Abstract ID: A12
Abstract Title: AN EVALUATION OF THE VERTICAL INFRACLAVICULAR PARACORACOID BLOCK
Authors: Carradori G1, Garcia Casalia A2, Moreno M3, Peleritti H4
Instituto Argentino de Diagnóstico y Tratamiento Buenos Aires Capital Federal Argentina1, Instituto Argentino de Diagnóstico y Tratamiento 2, Instituto Argentino de Diagnóstico y Tratamiento 3, Instituto Argentino de Diagnóstico y Tratamiento 4
Poster Type: Poster
ABSTRACT BODY
Introduction:Many techniques are described for brachial plexus block under the clavicle. Despite the advantages of the different infraclavicular approaches they are all still underused.
Evaluate and provide clinical evidence on the efficacy of the vertical paracoracoid approach (V.P.A) for elbow/forearm/wrist/hand surgery and postoperative analgesia.
Materials and Methods:59 patients ASA I-II scheduled for upper extremity surgery, age: 21-76 years old, height: 172 +/- 8 cm, weight: 68 +/- 12 kg, sex: F/M: 32/27. All patients were premedicated with midazolam: 0.03 mg/kg, pulse oximetry, NIBP, EKG. 2lts/min O2 via nasal spronge.
A PAJUNK MultiStim VARIO nerve stimulator and UniPlex UP 5/50, 25G long (in mm) 0.50 x 50 needle for nerve localization were used.
Nerve localization started with stimulus of 1.5 mA, 0.1 msec and 2Hz, until a response was elicited. The stimulus was then diminished to 0.5 mA and the needle advanced or not, until a brisk motor response, from the Median Nerve (flexion of the wrist and fingers with opposition of the thumb and pronation of the forearm and hand) was obtained as a final point. Local anesthetic (LA), lidocaine 1.5% with 1:200000 epinephrine and bupivacaine 0.375% without epinephrine at a total of 40 mL. We noted the following parameters: the onset time, the requiring of systemic analgesia or conversion into general anesthesia, the pneumatic cuff toleration, duration of postoperative analgesia, monitoring of complications.
Results:Needle depth insertion was mean 34.2 +/- 10.4 mm. Sensory block was obtained at 14 +/- 3 min (evaluated by means of the ¨cold test¨: 0 = no block,1 =analgesia (patient can feel touch, not cold), 2 = anesthesia (patient cannot feel touch) and the motor block was obtained at 20 +/- 5 minutes (evaluated by means of the motor test: 0 = no block, 1 = paresis, 2 = paralysis). Level 2 of both tests was accepted as optimal for the surgical procedure. Surgery could be performed in average 25 minutes later from injection. The pneumatic cuff was tolerated by all patients without difficulties during intraoperative procedure. No complications during the performance of the procedure, nor adverse or side effects were noted. General anesthesia was not required by any of the patients. Duration of postoperative analgesia was estimated at 16 +/- 4 hours.
Discussion:At the coracoid process level, the three divisions of the brachial plexus form the lateral, medial and posterior cords. Together with the axillary artery and the vein, they are located within the axillary sheath. As a single injection technique it enables an extensive block of upper extremity with low pleural puncture risk, possibility of performing the block in any position of the arm -especially important in patients with fractured extremity, with easily identifiable bony landmarks, ability to block the musculocutaneous nerve using a single injection, and ideal for brachial plexus catheterization due to its safety provided by thoracic wall support.
ATTACHED FILES
Reg Anesth Pain Med 2005; 30(3):A12