Randomized prospective study of three different techniques for ultrasound-guided axillary brachial plexus block
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2018
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Cunha Ferraro, Leonardo Henirque [UNIFESP]
Takeda, Alexandre [UNIFESP]
Castello Branco de Sousa, Paulo Cesar [UNIFESP]
Gomes Mehlmann, Fernanda Moreira [UNIFESP]
Mitsunaga Junior, Jorge Kiyoshi [UNIFESP]
dos Reis Falcao, Luiz Fernando [UNIFESP]
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Abstract
Introduction: Randomized prospective study comparing two perivascular techniques with the perineural technique for ultrasound-guided axillary brachial plexus block (US-ABPB). The primary objective was to verify if these perivascular techniques are noninferior to the perineural technique. Method: 240 patients were randomized to receive the techniques: below the artery (BA), around the artery (AA) or perineural (PN). The anesthetic volume used was 40 mL of 0.375% bupivacaine. All patients received a musculocutaneous nerve blockade with 10 mL. In BA technique, 30 mL were injected below the axillary artery. In AA technique, 7.5 mL were injected at 4 points around the artery. In PN technique, the median, ulnar, and radial nerves were anesthetized with 10 mL per nerve. Results: Confidence interval analysis showed that the perivascular techniques studied were not inferior to the perineural technique. The time to perform the blockade was shorter for the BA technique (300.4 +/- 78.4 s, 396.5 +/- 117.1 s, 487.6 +/- 172.6 s, respectively). The PN technique showed a lower latency time (PN - 655.3 +/- 348.9 s
BA - 1044 +/- 389.5 s
AA -932.9 +/- 314.5 s), and less total time for the procedure (PN - 1132 +/- 395.8 s
BA - 1346.2 +/- 413.4 s
AA -1329.5 +/- 344.4 s). BA technique had a higher incidence of vascular puncture (BA -22.5%
AA -16.3%
PN - 5%). Conclusion: The perivascular techniques are viable alternatives to perineural technique for US-ABPB. There is a higher incidence of vascular puncture associated with the BA technique. (C) 2017 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia.
BA - 1044 +/- 389.5 s
AA -932.9 +/- 314.5 s), and less total time for the procedure (PN - 1132 +/- 395.8 s
BA - 1346.2 +/- 413.4 s
AA -1329.5 +/- 344.4 s). BA technique had a higher incidence of vascular puncture (BA -22.5%
AA -16.3%
PN - 5%). Conclusion: The perivascular techniques are viable alternatives to perineural technique for US-ABPB. There is a higher incidence of vascular puncture associated with the BA technique. (C) 2017 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia.
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Revista Brasileira De Anestesiologia. New York, v. 68, n. 1, p. 62-68, 2018.