Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000100005
Brazilian Journal of Anesthesiology
Clinical Information

Efeito perioperatório do índice de massa corporal elevado no bloqueio do nervo periférico: uma análise de 528 bloqueios interescalênicos guiados por ultrassom

The perioperative effect of Increased body mass index on peripheral nerve blockade: an analysis of 528 ultrasound guided interscalene blocks

Kristopher Schroeder; Adin-Cristian Andrei; Meghan J Furlong; Melanie J Donnelly; Han Seungbong; Aimee M Becker

http://dx.doi.org/10.1590/S0034-70942012000100005 Braz J Anesthesiol, vol.62, n1, p.33-38, 2012
PDF Português
PDF English
Downloads: 0
Views: 919

Resumo

JUSTIFICATIVA E OBJETIVOS: Os pacientes obesos podem representar um desafio anestésico perioperatório único, tornando as técnicas anestésicas regionais um meio desafiador de oferecer analgesia para esta população. A orientação por ultrassom foi recentemente elogiada como sendo benéfica para esta população na qual os limites anatômicos de superfície podem ser obscurecidos. Neste estudo, é investigado o efeito do Índice de Massa Corporal (IMC) elevado no bloqueio interescalênico do nervo periférico guiado por ultrassom. MATERIAL E MÉTODOS: Este estudo é uma análise retrospectiva de 528 pacientes consecutivos que receberam bloqueios nervosos interescalênicos pré-operatórios guiados por ultrassom no Hospital e Clínica da University of Wisconsin. Examinamos a associação entre IMC e os parâmetros: tempo exigido para localização do bloqueio; presença de náuseas e vômitos pós-operatórios (NVPO); pontuações de dor pós-operatória na sala de recuperação pós-anestésica (SRPA); volume de anestésico local injetado; complicações agudas; e administração de opioides antes, durante e depois da cirurgia. Foram utilizadas regressões univariada e multivariada com estimativa dos mínimos quadrados e logística. RESULTADOS: Um IMC elevado foi associado a maiores: tempo exigido para localização do bloqueio (p = 0,025), administração de fentanil durante a cirurgia (p < 0,001), pico de pontuações de dor em SRPA (p < 0,001), administração de opioide na SRPA (p < 0,001), administração oral de opioide na SRPA (p < 0,001), administração total de opioide na SRPA (p < 0,001) e incidência de náusea em SRPA (p = 0,025). CONCLUSÕES: Os bloqueios nervosos interescalênicos guiados por ultrassom para analgesia perioperatória podem ser executados de forma segura e efetiva em pacientes obesos, mas o procedimento pode ser mais difícil e a analgesia talvez não seja completa

Palavras-chave

EQUIPAMENTOS, TÉCNICAS ANESTÉSICAS, TÉCNICAS DE MEDIÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Obese patients can pose a unique perioperative anesthetic challenge, making regional anesthetic techniques an intriguing means of providing analgesia for this population. Ultrasound guidance has been touted recently as being beneficial for this population in which surface landmarks can become obscured. In this study, the effect of increased Body Mass Index (BMI) on ultrasound guided interscalene peripheral nerve blockade is investigated. MATERIAL AND METHODS: This study is a retrospective review of 528 consecutive patients who received preoperative ultrasound-guided interscalene nerve blocks at the University of Wisconsin Hospital and Clinics. We examined the association between BMI and the following parameters: time required for block placement; presence of Postoperative Nausea and Vomiting (PONV); postoperative Post Anesthesia Care Unit (PACU) pain scores; volume of local anesthetic injected; acute complications; and opioid administration preoperatively, intraoperatively, and postoperatively. Univariate and multivariate least squares and logistic regression models were used. RESULTS: An elevated BMI was associated with an increased: time required for block placement (p-value = 0.025), intraoperative fentanyl administration (p-value < 0.001), peak PACU pain scores (p-value < 0.001), PACU opioid administration (p-value < 0.001), PACU oral opioid administration (p-value < 0.001), total PACU opioid administration (p-value < 0.001) and incidence of PACU nausea (p-value = 0.025) CONCLUSIONS: Ultrasound guided interscalene nerve blocks for perioperative analgesia can be safely and effectively performed in the obese patient but they may be more difficult to perform and analgesia may not be as complete

Keywords

Nerve Block, Body Mass Index, Ultrasonography

References

Bray GA. Pathophysiology of obesity. Am J Clin Nutr. 1992;55:488S-494S.

Eichenberger A, Proietti S, Wicky S. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg. 2002;95(6):1788-1792.

Sinha AC. Some anesthetic aspects of morbid obesity. Curr Opin Anaesthesiol. 2009;22(3):442-446.

Bryson GL, Chung F, Finegan BA. Patient selection in ambulatory anesthesia: an evidence-based review: part I. Can J Anaesth. 2004;51(8):768-781.

Bryson GL, Chung F, Cox RG. Patient selection in ambulatory anesthesia: an evidence-based review: part II. Can J Anaesth. 2004;51(8):782-794.

Liu SS, Strodtbeck WM, Richman JM. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. . 2005;101(6):1634-42.

McCartney CJ, Brull R, Chan VW. Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery. Anesthesiology. 2004;101(2):461-467.

Davis JJ, Swenson JD, Greis PE. Interscalene block for postoperative analgesia using only ultrasound guidance: the outcome in 200 patients. J Clin Anesth. 2009;21:272-277.

Kapral S, Greher M, Huber G. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med. 2008;33:253-258.

Schwemmer U, Papenfuss T, Greim C. Ultrasound-guided interscalene brachial plexus anaesthesia: differences in success between patients of normal and excessive weight. Ultraschall Med. 2006;27:245-250.

Conn RA, Cofield RH, Byer DE. Interscalene block anesthesia for shoulder surgery. Clin Orthop Relat Res. 1987;216:94-98.

Carles M, Pulcini A, Macchi P. An evaluation of the brachial plexus block at the humeral canal using a neurostimulator (1417 patients): the efficacy, safety, and predictive criteria of failure. Anesth Analg. 2001;92:197-198.

Cotter JT, Nielsen KC, Guller U. Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery: an analysis of 9,342 blocks. Can J Anaesth. 2004;51(8):810-816.

Nielsen KC, Guller U, Steele SM. Influence of obesity on surgical regional anesthesia in the ambulatory setting: an analysis of 9,038 blocks. Anesthesiology. 2005;102(1):181-187.

Franco CD, Gloss FJ, Voronov G. Supraclavicular block in the obese population: an analysis of 2020 blocks. Anesth Analg. 2006;102:1252-1254.

Kapral S, Greher M, Huber G. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med. 2008;33:253-258.

Liu S, Zayas V, Gordon M. A prospective, randomized, controlled trial comparing ultrasound versus nerve stimulator guidance for interscalene block for ambulatory shoulder surgery for postoperative neurological symptoms. Anesth Analg. 2009;109:265-271.

Dingermans E, Williams S, Arcand G. Neurostimulation in ultrasound-guided infraclavicular block: A prospective randomized trial. Anesth Analg. 2007;104:1275-1280.

Dufour E, Quennesson P, Van Robais A. Combined ultrasound and neurostimulation guidance for popliteal sciatic nerve block: a prospective, randomized comparison with neurostimulation alone. Anesth Analg. 2008;106:1553-1558.

5dd556300e8825fb11c8fca6 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