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1.
Sci Rep ; 10(1): 11585, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32665656

RESUMO

The perfusion index (PI) is an objective tool used to assess a successful nerve block. Epinephrine is a widely used adjuvant to local anesthetics, and it may affect PI values because of the vasoconstrictive property. The aim of this study was to investigate the influence of epinephrine on PI as an indicator of a successful block in ultrasound-guided supraclavicular brachial plexus block (SCBPB). In this randomized controlled trial, 82 adult patients underwent upper limb surgery under SCBPB were recruited between July 2018 and March 2019 in a single tertiary care center. Participants were randomly assigned to one of two groups: non-epinephrine group (n = 41) or epinephrine group (5 mcg ml-1, n = 41). The primary outcome was the comparison of the "PI ratio 10," which was defined as the ratio of the PI 10 to the baseline. Receiver operating characteristic (ROC) curves were constructed to determine the accuracy of the PI in predicting the block success at each time interval. The PI ratio 10 was 2.7 (1.9-4.0) in non-epinephrine group and 3.3 (2.2-4.4) in epinephrine group (median difference: 0.4; 95% confidence interval [CI] - 1.1 to 0.2; P = 0.207). The ROC curves compared without group identification were not significantly different over time. The cut-off value for the PI and PI ratio at 5 min (PI ratio 5) were 7.7 (area under the ROC [AUROC]: 0.89, 95% CI 0.83-0.94) and 1.6 (AUROC: 0.94, 95% CI 0.90-0.98), respectively. The perineural epinephrine did not affect the PI following a SCBPB. The PI ratio 5 > 1.6 might be considered as a relatively accurate predictor of a successful SCBPB.Trial registration: This study was registered at the Clinical Trial Registry of Korea (https://cris.nih.go.kr. CriS No. KCT0003006).


Assuntos
Anestésicos Locais/farmacologia , Bloqueio do Plexo Braquial/métodos , Plexo Braquial/efeitos dos fármacos , Epinefrina/farmacologia , Adulto , Plexo Braquial/patologia , Bloqueio do Plexo Braquial/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Perfusão , República da Coreia , Ropivacaina/farmacologia , Ultrassonografia , Ultrassonografia de Intervenção/métodos , Extremidade Superior/patologia
3.
J Vasc Interv Radiol ; 31(2): 236-241, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31883933

RESUMO

PURPOSE: To evaluate the efficacy and safety of the ultrasound-guided supraclavicular brachial plexus block (BPB) during angioplasty of dysfunctional arteriovenous access. MATERIALS AND METHODS: Eighty study participants with dysfunctional arteriovenous access were enrolled in this prospective, randomized clinical trial between November 2016 and February 2018. Eighty patients were randomized to either the ultrasound-guided supraclavicular BPB group (mean age ± standard deviation [SD], 65.1 ± 12.4; male:female = 17:23) or the no regional anesthesia group (mean age ± SD, 64.0 ± 11.7; male:female = 25:15). Pain was assessed on the 10-point Visual Analogue Scale. Participant satisfaction was examined. Six-month clinical follow-up was done to evaluate arteriovenous access patency and long-term complications. RESULTS: The BPB group showed a lower average pain score than the control group (mean ± SD, 0.9 ± 1.9 vs 6.4 ± 2.5; P < .001). Participant satisfaction (mean ± SD, 2.8 ± 0.5 vs 2.1±0.8; P < .001) was also higher in the BPB group. Six-month patency was 65% (26/40) in the BPB group and 59% (23/39) in the control group, with no significant difference between the 2 groups (P = .59). No major immediate or delayed complications were observed. CONCLUSIONS: Ultrasound-guided BPB is highly effective in reducing pain during angioplasty of dysfunctional arteriovenous access with an acceptable safety profile.


Assuntos
Angioplastia , Derivação Arteriovenosa Cirúrgica , Bloqueio do Plexo Braquial , Oclusão de Enxerto Vascular/terapia , Ultrassonografia de Intervenção , Idoso , Angioplastia/efeitos adversos , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Satisfação do Paciente , Estudos Prospectivos , República da Coreia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos , Grau de Desobstrução Vascular
4.
Best Pract Res Clin Anaesthesiol ; 33(4): 553-558, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31791570

RESUMO

BACKGROUND: Interscalene brachial plexus block (IBPB) has become a standard practice for perioperative analgesia for shoulder procedures. However, several side effects may occur owing to its anatomic location. We have chosen to evaluate vocal cord paresis and dysphonia following interscalene blocks. METHODS: After IRB approval, eight patients undergoing arthroscopic shoulder procedures were recruited into this prospective cohort study. Following informed consent, vocal cords were assessed by standardized fiberoptic evaluation. Subsequently, IBPB was performed under ultrasound (US) guidance. Patients were re-evaluated for vocal cord changes by a repeat fiberoptic assessment one hour following IBPB. Our primary outcome measure was incidence of vocal cord immobility. RESULTS: No patients had diminished vocal cord motion, dysphonia, or dysphagia. CONCLUSIONS: Although larger studies are required to determine the true incidence of vocal cord paresis following US-guided IBPB, our results suggest that incidence of unwanted nerve blockade other than brachial plexus is much lower than that previously described.


