Naslov
Double-Shot Technique in Axillary Block

Autori
Bartolek, Dubravka ; Cvjetko, Marija ; Domijan, Marina ; Torbica, Velimir ; Baranović, Senka ; Finci, Dijana ; Đurasek, Julija ; Juras, Sanja ; Kovačić Vicić, Vesna ; Slaviček, Vlado ; Beker, Tatjana

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

Izvornik
Knjiga sažetaka 2.hrvatskog traumatološkog kongresa s međunarodnim sudjelovanjem / - , 2005, 85-85

Skup
2.Hrvatski traumatološki kongres s međunarodnim sudjelovanjem

Mjesto i datum
Zagreb, Hrvatska, 03.11.2005. - 05.11.2005

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Domaća recenzija

Ključne riječi
aksilarni blok; tehnika dvostruke aplikacije
(axillary block; double-shot technique)

Sažetak
Introduction: 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 block 1. The neurostimulator improves the success rate of brachial plexus blocks performed by the axillary approach only when three nerves or more are stimulated 2. Double-shot technique of axillary block is still of interests. Aim: To evaluate the success rate of motor and sensor blockade after double-shot technique. Methods: Thirty 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 minutes before procedure. Electrical nerve stimulation was performed by Stimuplex&reg ; HNS 11 nerve stimulator (Brown). 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. Results In Group D only 1 (4%) patient had unsatisfactory axillary’ s block and in Group S 4 (15%). Motor blockade was significantly 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). Conclusion: 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

POVEZANOST RADA