Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000500004
Brazilian Journal of Anesthesiology
Scientific Article

Prevalência de paralisia diafragmática após bloqueio de plexo braquial pela via posterior com ropivacaína a 0,2%

Prevalence of diaphragmatic paralysis after brachial plexus blockade by the posterior approach with 0.2% ropivacaine

Marcos Guilherme Cunha Cruvinel; Carlos Henrique Viana de Castro; Yerkes Pereira Silva; Roberto Cardoso Bessa Júnior; Flávio de Oliveira França; Flávio Lago

http://dx.doi.org/10.1590/S0034-70942006000500004 Braz J Anesthesiol, vol.56, n5, p.461-469, 2006
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Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio de plexo braquial pela via interescalênica descrita por Winnie é uma das técnicas mais eficazes para promover analgesia pós-operatória de intervenções cirúrgicas no ombro. Uma de suas conseqüências é a paralisia diafragmática. Esta paralisia pode levar, em pacientes com algum grau de disfunção pulmonar prévia, à insuficiência respiratória. A abordagem do plexo braquial por via posterior tem conquistado espaço. O objetivo deste estudo foi determinar a prevalência de paralisia diafragmática, após o bloqueio de plexo braquial interescalênico pela via posterior com o uso de ropivacaína a 0,2%. MÉTODO: Vinte e dois pacientes submetidos ao bloqueio do plexo braquial interescalênico pela via posterior com ropivacaína a 0,2%, foram avaliados no pós-operatório com o objetivo de identificar sinais radiológicos de elevação da cúpula diafragmática sugestivos de paralisia hemidiafragmática. Em 20 pacientes utilizou-se 40 mL de ropivacaína a 0,2%, nestes foi realizada radiografia de tórax em inspiração. Em dois foram utilizados 20 mL de ropivacaína a 0,2%, com subseqüente avaliação fluoroscópica. RESULTADOS: Não houve complicações relacionadas à realização do bloqueio. Em todos os pacientes, o bloqueio foi efetivo e proporcionou boa analgesia pós-operatória. Foi observada elevação da cúpula diafragmática compatível com paralisia hemidiafragmática em todos os casos estudados. CONCLUSÕES: Nas condições deste estudo observou-se que o bloqueio do plexo braquial pela via posterior é uma técnica que está associada à alta prevalência de paralisia diafragmática, mesmo utilizando-se baixas concentrações de anestésico local.

Palavras-chave

ANESTÉSICOS, Local, CIRURGIA, Ortopédica, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Brachial plexus blockade by the interscalene approach, described by Winnie, is one of the most effective techniques in promoting postoperative analgesia in surgeries of the shoulder. Diaphragmatic paralysis is one of the consequences of this technique. This paralysis can cause respiratory failure in patients with prior lung dysfunction. Brachial plexus blockade by the posterior approach has become increasingly more popular. The objective of this study was to determine the prevalence of diaphragmatic paralysis after interscalene brachial plexus blockade by the posterior approach with 0.2% ropivacaine. METHODS: Twenty-two patients who underwent interscalene brachial plexus blockade by the posterior approach with 0.2% ropivacaine were evaluated in the postoperative period to identify radiological signs of elevation of the hemidiaphragm that could suggest hemidiaphragmatic paralysis. Forty mL of 0.2% ropivacaine were used in 20 patients; inspiratory chest X-rays were done in these patients. Twenty mL of 0.2% ropivacaine were used in two patients, with posterior fluoroscopic evaluation. RESULTS: There were no complications related to the procedure. The anesthesia was effective in every patient, providing good postoperative analgesia. Every patient in this study presented elevation of the diaphragm compatible with hemidiaphragmatic paralysis. CONCLUSIONS: We observed that brachial plexus blockade by the posterior approach is associated with a high prevalence of diaphragmatic paralysis, even with low concentrations of local anesthetics.

Keywords

ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional, COMPLICATIONS, SURGERY, Orthopedic

References

Singelyn FJ, Lhotel L, Fabre B. Pain relief after arthroscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block. Anesth Analg. 2004;99:589-592.

Ritchie E, Tong D, Chung F. Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality?. Anesth Analg. 1997;84:1306-1312.

Al-Kaisy A, McGuire G, Chan V. Analgesic effect of interscalene block using low-dose bupivacaine for outpatient arthroscopic shoulder surgery. Reg Anesth Pain Med. 1998;23:469-473.

D'Alessio J, Rosenblum M, Shea K. A retrospective comparison of interscalene block and general anesthesia for ambulatory shoulder arthroscopy. Reg Anesth Pain Med. 1995;20:62-68.

Brown A, Weiss R, Greenberg C. Interscalene block for shoulder arthroscopy: comparison with general anesthesia. Arthroscopy. 1993;9:295-300.

Savoie F, Field L, Jenkins R. The pain control infusion pump for postoperative pain control in shoulder surgery. Arthroscopy. 2000;16:339-342.

Niiyama Y, Omote K, Sumita S. The effect of continuous intra-articular and intra-bursal infusion of lidocaine on postoperative pain following shoulder arthroscopic surgery. Masui. 2001;50:251-255.

Henn P, Steuer K, Fischer A. Effectiveness of morphine by periarticular injections after shoulder arthroscopy. Anaesthesist. 2000;49:721-724.