Assuntos
Artroscopia/métodos , Bloqueio do Plexo Braquial/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Paralisia das Pregas Vocais/diagnóstico por imagem , Adulto , Idoso , Artroscopia/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Ultrassonografia de Intervenção/efeitos adversos , Paralisia das Pregas Vocais/epidemiologia
5.
Rev. bras. anestesiol ; 69(6): 580-586, nov.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1057470

RESUMO

Abstract Background and objectives: The frequent onset of hemidiaphragmatic paralysis during interscalene block restricts its use in patients with respiratory insufficiency. Supraclavicular block could be a safe and effective alternative. Our primary objective was to assess the incidence of hemidiaphragmatic paralysis following ultrasound-guided supraclavicular block and compare it to that of interscalene block. Methods: Adults warranting elective shoulder surgery under regional anesthesia (Toulouse University Hospital) were prospectively enrolled from May 2016 to May 2017 in this observational study. Twenty millilitres of 0.375% Ropivacaine were injected preferentially targeted to the "corner pocket". Diaphragmatic excursion was measured by ultrasonography before and 30 minutes after regional anesthesia. A reduction ≥25% in diaphragmatic excursion during a sniff test defined the hemidiaphragmatic paralysis. Dyspnoea and hypoxaemia were recorded in the recovery room. Predictive factors of hemidiaphragmatic paralysis (gender, age, weight, smoking, functional capacity) were explored. Postoperative pain was also analysed. Results: Forty-two and 43 patients from respectively the supraclavicular block and interscalene block groups were analysed. The incidence of hemidiaphragmatic paralysis was 59.5% in the supraclavicular block group compared to 95.3% in the interscalene block group (p < 0.0001). Paradoxical movement of the diaphragm was more common in the interscalene block group (RR = 2, 95% CI 1.4-3; p = 0.0001). A similar variation in oxygen saturation was recorded between patients with and without hemidiaphragmatic paralysis (p = 0.08). No predictive factor of hemidiaphragmatic paralysis could be identified. Morphine consumption and the highest numerical rating scale numerical rating scale (NRS) at 24 hours did not differ between groups. Conclusions: Given the frequent incidence of hemidiaphragmatic paralysis following supraclavicular block, this technique cannot be recommended for patients with an altered respiratory function.


Resumo Justificativa e objetivos: O aparecimento frequente de paralisia hemidiafragmática durante o bloqueio interescalênico restringe seu uso em pacientes com insuficiência respiratória. O bloqueio supraclavicular pode ser uma opção segura e eficaz. Nosso objetivo primário foi avaliar a incidência de paralisia hemidiafragmática após bloqueio supraclavicular guiado por ultrassom e compará-lo com o bloqueio interescalênico. Métodos: Os adultos agendados para cirurgia eletiva do ombro sob anestesia regional (Hospital Universitário de Toulouse) foram prospectivamente incluídos neste estudo observacional, de maio de 2016 a maio de 2017. Vinte mililitros de ropivacaína a 0,375% foram injetados, preferencialmente objetivando a interseção da primeira costela e da artéria subclávia. A excursão diafragmática foi medida por ultrassonografia antes e 30 minutos após a anestesia regional. Uma redução ≥ 25% na excursão diafragmática durante um sniff test definiu a paralisia hemidiafragmática. Dispneia e hipoxemia foram registradas na sala de recuperação. Fatores preditivos de paralisia hemidiafragmática (sexo, idade, peso, tabagismo, capacidade funcional) foram explorados. A dor pós-operatória também foi avaliada. Resultados: Quarenta e dois e 43 pacientes dos grupos bloqueio supraclavicular e bloqueio interescalênico, respectivamente, foram avaliados. A incidência de paralisia hemidiafragmática foi de 59,5% no grupo bloqueio supraclavicular em comparação com 95,3% no grupo bloqueio interescalênico (p < 0,0001). O movimento paradoxal do diafragma foi mais comum no grupo bloqueio interescalênico (RR = 2, 95% IC 1,4-3; p = 0,0001). Uma variação semelhante na saturação de oxigênio foi registrada entre os pacientes com e sem paralisia hemidiafragmática (p = 0,08). Nenhum fator preditivo de paralisia hemidiafragmática pôde ser identificado. O consumo de morfina e o maior escore na escala numérica (NRS) em 24 horas não diferiram entre os grupos. Conclusão: Devido à frequente incidência de paralisia hemidiafragmática após bloqueio supraclavicular, essa técnica não pode ser recomendada para pacientes com função respiratória alterada.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Paralisia Respiratória/etiologia , Bloqueio do Plexo Braquial/métodos , Ropivacaina/administração & dosagem , Anestésicos Locais/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/epidemiologia , Paralisia Respiratória/epidemiologia , Incidência , Estudos Prospectivos , Estudos de Coortes , Ultrassonografia de Intervenção , Bloqueio do Plexo Braquial/efeitos adversos , Analgésicos Opioides/administração & dosagem , Pessoa de Meia-Idade , Morfina/administração & dosagem
6.
AANA J ; 87(4): 313-316, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31587716

