Determinação do volume mínimo efetivo de bupivacaína 0,5% para bloqueio do plexo braquial por via axilar guiado por ultrassom

Ferraro, Leonardo Henrique Cunha; Takeda, Alexandre; Falcão, Luiz Fernando dos Reis; Rezende, André Hosoi; Sadatsune, Eduardo Jun; Tardelli, Maria Ângela

doi:10.1016/j.bjan.2013.03.014

Cited by 63 publications

(4 citation statements)

References 20 publications

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“…In the literature,234567182526 there is no consensus about used kinds, mixtures and combination of local anesthetic agents and combinations with other drugs such as cortisone. First, we used 10cc of 0,5% bupivacaine hydrochloride for blocking SSN and AN in shoulder arthroscopy, after that we used 5cc of 0,5% bupivacaine hydrochloride in each catheter respectively during 6 h intervals up to 24 h. At the end of the 24 h, we used last doses with combined 40 mg methylprednisolone acetate and we removed the catheters.…”

Section: Discussionmentioning

confidence: 99%

Post operative pain management in shoulder surgery

Basat

Ucar

Armangil

et al. 2016

IJOO

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Background:Postoperative pain management is the part of shoulder surgery to improve patient satisfaction, start rehabilitation process rapidly and decrease for hospital stay. Various treatment modalities have been used for pain management, but they have some limitations, side effects and risks. Throughout intraoperative and postoperative period, nerve blocks have been used more popularly than others because of efficacy. For the regional nerve block, local anesthetic should be infiltrated close to the nerve for maximum effect. Consequently, aim of this study was to evaluate analgesic efficacy when catheters are placed with assistance of arthroscope to block suprascapular and axillary nerves in patients undergoing arthroscopic repair of rotator cuff under general anesthesia.Materials and Methods:24 patients (5 males, 19 females; mean age: 54.3 years) who underwent arthroscopic repair of rotator cuff between June 2014 and September 2014 and were catheterized to block suprascapular and axillary nerves during shoulder arthroscopy were included in the study. Clinical outcomes were assessed using visual analog scale (VAS) scores preoperatively and at 0 h, 6 h, 12 h, 18 h, 24 h, and postoperative day 2.Results:Preoperative and postoperative 0 h, 6 h, 12 h, 18 h, 24 h, and day 2 mean VAS scores were 6.38 ± 0.77, 0.44 ± 0.42, 0.58 ± 0.42, 0.63 ± 0.40, 0.60 ± 0.44, 0.52 ± 0.42, and 1.55 ± 0.46, respectively. No statistical difference was found among 0 h, 6 h, 12 h, 18 h, and 24 h time points; however, comparison of postoperative day 2 and postoperative 0 h, 6 h, 12 h, 18h and 24 h VAS scores showed statistically significant difference (P < 0.05). All patients were discharged at the end of 24 h with no complication. The mean time (in minutes) required for blocking suprascapular nerve and axillar nerve were 14.38 ± 3.21 and 3.75 ± 0.85, respectively.Conclusion:These results demonstrated that blocking two nerves with arthroscopic approach was an excellent pain management method in postoperative period. Accordingly, patients could recover rapidly and patients’ satisfaction could be improved.

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Section: Discussionmentioning

confidence: 99%

Post operative pain management in shoulder surgery

Basat

Ucar

Armangil

et al. 2016

IJOO

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“…O posicionamento anatômico do plexo braquial do macaco-prego permite o desenvolvimento de técnicas de bloqueio anestésico de plexo braquial pela punção da fáscia aponeurótica que o recobre em três pontos anatômicos diferentes, como sendo nas regiões supraclavicular, infraclavicular e axilar conforme descrito na literatura anatômica humana por Ferraro et al [8] e Luz [11], assim como em interescalênico, perivascular subclávio e perivascular axilar na anestesia da medicina humana [4,5,11].…”

Section: Discussionunclassified

“…Na atualidade, tecnologias como o estimulador de nervo periférico [2,9], exame radiológico contrastado e ultrassom asseguram a correta localização da agulha em relação ao plexo e reduzem a necessidade de altos volumes de anestésico local [7]. Alguns estudos demonstraram que o uso do ultrassom permitiu a redução do volume de anestésico local para o bloqueio do plexo braquial na via interescalênica [8].…”

Section: Discussionunclassified

Anatomic Bases for Brachial Plexus Block of Capuching (Sapajus libidinosus)

Martins

Dias

Vasconcelos

et al. 2016

Acta Scientiae. Vet.