Scoggin JF 3rd, Mayfield G, Awaya D. Subacromial and intra-articular morphine versus bupivacaine after shoulder arthroscopy. Arthroscopy. 2002;18:464-468.

Muittari PA, Nelimarkka O, Seppala T. Comparison of the analgesic effects of intrabursal oxycodone and bupivacaine after acromioplasty. J Clin Anesth. 1999;11:11-16.

Rodola F, Vagnoni S, D'Avolio S. Intra-articular analgesia following arthroscopic surgery of the shoulder. Eur Rev Med Pharmacol Sci. 2001;5:143-146.

Park JY, Lee GW, Kim Y. The efficacy of continuous intrabursal infusion with morphine and bupivacaine for postoperative analgesia after subacromial arthroscopy. Reg Anesth Pain Med. 2002;27:145-149.

Axelsson K, Nordenson U, Johanzon E. Patient-controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression. Acta Anaesthesiol Scand. 2003;47:993-1000.

Klein SM, Nielsen KC, Martin A. Interscalene brachial plexus block with continuous intraarticular infusion of ropivacaine. Anesth Analg. 2001;93:601-605.

Klein SM, Greengrass RA, Steele SM. A comparison of 0.5% bupivacaine, 0.5% ropivacaine, and 0.75% ropivacaine for interscalene brachial plexus block. Anesth Analg. 1998;87:1316-1319.

Eroglu A, Uzunlar H, Sener M. A clinical comparison of equal concentration and volume of ropivacaine and bupivacaine for interscalene brachial plexus anesthesia and analgesia in shoulder surgery. Reg Anesth Pain Med. 2004;29:539-543.

Neal JM, McDonald SB, Larkin KL. Suprascapular nerve block prolongs analgesia after nonarthroscopic shoulder surgery but does not improve outcome. Anesth Analg. 2003;96:982-986.

Laurila PA, Lopponen A, Kanga-Saarela T. Interscalene brachial plexus block is superior to subacromial bursa block after arthroscopic shoulder surgery. Acta Anaesthesiol Scand. 2002;46:1031-1036.

Krone SC, Chan VW, Regan J. Analgesic effects of low-dose ropivacaine for interscalene brachial plexus block for outpatient shoulder surgery-a dose-finding study. Reg Anesth Pain Med. 2001;26:439-443.

Pippa P, Cominelli E, Marinelli C. Brachial plexus block using the posterior approach. Eur J Anaesthesiol. 1990;7:411-420.

Boezaart AP, Koorn R, Rosenquist RW. Paravertebral approach to the brachial plexus: an anatomic improvement in technique. Reg Anesth Pain Med. 2003;28:241-244.

Boezaart AP, de Beer JF, du Toit C. A new technique of continuous interscalene nerve block. Can J Anesth. 1999;46:275-281.

Beato L, Camocardi G, Imbelloni LE. Bloqueio de plexo braquial pela via posterior com uso de neuroestimulador e ropivacaína a 0,5%. Rev Bras Anestesiol. 2005;55:421-428.

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

Urmey WF, Gloeggler PJ. Pulmonary function changes during interscalene brachial plexus block: effects of decreasing local anesthetic injection volume. Reg Anesth. ;18:1993.

Winnie AP. Plexus Anesthesia. Perivascular Techniques of Brachial Plexus Block. 1990:180-181.

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

Pere P, Pitkanen M, Rosenberg PH. Effect of continuous interscalene brachial plexus block on diaphragm motion and on ventilatory function. Acta Anaesthesiol Scand. 1992;36:53-57.

Dullenkopf A, Blumenthal S, Theodorou P. Diaphragmatic excursion and respiratory function after the modified Raj technique of the infraclavicular plexus block. Reg Anesth Pain Med. 2004;29:110-114.

Gottesman E, McCool FD. Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med. 1997;155:1570-1574.

Chetta A, Rehman AK, Moxham J. Chest radiography cannot predict diaphragm function. Respir Med. 2005;99:39-44.

McCool FD, Tzelepis GE, Mead J. Absence of a hemidiaphragm: mechanical implications. Lung. 1991:169.

Urmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. Anesth Analg. 1992;74:352-357.

Sardesai AM, Chakrabarti AJ, Denny NM. Lower lobe collapse during continuous interscalene brachial plexus local anesthesia at home. Reg Anesth Pain Med. 2004;29:65-68.

Joho-Arreola AL, Bauersfeld U, Stauffer UG. Incidence and treatment of diaphragmatic paralysis after cardiac surgery in children. Eur J Cardiothorac Surg. 2005;27:53-57.

Borgeat A, Ekatodramis G. Anaesthesia for shoulder surgery. Best Pract Res Clin Anaesthesiol. 2002;16:211-225.

Cruvinel MGC, Castro CHV, Silva YP. Estudo radiológico da dispersão de diferentes volumes de anestésico local no bloqueio de plexo braquial pela via posterior. Rev Bras Anestesiol. 2005;55:508-516.

De Negri P, Ivani G, Tirri T. A comparison of epidural bupivacaine, levobupivacaine, and ropivacaine on postoperative analgesia and motor blockade. Anesth Analg. 2004;99:45-48.

Altintas F, Gumus F, Kaya G. Interscalene brachial plexus block with bupivacaine and ropivacaine in patients with chronic renal failure: diaphragmatic excursion and pulmonary function changes. Anesth Analg. 2005;100:1166-1171.

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