RESUMO

Horner syndrome is a known complication of cervical approaches to brachial plexus blocks due to local anesthetic-induced oculosympathetic paresis. It has rarely been described in relation to ultrasound-guided brachial plexus blocks in children. This syndrome is usually self-limiting but may cause apprehension to the child, parents, and the treating physicians until its resolution. We report delayed manifestations of Horner syndrome in 2 children following ultrasound-guided infraclavicular and subclavian perivascular blocks.


Assuntos
Anestésicos Locais/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Síndrome de Horner/diagnóstico , Bloqueio do Plexo Braquial/enfermagem , Criança , Diagnóstico Diferencial , Síndrome de Horner/induzido quimicamente , Síndrome de Horner/enfermagem , Humanos , Masculino , Enfermeiras Anestesistas , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/enfermagem , Ultrassonografia de Intervenção
7.
Trials ; 20(1): 533, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455407

RESUMO

BACKGROUND: A classical approach to produce interscalene brachial plexus block (ISBPB) consistently spares the posterior aspect of the shoulder and ulnar sides of the elbow, forearm, and hand, which are innervated by the lower trunk of the brachial plexus (C8-T1). As an alternative to the classical approach, a caudal approach to ISBPB successfully produces anesthesia of the ulnar sides of the elbow, forearm, and hand. However, its beneficial effects on anesthesia in the posterior aspect of the shoulder have not been investigated. In addition, the C8 nerve root is not routinely selectively blocked during ISBPB. Therefore, we will compare the C5 to C7 and C5 to C8 nerve root blocks during a caudal approach to ISBPB to assess the clinical benefit of C8 nerve blocks for the surgical anesthesia of the posterior aspect of the shoulder. METHODS/DESIGN: In this prospective parallel-group single-blind randomized controlled trial, 74 patients scheduled to undergo arthroscopic shoulder surgery under ISBPB are randomly allocated to receive the C5 to C7 or C5 to C8 nerve root block at a 1:1 ratio. The primary outcome is pain intensity, which is rated as 0 (no pain), 1 (mild pain), or 2 (severe pain), during the introduction of a posterior portal into the glenohumeral joint. The secondary outcomes are (1) the extent of the ipsilateral sensory, motor, hemidiaphragmatic, and stellate ganglion blockade, (2) changes in the results of a pulmonary function test, (3) incidence of complications related to ISBPB, (4) postoperative numerical pain rating scale scores, (5) patients' satisfaction with the ISBPB, (6) dose and frequency of analgesic use, and (7) incidence of conversion to general anesthesia. DISCUSSION: This study is the first to evaluate the beneficial effects of the C8 nerve root block during ISBPB, which has rarely been performed due to the technical challenge in visualizing and blocking the C8 nerve root. It is expected that a C8 nerve root block performed during ISBPB will provide sufficient surgical anesthesia of the posterior aspect of the shoulder, which cannot be achieved by a classical approach to ISBPB. TRIAL REGISTRATION: ClicnicalTrials.gov, NCT03487874 . Registered on 4 April 2018.


