Novosti
Khirurgii

 This journal is
indexed in Scopus
journal cover
android icon Android Applicaion

Year 2014 Vol. 22 No 6

ANESTHESIOLOGY-REANIMATOLOGY

A.V. BRUKHNOU, V.G. PIACHERSKI, A.V. MARACHKOU, Z.V. KOKHAN

REGIONAL INTERSCALENE BRACHIAL PLEXUS BLOCK ACCESS USING MINIMAL DOSES OF LOCAL ANESTHETIC

HI "Mogilev Regional Hospital"
The Republic of Belarus

Objectives. To work out an effective method of the ultrasound-assisted regional interscalene brachial plexus block access using minimal doses of local anesthetic.
Methods. Two groups of patients were formed. In group A 40 brachial plexus blocks using interscalene access with minimal doses of local anesthetic have been performed at the level of the ventral roots of spinal nerves C5, C6, C7, C8, Th1. Local anesthetic (ropivacaine 0,75%) was injected per one milliliter to each of five roots, the total volume of local anesthetic injected – 5 ml. In the control group B (27 cases) the block was done using interscalene access at the level of the brachial plexus trunks with 30 ml of 0,75% ropivacaine. In group A when the area of surgical intervention extended to the area of innervation by the branches of superficial cervical plexus (the operations on the clavicle), additionally, the block of the superficial cervical plexus branches has been performed. In group B the additional block of the superficial cervical plexus branches during surgical procedures on the clavicle was not required.
Results. According to the results of the blocks in all 67 patients the motor block was evaluated as «+» and «++»; the sensory block was evaluated in the areas of the intended surgery and, in all cases the patients reported the inability to differentiate the thermal stimulus and did not feel the needle injection. Anesthesia in both groups was found to be effective for a planned surgery; the transition to another type of anesthesia was not required.
Conclusion. The presented method for the selective block of the brachial plexus at the level of the ventral spinal nerve roots C5, C6, C7, C8, Th1 using minimal dose of local anesthetic (5 ml of 0,75% ropivacaine) is considered to be adequate to in terms of anesthesia to the brachial plexus block (30 ml of 0,75% ropivacaine) at the trunk level. Herewith the probability of systemic toxicity development of local anesthetic effect has reduced; this also applies to reduce financial costs of regional blockades.

Keywords: brachial plexus block, minimal volume, complications, ropivacaine
p. 715-720 of the original issue
References
  1. Brukhnov AV, Pecherskii VG, Marochkov AV, Kokhan ZV, Bordilovskii AN. perednii chrezsestnichnyi dostup k plechevomu spleteniiu pri vypolnenii regionarnoi blokady [The anterior interscalene brachial plexus block access in the performance of regional blockade]. Novosti Khirurgii. 2014;22(2):218–23 .
  2. Kuchin IuL. Blokada plechevogo spleteniia mezhlestnichnym dostupom u patsientov s perelomami kliuchitsy: randomizirovannoe sravnenie tekhnik s ul'trazvukovym kontrolem i neirostimuliatorom [Interscalene brachial plexus block access for patients with fractures of the clavicle: a randomized comparison of ultrasound techniques and neurostimulator]. Novosti Khirurgii. 2013; 21(6):105–108.
  3. Williams SR, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, Girard F.Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg. 2003 Nov;97(5):1518–23.
  4. Maier G, Biuttner I. Kamchatnov PR, red./ Perifericheskaia regionarnaia anesteziia atlas: [Peripheral regional anesthesia: atlas]. Moscow, RF: BINOM. Laboratoriia Znanii. 2010. 260 p.
  5. Malroi M. Emel'ianova SI. Red/. Mestnaia anesteziia [Local anesthesia]. Moscow, RF: Binom. Laboratoriia Znanii, 2003. 301 p.
  6. Neuburger M, Buttner J. [Complications of peripheral regional anesthesia]. [Article in German] Anaesthesist. 2011 Nov;60(11):1014-26.
  7. Kokhan ZV, Marochkov AV, Brukhnov AV, Pecherskii VG. O vozmozhnosti identifikatsii pravil'nogo polozheniia in"ektsionnoi igly pri blokade sedalishchnogo nerva [On the possibility of identifying of correct position of the injection needle in the blockade of sciatic nerve]. Novosti Khirurgii. 2013;21(5):80–85.
  8. Riazi S, Carmichael N, Awad I, Holtby RM, McCartney CJ.Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth. 2008 Oct;101(4):549–56.
  9. Gautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The Minimum Effective Anesthetic Volume of 0.75% Ropivacaine in Ultrasound-Guided Interscalene Brachial Plexus Block. Anesthesia & Analgesia. October 2011;113 (4):951–55.
  10. Duggan E, El Beheiry H, Perlas A, Lupu M, Nuica A, Chan VW, Brull R.Minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009 May-Jun;34(3):215–18.
  11. Sinel'nikov RD. Atlas anatomii cheloveka. Tom 3. Uchenie o nervnoi sisteme, organakh chuvstv i organakh vnutrennei sekretsii [The doctrine of the nervous system, sensory organs and organs of internal secretion]. Moscow, SSSR: Izdatel'stvo Meditsina, 1974. 399 p.
  12. Nizar Moayeri, Paul E Bigeleisen, Gerbrand J Groen. Quantitative architecture of the brachial plexus and surrounding compartments, and their possible significance for plexus blocks. Anesthesiology. 2008;108(2):299–304.
  13. Kovanov VV. Operativnaia khirurgiia i topograficheskaia anatomiia [Operative surgery and topographic anatomy]. Moscow, SSSR: Izdatel'stvo Meditsina, 1977. 410 p.
  14. Moayeri N, Bigeleisen PE , Groen GJ . Quantitative architecture of the brachial plexus and surrounding compartments, and their possible significance for plexus blocks. Anesthesiology. 2008;108(2):299–304.
  15. Cuvillon P, Nouvellon E, Ripart J, Boyer JC, Dehour L, Mahamat A, L'hermite J, Boisson C, Vialles N, Lefrant JY, de La Coussaye JE. A comparison of the pharmacodynamics and pharmacokinetics of bupivacaine, ropivacaine (with epinephrine) and their equal volume mixtures with lidocaine used for femoral and sciatic nerve blocks: a double-blind randomized study. Anesth Analg. 2009 Feb;108(2):641–49.
Address for correspondence:
212026, Respublika Belarus',
g. Mogilev, ul. B.-Biruli, d. 12,
UZ «Mogilevskaia oblastnaia bol'nitsa»,
otdelenie anesteziologii i reanimatsii,
tel. mob.: +375 29 630-75-48,
e-mail: andreibruhnov@gmail.com,
Brukhnov Andrei Viktorovich
Information about the authors:
Bruhnov AV. An anesthesiologist of department of anesthesiology and Intensive care of “Mogilev Regional Hospital”.
Pechersky VG. An anesthesiologist of department of anesthesiology and intensive care of “Mogilev Regional Hospital”.
Marochkov AV. MD, professor, a head of the department of anesthesiology and intensive care "Mogilev Regional Hospital."
Kohan ZV. An anesthesiologist of department of anesthesiology and Intensive care of “Mogilev Regional Hospital”.
Contacts | ©Vitebsk State Medical University, 2007-2023