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Background: In captivity, capuchin monkeys compete for space and rank. Fights can result in traumas, especially to the limbs, requiring interventions that are often outpatient. Local anesthesia as a tool in these procedures, as an aid to chemical restraint, is very relevant for small outpatient surgeries, or even for pain relief. Knowledge of peripheral nerve anatomy is essential to perform local anesthesia. Thus the objective of the present study was to determine, by anatomical studies of the brachial plexus region, the best access pathways for anesthetic blocking of the nerve.Materials, Methods & Results: Seven adult capuchin monkeys (Sapajus libidinosus) were used, weighing 2-3 kg, fixed and preserved in formaldehyde aqueous solution at 10%. In five of these animals the supraclavicular, infraclavicular and axillar regions were dissected to visualize the muscles, clavicle and bracchial plexus nerves. An analogical pachymeter was used to measure the depth of the plexus in relation to the cranial and caudal clavicle face and axillary fossa, comparing the length of two hypodermic needles (13x4.5 mm and 15x5 mm). Simulation of the anesthetic block was tested in two animals: before dissecting an acrylic varnish solution was injected using a syringe and 13x4.5 mm needle in the supraclavicular, infraclavicular regions and axillary fossa. To assess the positioning points of the syringe, dissection was performed and the varnish perfusion in the plexus was observed. For the anesthetic block in the supraclavicular region the dorsal median of the clavicle with a 95º deltoclavicular angle with the needle perpendicular to the skin was taken as point of reference. In the infraclavicular the reference point was the caudal face of the median clavicle with an 80º deltoclavicular angle. In the axillar region, with the limb at 90º, the syringe was positioned perpendicular to the axillar at the height of the mid portion of the thorax. The mean and standard deviation of the skin-brachial plexus distance for the supraclavicular, infraclavicular and axillar techniques were, respectively, 1.76 ± 0.1387 cm, 1.12 ± 0.239 cm and 1.59 ± 0.365 cm. These data showed the viability of executing the anesthesia technique by three access pathways. However, in the supraclavicular access pathway in the anesthetic simulation with the 13x4.5 mm hypodermic needle, the stain diffused to the plexus, showing, when compared with the 1.76 cm mean skin- plexus distance a safe distance to prevent the needle from perforating the nerve.Discussion: The techniques reported in the human literature for brachial plexus block presented a series of complications, with incomplete blocks and hemorrhages when the axillar access pathway was used and presented risk of pneumothorax in the supraclavicular. In the capuchin monkey the supraclavicular access pathway in anesthetic simulation with 13x4.5mm hypodermic needle showed a safe distance for the needle not to perforate the nerve, so that the use of this needle could be indicated in 2-3 kg animals. However, hypodermic needles are not recommended for use in this area because of the risk of perforating the subclavicular artery close to the plexus. As an alternative some anesthesiologists use the infraclavicular access pathway with atraumatic needles recommended for brachial plexus block, with relative success and fewer complications. Although the supraclavicular region showed the best depth in relation to the technique used here, anesthetic tests should be made to confirm the efficaciousness of executing the brachial plexus anesthetic technique in capuchin monkeys using atraumatic needles for nerve block.

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“…Thermal sensation evaluation was made with gauze and alcohol, testing the sensitivity of the dermatomes innervated by the ulnar, median, and radial nerves in the hand. In addition, for motor function evaluation, the modified Bromage scale 14 ( Table 1 ) was used for the flexors and extensors of the fingers.…”

Section: Introductionmentioning

confidence: 99%