Assuntos
Artroscopia , Bloqueio do Plexo Braquial/métodos , Bloqueio do Plexo Cervical/métodos , Dor Pós-Operatória/prevenção & controle , Dor de Ombro/prevenção & controle , Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Bloqueio do Plexo Cervical/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , República da Coreia , Ombro/inervação , Dor de Ombro/diagnóstico , Dor de Ombro/etiologia , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
J Shoulder Elbow Surg ; 28(10): e325-e338, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31353302

RESUMO

BACKGROUND: The ideal analgesic modality for total shoulder arthroplasty (TSA) remains controversial. We hypothesized that a multimodal analgesic pathway incorporating continuous interscalene blockade (ISB) provides better analgesic efficacy than both single-injection ISB and local infiltration analgesia. METHODS: This single-center, parallel, unblinded, randomized clinical trial evaluated 129 adults undergoing primary TSA. Patients were allocated to single-injection ISB, continuous ISB, or local infiltration analgesia. The primary outcome was the Overall Benefit of Analgesia Score (range, 0 [best] to 28 [worst]) on postoperative day 1. Additional outcomes included pain scores, opioid consumption, quality of life, and postoperative complications in the first 24 hours, at 3 months, and at 1 year. RESULTS: We analyzed 125 patients (42 with single-injection ISB, 41 with continuous ISB, and 42 with local infiltration analgesia). The Overall Benefit of Analgesia Score was significantly improved in the continuous group (median [25th percentile, 75th percentile], 0 [0, 2]) compared with the single-injection group (2 [1, 4]; P = .002) and local infiltration analgesia group (3 [2, 4]; P < .001). Pain scores were significantly lower in the continuous group compared with the local infiltration analgesia group (P < .001 for all time points) and after 12 hours from ward arrival compared with the single-injection group (median [25th percentile, 75th percentile], 1.0 [0.0, 2.8] vs. 2.5 [0.0, 4.0]; P = .016). After postanesthesia recovery discharge, opioid consumption (oral morphine equivalents) was significantly lower in the continuous group (median [25th percentile, 75th percentile], 7.5 mg [0.0, 25.0 mg]) than in the local infiltration analgesia group (30 mg [15.0, 52.5 mg]; P < .001) and single-injection group (17.6 mg [7.5, 45.5 mg]; P = .010). No differences were found across groups for complications, 3-month outcomes, and 1-year outcomes. CONCLUSION: Continuous ISB provides superior analgesia compared with single-injection ISB and local infiltration analgesia in the first 24 hours after TSA.


Assuntos
Analgesia/métodos , Anestésicos Locais/administração & dosagem , Artroplastia do Ombro , Bloqueio do Plexo Braquial/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Analgésicos Opioides/uso terapêutico , Artroplastia do Ombro/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Qualidade de Vida , Fatores de Tempo
9.
Eur J Anaesthesiol ; 36(6): 427-435, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31045699

RESUMO

BACKGROUND: Interscalene brachial plexus blockade is the most common regional anaesthesia technique for alleviating pain after shoulder surgery, but complications occur, including ipsilateral hemidiaphragmatic paresis, Horner's syndrome and hoarseness. The supraclavicular approach might be an effective alternative with fewer adverse effects. OBJECTIVES: The aim of this study was to determine whether there is a difference in postoperative pain scores and morphine equivalents between interscalene and supraclavicular brachial plexus blocks. Secondary endpoints were serious adverse events. DESIGN: A systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: A comprehensive literature search of Embase, CENTRAL, MEDLINE and Web of Science was performed from the earliest record to December 2018. ELIGIBILITY CRITERIA: Prospective randomised controlled trials that compare interscalene and supraclavicular brachial plexus blocks in patients undergoing shoulder surgery were eligible for inclusion. Only studies that reported their methods transparently and comprehensibly were included. Conference abstracts or meeting abstracts were not excluded a priori. Risk of bias was assessed using Cochrane methodology. RESULTS: Twelve studies were eligible for meta-analysis. The supraclavicular approach showed overall comparable 24-h pain scores (mean difference -0.34; 95% CI -0.75 to 0.07, P = 0.11) and comparable morphine equivalent consumption (mean difference 1.84 mg per 24 h; 95% CI -0.00 to 3.69, P = 0.05). Secondary endpoint analysis revealed a significantly lower rate of hemidiaphragmatic paresis (risk ratio 0.56; 95% CI 0.39 to 0.82, P = 0.003) and Horner's syndrome (risk ratio 0.29; 95% CI 0.19 to 0.44, P < 0.00001) for the supraclavicular approach. There was no significant difference in hoarseness (risk ratio 0.73; 95% CI 0.48 to 1.13, P = 0.16). CONCLUSION: After 24 postoperative hours, pain scores and consumption of morphine equivalents were comparable. Adverse effects were less common with the supraclavicular approach. The supraclavicular approach might be an efficient alternative to the interscalene approach for shoulder surgery. However, the available evidence is inadequate and prevents a firm conclusion.


