Naslov
Double-shot technique in axillary block : the saccess of motor and sensor blockade

Autori
Bartolek, Dubravka ; Šakić-Zdravčević, Kata ; Cvjetko, Marija ; Domijan, Marina ; Torbica, Velimir ; Finci, Dijana

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Abstract of the 2nd World Congress on Regional Anaesthesia and Pain Therapy / - , 2006

Skup
2nd World Congress on Regional Anaesthesia and Pain Therapy (2 ; 2006)

Mjesto i datum
Rio de Janeiro, Brazil, 04.03.2006. - 08.03.2006

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
axillary block; single shot technique; double shot technique

Sažetak
According to the innervations fields, axillary brachial plexus block is the method of choice for longer surgical procedures in the forearm, elbow and hand region as the partial parts of upper arm. It usually performs as a single-shot or continuous block1. The neurostimulator improves the success rate of brachial plexus blocks performed by the axillary approach only when three nerves or more are stimulated2. Double-shot technique of axillary block is still of interests. Aim was to evaluate the success rate of motor and sensor blockade after double-shot technique. Ninety patients (female 23, male 27 ; 21-81 old ; BMI: 23-31, ASA I-IV) were included in retrospective study during six months period. All patient were premedicated with midazolam 7.5 mg orally 30 min and sufentanyl 2.5μ g iv 10 min before procedure. Electrical nerve stimulation was performed by Stimuplex® HNS 11 nerve stimulator, (B/Brown, Germany) and 1 Stimuplex® D stimulating needle 22G, 0.7x50 mm (B/Brown, Japan). When the slight twitching of the motor response from the relevant musculature (at 0.5 mA, 2Hz, 0.1 ms) was achieved local aesthetic was carried out. In Group D (13 patients) was double-shot of 20 ml mixture of 10 ml 2% xylocaine and 10 ml 0.5% bupivacaine injected above and below axillary artery. In Group S (17 patients) single-shot of 40 ml of the same mixture was supplied only above axillary artery. Motor blockade was determined by the modified Bromage scale. Progression of sensory block was assessed every 5 min during 30 min by pinprick. Pain was assessed using a 0-10 verbal numerical rating scale. Data was analysed by Mann-Whitney Wilcoxon non-parametric test for the paired data. P>0.05 was accepted as significant. In Group D only 1 (4%) patient had unsatisfactory axillary’s block and in Group S 4 (15%). Motor blockade was significant better in Group D (unable to move: Group S 22%, Group D 39%, moving in elbow: Group S 41%, Group D 53%, partial motor block Group S 17%, Group D 8% flexion in elbow: Group S 16%, Group D 0, weakness of elbow flexion: Group S 4%, Group D 0) (P=0.0254). Sensory blockade was more successful in Group D (C5: 54%, Th1 92%, C6 100%, C7 77%, C8 92%) compare to Group S (C5: 12%, Th1 59%, C6 71%, C7 65%, C8 71%)(P=0.0000). VAS score was between 0-3 points in both groups and did not differs significant (Group S: 0=64%, 1=24%, 2=6%, 3=6%, Group D: 0=62%, 1=23%, 2=8%, 3=8%) (P=0.0551). Double-shot technique in comparison with single-shot, allows better motor and sensory blockade of axillary’s brachial plexus with more expansion of local aesthetic around ulnar nerve area. Increased BMI as ASA physical status may be independent risk factors for block failure3.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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