RESUMO
La creación de un acceso arteriovenoso es obligatorio en pacientes con enfermedad renal terminal para tratamiento con hemodiálisis. Habitualmente implica disección a nivel axilar o en la parte superior de brazo, y la anestesia general es usada predominantemente debido a que la inervación axilar es compleja. Evitar la anestesia general podría ser beneficioso en estos pacientes de riesgo. Presentamos dos casos en los que se empleó el bloqueo serrato-intercostal/BRILMA, junto con bloqueo supraclavicular ecoguiado y analgesia multimodal para cirugía de acceso arteriovenoso axilar o de brazo proximal. La combinación de técnicas de anestesia regional mediante bloqueo supraclavicular y serrato-intercostal/BRILMA en cirugía de fístula arteriovenosa fue exitosa y debe ser considerada por el anestesiólogo con el fin de evitar la anestesia general
Arteriovenous access creation is mandatory in patients with end stage renal disease for hemodialysis treatment. It frequently involves upper arm or axillary dissection and general anesthesia is predominantly used as axillary compartment innervation is complex. Avoiding general anesthesia may be beneficial in these risk patients. We present two cases where serratus-intercostal plane block (SIPB/BRILMA) was used, along with ultrasound guided supraclavicular block and multimodal analgesia for proximal arm and axillary AV access surgery. Regional anesthesia combination of supraclavicular and serratus-intercostal/BRILMA block in arteriovenous fistula surgery was successful and should be considered by anesthesiologist in order to avoid general anesthesia
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Bloqueio Nervoso/métodos , Anestesia por Condução/métodos , Nervos Intercostais/efeitos dos fármacos , Derivação Arteriovenosa Cirúrgica/métodos , Dispositivos de Acesso Vascular , Implante de Prótese Vascular/métodosRESUMO
ARTERIOVENOUS: access creation is mandatory in patients with end stage renal disease for hemodialysis treatment. It frequently involves upper arm or axillary dissection and general anesthesia is predominantly used as axillary compartment innervation is complex. Avoiding general anesthesia may be beneficial in these risk patients. We present two cases where serratus-intercostal plane block (SIPB/BRILMA) was used, along with ultrasound guided supraclavicular block and multimodal analgesia for proximal arm and axillary AV access surgery. Regional anesthesia combination of supraclavicular and serratus-intercostal/BRILMA block in arteriovenous fistula surgery was successful and should be considered by anesthesiologist in order to avoid general anesthesia.
