Bloqueo bilateral del plexo braquial. Reporte de casos y revisión sistemática de la literatura

Published on Jul 1, 2015in Cirugia Y Cirujanos0.264
· DOI :10.1016/J.CIRCIR.2015.05.018
Gabriel Enrique Mejía-Terrazas3
Estimated H-index: 3
María de Ángeles Garduño-Juárez2
Estimated H-index: 2
+ 2 AuthorsRaúl Carrillo-Esper10
Estimated H-index: 10
Resumen Antecedentes El bloqueo de plexo braquial bilateral se ha considerado una contraindicacion debido al posible desarrollo de complicaciones, como toxicidad por anestesicos locales o paresia diafragmatica bilateral; pero con la visualizacion en tiempo real que proporciona la ecografia, estas se reducen, lo que nos proporciona un procedimiento mas seguro. Casos clinicos Presentamos 4 casos en los que se realizo el bloqueo bilateral guiado por ecografia debido a la negativa de los pacientes a la administracion de anestesia general, por antecedente de efectos adversos con su utilizacion o con los opioides en el postoperatorio, o bien por prediccion de una via aerea dificil asociada a obesidad. Tambien exponemos una revision sistematica de la literatura de enero de 1993 a junio de 2013, en las bases de datos MEDLINE, EMBASE, ARTEMISA, LILACS y Google, en idioma espanol e ingles con las siguientes palabras: bilateral brachial plexus block, bilateral interscalene block, bilateral infraclavicular block, bilateral supraclavicular block, bilateral lateral supraclavicular block, bilateral axillary block, ultrasound guided bilateral brachial plexus block. Conclusion Con base en la evidencia encontrada, el bloqueo del plexo braquial bilateral guiado por ecografia en pacientes seleccionados y con personal entrenado deja de ser una contraindicacion.
#1Rohini Bhat PaiH-Index: 3
#2Harihar V HegdeH-Index: 4
Last. P Raghavendra RaoH-Index: 3
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Hypertrophic obstructive cardiomyopathy (HOCM) is a challenge to anesthesiologists due to the complex pathophysiology involved and various perioperative complications associated with it. We present a 50-year-old man, a known case of HOCM, who successfully underwent emergency haemostasis, and debridement of the traumatically amputated right upper limb and the contused lacerated wound on the left forearm under bilateral brachial plexus blocks. His co-morbidities included hypertension (in hypertens...
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2 CitationsSource
#1Alaa A. Abd-Elsayed (UC: University of Cincinnati)H-Index: 6
#2John Seif (Cleveland Clinic)H-Index: 5
Last. Loran Mounir-Soliman (Cleveland Clinic)H-Index: 6
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Peripheral nerve catheter placement is used to control surgical pain. Performing bilateral brachial plexus block with catheters is not frequently performed; and in our case sending patient home with bilateral brachial plexus catheters has not been reported up to our knowledge. Our patient is a 57 years old male patient presented with bilateral upper extremity digital gangrene on digits 2 through 4 on both sides with no thumb involvement. The plan was to do the surgery under sequential axillary b...
5 CitationsSource
#1Kazuya Toju (Fukushima Medical University)H-Index: 2
#2Takahiro Hakozaki (Fukushima Medical University)H-Index: 6
Last. Masahiro Murakawa (Fukushima Medical University)H-Index: 13
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We report the use of ultrasound-guided bilateral brachial plexus block in a patient with bilateral radius fractures. An axillary block was performed on the patient’s right and a supraclavicular block on her left using an in-plane (long-axis) needle insertion technique. Into each side was injected 20 ml 0.5% ropivacaine, giving a total volume (dose) of 40 ml (200 mg). Provisions were made for rescue analgesia or unplanned conversion to general anesthesia during the operation, but these were not n...