Assuntos
Bloqueio do Plexo Braquial/métodos , Procedimentos Ortopédicos/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Articulação do Ombro/cirurgia , Anestésicos Locais/administração & dosagem , Bloqueio do Plexo Braquial/efeitos adversos , Rouquidão/epidemiologia , Rouquidão/etiologia , Síndrome de Horner/epidemiologia , Síndrome de Horner/etiologia , Humanos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Paralisia Respiratória/epidemiologia , Paralisia Respiratória/etiologia
10.
Clin Orthop Relat Res ; 477(3): 622-632, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30762694

RESUMO

BACKGROUND: The pain experience for total shoulder arthroplasty (TSA) patients in the first 2 weeks after surgery has not been well described. Many approaches to pain management have been used, with none emerging as clearly superior; it is important that any approach minimizes postoperative opioid use. QUESTIONS/PURPOSES: (1) With a long-acting nerve block and comprehensive multimodal analgesia, what are the pain levels after TSA from day of surgery until postoperative day (POD) 14? (2) How many opioids do TSA patients take from the day of surgery until POD 14? (3) What are the PainOUT responses at POD 1 and POD 14, focusing on side effects from opioids usage? METHODS: From January 27, 2017 to December 6, 2017, 154 TSA patients were identified as potentially eligible for this prospective, institutional review board-approved observational study. Of those, 46 patients (30%) were excluded (either because they were deemed not appropriate for the study, research staff were not available, patients were not eligible, or they declined to participate), and another six (4%) had incomplete followup data and could not be studied, leaving 102 patients (66%) for analysis here. Median preoperative pain with movement was 7 (interquartile range [IQR], 5-9) and 13 of 102 patients used preoperative opioids. All patients received a single-injection bupivacaine interscalene block with adjuvant clonidine, dexamethasone, and buprenorphine. Multimodal analgesia included acetaminophen, NSAIDs, and opioids. The primary outcome was the Numerical Rating Scale (NRS) pain score with movement on POD 14. The NRS pain score ranges from 0 (no pain) to 10 (worst pain possible). Secondary outcomes included NRS pain scores at rest and with movement (day of surgery, and PODs 1, 3, 7 and 14), daily analgesic use from day of surgery to POD 14 (both oral and intravenous), Opioid-Related Symptom Distress Scale (which assesses 12 symptoms ranging from 0 to 4, with 4 being the most distressing; the composite score is the mean of the 12 symptom-specific scores) on POD 1, and the PainOut questionnaire on POD 1 and POD 14. The PainOut questionnaire includes questions rating nausea, drowsiness, itching from 0 (none) to 10 (severe), as well as rating difficulty staying asleep from 0 (does not interfere) to 10 (completely interferes). RESULTS: The median NRS pain scores with movement were 2 (IQR, 0-5) on POD 1, 5 (IQR, 3-6) on POD 3, and the pain score was 3 (IQR, 1-5) on POD 14. Median total opioid use (converted to oral morphine equivalents) was 16 mg (4-50 mg) for the first 24 hours, 30 mg (8-63 mg) for the third, and 0 mg (0-20 mg) by the eighth 24-hour period, while the most frequent number of activations of the intravenous patient-controlled analgesia device was 0. Median PainOut scores on POD 1 and POD 14 for sleep interference, nausea, drowsiness and itching were 0, and the median composite Opioid-Related Symptom Distress Scale score on day 1 was 0.3 (IQR, 0.1-0.5). CONCLUSIONS: Clinicians using this protocol, which combines a long-acting, single-injection nerve block with multimodal analgesia, can inform TSA patients that their postoperative pain will likely be less than their preoperative pain, and that on average they will stop using opioids after 7 days. Future research could investigate what the individual components of this protocol contribute. Larger cohort studies or registries would document the incidence of rare complications. Randomized controlled trials could directly compare analgesic effectiveness and cost-benefits for this protocol versus alternative strategies, such as perineural catheters or liposomal bupivacaine. Perhaps most importantly, future studies could seek ways to further reduce peak pain and opioid usage on POD 2 and POD 3. LEVEL OF EVIDENCE: Level IV, therapeutic study.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Artroplastia do Ombro/efeitos adversos , Bloqueio do Plexo Braquial , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Dor de Ombro/prevenção & controle , Idoso , Analgésicos Opioides/efeitos adversos , Anestésicos Locais/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Dor de Ombro/diagnóstico , Dor de Ombro/etiologia , Dor de Ombro/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
12.
Acta Anaesthesiol Scand ; 63(3): 389-395, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30338518

