Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942010000200004
Brazilian Journal of Anesthesiology
Scientific Article

Bloqueio do plexo braquial por via interescalênica: efeitos sobre a função pulmonar

Interscalene brachial plexus block: effects on pulmonary function

Alexandre Hortense; Marcelo Vaz Perez; Jose Luis Gomes do Amaral; Ana Cristina Martins de Vasconcelos Oshiro; Heloisa Baccaro Rossetti

http://dx.doi.org/10.1590/S0034-70942010000200004 Braz J Anesthesiol, vol.60, n2, p.130-133, 2010
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Resumo

JUSTIFICATIVA E OBJETIVOS: A via interescalênica é um dos acessos mais comumente utilizados no bloqueio do plexo braquial. Todavia, tem-se demonstrado associação dessa técnica com o bloqueio do nervo frênico ipsilateral. A disfunção diafragmática daí resultante provoca alterações na mecânica pulmonar, potencialmente deletérias em pacientes com limitação da reserva ventilatória. O objetivo do estudo foi avaliar a repercussão do bloqueio interescalênico sobre a função pulmonar por meio da medida da capacidade vital forçada (CVF). MÉTODO: Estudo duplamente encoberto com 30 pacientes, estado físico I ou II (ASA), distribuídos aleatoriamente em dois grupos de15. Foi administrada solução a 0,5% de ropivacaína (Grupo Ropi) ou bupivacaína a 0,5% com epinefrina (Grupo Bupi). O bloqueio foi realizado utilizando estimulador de nervo periférico e sendo injetados 30 mL de anestésico local. Quatro espirometrias foram realizadas em cada paciente: antes do bloqueio, 30 minutos, 4 e 6 horas após. Os pacientes não receberam sedação. RESULTADOS: Um paciente do Grupo Ropi e três pacientes do Grupo Bupi foram excluídos do estudo por falha de bloqueio. A redução da CVF no Grupo Ropi foi máxima aos 30 minutos (25,1%) e a partir de então houve tendência progressiva à recuperação. Já com bupivacaína, a redução da CVF pareceu ser menos acentuada nos diversos momentos estudados; observou-se redução adicional entre 30 minutos (15,8%) e 4 horas (17,3%), sendo esta sem diferença estatística. A partir de 4 horas, notou-se tendência à recuperação. Em ambos os grupos, após 6 horas de bloqueio a CVF encontra-se ainda abaixo dos valores prévios. CONCLUSÕES: O bloqueio interescalênico reduz a CVF na maioria dos casos; as alterações foram mais acentuadas no Grupo Ropivacaína.

Palavras-chave

ANESTÉSICO, Local, TÉCNICAS ANESTÉSICAS, Regional, SISTEMA RESPIRATÓRIO

Abstract

BACKGROUND AND OBJECTIVES: The interscalene is one of the most common approaches used in brachial plexus block. However, the association of this approach with the ipsilateral blockade of the phrenic nerve has been demonstrated. The resulting diaphragmatic dysfunction causes changes in lung mechanics, which can be potentially deleterious in patients with limited respiratory reserve. The objective of the present study was to evaluate the repercussion of interscalene brachial plexus block on pulmonary function by measuring forced vital capacity (FVC). METHODS: This is a double-blind study with 30 patients, physical status ASA I or II, randomly separated into two groups of 15 patients each; 0.5% ropivacaine (Ropi Group) or 0.5% bupivacaine with epinephrine (Bupi Group) was administered. A peripheral nerve stimulator was used, and 30 mL of the local anesthetic were administered. Four spirometries were done in each patient: before the blockade, 30 minutes, four hours, and six hours after the blockade. Patients were not sedated. RESULTS: One patient in the Ropi Group and three patients in the Bupi Group were excluded from the study due to failure of the blockade. The Ropi Group showed maximal FVC reduction at 30 minutes (25.1%), with a tendency for recovery from this point on. With bupivacaine, the reduction in FVC was less important at the different study moments; an additional reduction was observed between 30 (15.8%) and four hours (17.3%), but it was not statistically significant. A tendency for recovery was observed from four hours on. In both groups, the FVC six hours after the blockade was still below baseline levels. CONCLUSIONS: Interscalene block reduces FVC in most cases. Changes were more pronounced in the Ropivacaine group.

