Complicaciones neurológicas asociadas a bloqueos interescalénico y supraclavicular guiados con ecografía en cirugía electiva de hombro y extremidad superior. Estudio observacional prospectivo en un hospital universitario / Neurological complications associated with ultrasound-guided interscalene and supraclavicular block in elective surgery of the shoulder and arm. Prospective observational study in a university hospital

Objetivos. La incidencia de síntomas neurológicos postoperatorios tras la realización de bloqueo interescalénico varía entre un 4 y un 16%. La mayoría de los casos se resuelven de forma espontánea antes de un año, pero algunos pacientes mantienen sus síntomas de forma permanente. Nuestro objetivo fue valorar la incidencia de síntomas neurológicos postoperatorios tras la realización de los bloqueos anestésicos ecoguiados interescalénico y supraclavicular. Material y métodos. Estudio prospectivo, observacional. Se incluyeron, de forma consecutiva, pacientes sometidos a cirugía de extremidad superior en un hospital universitario, en los que se realizó un bloqueo interescalénico o supraclavicular como técnica aislada o con anestesia general. Siete días después de la intervención se realizó una entrevista telefónica enfocada a la detección de síntomas neurológicos en la extremidad intervenida. En los pacientes con síntomas se realizaron nuevas entrevistas seriadas (al cabo de uno, 3 y 6 meses, y al año de la intervención) hasta la resolución de la sintomatología. A aquellos pacientes con persistencia de sintomatología al cabo de un año se les ofreció la posibilidad de evaluación neurológica. Resultados. Fueron incluidos 121 pacientes, en los que se realizaron 96 bloqueos interescalénicos y 22 bloqueos supraclaviculares. Un 9,9% (IC 95% 5-15%) de los pacientes presentaron algún síntoma neurológico postoperatorio durante la primera semana. No hubo diferencias significativas entre el bloqueo interescalénico (9%) y el supraclavicular (14%). A los 3 meses los síntomas se mantuvieron en 9 pacientes (7,4%), permaneciendo en 4 de ellos (3,3%) la sintomatología al cabo de 1,5 años. Se realizó electromiograma en 3 de ellos, con resultado positivo para lesión nerviosa en todos ellos. Conclusiones. Observamos una elevada incidencia de síntomas neurológicos postoperatorios, así como un preocupante porcentaje de permanencia de la sintomatología. No se evidenciaron diferencias relevantes en la incidencia según el tipo de bloqueo, y tampoco se identificó ninguna característica del paciente o del procedimiento anestésico que estuvieran asociadas con la incidencia de dichos síntomas, salvo una relación marginal con la edad. Basados en estos resultados, es imprescindible la explicación detallada de esta complicación a los pacientes antes de realizar estos bloqueos(AU)

Objectives. The incidence of postoperative neurological symptoms after performing interscalene block varies between 4 and 16%. The majority of cases are resolved spontaneously within a year, but some patients have their symptoms permanently. Our objective was to assess the incidence of postoperative neurological symptoms after performing the ultrasound-assisted interscalene and supraclavicular anaesthetic blocks. Material and methods. A prospective and observational study was conducted on consecutive patients who had undergone upper extremity surgery with an interscalene or supraclavicular block as an isolated technique, or as a complement to general anaesthesia. Seven days after the intervention, a telephone interview was conducted that focused on the detection of neurological symptoms in the operated limb. Further serial interviews were conducted on patients with symptoms (after the first, the third and the sixth month, and one year after surgery) until resolution of symptoms. Neurological evaluation was offered to those patients with persistent symptoms after one year. Results. A total of 121 patients were included, on whom 96 interscalene blocks and 22 supraclavicular blocks were performed. Postoperative neurological symptoms were detected in 9.9% (95% CI , 5-15%) of patients during the first week. No significant differences were observed between interscalene (9%) and supraclavicular block (14%). After 3 months the symptoms persisted in 9 patients (7.4%), with symptoms remaining in 4 patients (3.3%) after 1.5 years. Electromyogram was performed on 3 patients who tested positive for nerve damage. Conclusions. A high incidence of postoperative neurological symptoms was observed, and a worrying percentage of permanence of them. There were no significant differences in incidence according to the type of block, or any features of the patient or the anaesthesia technique that were associated with the incidence of these symptoms, except a marginal relationship with age. These complications must be clearly explained to the patients before performing these blocks(AU)

[Neurological complications associated with ultrasound-guided interscalene and supraclavicular block in elective surgery of the shoulder and arm. Prospective observational study in a university hospital]. / Complicaciones neurológicas asociadas a bloqueos interescalénico y supraclavicular guiados con ecografía en cirugía electiva de hombro y extremidad superior. Estudio observacional prospectivo en un hospital universitario.

OBJECTIVES: The incidence of postoperative neurological symptoms after performing interscalene block varies between 4 and 16%. The majority of cases are resolved spontaneously within a year, but some patients have their symptoms permanently. Our objective was to assess the incidence of postoperative neurological symptoms after performing the ultrasound-assisted interscalene and supraclavicular anaesthetic blocks. MATERIAL AND METHODS: A prospective and observational study was conducted on consecutive patients who had undergone upper extremity surgery with an interscalene or supraclavicular block as an isolated technique, or as a complement to general anaesthesia. Seven days after the intervention, a telephone interview was conducted that focused on the detection of neurological symptoms in the operated limb. Further serial interviews were conducted on patients with symptoms (after the first, the third and the sixth month, and one year after surgery) until resolution of symptoms. Neurological evaluation was offered to those patients with persistent symptoms after one year. RESULTS: A total of 121 patients were included, on whom 96 interscalene blocks and 22 supraclavicular blocks were performed. Postoperative neurological symptoms were detected in 9.9% (95% CI, 5-15%) of patients during the first week. No significant differences were observed between interscalene (9%) and supraclavicular block (14%). After 3 months the symptoms persisted in 9 patients (7.4%), with symptoms remaining in 4 patients (3.3%) after 1.5 years. Electromyogram was performed on 3 patients who tested positive for nerve damage. CONCLUSIONS: A high incidence of postoperative neurological symptoms was observed, and a worrying percentage of permanence of them. There were no significant differences in incidence according to the type of block, or any features of the patient or the anaesthesia technique that were associated with the incidence of these symptoms, except a marginal relationship with age. These complications must be clearly explained to the patients before performing these blocks.