Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000100004
Brazilian Journal of Anesthesiology
Scientific Article

Eficácia analgésica pós-operatória de diferentes volumes e massas de ropivacaína no bloqueio de plexo braquial pela via posterior

Postoperative analgesic efficacy of different volumes and masses of ropivacaine in posterior brachial plexus block

Bruno Salome de Morais; Marcos Guilherme Cunha Cruvinel; Fabiano Soares Carneiro; Flavio Lago; Yerkes Pereira Silva

http://dx.doi.org/10.1590/S0034-70942012000100004 Braz J Anesthesiol, vol.62, n1, p.23-27, 2012
PDF Português
PDF English
Downloads: 0
Views: 984

Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo braquial pela via posterior tem sua eficácia para cirurgias de ombro demonstrada por diferentes autores. Entretanto, não há um consenso sobre a massa e o volume ideal de anestésico local a ser empregado. O objetivo deste estudo é com parar diferentes volumes e massas de ropivacaína no bloqueio do plexo braquial pela via posterior em cirurgias artroscópicas de ombro. MÉTODO: Sessenta pacientes com idade > 18 anos, estado físico ASA I e II, escalados para cirurgias artroscópicas de ombro unilateral foram alocados aleatoriamente em três grupos: A (10 mL a 0,5%), B (20 mL a 0,5%), C (5 mL a 1%). O bloqueio foi realizado com agulha 22G de 100 mm conectada ao neuroestimulador, em um ponto 3 cm lateral ao ponto médio do interespaço de C6 e C7, sendo injetada a solução correspondente a cada grupo. A dor pós-operatória foi avaliada na SRPA e nas primeiras 24 horas do pós-operatório. Os grupos foram comparados quanto ao tempo para primeira queixa de dor, à pontuação na ENV e ao consumo de morfina nas primeiras 24 horas. RESULTADOS: Não houve diferença estatisticamente significativa entre os três grupos em relação a idade, peso e altura. Não houve diferença no tempo até a primeira queixa de dor, ENV superior a três e consumo de morfina no pós-operatório entre os grupos. CONCLUSÕES: O presente estudo concluiu que 5 mL de ropivacaína 1% promoveu eficácia analgésica similar a 10 mL ou 20 mL de ropivacaína 0,5% no bloqueio do plexo braquial pela via posterior com o uso do neuroestimulador

Palavras-chave

ANESTÉSICOS, CIRURGIA, DOR, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: The efficacy of posterior brachial plexus block for shoulder surgeries is demonstrated by different authors. However, there is no consensus on the ideal mass and volume of local anesthetic to be employed. The objetive of this study was to compare different volumes and masses of ropivacaine in posterior brachial plexus block in arthroscopic surgeries of the shoulder. METHOD: Sixty patients > 18 years, physical status ASA I and II, scheduled for unilateral arthroscopic surgeries of the shoulder were randomly placed in three groups: A (10 mL to 0.5%), B (20 mL to 0.5%), C (5 mL to 1%). The block was performed with a 22G needle of 100 mm connected to neurostimulator, in a point 3 cm lateral to the midpoint of C6 and C7 interspace, being injected the solution corresponding to each group. The postoperative pain was evaluated at the recovery room and within the first 24 hours of the postoperative period. The groups were compared on length of time until the first complaint of pain, visual numeric scale (VNS) score and morphine consumption within the first 24 hours. RESULTS: There was no statistically significant difference between the three groups related to age, weight and height. There was no difference in length of time until the first complaint of pain, VNS scores over three and morphine consumption in the postoperative period between the groups. CONCLUSIONS: This study concluded that 5 mL of 1% ropivacaine promoted analgesic efficacy similar to 10 mL or 20 mL of 0.5% ropivacaine in the posterior brachial plexus block using neurostimulator

Keywords

Anesthetics, Pain Measurement, Orthopedics, Brachial Plexus

References

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, duToit 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;45:421-428.

Riazi S, Carmichael N, Awad I. Effect of local anaesthetic volume (20 vs 5 mL) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth. 2008;101:549-556.

Vargas-Schaffer G. Is the WHO analgesic ladder still valid?: Twenty-four years of experience. Can Fam Physician. 2010;56(6):514-517.

Cruvinel MGC, Castro CHV, Silva YP. Estudo comparativo da eficácia analgésica pós-operatória de 20 mL de ropivacaína a 0,5, 0,75 ou 1% no bloqueio de plexo braquial pela via posterior. Rev Bras Anestesiol. 2008;58(5):431-439.

Singelyn FS, Lhotel L, Fabre B. Pain relief after arthorscopic 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 intraarticular and intra-bursal infusion of lidocaine on postoperative pain following shoulder arthroscopic surgery. Masui. 2001;50:251-255.

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

Scoggin J, Mayfield G, Awaya D. Subacromial and intraarticular morphine versus bupivacaine after shoulder arthroscopy. Arthroscopy. 2002;18:464-468.

Muittari P, 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 J, Lee G, 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, Martín Aliki. Interscalene brachial plexus block with continuos intraarticular infusión of ropivacaine. Anesth Analg. 2001;93:601-605.

Klein S, Greengrass R, Steele S. 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 inter-scalene 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 P, Löppönen A, Kangas-Saarela T. Interscalene brachial plexus block is superior to subacromial bursa block after arthroscopic shoulder surgery. Acta Anaesthesiol Scand. 2002;46:1031-1036.

Krone S, Chan V, 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.

Cruvinel MGC, Castro CHV, Silva YP. Estudo comparativo da eficácia analgésica pós-operatória de 20, 30 ou 40 mL de ropivacaína no bloqueio de plexo braquial pela via Posterior. Rev Bras Anestesiol. 2007;57(5):500-513.

Cruvinel MGC, Castro CHV, Silva YP. Prevalência de paralisia diafragmática após bloqueio de plexo braquial pela via posterior com ropivacaína a 0,2%. Rev Bras Anestesiol. 2006;56(5):461-469.

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.

Chappell D, Jacob M. Influence of non-ventilatory options on postoperative outcome. Best Pract Res Clin Anaesthesiol. 2010;24(2):267-281.

Bonnet F, Marret E. Influence of anaesthetic and analgesic techniques on outcome after surgery. Br J Anaesth. 2005;95(1):52-58.

Palmer PP, Miller RD. Current and developing methods of patient-controlled analgesia. Anesthesiol Clin. 2010;28(4):587-599.

5dd555fc0e88258f11c8fca6 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