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#1Brian C. SpenceH-Index: 9
#2Michael L. BeachH-Index: 65
Last. Brian D. Sites (Dartmouth College)H-Index: 29
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Summary Although ultrasound-guided regional anaesthesia has gained in popularity, few data exist describing the optimal location(s) to inject local anaesthetic. Our objective was to compare, for interscalene blocks, the effectiveness of an injection between the middle scalene muscle and brachial plexus sheath (peri-plexus) with an injection within the brachial plexus sheath (intra-plexus). We enrolled 170 patients undergoing shoulder surgery with general anaesthesia and interscalene block in thi...
74 CitationsSource
#1K. VermeylenH-Index: 6
#2Johan M. BerghmansH-Index: 7
Last. Dirk HimpeH-Index: 5
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: We present a case of the combination of a bilateral supraclavicular block and a caudal block in a two year old boy who needed amputations of four extremities after a pneumococcal sepsis. With the use of ultrasound guidance, reduction of local anaesthetic dose could be obtained in order not to reach the toxic dose of the local anaesthetic. Amputations of four extremities is not common practice. A good postoperative pain management is more than a challenge.
4 Citations
#1J Holborow (SCGH: Sir Charles Gairdner Hospital)H-Index: 1
#2Graham Hocking (University of Notre Dame Australia)H-Index: 1
Regional anaesthesia for bilateral upper limb surgery can be challenging, yet surgeons are becoming increasingly interested in performing bilateral procedures at the same operation. Anaesthetists have traditionally avoided bilateral brachial plexus block due to concerns about local anaesthetic toxicity, phrenic nerve block and pneumothorax. We discuss these three concerns and review whether advances in ultrasound guidance and nerve catheter techniques should make us reconsider our options. A sea...
17 CitationsSource
#1Murat TekinH-Index: 6
#2Yavuz GürkanH-Index: 20
Last. Kamil TokerH-Index: 22
view all 5 authors...
: Bilateral brachial plexus block is rarely performed due to the risk of systemic toxicity of local anesthetics. Therefore, general anesthesia is generally preferred in bilateral extremity operations. However, usage of ultrasound allows easy visualization of the structures of the vessels and the nerves. In this case report, we present a 28-year-old man who was scheduled for bilateral hand surgery with ultrasound-guided bilateral infraclavicular block after he refused general anesthesia. After vi...
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#1Murat TekinH-Index: 6
#2Yavuz GürkanH-Index: 2
Last. Kamil TokerH-Index: 4
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3 Citations
#1Steven H. Renes (Radboud University Nijmegen Medical Centre)H-Index: 10
Last. Geert J. van Geffen (Radboud University Nijmegen Medical Centre)H-Index: 12
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BACKGROUND AND OBJECTIVES: Supraclavicular brachial plexus block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular brachial plexus block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis. METHODS: In a prospective randomized observer-blinded controlled trial, 60 patients scheduled for elective elbow, forearm, wrist, or hand s...
89 CitationsSource
Cited By2
#1Habib Md Reazaul Karim (AIIMS: All India Institute of Medical Sciences)H-Index: 5
#2Chinmaya Kumar Panda (AIIMS: All India Institute of Medical Sciences)H-Index: 2
Last. A. Arshad (AIIMS: All India Institute of Medical Sciences)
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Background Analgesia, sedation, and anesthesia all can be dangerous in patients with obstructive sleep apnoea and have been associated with critical events during perioperative management. The risk further increases when obstructive sleep apnoea is associated with other comorbidities. Although regional anesthesia when feasible is preferred over general anesthesia, it is not a clear cut decision always. The dilemma and challenges for the management of such cases still persist.
#1James M. Flaherty (Virginia Mason Medical Center)H-Index: 2
#2David B. AuyongH-Index: 14
Last. Neil A. HansonH-Index: 13
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: We report a novel case of a patient undergoing a bilateral shoulder hemiarthroplasty for chronic bilateral shoulder dislocations with proximal humeral fractures. Bilateral selective suprascapular nerve catheters were placed preoperatively with the intent to provide continuous local anesthetic-based analgesia while sparing diaphragmatic function. Postoperative respiratory mechanics were relatively spared while numerical rating scale pain scores were suggestive of analgesic benefit.
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