Cuesta PD, Iodo J

Language: Spanish
References: 15
Page: 249-254
PDF size: 61.12 Kb.

ABSTRACT

Introduction: Regional anesthesia has experienced major changes in recent years, particularly due to the use of electrostimulation and ecogram. The unilateral paralysis of the diaphragm is a secondary complication after blocking the supraclavicular brachial plexus, with an incidence of 50 to 67 %. The introduction of echolocation is not exempt from this. Every scholar should provide all the details related to it, so that they can serve as a guide to the coming generations.
Objective: To increase knowledge on the management of patients with peripheral nerve blocks under the use of ultrasound and the importance of following them.
Clinical case: 60-year-old patient with 82 kg of weight, which was planned elective surgery to remove tumor from the forearm. The patient had antecedents of hypertensive ischemic heart disease treated with the placement of two stents. It was decided to lock the supraclavicular brachial plexus, obtaining a correct locking, but there was a unilateral paralysis of the diaphragm with implications for the patient's welfare.
Conclusions: despite using ultrasound for peripheral nerve blocks, you must follow a strict monitoring of each patient throughout the surgical act.

REFERENCES

1. Blanco R, López S, Parras T. Manual de anestesia regional y ecoanatomía avanzada. Editorial EN EDICIONES. España. 2011. p. 5-23.

2. Bollini CA, Wikinski JA. Anatomical review of the brachial plexus. Tech Reg Anesthand Pain Manag. 2006;10:69-78.

3. Franco CD. Bloqueo del plexo braquial supraclavicular. En: Hadzic A. Tratado de anesthesia regional y manejo del dolor agudo. New York: Editorial Mc Graw Hill Interamericana; 2010. p. 419-26.

4. Urmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. Anesth Analg. 1992;74352-7.

5. Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991;72:498-503.

6. Bonilla Ramírez AJ, Grueso Angulo R, Peñate Suárez EE. Parálisis diafragmática secundaria a bloqueo de plexo braquial vía infraclavicular para cirugía de miembro superior. Rev Colomb Anestesio. 2012;39(4):589-94.

7. Aibar Arregui MA, Conget López F. Parálisis frénica unilateral reversible. SEMERGEN. 2004;30(2)583-5.

8. Irwinmg M, Chowb O. Incidence of diafragmatic paralysis following supraclavicular brachial plexus blockand its effect on pulmonary function. Anaesthesia. 2001;56(4):352-56.

9. Renes SH, Spoormans HH, Gielen MJ, Rettig HC, Van Geffen GJ. Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009;34(6):595-9.

10. Prakash; Prabhu L V, Kumar J, Madhyastha S, Singh G. A variation of phrenic nerve: Case report and review. Int. J. Morphol 2006;24(4):689-90.

11. Perlas A, Riazi S, Cyrus CH. Ultrasound-Guided Nerve Blocks of the Upper Extremity en Atlas of Ultrasound-Guided Procedures in Interventional Pain Management. Narouze SN: Editorial Springer Science Business; 2011. p. 227-36 S.

12. Brown DL. Supraclavicular Block en Atlas of regional anesthesia. Philadelphia: Editorial Sanders Elsevier; 2010. p. 49-57.

13. Lemus GZ, Limón Muñoz M, García Reyes W. Evaluación ultrasonográfica de la parálisis hemidiafragmática secundaria a bloqueo interescalénico. Rev Mexicana Anest. 2012;80(4):352-356.

14. Renes SH, Rettig HC, Gielen MJ, Wilder-Smith OH, Van Geffen GJ. Ultrasound guided low dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis. Reg Anesth Pain Med. 2009;34(5):498-502.

15. Vásqueza MI, Jiménez AM, Aguirre OD, González MP, Ríos AM. Bloqueo supraclavicular bilateral con ecografía. Rev Colomb Anestesiol. 2012;40(4):304-08.