Avaliação prospectiva das características das diversas técnicas de anestesia do plexo branquial em hospital terciário de ensino
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Data
2012-02-28
Autores
Mizubuti, Glênio Bitencourt [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
São várias as técnicas disponíveis para realização de bloqueio do plexo braquial (PB). Este estudo teve como objetivo a análise epidemiológica dos bloqueios do PB realizados no Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP (HC-FMB-UNESP). Realizou-se estudo observacional que incluiu pacientes submetidos à anestesia do PB no período de 1 ano, contemplando as técnicas e as características da anestesia, bem como a satisfação dos pacientes. Entre Fevereiro de 2009 e Janeiro de 2010, 150 pacientes (16 a 89 anos) foram incluídos. Houve sedação pré-anestésica em 77% dos casos com o midazolam, associado ou não ao fentanil. Os bloqueios foram realizados com 15 a 20 mL de lidocaína 1,5% seguidos de igual volume de ropivacaína 0,5%. A incidência total de falhas foi de 22%. A técnica de Winnie foi empregada em 32% dos bloqueios, a perivascular subclávia em 27%, a axilar em 32% e a descrita por Vieira em 9%. O estimulador de nervo periférico (ENP) e o ultrassom (US) foram empregados isoladamente em 49% e 21% dos pacientes, respectivamente, sendo esses aparelhos usados simultaneamente em 21% dos casos. Dentre as anestesias realizadas com o ENP, com o US, sem esses equipamentos ou com ambos, simultaneamente, 28%, 16%, 15% e 16%, respectivamente, falharam. Dos 150 bloqueios, 43% foram realizados por médicos em especialização (ME) do 3º ano (ME3), 32% por ME2 e 25% por ME1, havendo falha em 16%, 25% e 29%, respectivamente. Houve parestesia não intencional (6%) e punção vascular acidental (6%), além de 49% de elevação de cúpula diafragmática nos bloqueios supraclaviculares. No HC-FMB-UNESP verificou-se diversidade na escolha da técnica anestésica para bloqueios do PB, sendo a incidência de falhas dentro do que se observa na literatura. O US sobrepuja o ENP em termos...
There are several approaches for the brachial plexus blockade. This study aimed the epidemiologic analysis of the brachial plexus blocks performed at the Hospital das Clínicas of the Botucatu Medical School, São Paulo State University (UNESP). Observational study was carried out including patients who underwent brachial plexus blockade throughout 1 year, contemplating the techniques and anesthetic features, as well as patient satisfaction. From February 2009 to January 2010, 150 patients (16 to 89 years) were included. Pre-anesthetic sedation was administered to 77% of the patients with midazolam associated or not with fentanyl. The blocks were carried out with 15 to 20 mL of lidocaine 1.5% followed by the same volume of ropivacaine 0.5%. Total failure incidence was 22%. The Interscalene Block (Winnie´s technique) was used in 32% of the blocks, the Subclavian Perivascular Block in 27%, the Axillary Block in 32% and the Supraclavicular Block described by Vieira in 9%. Peripheral nerve stimulator (PNS) and Ultrasound (US) were used alone in 49% and 21% of the blocks, respectively, and in 21% of the patients, simultaneously. Among the anesthetics carried out with PNS, with US, without those devices or with both, simultaneously, 28%, 16%, 15% and 16%, respectively, failed. Of the 150 blocks, 43% were performed by Postgraduate Year 3 (PGY3) residents, 32% by PGY2 residents and 25% by PGY1 residents, with failure rates of 16%, 25% and 29%, respectively. Unintended paresthesia (6%) and accidental vascular puncture (6%) were observed. Also, a 49% incidence of hemidiaphragmatic dome elevation (phrenic nerve palsy) was observed among patients submitted to supraclavicular approaches. At the Hospital das Clínicas of the Botucatu Medical School, UNESP, a great diversity on the choice of the brachial... (Complete abstract click electronic access below)
There are several approaches for the brachial plexus blockade. This study aimed the epidemiologic analysis of the brachial plexus blocks performed at the Hospital das Clínicas of the Botucatu Medical School, São Paulo State University (UNESP). Observational study was carried out including patients who underwent brachial plexus blockade throughout 1 year, contemplating the techniques and anesthetic features, as well as patient satisfaction. From February 2009 to January 2010, 150 patients (16 to 89 years) were included. Pre-anesthetic sedation was administered to 77% of the patients with midazolam associated or not with fentanyl. The blocks were carried out with 15 to 20 mL of lidocaine 1.5% followed by the same volume of ropivacaine 0.5%. Total failure incidence was 22%. The Interscalene Block (Winnie´s technique) was used in 32% of the blocks, the Subclavian Perivascular Block in 27%, the Axillary Block in 32% and the Supraclavicular Block described by Vieira in 9%. Peripheral nerve stimulator (PNS) and Ultrasound (US) were used alone in 49% and 21% of the blocks, respectively, and in 21% of the patients, simultaneously. Among the anesthetics carried out with PNS, with US, without those devices or with both, simultaneously, 28%, 16%, 15% and 16%, respectively, failed. Of the 150 blocks, 43% were performed by Postgraduate Year 3 (PGY3) residents, 32% by PGY2 residents and 25% by PGY1 residents, with failure rates of 16%, 25% and 29%, respectively. Unintended paresthesia (6%) and accidental vascular puncture (6%) were observed. Also, a 49% incidence of hemidiaphragmatic dome elevation (phrenic nerve palsy) was observed among patients submitted to supraclavicular approaches. At the Hospital das Clínicas of the Botucatu Medical School, UNESP, a great diversity on the choice of the brachial... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Anestesia, Sistema nervoso - Cirurgia, Residentes (Medicina), Anesthesia, Nervous system - Surgery
Como citar
MIZUBUTI, Glênio Bitencourt. Avaliação prospectiva das características das diversas técnicas de anestesia do plexo branquial em hospital terciário de ensino. 2012. 85 f. Dissertação (mestrado) - Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina de Botucatu, 2012.