A comparative study between ultrasound and neurostimulation guided axillary brachial plexus block

Rev Bras Anestesiol 2009; 59: 5: 585-591 ARTIGO CIENTÍFICO SCIENTIFIC ARTICLE Estudo Comparativo entre Ultrassom e Neuroestimulação no Bloqueio do Plexo Braquial pela Via Axilar * A Comparative Study between Ultrasound and Neurostimulation Guided Axillary Brachial Plexus Block* Diogo Brüggemann da Conceição, TSA 1, Pablo Escovedo Helayel, TSA 2, Getúlio Rodrigues de Oliveira Filho, TSA 1 RESUMO Conceição DB, Helayel PE, Oliveira Filho GR - Estudo Comparativo entre Ultrassom e Neuroestimulação no Bloqueio do Plexo Braquial pela Via Axilar. JUSTIFICATIVA E OBJETIVOS: O uso do ultrassom em Anestesia Regional vem crescendo. Existem poucos estudos comparando o uso do ultrassom com a neuroestimulação. O objetivo deste estudo foi comparar a execução do bloqueio do plexo braquial pela via axilar guiado por neuroestimulação com dupla injeção e guiado por ultrassonografia em procedimentos cirúrgicos na mão. Para isto, foram comparados o tempo de realização, a taxa de sucesso e complicações. MÉTODO: Após a aprovação do Comitê de Ética em Pesquisa do Hospital Governador Celso Ramos foram selecionados 40 pacientes escalados para operações eletivas na mão com bloqueio de plexo braquial via axilar. Os pacientes foram distribuídos aleatoriamente eletronicamente em dois grupos de 20 pacientes: Grupo Neuroestimulação (NE) e Grupo Ultrassonografia (US). Foram comparados tempo de realização, taxa de sucesso e taxa de complicações. RESULTADOS: As taxas de bloqueio completo, falha parcial e falha total não apresentaram diferença estatística significativa entre os grupos US e NE. O tempo médio para realização do procedimento no grupo US (354 segundos) não apresentou diferença estatística significativa quando comparado ao grupo NE (381 segundos). Pacientes do grupo NE apresentaram maior taxa de punção vascular (40%) quando comparados ao grupo US (10%, p < 0,05). A taxa de presença de parestesia durante a realização do bloqueio foi igual entre os dois grupos (15%). * Recebido do CET/SBA Integrado de Anestesiologia da Secretaria do Estado da Saúde de Santa Catarina (SES/SC), Hospital Governador Celso Ramos, Florianópolis, SC 1. Anestesiologista; Pesquisador do Núcleo de Ensino e Pesquisa em Anestesia Regional (NEPAR) do CET/SBA Integrado de Anestesiologia da SES/ SC 2. Anestesiologista; Coordenador e Pesquisador do NEPAR do CET/SBA Integrado de Anestesiologia da SES/SC Apresentado (Submitted) em 10 de janeiro de 2008 Aceito (Accepted) para publicação em 18 de maio de 2009 Endereço para correspondência (Correspondence to): Dr. Diogo Brüggemann da Conceição Rua Bocaiúva, 1659/1103 88015-530 Florianópolis, SC E-mail: Revista Brasileira de Anestesiologia Vol. 59, No 5, Setembro-Outubro, 2009 CONCLUSÕES: A taxa de sucesso e tempo para a realização foram semelhantes entre o bloqueio de plexo braquial via axilar guiado por ultrassom quando comparado com o guiado por neuroestimulação com dois estímulos em operações sobre a mão. Maior taxa de punção vascular ocorreu no bloqueio guiado por neuroestimulação. Unitermos: ANESTESIA, Regional: bloqueio do plexo braquial; EQUIPAMENTOS: neuroestimulador, ultrassom. SUMMARY Conceição DB, Helayel PE, Oliveira Filho GR – A Comparative Study between Ultrasound- and Neurostimulation-Guided Axillary Brachial Plexus Block. BACKGROUND AND OBJECTIVES: The use of ultrasound in Regional Blocks is increasingly more frequent. However, very few studies comparing ultrasound and neurostimulation have been conducted. The objective of this study was to compare neurostimulation-guided axillary brachial plexus block with double injection and ultrasound-guided axillary plexus block for hand surgeries. The time to perform the technique, success rate, and complications were compared. METHODS: After approval by the Ethics on Research Committee of the Hospital Governador Celso Ramos, 40 patients scheduled for elective hand surgeries under axillary plexus block were selected. Patients were randomly divided into two groups with 20 patients each: Neurostimulation (NE) and Ultrasound (US) groups. The time to perform the technique, success rate, and complication rate were compared. RESULTS: Complete blockade, partial failure, and total failure rates did not show statistically significant differences between the US and NE groups. The mean time to perform the technique in the US group (354 seconds) was not statistically different than that of the NE group (381 seconds). Patients in the NE group had a higher incidence of vascular punctures (40%) when compared with those in the US group (10%, p < 0.05). The rate of paresthesia during the blockade was similar in both groups (15%). CONCLUSIONS: The success rate and time to perform the blockade were similar in ultrasound- and neurostimulation-guided axillary plexus block for hand surgeries. The rate of vascular puncture was higher in neurostimulation-guided axillary plexus block. Keywords: ANESTHESIA, Regional: axillary plexus block; EQUIPMENT: neurostimulator, ultrasound. 585 CONCEIÇÃO, HELAYEL AND OLIVEIRA FILHO identify the branches of the brachial plexus: loss of resistance, transarterial injection, presence of paresthesia, neurostimulation, and ultrasound 1,2. Neurostimulation is the technique used more often in peripheral nerve blocks. Surgeries in areas of the forearms and hands that are not innervated by the musculocutaneous nerve can be successfully done under axillary brachial plexus block with double stimuli and double injection3. The use of the ultrasound to guide regional blocks is becoming increasingly popular4,5. It allows the anatomical evaluation of the region before the blockade to correctly identify the structures of the brachial plexus6,7. This can avoid lesions of the blood vessels and pleura, and the local anesthetic can be deposited around the nerves under real time direct visualization4,8. A systematic review compared the use of the ultrasound with neurostimulation in peripheral nerve blocks and it concluded that the ultrasound was associated with a lower risk of failure of the blockade, reduced the time to perform the technique and the latency, and it increased the duration of the blockade. Besides, the use of the ultrasound also decreased the risk of vascular puncture9. A systematic qualitative review concluded that there is not enough evidence that the use of the ultrasound increases the success rate of regional blocks when compared to other techniques because of the limited number of studies in the literature10. The same authors concluded that randomized controlled studies and series of cases should be encouraged to allow future comparison10. Three variables have been identified as relevant when comparing ultrasound and neurostimulation in peripheral nerve blocks: time to perform the procedure, success rate, and complications13. The objective of the present study was to compare those three variables in neurostimulation with double injection and ultrasound-guided axillary brachial plexus block for hand surge (...truncated)