Aksiller, supraklavikular ve interskalen yaklaşımlar ile uygulanan brakiyal pleksus bloğunun yayılımı

Amaç: Bu çalışmanın amacı, aksiller, supraklaviküler veya interskalen yaklaşım yoluyla gerçekleştirilen brakiyal pleksusbloklarında duyusal ve motor bloğun başlangıcı, kalitesi ve yayılımını araştırmaktır.Yöntem ve gereç: Çalışma, ortopedik üst ekstremite cerrahisi planlanmış 75 hastayı içermektedir. Hastalarda aksiler(grup AX, n = 25), supraklaviküler (grup SC, n = 25) veya interskalen yaklaşım (grup İS, n = 25) yoluyla brakiyal pleksusbloğu gerçekleştirilmiştir.Bulgular: Grup AX’de interkostobrakiyal sinir hariç olmak üzere brakiyal pleksusa ait sinirlere ilişkin yeterli duyusalblok oranı % 100, yeterli motor blok oranı ise % 92-100 olarak bulunmuştur. Grup SC’de duyusal ve motor blokoranlarının her ikisi de % 96-100, grup İS’de ise bu oranlar sırasıyla % 80-% 100 ve % 88 olarak bulunmuştur. Duyusal vemotor blok yönünden, değerlendirilen tüm sinirlerde, ölçüm yapılan tüm zaman dilimlerinde, üç grup arasında anlamlıfark vardır (P < 0,05).Sonuç: Brakiyal pleksus bloğunda duyusal ve motor bloğun başlangıcı, kalitesi ve yayılımı uygulanan aksiller,supraklavikular veya interskalen yaklaşıma bağlı olarak değişmektedir.

Anahtar Kelimeler:

Brakiyal pleksus bloğu, aksiller, supraklaviküler, interskalen

The extent of blockade following axillary, supraclavicular, and interscalene approaches of brachial plexus block

To investigate the onset, quality, and extent of the sensory and motor blocks in brachial plexus blocks performed through axillary, supraclavicular, or interscalene approaches. Materials and methods: This study involved 75 patients scheduled for orthopedic surgery of the upper extremity. Brachial plexus block was performed in patients through axillary (group AX, n = 25), supraclavicular (group SC, n = 25), or interscalene (group IS, n = 25) approaches. Results: Excluding intercostobrachial nerve, the adequate sensory and motor block rates in group AX on the nerves of brachial plexus were found to be 100% and 92%-100%, respectively. Sensory and motor block rates were both found to be 96%-100% in group SC and also 80%-100%, and 88% in group IS, respectively. In terms of sensory and motor block evaluation of all the nerves, there were statistically significant differences among the 3 groups at all measurement times (P < 0.05). Conclusion: The onset, quality, and extent of the sensory and motor block in brachial plexus blocks changed depending on the axillary, supraclavicular, or interscalene approaches.

Keywords:

axillary, supraclavicular, interscalene, Brachial plexus block,

PDF

___

De Tran QH, Clemente A, Doan J, Finlayson RJ. Brachial plexus blocks: a review of approaches and techniques. Can J Anesth 2007; 54: 662-74. 2. Neal JM, Hebl JR, Gerancher JC, Hogan QH. Brachial plexus anesthesia: Essentials of our current understanding. Reg Anesth Pain Med 2002; 27: 402-28.
Winnie AP, Radonjic R, Akkineni SR, Durrani Z. Factors infl uencing distribution of local anesthetic injected into the brachial plexus sheath. Anesth Analg 1979; 58: 225-34.
Kulenkampff D. Die Anaesthesierung des plexus brachialis. Dtsch Med Wochenschr 1912; 38: 1878-80. 5. Winnie AP. Interscalene brachial plexus block. Anesth Analg 1970; 49: 455-66. 6. Hempel V, Baur KF. Regional Anaesthesie für Schülter Arm und Hand. München: Urban & Schwarzenberg; 1982. p.60-4. 7. Lanz E, Th eiss D, Jankovic D. Th e extent of blockade following various techniques of brachial plexus block. Anesth Analg 1983; 62: 55-8.
Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJL, Franco CD et al. Upper extremity regional anesthesia: Essentials of our current understanding, 2008. Reg Anesth Pain Med 2009; 34: 134-70. 9. Mortazavi MT, Ghazani MN, Ansari M. Brachial plexus block in elbow, arm or hand surgeries. Pak J Biol Sci. 2009; 12: 1353- 8.
Riegler FX. Brachial plexus block with the nerve stimulator: Motor response characteristics at three sites. Reg Anesth 1992; 17: 295-9.
Brockway MS, Wildsmith JAW. Axillary brachial plexus block: Method of choice. Br J Anaesth 1990; 64: 224-31.
Cockings E, Moore PL, Lewis RC. Transarterial brachial plexus blockade using high doses of 1.5% mepivacaine. Reg Anesth Pain Med 1987; 12: 159-64.
Pere P, Pitkanen M, Tuominen M, Edgren J, Rosenberg PH. Clinical and radiological comparison of perivascular and transarterial techniques of axillary brachial plexus block. Br J Anaesth 1993; 70: 276-9.
Quinlan JJ, Oleksey K, Murphy FL. Alkalinization of mepivacaine for axillary block. Anesth Analg 1992; 74: 371-4.
Schroeder LE, Horlocker TT, Schroeder DR. Th e effi cacy of axillary block for surgical procedures about the elbow. Anesth Analg 1996; 83: 747-51.
Brown DL, Bridenbaugh LD. Th e Upper Extremity Somatic Block. In: MJ Cousins, PO Bridenbaugh, editors. Neural blockade in clinical anesthesia and management of pain. 3rd ed. Philadelphia: Lippincott-Raven Publishers; 1998. p. 345-71.
Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional anesthesia of brachial plexus. Anesth Analg 1994; 78: 507-13.
Knoblanche GE. Th e incidence and aetiology of phrenic nerve blockade associated with supraclavicular brachial plexus block. Anaesth Intensive Care 1979; 7: 346-9.
Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg 1991; 72: 498-503.
Urmey WF, Gloeggler PJ. Pulmonary function changes during interscalene brachial plexus block: Eff ects of decreasing local anesthetic injection volume. Reg Anesth 1993; 18: 244-9.
Winnie AP. Plexus Anesthesia: Perivascular Techniques of Brachial Plexus Block. Volume 1. Edinburgh: Churchill Livingstone; 1983. p.117-88.
Dewees JI, Schultz CT, Wilkerson FK, Kelly JA, Biegner AR, Pellegrini JE. Comparison of two approaches to brachial plexus anesthesia for proximal upper extremity surgery: interscalene and intersternocleidomastoid. ANNA J 2006; 74: 201-6.