lunes, 15 de junio de 2015

Bloqueo del plexo braquial/Brachial plexus block

Estudio comparativo de tramadol sistémico o perineural como adyuvante del bloqueo braquial subclavicular
Comparative study of systemically and perineurally administered tramadol as an adjunct for supraclavicular brachial plexus block.
Nagpal V, Rana S, Singh J, Chaudhary SK.
J Anaesthesiol Clin Pharmacol. 2015 Apr-Jun;31(2):191-5. doi: 10.4103/0970-9185.155147.
BACKGROUND AND AIMS: The study was designed to compare the effects of tramadol administered as an adjunct to bupivacaine in supraclavicular block to that of systemic administration, on postoperative analgesia and rescue analgesic requirement following upper limb surgeries. MATERIAL AND METHODS: A prospective, randomized, controlled, double-blind study was undertaken in patients scheduled for upper limb surgeries under supraclavicular block. All the three group patients received either of the following drugs mixtures: Group A - bupivacaine 0.5%-18 ml + normal saline-7 ml for block and normal saline-10 ml intravenously. Group B - bupivacaine 0.5%-18 ml + normal saline-7 ml mixture for block and tramadol (100 mg) diluted to 10 ml - intravenously. Group C - bupivacaine 0.5%-18 ml + tramadol (100 mg) + normal saline-5 ml mixture and normal saline 10 ml intravenously. The patients were observed for sensory, motor onset along with the duration of sensory and motor block. Patients were monitored for sedation and hemodynamic parameters during intra-operative and postoperative period. Pain-free period and demand for rescue analgesia was noted in all the patients. RESULTS: The study demonstrates that the mixture of tramadol and bupivacaine injected perineurally for supraclavicular brachial plexus blockhastens the onset of sensory block, motor block and provides a longer duration of motor blockade and demand for rescue analgesia as compared to other two groups. CONCLUSIONS: In conclusion, the addition of tramadol to bupivacaine mixtures as an adjunct for supraclavicular brachial plexus block provide better postoperative analgesia for orthopedic upper extremity surgery in comparison to control or systemic tramadol group without any side effects.
KEYWORDS: Bupivacaine; supraclavicular brachial plexus; tramadol
Estudio comparativo entre ropivacaína 30 mL (0.75%) y ropivacaína 30 mL (0.75%) con clonidina 150 μg como adyuvante en bloqueo braquial supraclavicular
A comparative study between ropivacaine 30 ml (0.75%) and ropivacaine 30 ml (0.75%) with clonidine 150 μg as an adjuvant in brachial plexus block through supraclavicular approach. Gupta S, Gadani HN, Thippeswamy H G.
Sudan Med Monit [serial online] 2015 [cited 2015 May 21];10:11-6.
Background: Ropivacaine is a novel alternative to bupivacaine with the less cardiovascular system and central nervous system toxicity. Clonidine, an alpha 2 agonist, may have benefited patients when it is injected at peripheral nerve sites with local anesthetic ropivacaine. Clonidine is second only to epinephrine as a useful adjuvant for brachial plexus blockade. Objective: A clinical study was carried out to compare the anesthetic effects of ropivacaine alone and clonidine as an adjuvant to ropivacaine in brachial plexus block for upper limb surgeries. Materials and Methods: A comparative, double-blind, prospective, randomized, clinical study was carried out on 60 patients of either sex of American Society of Anesthesiologist physical status I and II, with age group 25-65 years undergoing various orthopedic surgeries of upper limb under supraclavicular brachial plexus block. Patients were randomly allocated to either of the two groups of 30 each. Group-R: Injection ropivacaine 30 ml (0.75%) with 1 ml normal saline. Group-ropivacaine clonidine (RC): Iinjection ropivacaine 30 ml (0.75%) with injection clonidine 1 ml (150 μg). Heart rate, mean arterial pressure, onset and duration of motor and sensory blockade were observed during preoperative, intraoperative and postoperative period. At the end of the study, the data were analyzed using Chi-square test for qualitative data and Student t-test. P < 0.05 was considered significant and P < 0.01 was considered as highly significant.Results: Demographic and hemodynamic data were comparable. Onset of sensory and motor block was significantly earlier in Group-R. Duration of analgesia and motor blockade was prolonged in the RC group. Both groups were observed for the side-effects, which were not significant. Conclusions: Addition of clonidine 150 μm to ropivacaine 0.75% 30 ml delays the onset of sensory and motor blockade while prolongs the postoperative motor blockade and analgesia significantly without producing any clinical significant side-effects in brachial plexus block through supraclavicular approach.
Keywords: Brachial plexus block, clonidine, ropivacaine, supraclavicular approach
Anestesia y Medicina del Dolor
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