medigraphic.com
ISSN 1561-3046 (Electronic)

2013, Number 1

<< Back Next >>

Rev Cub Med Mil 2013; 42 (1)

Metabolic and clinical correlation in traumatic upper limb surgery and continuous brachial plexus block

García CE, García GGL, Melis SA, Cabana SJA

Language: Spanish
References: 32
Page: 72-79
PDF size: 52.98 Kb.


ABSTRACT

Objective: to assess changes in metabolic clinical correlation with traumatic upper limb surgery in patients receiving regional-analgesia anesthesia by continuous brachial plexus block (DNB).
Methods: 60 patients were studied. All of them were ASA-I, and they were placed into two equal groups: G (control), general anesthesia and systemic analgesia with dipyrone 1.2 g IM every 6 hours, and B (study), DNB regional anesthesia (axillary or supraclavicular) with 100 mg of bupivacaine and analgesia with the same local anesthetic every 6 hours. Clinical and metabolic alterations were correlated 24 hours postoperatively by clinical examination and capillary blood gasometry in both upper limbs.
Results: most of the subjects studied were male and most of them aged 30-44 and 45-59 years in both groups (p = 0.05). Simple and multiple fractures accounted for 60% of the total sample in groups G and B respectively (p = 0.05) and emergency treatment was required in both groups (p = 0.05). 70 % of patients in group G felt the injured limb cold, and 13.3 % in group B (p = 0.01). A slow capillary refill was found in 53.3 % of patients in group G and 10 % in B (p = 0.01) and 56.7 and 10% patients in groups G and B (p = 0.01) showed pale hand respectively. HbO2 £ 89 % was found in the injured limb in 60 and 6.7 % patients in groups G and B respectively (p = 0.01), and a difference HbO2 > 5 % was corroborated among the upper limbs: 76.7 % patients in group G and 16.7 % in B (p = 0.01).
Conclusions: the method of regional anesthesia-analgesia by continuous brachial plexus block is superior in terms of advantages, as there is a reduction in terms of changes in the metabolic clinical correlation in injured upper limbs.


REFERENCES

  1. García GL, Delgado G, Meana Z. Bloqueo continuo del plexo braquial vía supraclavicular. Implicaciones fisiopatológicas y terapéuticas. Med Periop. 1999;2(3):33-8.

  2. Buckenmaier CC, Klein SM, Nielsen KC, Steele SM. Continuous paravertebral catheter and outpatient infusion for breast surgery. Anest Analg. 2003;97:715-17.

  3. Soler R. Sistema de atención al politraumatizado. La Habana, Cuba: Editorial Academia; 1994. pp. 23-51.

  4. Buckenmaier CC, Lee EH, Shields CH, Sampson JB, Chiles JH. Regional anesthesia in austere environments. Reg Anesth Pain Med. 2003;28:321-7.

  5. Buckenmaier CC, McKnight GM, Winkley JV, Bleckner LL, Shannon C, Klein SM, et al. Continuous peripheral nerve block for battlefield anesthesia and evacuation. Reg Anesth Pain Med. 2005;30(2):10-6.

  6. Plunkett AR, Brown DS, Roger JM, Buckenmaier CC. Supraclavicular continuous peripheral nerve block in a wounded soldier: when ultrasound is the only option. Br J Anesth. 2006;97(5):715-7.

  7. Buckenmaier CC, Shields CH, Auton AA, Evans SL, Croll SM, Bleckner LL, et al. Continuous peripheral nerve block in combat casualties receiving low-molecular weight heparin. Br J Anesth. 2006;97:874-7.

  8. Ruiz Castro M. Manual de Anestesia Regional. Práctica clínica y tratamiento del dolor. Madrid: 2005. pp. 175-262.

  9. Imani F, Hassani V, Taghipour Z, Alebouyeh MR, Mohebi M. Evaluation of adding clonidine to bupivacaine in continuous supraclavicular brachial block. Reg Anesth Pain Med. 2006;31(5):65.

  10. Imani F, Hassani V, Morassaghi GR, Alebouyeh MR. Evaluation of adding tramadol to lidocaine in continuous supraclavicular block. Reg Anesth Pain Med. 2005;30(5):26.

  11. Ekman EF, Koman LA. Acute pain following musculoskeletal injuries and orthopaedic surgery. J Bone Joint Surg. 2004;86:1316-27.

  12. Samad TA, Moore KA, Sapirstein A, Billet S, Allchorne A, Poole S, et al. Interleukin-1-mediated induction of COX-2 in the CNS contributes to inflammatory pain hypersensitivity. Nature. 2001;410:471-5.

