ABSTRACT
Abstract Objective The incidence of traumatic brachial plexus injuries has been increasing considerably in Brazil, mainly due to the increase in the number of motorcycle accidents. The aim of the present study is to evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) in the diagnosis of brachial plexus avulsion lesions, comparing it with the findings of physical and intraoperative examination. Methods A total of 16 patients with brachial plexus injury were prospectively evaluated and treated at the hand surgery outpatient clinic from our service. All patients underwent MRI of the brachial plexus, and the findings were inserted on a table, as well as the physical examination data, and part of the patients had the plexus evaluated intraoperatively. Results In the present study, the accuracy of MRI in the identification of root avulsion was 100%, with 100% sensitivity and specificity when comparing imaging with surgical findings. Conclusion Magnetic resonance imaging showed high sensitivity and specificity, confirmed by intraoperative findings, which allows considering this test as the gold standard in the diagnosis of avulsion in traumatic brachial plexus injuries.
Resumo Objetivo A incidência de lesões traumáticas do plexo braquial vem aumentando consideravelmente no Brasil, principalmente devido ao aumento do número de acidentes de motocicleta. O objetivo do presente estudo é avaliar a sensibilidade e a especificidade da ressonância magnética (RM) no diagnóstico das lesões por avulsão do plexo braquial, comparando com os achados do exame físico e do intraoperatório. Métodos Foram avaliados prospectivamente 16 pacientes com lesão do plexo braquial atendidos no ambulatório de cirurgia da mão de nosso serviço. Todos os pacientes foram submetidos ao exame de RM do plexo braquial e os achados foram inseridos em uma tabela, assim como os dados do exame físico, e parte dos pacientes teve o plexo avaliado intraoperatoriamente. Resultados No presente estudo, a acurácia da RM na identificação de avulsão de raízes foi de 100%, com 100% de sensibilidade e especificidade comparando-se achados da imagem e cirúrgicos. Conclusão A RM mostrou alta sensibilidade e especificidade, confirmadas por achados intraoperatórios, o que permite considerar este exame como padrão outro no diagnóstico de avulsão nas lesões traumáticas do plexo braquial.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Brachial Plexus/surgery , Brachial Plexus/injuries , Brachial Plexus/diagnostic imaging , Magnetic Resonance Imaging , Diagnosis, Differential , Peripheral Nerve InjuriesABSTRACT
PURPOSE: To update the gross and sonographic anatomy and propose landmarks to perform ultrasound-guided (US-guided) axillary brachial plexus block (BPB) in rabbits. METHODS: Forty New Zeeland's rabbit (NZR) cadavers were dissected and the nerves were trimmed, identified, measured, and photographed. Additionally, in twenty NZRs, sonographic images of brachial plexus (BP) were performed through a simple-resolution ultrasound device. The US-guided block was achieved through a minimum volume of lidocaine necessary to surround the BP roots. The effectiveness of the brachial plexus block was assessed on sensitivity and motor functions. RESULTS: The BP resulted from connections between the ventral branches of the last four cervical spinal nerves and the first thoracic spinal nerve. In the axillary sonoanatomy, the BP appeared as an agglomerate of small, round hypoechoic structures surrounded by a thin hyperechoic ring. The amount of time and the minimum volume required to perform was 4.3 ± 2.3 min and 0.8 ± 0.3ml, respectively. CONCLUSIONS: The gross and sonographic anatomy of the BP showed uncommon morphological variations. Moreover, from sonographic landmarks, we showed complete reproducibility of the axillary US-guided brachial plexus block with simple resolution equipment and small volume of anesthetics required.
Subject(s)
Animals , Male , Female , Rabbits , Brachial Plexus/anatomy & histology , Brachial Plexus/diagnostic imaging , Models, Animal , Brachial Plexus Block/methods , Axilla/innervation , Axilla/blood supply , Axillary Artery/anatomy & histology , Reproducibility of Results , Ultrasonography/methods , Anatomic Landmarks , Brachial Plexus Block/veterinary , Forelimb/innervation , Anesthetics, Local/administration & dosageABSTRACT
Ketamine has anti-inflammatory, analgesic and antihyperalgesic effect and prevents pain associated with wind-up. We investigated whether low doses of ketamine infusion during general anesthesia combined with single-shot interscalene nerve block (SSISB) would potentiate analgesic effect of SSISB. Forty adult patients scheduled for elective arthroscopic shoulder surgery were enrolled and randomized to either the control group or the ketamine group. All patients underwent SSISB and followed by general anesthesia. During an operation, intravenous ketamine was infused to the patients of ketamine group continuously. In control group, patients received normal saline in volumes equivalent to ketamine infusions. Pain score by numeric rating scale was similar between groups at 1, 6, 12, 24, 36, and 48 hr following surgery, which was maintained lower than 3 in both groups. The time to first analgesic request after admission on post-anesthesia care unit was also not significantly different between groups. Intraoperative low dose ketamine did not decrease acute postoperative pain after arthroscopic shoulder surgery with a preincisional ultrasound guided SSISB. The preventive analgesic effect of ketamine could be mitigated by SSISB, which remains one of the most effective methods of pain relief after arthroscopic shoulder surgery.