Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942005000100005
Brazilian Journal of Anesthesiology
Scientific Article

Comparação das técnicas transarterial e de estimulação de múltiplos nervos para bloqueio do plexo braquial por via axilar usando lidocaína com epinefrina

Comparison of transarterial and multiple nerve stimulation techniques for axillary block using lidocaine with epinephrine

Luiz Eduardo Imbelloni; Lúcia Beato; José Antônio Cordeiro

http://dx.doi.org/10.1590/S0034-70942005000100005 Braz J Anesthesiol, vol.55, n1, p.40-49, 2005
PDF Português
PDF English
Downloads: 0
Views: 904

Resumo

JUSTIFICATIVA E OBJETIVOS: A técnica transarterial com grandes doses de anestésico local resulta em alta efetividade para o bloqueio axilar do plexo braquial. A técnica utilizando múltiplos estímulos exige mais tempo e maior experiência. Este estudo prospectivo compara a latência e o índice de sucesso do bloqueio do plexo braquial usando duas técnicas de localização: transarterial ou múltipla estimulação dos nervos. MÉTODO: A lidocaína com epinefrina, 800 mg, foi usada inicialmente para o bloqueio axilar. No grupo transarterial, 30 mL de lidocaína a 1,6% com epinefrina foram injetados profundamente e 20 mL superficialmente à artéria axilar. No grupo de múltipla estimulação, três nervos foram localizados eletricamente e bloqueados com volumes 20 mL, 20 mL e 10 mL da solução. O bloqueio foi considerado efetivo quando a analgesia estava presente em todos os nervos na área distal ao cotovelo. RESULTADOS: O tempo de latência (8,8 ± 2,3 min versus 10,2 ± 2,4 min; p-valor = 0,010) foi significativamente menor no grupo transarterial. Bloqueios sensitivos completos nos quatro nervos (mediano, ulnar, radial e musculocutâneo) foram obtidos em 92,5% versus 83,3% no grupo de múltipla estimulação e acesso transarterial, respectivamente sem diferença significativa (p-valor = 0,68). O nervo musculocutâneo foi significativamente mais fácil de bloquear com o estimulador de nervo periférico (p = 0,034). CONCLUSÕES: A técnica de múltipla estimulação para o bloqueio axilar usando estimulador de nervos (3 injeções) e a técnica transarterial (2 injeções) produzem resultados semelhantes na qualidade do bloqueio. O nervo musculocutâneo é mais facilmente bloqueado com o uso do estimulador de nervo periférico. A técnica de múltipla estimulação necessitou menor suplementação do bloqueio e aumentou o tempo para o início da cirurgia.

Palavras-chave

ANESTÉSICOS, Local, ANESTÉSICOS, Local, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: High-dose transarterial technique results in highly effective axillary block. The multiple nerve stimulation technique (MNS) requires more time and experience. This prospective study aimed at comparing onset and success rate of multiple-injection axillary brachial plexus block using two methods of nerve location: transarterial or multiple nerve stimulation technique. METHODS: Axillary block was initially induced with 800 mg lidocaine with epinephrine. The transarterial group received deeply injected 30 mL of 1.6% lidocaine with epinephrine, and 20 mL superficially to the axillary artery. For the multiple nerve stimulation group, three terminal motor nerves were electrolocated and blocked with 20 mL, 20 mL and 10 mL. Blockade was considered effective when analgesia was present in all sensory nerves distal to the elbow. RESULTS: Onset (8.8 ± 2.3 min versus 10.2 ± 2.4 min; p-value = 0.010) was significantly shorter in the transarterial group. Complete sensory block of all four nerves (median, ulnar, radial and musculocutaneus) was achieved in 92.5% versus 83.3% for multiple nerve stimulation group and transarterial group, respectively, without significant difference (p = 0.68). Musculocutaneous nerve was significantly easier to be blocked with the aid of peripheral nerve stimulator (p = 0.034). CONCLUSIONS: Both MNS technique for axillary block with nerve stimulator (3 injections) and transarterial technique (2 injections) promote similar results. Musculocutaneous nerve is more easily blocked with the aid of peripheral nerve stimulator. MNS technique has required less supplementary blocks and has delayed beginning of surgery.

Keywords

ANESTHETIC, Local, ANESTHETIC, Local, ANESTHETIC TECHNIQUES, Regional, ANESTHETIC TECHNIQUES, Regional

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.

Oliva Filho AL. O bloqueio do plexo braquial via axilar. Rev Bras Anestesiol. 1995;45(^s20):116-118.

