Ece AYDIN, Sanem ÇAKAR TURHAN, Fatma Feyhan ÖKTEN

AKSİLLER BLOKTA İDEAL DOZ NE OLMALIDIR

Rejyonal anestezi genel anesteziye kıyasla güçlü perioperatif analjezi, azalmış opioid gereksinimi, azalmış postoperatif bulantı,kusma, anestezi sonrası bakım ünitesinde kısa süreli gözlemve erken taburculuk sağlamakta, bu nedenle anestezi pratiğinde rejyonalanestezi tekniklerine ilgi her geçen gün artmaktadır.Uzun etkili ve kardiyotoksik özelliği daha az olan levobupivakain ve ropivakain gibi lokal anesteziklerin kullanıma girmesi veözellikle sinirlerin ultrason (USG) yardımı ile direkt görüntülenerek çok düşük doz lokal anesteziklerle başarılı blok yapılabilmesi,periferik sinir bloklarının kullanımını arttırmıştır. Brakiyal pleksusa yaklaşımda en sık uygulanan aksiller blok, etkin ve güvenilirbir periferik sinir bloğudur. Aksiller blok ile ilgili uygulanan farklı tekniklere, kullanılan lokal anestezik ajanların uygun doz,konsantrasyon ve volümlerine ait günümüze kadar sayısız çalışma yapılmıştır. Bu yazımızda literatür ışığında çalışmalar tekrargözden geçirilerek sonuçların tartışılması amaçlanmıştır

WHAT IS THE APPROPRIATE DOSE FOR AXILLARY BRACHIAL PLEXUS BLOCKS?

Regional anesthesia provides better perioperative analgesia, decreased opioid requirement, reduced postoperative nausea andvomiting, lesser duration of stay in postoperative care unit and earlier discharge when compared with general anesthesia, so thereis an increased interest in regional anesthesia technics in anesthesiology practice. Together with the use of long-acting localanesthetics with lesser cardiotoxic effects such as levobupivacaine and ropivacaine and especially performing successful nerveblocks with very low doses of local anesthetics by direct visualization of nerves under ultrasound-guidance have increased the useof peripheral nerve blocks. The axillary nerve blockade which is the most frequently used approach in brachial plexus blockade, isan effective and a reliable peripheral nerve blockade. Up to, there are numerous studies regarding the appropriate dose, volumeand concentration of local anesthetics, as well as different approaches of axillary plexus blockade. In the present article, the authorsaimed to revise the studies in light of the recent literature

