Implicación en Cataluña de los Servicios de Anestesiología y Reanimación en la pandemia por SARS-CoV-2. Una solución real coste-efectiva para una crisis sanitaria sin precedentes / Involvement in Catalonia of the Anaesthesiology and Resuscitation Services in the SARS-CoV-2 pandemic. A real, cost-effective solution to an unprecedented health crisis

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[Ultrasound-guided supraclavicular brachial plexus block with small volumes of local anesthetic: technical description and analysis of results]. / Bloqueo supraclavicular del plexo braquial con bajos volúmenes de anestésico local y dirigido por ecografía. Descripción de la técnica y análisis de resultados.

OBJECTIVE: To assess the use of ultrasound guidance to enable injection of 10 mL of 2% mepivacaine into the brachial plexus to maintain an effective block and surgical conditions comparable to those that can be provided with larger volumes and higher doses. MATERIAL AND METHODS: This was a prospective study of 200 consecutive adults in whom a 7.5 Mhz linear array was used for ultrasound guidance of a 40-mm 21-gauge needle with a 15 degrees bevel tip. The probe was placed in the coronal oblique plane and the needle was inserted along its axis to the outer edge. The anesthetic was injected at 3 locations. The quality of sensory block was assessed at 30 minutes and effectiveness at the end of surgery. RESULTS: The patient sample consisted of 87 women and 113 men with a mean (SD) age of 40 (13) years and body mass index of 26 (4) kg x m(-2). Most procedures were on the hand and elbow (82%). All blocks were performed by the same anesthesiologist. Sensory block of pain was achieved in 97% of the patients and analgesia was effective for 95%. Paresthesias were noted by 28% when the needle was moved and by 71.5% during injection. The only complications observed were 2 arterial punctures (1%). CONCLUSIONS: Ultrasound guidance enables use of less local anesthetic for supraclavicular brachial plexus blocks. The surgical conditions possible are comparable in quality to those achieved at higher volumes and doses. The incidence of complications is minimal.

Bloqueo supraclavicular del plexo braquial con bajos volúmenes de anestésico local y dirigido por ecografía. Descripción de la técnica y análisis de resultados / Ultrasound-guided supraclavicular brachial plexus block with small volumes of local anesthetic: technical description and analysis of results

OBJETIVO: Valorar si el uso del ecógrafo permite anestesiarel plexo braquial a nivel supraclavicular con 10cc. de Mepivacaína al 2%, manteniendo igual calidad yefectividad quirúrgica, que a volúmenes y dosis superiores.MATERIAL Y MÉTODO: Estudio prospectivo de 200adultos consecutivos, usando un ecógrafo con sonda lineal7,5 Mhz. y para la punción una aguja 21G, 40 mm conbisel de 15º. La sonda se situó en corte coronal-oblicuo,insertando la aguja desde su borde externo, siguiendo sueje largo. Se inyectó el anestésico en tres zonas, valorandola calidad del bloqueo sensitivo a los 30 minutos y laefectividad al finalizar la cirugía.RESULTADOS: La muestra estaba formada por 87mujeres y 113 varones, con una edad media 40±13años, IMC media 26±4 Kg.m-2. La cirugía se localizóprincipalmente en mano y codo (82%). Todos los bloqueosanestésicos fueron realizados por el primerautor. Se consiguió bloqueo sensitivo al dolor en el97% de los pacientes, siendo la eficacia del 95%. Un28% notaron parestesias al manipular la aguja, y el71,5% durante la inyección. Se produjeron dos puncionesarteriales (1%), no observándose otras complicaciones.CONCLUSIONES: El uso del ecógrafo facilita la reducciónde anestésico local en el bloqueo del plexo braquiala nivel supraclavicular, permitiendo la cirugía con idénticacalidad que a volúmenes y dosis superiores, conmínima incidencia de complicaciones

OBJETIVE: To assess the use of ultrasound guidance toenable injection of 10 mL of 2% mepivacaine into thebrachial plexus to maintain an effective block and surgicalconditions comparable to those that can be providedwith larger volumes and higher doses.MATERIAL AND METHODS: This was a prospectivestudy of 200 consecutive adults in whom a 7.5 Mhz lineararray was used for ultrasound guidance of a 40-mm21-gauge needle with a 15° bevel tip. The probe wasplaced in the coronal oblique plane and the needle wasinserted along its axis to the outer edge. The anestheticwas injected at 3 locations. The quality of sensory blockwas assessed at 30 minutes and effectiveness at the endof surgery.RESULTS: The patient sample consisted of 87 womenand 113 men with a mean (SD) age of 40 (13) years andbody mass index of 26 (4) kg.m-2. Most procedures wereon the hand and elbow (82%). All blocks were performedby the same anesthesiologist. Sensory block ofpain was achieved in 97% of the patients and analgesiawas effective for 95%. Paresthesias were noted by 28%when the needle was moved and by 71.5% during injection.The only complications observed were 2 arterialpunctures (1%).CONCLUSIONS: Ultrasound guidance enables use of lesslocal anesthetic for supraclavicular brachial plexusblocks. The surgical conditions possible are comparablein quality to those achieved at higher volumes and doses.The incidence of complications is minimal