Keywords

ANESTHETIC, Local, ANESTHETIC TECHNIQUES, Regional, RESPIRATORY SYSTEM

References

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.

Casati A, Fanelli G, Cedrati V. Pulmonary function changes after interscalene brachial plexus anesthesia with 0.5% and 0.75% ropivacaine: a double-blinded comparison with 2% mepivacaine. Anesth Analg. 1999;88:587-592.

Cangiani LH, Rezende LAE, Giancoli Neto A. Bloqueio do nervo frênico após realização de bloqueio do plexo braquial pela via interescalênica: Relato de caso. Rev Bras Anestesiol. 2008;58:152-159.

Gottardis M, Luger T, Florl C. Spirometry, blood gas analysis and ultrasonography of the diaphragm after Winnie's interscalene brachial plexus block. Eur J Anaesthesiol. 1993;10:367-369.

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.

Mulroy MF. Peripheral Nerve Blockade. Clinical Anesthesia. 2001:724-725.

Quanjer PH, Lebowitz MD, Gregg I. Peak expiratory flow: conclusions and recommendations of a Working Party of the European Respiratory Society. Eur Respir J. 1997:2S-8S.

Gould L, Kaplan S, McElhinney AJ. A method for the production of hemidiaphragmatic paralysis: Its application to the study of lung function in normal man. Am Rev Respir Dis. 1967;96:812-814.

Arborelius Jr M, Lilja B, Senyk J. Regional and total lung function studies in patients with hemidiaphragmatic paralysis. Respiration. 1975;32:253-264.

Bashein G, Robertson HT, Kennedy Jr WF. Persistent phrenic nerve paresis following interscalene brachial plexus block. Anesthesiology. 1985;63:102-104.

Lombard TP, Couper JL. Bilateral spread of analgesia following interscalene brachial plexus block. Anesthesiology. 1983;58:472-473.

Bennani SE, Vandenabele-Teneur F, Nyarwaya JB. An attempt to prevent spread of local anaesthetic to the phrenic nerve by compression above the injection site during the interscalene brachial plexus block. Eur J Anaesthesiol. 1998;15:453-456.

Sala-Blanch X, Lazaro JR, 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.

Urmey WF, Gloeggler PJ. Pulmonary function changes during interscalene brachial plexus block: effects of decreasing local anesthetic injection volume. Reg Anesth. 1993;18:244-249.

Dagli G, Guzeldemir ME, Volkan Acar H. The effects and side effects of interscalene brachial plexus block by posterior approach. Reg Anesth Pain Med. 1998;23:87-91.

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.

Liisanantti O, Luukkonen J, Rosenberg PH. High-dose bupivacaine, levobupivacaine and ropivacaine in axillary brachial plexus block. Acta Anaesthesiol Scand. 2004;48:601-606.

Vainionpaa VA, Haavisto ET, Huha TM. A clinical and pharmacokinetic comparison of ropivacaine and bupivacaine in axillary plexus block. Anesth Analg. 1995;81:534-538.

Pereira MC, Mussi RF, Massucio RA. Paresia diafragmática bilateral idiopática. J Bras Pneumol. 2006;32:481-485.

Tetzlaff JE. Bloqueios de Nervos Periféricos. Anestesiologia Clínica. 2003.

Reiz S, Haggmark S, Johansson G. Cardiotoxicity of ropivacaine: a new amide local anaesthetic agent. Acta Anaesthesiol Scand. 1989;33:93-98.

Heavner JE. Cardiac toxicity of local anesthetics in the intact isolated heart model: a review. Reg Anesth Pain Med. 2002;27:545-555.

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.

Carneiro AF, Oliva Filho AL, Hamaji A. Anestésicos Locais. Curso de Educação à Distância em Anestesiologia. 2002:104-105.

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