Naslov
Sugamadex in conversion of residual paralysis after rocuronium supplementation in Bier’s block: does it work?
(Sugamadex in conversion of residual paralysis after rocuronium supplementation in Bier’s block: does it work? //Abstract of the 30th Annual ESRA Congress of Europen Sociaty of Regional Anaesthesia & Pain, Dresden, September, 2011 ; u Regional Anesthesia and Pain Medicine (2011)36(7):E247.)

Autori
Bartolek, Dubravka

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

Izvornik
Regional Anesthesia and Pain Medicine Journal / - , 2011, E247-doi10.1097/AAP.0b013e3181b968fc

Skup
The XXX Annual ESRA Congres of Europen Sociaty of Regional Anaesthesia & Pain Medicine

Mjesto i datum
Dresden, Njemačka, 07.09.2011. - 10.09.2011

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
Bier's block; muscle relaxants; sugammadex

Sažetak
Introduction with Hypothesis: Bier’s block (IVRA) is effective, successful and safe regional anesthesia technique. Local anesthetic (LA) in ischemic conditions allows good condition for most soft tissue forearm surgery1. Poor muscle relaxation is found in IVRA by open forearm bone reposition and osteosynthesis2. Addition of low-dose non-depolarizing muscle relaxant to LA prolongs unwanted residual paralysis of extremity3. Acetylcholine inhibitors interact with LA activity and could not be used for neuromuscular block (NMB) reversal4. We assume that sugamadex as selective, non-competitive rocuronium neutralizer may converse the residual paralysis after IVRA when supplementation of muscle relaxant is indicated. Methods Ethic Committee of University Clinic of Traumatology approved prospective clinical study. After written inform consent, ninety adult patients with forearm fracture (ASA I/II, 45-56 age, bought gender), were randomized in three equal groups. In Group LA 0.5% lidocaine (3 mg/kg) was used. Rocuronium (0.6 mg/6% body weight of upper extremity) was supplemented to LA in Group LR. In Group LRS, LA and rocuronium were used during IVRA and sugamadex was applied i.v. in opposite arm immediately after tourniquet release. Patients were premedicated (midazolam 0.1 mg/kg, orally). Before start of procedure and monitoring all patients received sufentanil 0.5 μg and midazolam 0.05 mg i.v. Pneumatic exsanguinations of upper arm was done. Ischemic condition was achieved with tourniquet pressure (100 mmHg above systolic blood pressure) and maintain for 60 min. Muscle function was monitored by Trai-of-Four stimulation (TOF)(n.ulnaris ; 2 Hz, 35 mA). Data was analyzed by SPSS 11.0. Results Study groups were comparable by demographic structure. Bone reposition (16-18 vs. 34 min)(P=0.0298) and osteosyntesis (40-43 vs. 54 min)(P=0.0283) were faster with rocuronium addition. VAS score (0.6-0.7 vs. 1.5)(P=0.0014) and additional sedation (7-13% vs. 33%)(P=0.0014) and analgesia (3-7% vs.17%)(P=0.0017) were significantly lower in rocurnium groups. Maximal TOF depression was achieved faster with rocuronium supplementation: complete NM block in LR and LRS Group (TOF 0/4) in 5.4 and 6.2 min (Group L: intensive but incomplete NMB ; TOF ¾ in 13 min)(P=0.0080). Residual muscle paralysis with standard LA solution was detected 21+/1 min after tourniquet release and ten times longer (3.5 hours) when rocuronium was supplemented (P=0.0001). Sugamadex shorted muscle function recovery on 41+/2 min after rocuronium addition (P=0.0102)(Graph 1). No one patient had systemic adverse effect during and after study procedure. Discussion Supplementation of NMB drug to LA solution is not routine procedure in Bier’s block. According local ischemic condition during Bier’s block, metabolic processes differs from usual rules. Sugamadex encapsulates free rocuronium’s molecule by noncompetitive mechanism5. It effects very fast in systemic circulation. In our study, sugamadex shorted rocuronium induced 3.5 hours long residual paralysis after Bier’s block on 40 min. This was 20 min longer difference from our expectation and muscle function recovery after standard LA solution. Conclusion Rocuronium supplementation in IVRA is allowed for forearm bone surgery if complete muscle relaxation is needed. In these cases, sugamadex has to be used to eliminate potential rocuronium adverse effects and to reduce limb paralysis on acceptable 40 minutes postoperatively.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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