Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-23T02:06:45.774Z Has data issue: false hasContentIssue false
  • English
  • Français

High volume and low concentration of anaesthetic solution in the perivascular interscalene sheath determines qualityof block and incidence of complications

Published online by Cambridge University Press:  11 July 2006

P. Pippa ,
P. Cuomo ,
A. Panchetti ,
M. Scarchini ,
G. Poggi  and
M. D'Arienzo
P. Pippa
Affiliation:
University of Florence, Department of Anaesthesiology, Florence, Italy
P. Cuomo
Affiliation:
University of Florence, Department of Orthopaedics, Florence, Italy
A. Panchetti
Affiliation:
University of Florence, Department of Anaesthesiology, Florence, Italy
M. Scarchini
Affiliation:
University of Florence, Department of Orthopaedics, Florence, Italy
G. Poggi
Affiliation:
University of Florence, Department of Anaesthesiology, Florence, Italy
M. D'Arienzo
Affiliation:
University of Florence, Department of Orthopaedics, Florence, Italy
Get access

Abstract

Summary

Background and objective: In the perivascular sheath of the brachial plexus, the volume of anaesthetic solution determines the quality of anaesthetic cover. Fibrous septa may divide the perivascular space into compartments, leading to inadequate diffusion of the anaesthetic solution. The aim of our study was to obtain good anaesthesia and less complications using high volume of low concentration anaesthetic solution, overcoming the obstacle of the septa with a double approach to the scalene sheath. Methods: Sixty patients scheduled for shoulder capsuloplasty received both Winnie interscalene brachial plexus block and Pippa proximal cranial needle approach. The patients were randomly assigned to two groups. A constant dose of local anaesthetic was administered to each group: Group I (30 patients) received high volume (60 mL of anaesthetic solution) and Group II (30 patients) received low volume of solution (30 mL of anaesthetic solution). Sensory and motor block in the upper limb and complications were evaluated. Results: In all the patients the quality of anaesthesia obtained at the surgical site was excellent. In Group I also the areas supplied by the medial cutaneous nerves of the arm and forearm, ulnar, median and radial nerves were blocked (P < 0.002). Complications were only observed in Group II and consisted of bradycardia and hypotension (66% of the patients) and phrenic nerve paresis (27% of the patients). Conclusions: The lower concentration of the anaesthetic solution avoids complications while increased volume provides good analgesic cover. The combination of the Winnie interscalene plexus block and the Pippa proximal cranial needle approach should contribute to fill up the scalene sheath overcoming the septa obstacles.

