Bloqueo continuo del plexo braquial en el posoperatorio inmediato / Continuous brachial plexus block in immediate postoperative

OBJETIVO: evaluar el período posoperatorio inmediato en pacientes con lesiones traumáticas quirúrgicas del miembro superior que han recibido dos métodos de anestesia-analgesia. MÉTODOS: se estudiaron 240 pacientes, todos ASA I-II-III según la clasificación del estado físico de la Sociedad Americana de Anestesiología. Se dividieron en dos grupos iguales, grupo G: anestesia general endotraqueal más fentanil y analgesia con dipirona 1,2 g IM cada 6 h, y grupo B: anestesia regional por técnicas continuas de bloqueo del plexo braquial con 100 mg de bupivacaína y analgesia regional con igual anestésico local cada 6 h. RESULTADOS: las complicaciones respiratorias se presentaron solamente en el grupo G (p= 0,01), mientras que las cardiovasculares se observaron 5,3 veces más en el grupo G (p= 0,000). Las náuseas y vómitos se manifestaron en más de la mitad de los pacientes (55 %) del grupo G y solo en seis (5 %) del grupo B (p= 0,000). La retención de orina y la oliguria se observó en tres y cuatro pacientes respectivamente, todos masculinos y del grupo G (p= 0,000). La tendencia a la hiperglucemia apareció en el grupo G en 27 pacientes (22,5 %) y solo en cinco (4,2 %) del grupo B (p= 0,000). Las molestias por la manipulación de la vía aérea superior, se presentaron en 79 pacientes (65,8 %) del grupo G; mientras que las molestias por el catéter solo se refirió en 16 pacientes (13,3 %) del grupo B. El grupo G a las 24 h llegó a tener 69 pacientes (57,5 %) en el nivel de analgesia no satisfactoria (p= 0,01). CONCLUSIONES: el método de anestesia-analgesia regional por bloqueo continuo del plexo braquial tuvo menor incidencia de complicaciones en el posoperatorio inmediato y mejor calidad de analgesia.

OBJECTIVE: to evaluate the immediate postoperative period in surgical patients with traumatic injuries of the upper limb who have undertaken two methods of anesthesia-analgesia. METHODS: 240 patients were studied, all ASA I-II-III according to the classification of the American Society of Anesthesiologists for physical state. They were divided into two equal groups. Group G had general endotracheal anesthesia and analgesia with fentanyl plus dipyrone 1.2 g IM every 6 h, and group B who had regional anesthesia techniques for continuous brachial plexus block with 100 mg of bupivacaine and regional analgesia with equal local anesthetic every 6 h. RESULTS: respiratory complications occurred only in group G (p= 0.01), cardiovascular complications were observed 5.3 times more in G group (p= 0.000). Nausea and vomiting were expressed in more than half of patients (55 %) in group G and only in six (5 %) from group B (p= 0.000). Urine retention and oliguria were observed in three and four patients respectively, all male from group G (p= 0.000). Hyperglycemia tendency appeared in group G in 27 patients (22.5 %) and in only five (4.2 %) from group B (p= 0.000). Discomfort by manipulating the upper airway occurred in 79 patients (65.8 %) from group G; nuisance due to the catheter was only referred in 16 patients (13.3 %) from group B. 24 hours after surgery, Group G had 69 patients (57.5 %) in unsatisfactory analgesia level (p= 0.01). CONCLUSIONS: the method of regional anesthesia-analgesia by continuous brachial plexus block had lower incidence of complications in the immediate postoperative period and better quality of analgesia.

Clinical Effects of Ketamine on Ropivacaine in Brachial Plexus Blockade / 대한마취과학회지

BACKGROUND: Ketamine enhances local anesthetic and analgesic effects of bupivacaine by peripheral mechanisms. We evaluated the additive effects of ketamine (30 mg) on 0.5%, and 0.75% ropivacaine (total 30 ml) for an interscalene brachial plexus blockade (IBPB). METHODS: Thirty five adult patients scheduled for major forearm or hand surgery were prospectively randomized to receive one of the following solutions. Group 1 received 0.75% ropivacaine 28 ml with normal saline 2 ml, group 2 received 0.75% ropivacaine 28 ml with 5% ketamine 0.6 ml and normal saline 1.4 ml, group 3 received 0.75% ropivacaine 20 ml with normal saline 10 ml, and group 4 received 0.75% ropivacaine 20 ml with 5% ketamine 0.6 ml and normal saline 9.4 ml. At 1 minute intervals after IBPB, patients were assessed to determine loss of shoulder abduction, elbow flexion, wrist flexion and loss of pinprick in the deltoid, radial, median, and ulnar dermatomes. At 5 minute intervals after IBPB, pulse rate, blood pressure, sedation score and level of discomfort were assessed. Before discharge, patients were asked to document when incisional discomfort began and when full sensation and motor control returned to the arm. RESULTS: The onset time of loss of pinprick and motor blockade were similar. Duration of sensory and motor blockade were similar in all groups. Hemodynamic changes and sedation scores were not significantly different in all groups. CONCLUSIONS: We demonstrated that 30 mg of ketamine didn't enhance the onset and duration of sensory or motor blockade of ropivacaine during the 0.75% or 0.5% ropivacaine IBPB.