  13. Hartmann CW, Goldfarb NI, Kim SS, Nuthulaganti BR, Seifeldin R. Care management for persistent pain: an introduction. Dis Manag. 2003;6:103-10.

  14. Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg. 2002;10:117-29.

  15. Stephens J, Laskin B, Pashos C, Pena B, Wong J. The burden of acute posoperative pain and the potential role of the COX-2-specific inhibitors. Rheumatology. 2003;42(Suppl. 3):40-52.

  16. Choi J, Park S, Kim S, Yoon Y, Lee K, Lee Y, et al. Oral alprazolam attenuates stress responses to regional anesthesia and surgery. Reg Anesth Pain Med. 2006;31(5):91.

  17. National Pharmaceutical Council; Joint Commission on Accreditation of Healtheare Oeganizations. Pain: current understanding of assesment, management and treatments [Internet]. 2004 [Consultado: febrero 19, 2004]. Disponible en: http://www.npcnow.org/resources/PDFs/painmonograph.pdf

  18. Reuben SS, Bhopatkar S, Maciolek H, Joshi W, Sklar J. The prevemptive analgesic effect of rofecoxib after ambulatory arthroscopic knee surgery. Anesth Analg. 2002;94:55-9.

  19. Groen GJ, Gielen MJ, Jack NT, Knape JT. At the cords, the pinkie towards: interpreting infraclavicular motor responses to neurostimulation. Reg Anesth Pain Med. 2004;29(5):505-7.

  20. Rodríguez J, Barcena M, Lagunilla J, Álvarez J. Increased success rate with infraclavicular brachial plexus block using a dual-injection technique. J Clin Anesth. 2004;16(4):251-6.

  21. Borene SC, Edwards JN, Boezaart AP. At the cords, the pinkie towards: Interpreting infraclavicular motor responses to neurostimulation. Reg Anesth Pain Med. 2004;29 (2):125-9.

  22. Serradell A, Herrero R, Villanueva JA, Santos JA, Moncho JM, Masdeu J. Comparison of three different volumes of mepivacaine in axillary plexus blocks using multiple nerve stimulation. Br J Anesth. 2003;91(4):519-24.

  23. Klein SM, Eck J, Nielson K, Steele SM. Anesthetizing the phantom: peripheral nerve stimulation of a nonexistent extremity. Anesthesiol. 2004;100:736-7.

  24. Rodríguez J. Estudio del bloqueo axilar del plexo braquial con la técnica de la inducción de parestesias con suero salino frío. Madrid: Rev Esp Univ. 2000;1:22-45.

  25. García GL, Núñez Y. Comparación de los resultados del bloqueo continuo del plexo braquial por vía supraclavicular versus la vía axilar. Rev Cub Anest Rean. 2005;4(1):35-57.

  26. García GL, Aragón N, Cabana JA. Bloqueo continuo del plexo braquial. Vía supraclavicular. Rev Cub Anest Rean. 2003;2(3):5-12.

  27. Calvo JI, Pezonaga L, Anadón MP. Eficacia en el bloqueo del plexo braquial en cirugía del miembro torácico entre la vía supraclavicular y la interescalénica. Trauma. 2004;7(3):79-84.

  28. Calvo JI, Pezonaga L, Anadón MP. Bloqueo continuo del plexo braquial. Rev Soc Esp Dol. 2002;7(1):34-42.

  29. Szili-Torok T, Paprika D, Peto Z, Babik B, Bari F, Barzo P, et al. Effect of axillary brachial plexus blockade on baroreflex-induced skin vasomotor responses: assessing the effectiveness of sympathetic blockade. Acta Anaesthesiol Scand. 2002;46(7):815-20.

  30. Lehtipalo S, Winso O, Koskinen LO, Johansson G, Biber B. Cutaneous sympathetic vasoconstrictor reflexes for the evaluation of interscalene brachial plexus block. Acta Anaesthesiol Scand. 2000;44(8):946-52.

  31. Breschan C, Kraschl R, Jost R, Marhofer P, Likar R. Axillary brachial plexus block for treatment of severe forearm ischemia after arterial cannulation in an extremely low birth-weight infant. Paediatr Anaesth. 2004;14(8):681-4.

  32. Bhat R. Transient vascular insufficiency after axillary brachial plexus block in a child. Anesth Analg. 2004;98(5):1284-5.




2020     |     www.medigraphic.com