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
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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

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