Chaves IMM, Chaves LFM, Dias CL. Bloqueio do plexo braquial por via axilar com neuroestimulador: verificação da latência e da eficácia. Rev Bras Anestesiol. 2001;51:244-249.

Koscielniak-Nielsen ZJ, Stens-Pedersen HL, Knudesen Lippert F. Readiness for surgery after axillary block: single or multiple injection techniques. Eur J Anaesthesiol. 1997;14:164-171.

Koscielniak-Nielsen ZJ, Hesselbjerg L, Fejlberg V. Comparison of transarterial and multiple nerve stimulation techniques for an initial axillary block by 45 ml of mepivacaine 1% with adrenaline. Acta Anaesthesiol Scand. 1998;42:570-575.

Sia S, Bartoli M. Selective ulnar nerve localization is not essential for axillary brachial plexus block using a multiple nerve stimulation technique. Reg Anesth Pain Med. 2001;26:12-16.

Serradell Catalan A, Moncho Rodríguez JM, Santos Carnes JA. Anestesia de plexo braquial por via axilar: Cuántas respuestas buscamos com neuroestimulación?. Rev Esp Anestesiol Reanim. 2001;48:356-363.

Koscielniak-Nielsen ZJ, Nielsen PR, Nielsen SL. Comparison of transarterial and multiple nerve stimulation techniques for axillary block using a high dose of mepivacaine with adrenaline. Acta Anaesthesiol Scand. 1999;43:398-404.

de Jong RH. Axillary block of the brachial plexus. Anesthesiology. 1961;22:215-225.

Vester-Andersen T, Christiansen C, Sorensen M. Perivascular axillary block. II: influence of injected volume of local anaesthetic on neural blockade. Acta Anaesthesiol Scand. 1983;27:95-98.

Vester-Andersen T, Husum B, Lindeburg T. Perivascular axillary block: IV: blockade following 40, 50 or 60 ml of mepivacaine 1% with adrenaline. Acta Anaesthesiol Scand. 1984;28:99-105.

Koscielniak-Nielsen ZJ, Horn A, Nielsen PR. Effect of arm position on the effectiveness of perivascular axillary block. Br J Anaesth. 1995;74:387-391.

Koschielniak-Nielsen ZJ, Christensen LQ, Pedersen HL. Effect of digital pressure on the neurovascular sheath during perivascular axillary block. Br J Anaesth. 1995;75:702-706.

Baranowski AP, Pither CE. A comparison of three methods of axillary brachial plexus anaesthesia. Anaesthesia. 1990;45:362-365.

Lavoie J, Martin R, Tetrault JP. Axillary plexus block using a peripheral nerve stimulator: single or multiple injections. Can J Anaesth. 1992;39:583-586.

Inberg P, Annila I, Annila P. Double-injection method using peripheral nerve stimulator is superior to single injection in axillary plexus block. Reg Anesth Pain Med. 1999;24:509-513.

Brockway MS, Wildsmith JA. Axillary brachial plexus block: method of choice?. Br J Anaesth. 1990;64:224-231.

Yamamoto K, Tsubokawa T, Shibata K. Area of paresthesia as determinant of sensory block in axillary brachial plexus block. Reg Anesth. 1995;20:493-497.

Goldberg ME, Gregg C, Larijani GE. A comparison of three methods of axillary approach to brachial plexus blockade for upper extremity surgery. Anesthesiology. 1987;66:814-816.

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.

Merrill DG, Brodsky JB, Hentz RV. Vascular insufficiency following axillary block of the brachial plexus. Anesth Analg. 1981;60:162-164.

Zipkin M, Backus WW, Scott B. False aneurysm of the axillary artery following brachial plexus block. J Clin Anesth. 1991;3:143-145.

de Jong RH, Grazer FM. Perioperative management of cosmetic liposuction. Plast Reconstr Surg. 2001;107:1039-1044.

Klein JA. Anesthetic formulation of tumescent solutions. Dermatol Clin. 1999;17:751-759.

Tucker GT, Mather LE. Properties, Absorption and Disposition of Local Anaesthetics Drugs. Briedenbaugh PO: Neural Blockade. 1988:62-63.

Aantaa R, Kirvela O, Lahdenpera A. Transarterial brachial plexus anesthesia for hand surgery: a retrospective analysis of 346 cases. J Clin Anesth. 1994;6:189-192.

Palve H, Kirvela O, Olin H. Maximum recommended doses of lignocaine are not toxic. Br J Anaesth. 1995;74:704-705.

5dd7e1410e88259e5c13f286 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