Estudo comparativo entre o bloqueio interescalênico do plexo branquial e o bloqueio seletivo dos nervos supraescapular e axilar nas cirurgias artroscópicas de ombro
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Data
2011-12-02
Autores
Pitombo, Patrícia Falcão [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
As cirurgias de ombro apresentam grande potencial para causar dor pós-operatória. O bloqueio interescalênico do plexo braquial é a técnica anestésica mais utilizada para estes procedimentos. Apesar da eficácia comprovada, alguns efeitos adversos e a extensa paralisia do membro superior são motivos comuns de preocupação e desconforto por parte dos pacientes. Os nervos supraescapular e axilar são os principais responsáveis pelo suprimento sensitivo-motor da articulação. Bloqueio isolado do nervo supraescapular é bem descrito e utilizado, porém, apresenta efetividade variável. Escassas publicações em levantamentos de bancos de dados de saúde (Pubmed) descrevem e atestam a segurança e a eficácia analgésica na associação de bloqueio dos nervos axilar e supraescapular em cirurgias do ombro. Este estudo se propõe a avaliar uma nova técnica anestésica de bloqueio seletivo dos nervos supraescapular e axilar, com relação à qualidade da analgesia e, secundariamente, com relação à intensidade e desconforto do bloqueio motor, complicações e/ou efeitos adversos, satisfação, aceitabilidade e duração da analgesia, comparando-a com a abordagem interescalênica do plexo braquial. 68 pacientes portadores de lesão do manguito rotador e/ou luxação recidivante escapulo-umeral foram divididos em dois grupos de 34, de acordo com a técnica utilizada: grupo interescalênico (GI) e grupo seletivo (GS), sendo ambas as técnicas realizadas com neuroestimulador. GI foi submetido a bloqueio interescalênico do plexo braquial pela técnica de Winnie, e após haver resposta motora dos músculos deltóide ou bíceps, foram injetados 30 mL de bupivacaína em excesso enantiomérico a 0,33% com epinefrina 1:200000. GS foi submetido a bloqueio dos nervos supraescapular e axilar pelas técnicas de Feigl e Price...
Shoulder surgery carries great potential to cause post-operative pain. Interscalene brachial plexus block is the anaesthetic technique most utilized in these procedures. Despite its proven efficacy, certain adverse effects and the extensive paralysis of the upper limb are common causes of concern and discomfort for the patient. The suprascapular and axillary nerves are the main nerves responsible for the sensory-motor supply of the joint. Isolated suprascapular nerve block is well described and utilized, its effectiveness, however, is variable. In a survey of health databases (Pubmed) few publications describe and attested to the safety and analgesic efficacy in associating suprascapular and axillary nerve block with shoulder surgery. This study aims to assess selective suprascapular and axillary nerve block compared to the interscalene brachial plexus block approach, primarily in terms of analgesic quality and secondly in relation to motor block intensity and discomfort, complications and/or adverse effects, satisfaction, acceptability and analgesic duration. Sixty-eight patients with rotator cuff injury and/or recurrent scapulohumeral dislocation were divided into two groups of 34 each, depending on the technique utilized: interscalene group (IG) and selective group (SG). Both groups were subjected to neurostimulation techniques. The IG was subjected to the interscalene brachial plexus block using the Winnie technique. Following motor response from the deltoid or biceps muscles we injected 30 mL of 0.33% enantiomeric excess bupivacaine with 1:200000 epinephrine. The SG was subjected to the suprascapular and axillary nerve block using the Feigl and Price techniques respectively. Following response from the supraspinatus, and/or infraspinatus (suprascapular nerve) and deltoid (axillary nerve) we injected 15 mL... (Complete abstract click electronic access below)
Shoulder surgery carries great potential to cause post-operative pain. Interscalene brachial plexus block is the anaesthetic technique most utilized in these procedures. Despite its proven efficacy, certain adverse effects and the extensive paralysis of the upper limb are common causes of concern and discomfort for the patient. The suprascapular and axillary nerves are the main nerves responsible for the sensory-motor supply of the joint. Isolated suprascapular nerve block is well described and utilized, its effectiveness, however, is variable. In a survey of health databases (Pubmed) few publications describe and attested to the safety and analgesic efficacy in associating suprascapular and axillary nerve block with shoulder surgery. This study aims to assess selective suprascapular and axillary nerve block compared to the interscalene brachial plexus block approach, primarily in terms of analgesic quality and secondly in relation to motor block intensity and discomfort, complications and/or adverse effects, satisfaction, acceptability and analgesic duration. Sixty-eight patients with rotator cuff injury and/or recurrent scapulohumeral dislocation were divided into two groups of 34 each, depending on the technique utilized: interscalene group (IG) and selective group (SG). Both groups were subjected to neurostimulation techniques. The IG was subjected to the interscalene brachial plexus block using the Winnie technique. Following motor response from the deltoid or biceps muscles we injected 30 mL of 0.33% enantiomeric excess bupivacaine with 1:200000 epinephrine. The SG was subjected to the suprascapular and axillary nerve block using the Feigl and Price techniques respectively. Following response from the supraspinatus, and/or infraspinatus (suprascapular nerve) and deltoid (axillary nerve) we injected 15 mL... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Ombro - Cirurgia, Artroscopia, Branchial plexus block
Como citar
PITOMBO, Patrícia Falcão. Estudo comparativo entre o bloqueio interescalênico do plexo branquial e o bloqueio seletivo dos nervos supraescapular e axilar nas cirurgias artroscópicas de ombro. 2011. 89 f. Tese (doutorado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2011.