response persisted with a stimulus below 0.5 mA, 50 ml of 1.6% lidocaine with epinephrine 1:200,000 were injected. The following parameters were evaluated: block onset time, surgery duration, tourniquet tolerance, sensory and motor block duration, complications and side effects. RESULTS: Blockade was effective in 94% of patients; mean onset time was 8.78 min, surgical mean duration was 65.52 min, tourniquet tolerance was 100%, mean sensory block duration was 195.56 min and mean motor block duration was 198.86 min. There has been one vascular puncture. There were no clinical signs or symptoms of toxic effects of local anesthetics and vasoconstrictors. No patient showed blockade side effects. CONCLUSIONS: Infraclavicular plexus block provides an effective anesthesia for upper limb surgery. The use of a nerve stimulator helps the technique to be both highly successful and safe: no pneumothorax or any other major complication were observed. The local anesthetic solution used provided an adequate and safe anesthesia.

Keywords

ANESTETHICS, Local: lidocaine, ANESTHETIC TECHNIQUES, Regional: brachial plexus, SURGERY, Orthopedic

References

Imbelloni LE, Pinto AL, Neumann CR. Bloqueio do plexo braquial pela via transarterial com altas doses de lidocaína 1,6%. Rev Bras Anestesiol. 1989;39:273-276.

Stan TC, Krantz MA, Solomon DL. The incidence of neurovascular complications following axillary brachial plexus block using a transarterial approach: A prospective study of 1.000 consecutive patients. Reg Anesth. 1995;20:486-492.

Brown DL, Cahill DR, Bridenbaugh DL. Supraclavicular nerve block: anatomic analysis of a method to prevent pneumothorax. Anesth Analg. 1993;76:530-534.

Winnie AP, Collins VJ. The subclavian perivascular technique of brachial plexus anesthesia. Anesthesiology. 1964;25:353-363.

Vieira JL. Bloqueio do plexo braquial. Rev Bras Anestesiol. 1995;45(^s20):106-115.

Urmey WF. Brachial plexus block. Curr Opin Anesthesiol. 1992;5:666-671.

Winnie AP. Interescalene brachial plexus block. Anesth Analg. 1970;49:455-466..

Moore DC. "No paresthesias - no anesthesia", the nerve stimulator or neither?. Reg Anesth. 1997;22:388-390.

Selander D, Edshage S, Wolff T. Paresthesiae or no paresthesiae?. Acta Anaesthesiol Scand. 1979;3:27-33.

Raj PP. Guidelines for Regional Anesthetic Techniques. Regional Anesthesia: An Atlas of Anatomy and Techniques. 1996:21-38.

Raj PP, Montgomery SJ, Nettles D. Infraclavicular brachial plexus block: A new approach. Anesth Analg. 1973;52:897-904.

Salazar CH, Espinosa W. Infraclavicular brachial plexus block: variation in approach and results in 360 cases. Reg Anesth Pain Med. 1999;24:411-416.

Rodríguez J, Bárcena M, Rodríguez V. Infraclavicular brachial plexus block effects on respiratory function and extent of the block. Reg Anesth Pain Med. 1998;23:564-568.

Fitzgibbon DR, Debs AD, Erjavec MK. Selective musculocutaneus nerve block and infraclavicular brachial plexus anesthesia. Case Report. Reg Anesth. 1995;20:239-241.

Geier KO. Bloqueio do plexo braquial no trauma: analgesia regional prolongada por cateter axilar. Rev Bras Anestesiol. 1995;45:173-182.

Urban MK, Urquhart B. Evaluation of bachial plexus anesthesia for upper extremity surgery. Reg Anesth. 1994;19:175-182.

Franco CD, Vieira ZE. 1.001 subclavian perivascular brachial plexus blocks: success with a nerve stimulator. Reg Anesth Pain Med. 2000;25:41-46.

Labat G. Regional Anesthesia. 1930.

De Jong RD. Axillary block of the brachial plexus. Anesthesiology. 1961;26:215-225.

Perthes G. Conduction anesthesia with the help of electrical stimulation. München Med Wochenschr. 1912;59:2545-2548.

Greenblatt GM, Denson JS. Needle nerve stimulator-locator: Nerve blocks with a new instrument for locating nerves. Anesth Analg. 1962;41:599-602.

Barthram CN. Nerve stimulators for nerve location: Are they all the same? A study of stimulator performance. Anaesthesia. 1997;52:761-764.

Ford DJ, Pither C, Raj PP. Comparison of insulated and uninsulated needles for locating peripheral nerves with a peripheral nerve stimulator. Anesth Analg. 1984;63:925-928.

Bashein G, Haschke RH, Ready LB. Electrical nerve location: numerical and electrophoretic comparison of insulated vs uninsulated needles. Anesth Analg. 1984;63:919-24.

Thompson GE, Rorie DE. Functional anatomy of brachial plexus sheaths. Anesthesiology. 1983;59:117-122.

Moore DC. Complications of regional anesthesia. Clin Anesth. 1969;2:218-251.

Salazar CH, Espinosa W. Bloqueo Infraclavicular del Plexo Braquial. Anestesia Regional Hoy. 1998:249-257.

Urmey WF, Talts KH, Sharrock EN. One hundred percent incidence of hemidiaphragmatic paresis associated with interescalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991;72:498-503.

Sala-Blanch X, Lázaro JF, Gómez-Fernández M. Parális frénica tras bloqueo del plexo braquial: Estudio comparativo entre el abordaje interescalénica y el axilar. Rev Soc Esp Dolor. 1997;4:238-244.

Sala-Blanch X, Lázaro JF, Correa J. Phrenic nerve block caused by interscalene brachial plexus block: effects of digital pressure and a low volume of local anesthetic. Reg Anesth Pain Med. 1999;24:231-235.

5dd81a920e88250b7213f286 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