Clinical Efficacy of the Brachial Plexus Block via the Posterior Approach

Sandefo, Ignace; Iohom, Gabriella; Elstraete, Alain Van; Lebrun, T.; Polin, Bruno

doi:10.1016/j.rapm.2005.01.005

Cited by 32 publications

(14 citation statements)

References 16 publications

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“…The interscalene brachial plexus block, described by Winnie (lateral approach) is more commonly used in shoulder surgeries [5][6][7][8][9] . Some alternatives to the Winnie technique have been proposed and, among them, the posterior brachial plexus block has been shown to be safe and effective [9][10][11][12][13][14][15][16] . A prior study observed that the Table II use of 20, 30, or 40 mL of local anesthetic in the posterior approach promoted similar postoperative analgesia 13 .…”

Section: Resultsmentioning

confidence: 99%

“…A técnica de bloqueio do plexo braquial, por via interescalênica, descrita por Winnie (abordagem lateral) é a mais utilizada para intervenções cirúrgicas no ombro [5][6][7][8][9] . Algumas alternativas à técnica de Winnie têm sido propostas, dentre elas, a abordagem do plexo braquial pela via posterior se demonstrou ser segura e eficaz [9][10][11][12][13][14][15][16] . Em estudo anterior, foi observado que a utilização de volumes de anestésico de 20, 30 ou 40 mL na abordagem posterior promove analgesia pós-operatória semelhante 13 .…”

Section: Discussionunclassified

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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

Cruvinel¹,

Castro²,

Silva³

et al. 2008

Rev. Bras. Anestesiol.

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Rev Bras AnestesiolARTIGO CIENTÍFICO 2008; 58: 5: 431-439 SCIENTIFIC ARTICLE RESUMO Cruvinel MGC, Castro CHV, Silva YP, Morais BS, França FO, Lago F -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. JUSTIFICATIVA E OBJETIVOS:As intervenções cirúrgicas por via artroscópica no ombro estão relacionadas com a dor pós-operató-ria de grande intensidade. Dentre as técnicas de analgesia, o bloqueio do plexo braquial é a que oferece os melhores resultados. O objetivo deste estudo foi determinar qual concentração de anestésico local no bloqueio de plexo braquial pela via posterior propicia analgesia pós-operatória mais prolongada para essas operações. MÉTODO:Noventa pacientes submetidos ao bloqueio do plexo braquial pela via posterior foram divididos aleatoriamente em três grupos de 30. Grupo 1: 20 mL de ropivacaína a 0,5%; Grupo 2: 20 mL de ropivacaína a 0,75%; Grupo 3: 20 mL de ropivacaína a 1%. O bloqueio foi avaliado por meio da pesquisa de sensibilidade tér-mica utilizando-se algodão embebido em álcool e a dor pós-operatória foi avaliada seguindo-se uma escala numérica verbal (ENV) nas primeiras 48 horas. RESULTADOS:Nos três grupos a analgesia pós-operatória foi similar segundo os parâmetros avaliados; ENV de dor média, tempo até a primeira queixa de dor e consumo de opióides no pós-operatório. CONCLUSÕES:Este estudo mostrou que o bloqueio do plexo braquial pela via posterior é uma técnica que promove analgesia eficaz para intervenções cirúrgicas no ombro. Utilizando-se 20mL de ropivacaína, as três diferentes concentrações estudadas promovem analgesia similar.Unitermos: ANESTÉSICOS, Local: ropivacaína; CIRURGIA, Ortopé-dica; DOR, Pós-operatória; TÉCNICAS ANESTÉSICAS, Regional: plexo braquial. SUMMARY BACKGROUND AND OBJECTIVES:Arthroscopic shoulder surgeries are associated with severe postoperative pain. Among the analgesic techniques available, brachial plexus block has the best results. The objective of this study was to determine which concentration of local analgesic used in the posterior brachial plexus block provides longer postoperative analgesia. METHODS:Ninety patients undergoing posterior brachial plexus block were randomly divided into three groups of 30 patients each. Group I: 20 mL of 0.5% ropivacaine; Group 2: 20 mL of 0.75% ropivacaine; and Group 3: 20 mL of 1% ropivacaine. The blockade was evaluated by assessing the thermal sensitivity using a cotton pad with alcohol and postoperative pain was evaluated according to a Verbal Numeric Scale (VNS) in the first 48 hours. RESULTS:Postoperative analgesia was similar in all three groups according to the parameters evaluated: mean VNS, time until the first complaint of pain, and postoperative opioid consumption. CONCLUSIONS:This study demonstrated that posterior brachial plexus block provides effective analgesia for shoulder surgeries. Twenty milliliters of ropivacaine in the different concentrations used in this study promoted similar analgesia.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionunclassified

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

Cruvinel¹,

Castro²,

Silva³

et al. 2008

Rev. Bras. Anestesiol.

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“…After a slight needle adjustment, muscle contractions were produced. Needle placement was accurate in a median [range] of 2 [1][2][3][4] attempts. In nine patients, the brachial plexus was found at the first attempt.…”

Section: Resultsmentioning

confidence: 99%

Ultrasound‐guided training in the performance of brachial plexus block by the posterior approach: an observational study

et al. 2007

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SummaryThe application of ultrasonography in guiding and controlling the path of the stimulating needle to the brachial plexus via the posterior approach (Pippa technique) was studied. In 21 ASA physical status 1 and 2 patients, scheduled for surgery of the shoulder or upper arm, needle insertion was monitored by ultrasonography and the interaction between needle, surrounding structures and brachial plexus was followed. During injection, the spread of local anaesthetic was visualised and a prediction of block success was made. One failure was predicted. Complete block was achieved in 20 (95%) patients. One potential complication, puncture of the carotid artery, was prevented using ultrasound. Ultrasound is a useful tool in the training and performance of a neurostimulation-guided brachial plexus block by the posterior approach. Ultrasonographic guidance may prevent serious complications associated with this approach to the brachial plexus.

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“…The technique performed in this case has been used by several authors without producing significant complications [5–7]. However, the accidental production of spinal anaesthesia has been reported as a complication of attempted brachial plexus blockade using the posterior approach [11].…”

Section: Discussionmentioning

confidence: 99%

“…[6]. The posterior approach has been shown to be effective, relatively safe and well tolerated by patients [7]. In this report, we describe a patient who developed the symptoms and signs of high epidural anaesthesia after an attempted brachial plexus blockade by the posterior approach.…”

mentioning

confidence: 99%

Epidural anaesthesia as a complication of attempted brachial plexus blockade using the posterior approach

Gómez

Mendes

2006

Anaesthesia

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Summary We report a case of accidental epidural anaesthesia as a complication of attempted brachial plexus blockade using a posterior approach in a 31‐year‐old man scheduled to undergo elective shoulder surgery. The block was inserted with the patient in the lateral position before induction of general anaesthesia. On emergence from anaesthesia, the patient could breathe but could not move his arms. He had no pain sensation from the fifth cervical dermatome to the third thoracic dermatome bilaterally; this resolved 8 h after surgery and he was discharged well 2 days later. Although proponents of the posterior approach to the brachial plexus claim that its use is associated with a lower incidence of significant complications, this case proves that the technique is not devoid of potentially serious complications.

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Clinical Efficacy of the Brachial Plexus Block via the Posterior Approach

Abstract: This study reports the clinical effectiveness of the single-injection nerve-stimulation technique for the brachial plexus block via the posterior approach in patients undergoing shoulder surgery. It appears to be effective, relatively safe, and well tolerated.

Cited by 32 publications

References 16 publications

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

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

Ultrasound‐guided training in the performance of brachial plexus block by the posterior approach: an observational study

Epidural anaesthesia as a complication of attempted brachial plexus blockade using the posterior approach

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