RESUMO

BACKGROUND: We recently showed that the novel combination of a superficial cervical plexus block, a suprascapular nerve block, and the lateral sagittal infraclavicular brachial plexus block (LSIB) provides an alternative anaesthetic method for arthroscopic shoulder surgery. In this study, we hypothesised that the LSIB dose for this shoulder block could be significantly reduced by injecting only towards the shoulder relevant posterior and lateral cords. Our aim was to determine the minimum effective volume in 50% of the patients (MEV50 ) and to estimate the MEV95, when using ropivacaine 7.5 mg/mL to block these cords. METHODS: Twenty-three adult patients scheduled for hand surgery participated in the study. Considering the artery as a clock face with 12 o'clock ventral, the designated volume was injected immediately outside the arterial wall and between 8 and 9 o´clock. The in-plane technique was used. Block success was assessed 30 minutes after withdrawal of the needle. Successful posterior cord block was defined as anaesthesia or analgesia of the axillary nerve. Successful lateral cord block was defined as either anaesthesia or analgesia, or >50% motor block of the musculocutaneous nerve. MEV50 was determined by the staircase up-and-down method. Logistic regression and probit transformation were applied to estimate MEV95 . RESULTS: MEV50 and MEV95 were 7.8 mL [95% confidence interval (CI), 7.3-8.4] and 9.0 mL (95% CI, 7.8-10.3), respectively. CONCLUSION: For single-deposit infraclavicular posterior and lateral cord block, the MEV95 of ropivacaine 7.5 mg/mL was estimated to 9.0 mL.


Assuntos
Anestésicos Locais , Bloqueio do Plexo Braquial/métodos , Ropivacaina , Adolescente , Adulto , Idoso , Analgesia , Anestesia Local , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Artroscopia , Plexo Braquial/diagnóstico por imagem , Bloqueio do Plexo Braquial/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ropivacaina/administração & dosagem , Ropivacaina/efeitos adversos , Ombro/cirurgia , Ultrassonografia de Intervenção , Adulto Jovem
13.
Medicine (Baltimore) ; 97(41): e12573, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30313043

RESUMO

BACKGROUND: Dexmedetomidine has been used as an adjuvanty added to local anesthetics to prolong analgesia following peripheral nerve blockade. The aim of this meta-analysis was to investigate the effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block (BPB). METHODS: A search strategy was created to identify eligible randomized clinical trial (RCT) in PubMed, Embase, and The Cochrane Library (updated May, 2018). The methodologic quality for each included study was evaluated using the Cochrane Tool for Risk of Bias by 2 independent researchers. RESULTS: Twelve RCTs were included in the meta-analysis (n = 671). As an adjuvant to ropivacaine, dexmedetomidine significantly reduced the onset time of sensory (mean difference [MD], -3.86 minutes, 95% CI -5.45 to -2.27 minutes; I = 85%) and motor (MD, -5.21 minutes; 95% CI -7.48 to -2.94 minutes; I = 94%). In addition, it increased the blockade duration of sensory (MD, 228.70 minutes; 95% CI 187.87-269.52 minutes; I = 93%) and motor (MD, 191.70 minutes; 95% CI 152.48-230.91 minutes; I = 92%). Moreover, the combination prolonged the duration of analgesia (MD, 303.04 minutes; 95% CI 228.84-377.24 minutes; I = 86%). There was no difference of the incidence of bradycardia (risk difference [RD], 0.01, 95% CI -0.02 to 0.05, I = 45%; P = .45) and hypotension (RD, 0.01, 95% CI -0.01 to 0.03, I = 0%; P = .57) between 2 groups. CONCLUSION: Dexmedetomidine added to ropivacaine in BPB has a better analgesia effect (shorter onset time and longer duration) compared to ropivacaine alone. At the same time, there was no difference in the incidence of bradycardia and hypotension.