PDF

___

1. Richman JM, Liu SS, Courpas G, et al. Does continuous peripheral nerve block provide superior pain control to opioids? Anesth Analg 2006; 102: 248-257.
2. Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia. Anesth Analg 2005; 101: 1634-1642.
3. O'Donnell BD, Iohom G. An estimation of the minimum effective anesthetic volume of 2% lidocaine in ultrasound-guided axillary brachial plexus block. Anesthesiology 2009; 111: 25-29.
4. Satapathy AR, Coventry DM. Axillary brachial plexus block. Anesthesiol Res Pract 2011; 2011: 173796.
5. Mian A1, Chaudhry I, Huang R, Rizk E, Tubbs RS, Loukas M. Brachial plexus anesthesia: A review of the relevant anatomy, complications, and anatomical variations. Clin Anat 2014; 27: 210-221.
6. Hirschel G. Anethesia of the brachial plexus for operations on the upper extremity. Munchen Med Wochenschr 1911; 58: 1555-1556.
7. Winnie AP, Collins VJ. The subclavian perivascular technique of brachial plexus anesthesia. Anesthesiology 1964; 25: 353-363.
8. Reding M. Nouvelle methode D'anesthesie du membre superieur. Presse Med 1921; 29: 294.
9. Burnham PJ. Simple regional nerve block for surgery for the hand and forearm. JAMA 1959; 169: 941-943.
10. Selander D. Axillary plexus block: Parestehetic or perivascular. Anethesiology 1987; 66: 726-728.
11. Thompson GE, Rorie DK. Functional anatomy of the brachial plexus sheat. Anesthesiology 1983; 59: 117-122.
12. Partridge. Functional anatomy of the brachial plexus sheat: ‹mplications for anesthesia. Anesthesiology 1987; 66: 743-747.
13. DeJong RH. Axillary block of the brachial plexus. Anesthesiology 1961; 22: 215-224.
14. Youssef MS, Desgrand DA. Comparison of two methods of axillary brachial plexus anaesthesia. Br J Anaesth 1988; 60: 841-844.
15. Koscielniak-Nielsen ZJ, Hesselbjerg L, Fejlberg V. Comparison of transarterial and multiple nerve stimulation techniques for an initial axillary block by 45 mL of mepivacaine 1% with adrenaline. Acta Anaesthesiol Scand 1998; 42: 570-575.
16. Koscielniak-Nielsen ZJ, Rotbøll Nielsen P, Sørensen T, Stenør M. Low dose axillary block by targeted injections of the terminal nerves. Can J Anaesth 1999; 46: 658-664.
17. Perlas A, Niazi A, McCartney C, Chan V, Xu D, Abbas S. The sensitivity of motor response to nerve stimulation and paresthesia for nerve localization as evaluated by ultrasound. Reg Anesth Pain Med 2006; 31: 445-450.
18. Cuvillon P. Axillary nerve block under ultrasonography: Review of evidence. Ann Fr Anesth Reanim 2012; 31: 193-197.
19. Conroy PH, Awad IT. Ultrasound-guided blocks for shoulder surgery. Curr Opin Anaesthesiol 2011; 24: 638-643.
20. Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: Part 1. Br J Anaesth 2010; 104: 538-546.
21. Barrington MJ, Kluger R. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following nerve blockade. Reg Anesth Pain Med 2013; 38: 289-297.
22. Neal JM. Ultrasound guided regional anesthes and patient safety: An evidence based analysis. Reg Anesth Pain Med 2010; 35: 59-67.
23. Vester-Andersen T, Christiansen C, Sørensen M, Kaalund-Jørgensen HO, Saugbjerg P, Schultz-Møller K. Perivascular axillary block II: influence of injected volume of local anaesthetic on neural blockade. Acta Anaesthesiol Scand 1983; 27: 95-98.
24. Cocking E, Moore PL, Lewis RC. Transarterial brachial plexus blockade using high doses of 1,5% mepivacaine. Reg Anesth 1987; 12: 159-164.
25. Perris TM, Watt JM. The Road To Success: A review of 1000 axillary brachial plexus blocks. Anaesthesia 2003; 58: 1220-1224.
26. Serradell A, Herrero R, Villanueva JA, Santos JA, Moncho JM, Masdeu J. Comparison of three different volumes of mepivacaine in axillary plexus block using multiple nerve stimulation. Br J Anaesth 2003; 91: 519-524.
27. Bertini L, Palmisani S, Mancini S, Martini O, Ioculano R, Arcioni R. Does local anesthetic dilution influence the clinical effectiveness of multiple-injection axillary brachial plexus block?: a prospective, double-blind, randomized clinical trial in patients undergoing upper limb surgery. Reg Anesth Pain Med 2009; 34: 408-413.
28. Zhao X, Wang YW, Chen H, et al. Efficacy of low dose levobupivacaine (0,1%) for axillary plexus block using multiple nerve stimulation. Anaesth Intensive Care 2008; 36: 850-854.
29. Fornage BD. Peripheral nerves of the extremities: Imaging with US. Radiology 1988; 167: 179-182.
30. Ting PL, Sivagnanaratnam V. Ultrasonographic study of the spread of local anaesthetic during axillary brachial plexus block. Br J Anaesth 1989; 63: 326-329.
31. Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg 1994; 78: 07-13.
32. Casati A, Danelli G, Baciarello M, et al. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axil