Bilateral brachial plexus block. Case report and systematic review

Published on Jun 25, 2015in Cirugia Y Cirujanos0.264
· DOI :10.1016/J.CIRCIR.2015.05.018
Gabriel Enrique Mejía-Terrazas3
Estimated H-index: 3
,
Garduño-Juárez Mde Á1
Estimated H-index: 1
+ 2 AuthorsRaúl Carrillo-Esper10
Estimated H-index: 10
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Abstract
BACKGROUND: The bilateral brachial plexus block is considered a contraindication, due to the possible development of complications, such as: toxicity from local anaesthetics or bilateral diaphragmatic paralysis. However, with the real time visualisation provided by the ultrasound scan, these complications have decreased and it is a safer procedure. CLINICAL CASES: Four cases are presented where the bilateral block was performed using guided ultrasound, as the patients were unable to receive general anaesthesia due to a history of adverse effects or the use of opioids in the post-operative or by the prediction of a difficult airway associated with obesity. A systematic review of the literature from January 1993 to June 2013, was also performed by using a search in the MEDLINE, EMBASE, ARTEMISA, LILACS, Google data bases, in Spanish and English language with the following words: 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: Based on the evidence found, ultrasound-guided bilateral brachial plexus block in selected patients and expert hands, is no longer a contraindication.
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#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.
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#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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