| Bloqueo interescalénico posterior: Serie de casos guiados con ultrasonido y visión general de historia, anatomía y técnicas |
Posterior interscalene block: an ultrasound-guided case series and overview of history, anatomy and techniques.
McNaught A, McHardy P, Awad IT.
Department of Anesthesia, Sunnybrook Health Sciences Centre and Holland Orthopedic and Arthritic Centre, University of Toronto, Toronto, Ontario, Canada.
Pain Res Manag. 2010 Jul-Aug;15(4):219-23.
Abstract
BACKGROUND: The posterior interscalene block has been described as an alternative to the lateral interscalene block. However, this technique has not gained popularity because of the close proximity of the approach to vascular and central neural structures. OBJECTIVE: To describe the posterior interscalene block technique using ultrasound imaging, and to review the history of its evolution. METHODS: The use of ultrasound imaging to facilitate the insertion of interscalene catheters using the posterior approach in 11 patients undergoing total shoulder arthroplasty is described. RESULTS: All 11 patients had satisfactory analgesia in the first 24 h of the postoperative period. None of the patients complained of neck pain, as had been found in earlier techniques using the posterior approach. CONCLUSIONS: This modification of the posterior approach is a safe and effective method for the insertion of interscalene brachial plexus catheters. These catheters are also comfortable for patients and, in the present study, none of the catheters inadvertently fell out.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935721/pdf/prm15219.pdf
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| Bloqueo interescalénico posterior del plexo braquial guiado con ultrasonido: estudio randomizado, ciego triple, placebo controlado. |
Continuous interscalene brachial plexus block via an ultrasound-guided posterior approach: a randomized, triple-masked, placebo-controlled study.
Mariano ER, Afra R, Loland VJ, Sandhu NS, Bellars RH, Bishop ML, Cheng GS, Choy LP, Maldonado RC, Ilfeld BM.
Department of Anesthesiology, University of California, San Diego Medical Center, San Diego, California 92037-7651, USA.
Anesth Analg. 2009 May;108(5):1688-94. doi: 10.1213/ane.0b013e318199dc86.
Abstract
BACKGROUND:
The posterior approach for placing continuous interscalene catheters has not been studied in a controlled investigation. In this randomized, triple-masked, placebo-controlled study, we tested the hypothesis that an ultrasound-guided continuous posterior interscalene block provides superior postoperative analgesia compared to a single-injection ropivacaine interscalene block after moderately painful shoulder surgery. METHODS: Preoperatively, subjects received a stimulating interscalene catheter using an ultrasound-guided, in-plane posterior approach. All subjects received an initial bolus of ropivacaine. Postoperatively, subjects were discharged with oral analgesics and a portable infusion device containing either ropivacaine 0.2% or normal saline programmed to deliver a perineural infusion over 2 days. The primary outcome was average pain on postoperative day (POD) 1 (scale: 0-10). Secondary outcomes included least and worst pain scores, oral opioid requirements, sleep disturbances, patient satisfaction, and incidence of complications. RESULTS: Of the 32 subjects enrolled, 30 perineural catheters were placed per protocol. Continuous ropivacaine perineural infusion (n = 15) produced a statistically and clinically significant reduction in average pain (median [10th-90th percentile]) on POD 1 compared with saline infusion (n = 15) after initial ropivacaine bolus (0.0 [0.0-5.0] versus 3.0 [0.0-6.0], respectively; P < 0.001). Median oral opioid consumption (oxycodone) was lower in the ropivacaine group than in the placebo group on POD 1 (P = 0.002) and POD 2 (P = 0.002). Subjects who received a ropivacaine infusion suffered fewer sleep disturbances than those in the placebo group (P = 0.005 on POD 0 and 1 nights) and rated their satisfaction with analgesia higher than subjects who received normal saline (P < 0.001). CONCLUSIONS: Compared to a single-injection interscalene block, a 2-day continuous posterior interscalene block provides greater pain relief, minimizes supplemental opioid requirements, greatly improves sleep quality, and increases patient satisfaction after moderate-to-severe painful outpatient shoulder surgery.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2745838/pdf/nihms131871.pdf
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Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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