Assuntos
Amidas/uso terapêutico , Analgésicos não Entorpecentes/uso terapêutico , Anestésicos Locais/uso terapêutico , Bloqueio do Plexo Braquial/métodos , Dexmedetomidina/uso terapêutico , Amidas/administração & dosagem , Amidas/efeitos adversos , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos não Entorpecentes/efeitos adversos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Quimioterapia Combinada , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ropivacaina , Fatores de Tempo
14.
Anaesthesiol Intensive Ther ; 50(4): 263-269, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30221338

RESUMO

BACKGROUND: Adequate pain management after arthroscopic procedures improves patients' satisfaction with the performed procedure, as well as facilitating early rehabilitation. The aim of the current randomised, prospective clinical study was to assess the influence of anthropometric parameters and the interscalene brachial plexus block (IBPB) technique on the quality of post-operational analgesia. METHODS: 109 randomly selected patients of ASA I-III status were scheduled for elective shoulder arthroscopy. Reasons for non-inclusion were as follows: neurological deficit in the upper arm; allergies to amide Las; coagulopathy; and pregnancy. The patients received 20 mL of 0.5% ropivacaine for an ultrasound (US)-guided IBPB (group U), peripheral nerve stimulation (PNS)-confirmation IBPB (group N), or US-guided, PNS-confirmed IBPB (dual guidance; group NU). RESULTS: We observed that the studied groups did not differ in mean time of sensory and motor block terminations and, surprisingly, in each group in individual cases the sensory block lasted up to 890-990 minutes providing satisfactory long-lasting post-operational analgesia in patients receiving IBPB. We observed a negative correlation between BMI and termination of the motor block and a positive correlation between age and termination of the sensory block in patients receiving US-guided IBPB (group U) in comparison with the two other groups. We found a positive correlation between the male gender and termination of the motor block in patients receiving PNS-guided IBPB (group N) in comparison with two other groups. CONCLUSION: In our study, patients received satisfactory analgesia in the post-operational period no matter what technique was used regardless of their age, gender or potentially uncommon anthropometry.


Assuntos
Anestésicos Locais/farmacologia , Artroscopia/métodos , Bloqueio do Plexo Braquial/efeitos adversos , Ropivacaina/farmacologia , Ombro/cirurgia , Adulto , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
16.
Orthopedics ; 41(5): e598-e606, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30125041

RESUMO

The purpose of this review was to determine the incidence and duration of peripheral neurologic symptoms following interscalene blocks for shoulder surgery. Three databases were reviewed for subjective and objective injuries by guidance modality and delivery method. The incidence of neurologic injuries following single site injection interscalene blocks, 3.16%, was significantly less than the 5.24% incidence for continuous catheter infusion interscalene blocks. Less than 0.51% of peripheral neurologic symptoms persisted beyond 1 year for both groups. There is a notable risk of injury following interscalene blocks by all modes of guidance and anesthetic technique, but only a small percentage of injuries persist. [Orthopedics. 2018; 41(5):e598-e606.].


Assuntos
Artroscopia/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Traumatismos dos Nervos Periféricos/etiologia , Anestésicos Locais/administração & dosagem , Artroscopia/métodos , Bloqueio do Plexo Braquial/métodos , Humanos , Infusões Intravenosas , Injeções , Estudos Observacionais como Assunto , Cirurgiões Ortopédicos , Traumatismos dos Nervos Periféricos/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Articulação do Ombro/cirurgia
17.
Rev Esp Anestesiol Reanim ; 65(10): 593-596, 2018 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30033043

RESUMO

Phrenic nerve block is a complication that can occur after brachial plexus anaesthesia above the clavicle. The main consequence of this blockage is ipsolateral diaphragmatic paralysis, which can sometimes lead to the appearance of post-operative respiratory complications. A case is presented on a woman, who after having undergone a total shoulder prosthesis, presented with dyspnoea in the post-operative recovery unit. A diaphragmatic ultrasound was performed that enabled a rapid diagnosis to be made of a complete paralysis of the ipsolateral hemi-diaphragm. Given the suspicion of phrenic nerve block, ultrasound has proven to be a rapid diagnostic tool with high sensitivity and specificity. Its use can anticipate the possible development of immediate complications, and act as a guide in choosing the appropriate therapeutic strategy for each case in an early manner. In this case it enabled us to treat early with oxygen therapy, interscalene catheter removal, and intensive surveillance.