Keywords

ANAESTHESIA CONDUCTION, axillary block, brachial plexus blockANAESTHETICS LOCAL, lidocaine, bupivacainePREOPERATIVE CARE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 10 , October 2006 , pp. 855 - 860
Copyright
2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Winnie AP, Radonjic R, Akkineni SR, Durrani Z. Factors influencing distribution of local anaesthetic injected into the brachial plexus sheath. Anesth Analg 1979; 58: 225–234.Google Scholar
Winnie AP. Interscalene brachial plexus block. Anesth Analg 1970; 49: 455–466.Google Scholar
Pippa P. Brachial plexus block using a new subclavian perivascular technique: the proximal cranial needle approach. Eur J Anaesth 2000; 17: 120–125.Google Scholar
Turkan H, Baykal B, Ozisik T. Axillary brachial plexus blockade: an evaluation of three techniques. Mil Med 2002; 167: 723–725.Google Scholar
Delgado Tapia JA, Garcia Sanchez MJ, Prieto Cuellar M, Jimenez Ayala I, Garcia Rescalvo MA, Lopez-Andrade Jurado A. Infraclavicular brachial plexus block using a multiple injection technique and an approach in the cranial direction in a patient with anticipated difficulties in tracheal intubation. Rev Esp Anestesiol Reanim 2002; 49 (2): 105–107 [in Spanish].Google Scholar
Fanelli G, Casati A, Garancini P, Torri G. Nerve stimulator and multiple injection technique for upper and lower limb blockade: failure rate, patient acceptance and neurologic complication. Study group of regional Anesthesia. Anesth Analg 1999; 88 (4): 847–852.Google Scholar
Urmey WF. Combined axillary-interscalene (axis) brachial plexus block for elbow surgery. Reg Anesth 1993; 18: 88.Google Scholar
Bromage PR. Epidural Analgesia.Philadelphia, PA: W. Saunders, 1978: 144.
Casati A, Fanelli G, Cedrati V, Berti M, Aldegheri G, Torri G. Pulmonary function changes after interscalene brachial plexus anaesthesia with 0.5% and 0.75% ropivacaine: a double-blind comparison with 2% mepivacaine. Anesth Analg 1999; 88: 587–592.Google Scholar
Cohen E, Mier A, Heywood P, Murphy K, Boultbee J, Guz A. Excursion volume relation of the right hemidiaphragm measured by ultrasonography and respiratory airflow measurements. Thorax 1994; 49: 885–889.Google Scholar
Neal JM, Moore JM, Kopacz DJ, Liu SS, Kramer DJ, Plorde JJ. Quantitative analysis of respiratory, motor and sensory function after supraclavicular block. Anesth Analg 1998; 86: 1239–1244.Google Scholar
D'Alessio JG, Weller RS, Rosenblum M. Activation of the Bezold–Jarisch reflex in the sitting position for shoulder arthroscopy using interscalene block. Anesth Analg 1995; 80: 1158–1162.Google Scholar
Urmey WF, Talts KH, Sharrock NE. One hundred percent of hemidiaphragmatic paresis associated with interscalene brachial plexus anaesthesia as diagnosed by ultrasonography. Anesth Analg 1991; 72: 498–503.Google Scholar
Thomson GE, Rorie DK. Functional anatomy of the brachial plexus sheath. Anesthesiology 1983; 59: 117–122.Google Scholar
Partridge BL, Katz J, Bernischke K. Functional anatomy of brachial plexus sheath implication for anaesthesia. Anesthesiology 1987; 66: 743–747.Google Scholar
Vester-Andersen T, Christiansen C, Sorensen M, Eriksen C. Perivascular axillary block: blockade following 40 ml 1% mepivacaine with adrenaline. Acta Anesthesiol Scand 1982; 26: 519–523.Google Scholar
Pippa P, Rucci FS. Preferential channelling of anaesthetic solution injected within the perivascular axillary sheath. Eur J Anaesthesiol 1994; 11: 391–396.Google Scholar
De Jong RH. Local Anaesthetic.St. Louis: Mosby Year book Inc., 1991.
Urmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effect on pulmonary function and chest wall mechanism. Anesth Analg 1992; 74: 352–357.Google Scholar
Kahn RI, Hargett MJ. Beta-adrenergic blockers and vasovagal episodes during shoulder surgery in the sitting position under interscalene block. Anesth Analg 1999; 88: 378–381.Google Scholar
Liguori GA, Kahn RI, Gordon J, Gordon MA, Urban MK. The use of metoprolol and glycopyrrolate to prevent hypotensive-bradycardic events during shoulder arthroscopy in the sitting position under interscalene block. Anesth Analg 1998; 87: 1320–1325.Google Scholar
Morris GN. The Bezold–Jarisch reflex. Anesth Analg 1996; 83: 201–202.Google Scholar
Stienstra R. Mechanism behind and treatment of sudden, unexpected circulatory collapse during central neuraxis blockade. Acta Anaesthesiol Scand 2000; 44: 965–971.Google Scholar
McCrae AF, Wildsmith JAW. Prevention and treatment of hypotension during central neural block. Br J Anaesth 1993; 70: 672–680.Google Scholar
Campagna JA, Carter C. Clinical relevance of the Bezold– Jarisch reflex. Anaesthesiology 2003; 98: 1250–1260.Google Scholar