Assuntos
Artroplastia do Ombro , Diafragma/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/diagnóstico , Nervo Frênico/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Paralisia Respiratória/diagnóstico , Idoso , Anestésicos Locais/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Remoção de Dispositivo , Dispneia/etiologia , Dispneia/terapia , Diagnóstico Precoce , Feminino , Humanos , Levobupivacaína/efeitos adversos , Oxigenoterapia , Doenças do Sistema Nervoso Periférico/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/etiologia , Ultrassonografia
18.
Medicine (Baltimore) ; 97(24): e11034, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29901598

RESUMO

BACKGROUND: Postoperative ipsilateral shoulder pain occurs in 37% to 68% of patients undergoing a thoracotomy. We examined whether interscalene brachial plexus block using a lower concentration of local anesthetic would reduce the incidence of post-thoracotomy ipsilateral shoulder pain with assessment of pulmonary function in patients who underwent a lung lobectomy. METHODS: Forty-four patients who underwent a lung lobectomy were randomly assigned to either the control or the interscalene block group. Single-shot interscalene block on the surgical site side was performed using ropivacaine 0.25% 10 mL including dexamethasone 5 mg under ultrasound guidance in the interscalene block group. Lobectomy and continuous paravertebral block were performed under general anesthesia. The presence of ipsilateral shoulder pain and postoperative adverse events were assessed. Pulmonary function tests were performed preoperatively, the day after surgery, and the day after removing the chest tube. RESULTS: The incidence of ipsilateral shoulder pain was significantly lower in the interscalene block group than in the control group (54.5% vs 14.3%, P = .006) with an overall incidence of 34.9%. Postoperative adverse events were similar between the groups, with no patients presenting symptoms of respiratory difficulty. Significant reductions in pulmonary function were observed in all patients after lobectomy; however, no significant difference in any of the pulmonary function test variables was observed postoperatively between the groups. CONCLUSIONS: Interscalene block using 10 mL of 0.25% ropivacaine including dexamethasone 5 mg reduced the incidence of post-thoracotomy ipsilateral shoulder pain and did not result in additional impairment of pulmonary function.


Assuntos
Bloqueio do Plexo Braquial/métodos , Dor Pós-Operatória/epidemiologia , Pneumonectomia/efeitos adversos , Dor de Ombro/epidemiologia , Toracotomia/efeitos adversos , Adulto , Idoso , Amidas/administração & dosagem , Amidas/efeitos adversos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Plexo Braquial/cirurgia , Bloqueio do Plexo Braquial/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/cirurgia , Pneumonectomia/métodos , Estudos Prospectivos , Sistema de Registros , Testes de Função Respiratória/métodos , Ropivacaina , Dor de Ombro/prevenção & controle , Dor de Ombro/cirurgia
20.
J Clin Anesth ; 48: 67-72, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29778971

RESUMO

STUDY OBJECTIVE: To compare the effectiveness of supraclavicular and infraclavicular approaches to brachial plexus block for elbow surgery. DESIGN: Prospective, parallel arm, observer-blinded, randomized controlled trial. SETTING: This study occurred in a designated block room at St. Joseph's hospital, a large academic tertiary hospital in London, Canada. PATIENTS: 150 adult ASA class I-III patients undergoing elective ambulatory elbow surgery. INTERVENTIONS: Patients were randomized to receive either an ultrasound-guided infraclavicular or a supraclavicular block with ropivacaine. MEASUREMENTS: Both groups were assessed for performance and sensory block onset times. Motor block, effective surgical anesthesia, procedure-related pain, axillary nerve block and ulnar nerve sparing were additional outcomes. We analyzed continuous and non-continuous variables with the independent t-test and chi-square test respectively and considered statistical significance when type 1 error was under 0.05. MAIN RESULTS: We observed similar mean block procedure times at 285 (±128) seconds in infra and 307 (±138) seconds in supra group (p = 0.3). The mean time of sensory block onset in both groups was similar: Infra 20.4 (±7.9) and supra 18.9 (±7.1) min (p = 0.4). Conversion to general anesthesia (4.2 vs 5.5%; p = 0.73) and the need for local anesthetic supplement (4.2 vs 4.1%; p = 0.98) was similar in both groups. We observed an increased incidence of paresthesia in the supra group (8.3 vs 23.2%; p = 0.014). CONCLUSION: We found that both blocks were equally effective for elbow surgery with similar procedure and block onset times and failure rates. Lower incidence of paresthesia was associated with the infraclavicular block with no change in other complications compared to the supraclavicular technique.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Bloqueio do Plexo Braquial/métodos , Procedimentos Ortopédicos/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Parestesia/epidemiologia , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/métodos , Anestésicos Locais/administração & dosagem , Plexo Braquial/diagnóstico por imagem , Plexo Braquial/efeitos dos fármacos , Bloqueio do Plexo Braquial/efeitos adversos , Cotovelo/diagnóstico por imagem , Cotovelo/inervação , Cotovelo/cirurgia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/inervação , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Incidência , Injeções/efeitos adversos , Injeções/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Parestesia/etiologia , Ropivacaina/administração & dosagem , Resultado do Tratamento , Ultrassonografia de Intervenção
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