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146
70
Posters
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Peripheral Nerve Block
139. Methadone added to local anesthetic for infraclavicular brachial plexus block does not prolong postoperative analgesia J.C. Tornero Tornero1, E. Domenech Pascual1, V. Roque´s Escolar2, B. Escamilla Can˜ete1, P. Ruiz Gimeno1 [email protected] 1Department Anethesiology, Hospital Clı´nico Universitario, Valencia, Spain, 2Department of Anesthesiology, Hospital Arrixaca, Murcia, Spain Background and Aims: Many opioids have been described as local anaesthetic coadjuvants (1-3). Our hypothesis checks whether the use of peripheral methadone in brachial plexus allows the prolongation the postoperative analgesia or not, therefore, allowing the decrease of systemic analgesic needs and their side effects. Methods: Prospective, double-blinded randomized study with 39 patients, ASA I-III, scheduled for superior limb traumatologic surgery. Three groups: 1. Infraclavicular control receiving infraclavicular mepivacaine; 2. Infraclavicular methadone receiving mepivacaine and methadone (0.1 mg/kg); 3. Systemic methadone receiving infraclavicular mepivacaine and subcutaneous methadone. Blockade was performed using the Wilson’s technique(4). All patients received 40 ml of 1.5% mepivacaine. Brachial plexus block was assessed after 10, 20 and 30 minutes. Analyzed parameter: Sensory and motor blockade of cubital, median, radial and musculous-cutaneous nerves, effectiveness, sensitivity duration, anesthesic technique assessment for patients after 24h. Adverse events and complications were recorded. Statistical analyses: ANOVA Test for quantitative parameters and chi-2 test for categorical parameters. Differences were considered statistically significant when P values were ⬍0.05. Results: No statistical difference was found for all parameters including sensory and motor blockade onset for the three groups on whatever the nerves studied (table 1). Conclusions: This study shows that 0.1 mg/kg methadone associated to mepivacaine for the infraclavicular blockade does not yield advantages when neither effectiveness, nor sensitivity duration nor patient’s satisfaction are analyzed.
References 1. 2. 3. 4.
Stewart DJ. J Bone Joint Surg Am 2005;87-A:140-4. Prieto-A´lvarez P. Can J Anaesth 2002;49:25-31. Candido KD. Reg Anesth Pain Med 2002;27:162-7. Wilson JL. Anesth Analg 1998;87:870-3.
146. Brachial plexus block for av-fistula surgery - comparison between infraclavicular coracoid and axillary techniques P.H. Rosenberg, T.T. Niemi [email protected] Department of Anaesthesiology and Intensisve Care Medicine, Helsinki University Hospital, Helsinki, Finland Infraclavicular brachial plexus block may guarantee better success in anaesthetizing the innervation area of surgery for creation of an AV-fistula on the lateral forearm (territory of musculociutaneous nerve) than the axillary approach. Sixty uremic patients were given in random order either an infraclavicular coracoid brachial plexus block (Group C) or an axillary brachial plexus block (Group A) using single nerve stimulation and 35-50 ml of mepivacaine 10 mg/ml with adrenaline. The first twitch response in one of the innervation areas of the four main nerves with current ⬍ 0.5 mA was accepted for locating the plexus. Sensory block was tested (blinded) with pin-prick and motor block by grip strength of the hand. In one obese patient, the coracoid process and the plexus could not be identified. In the majority of patients in both groups (NS) the median nerve was first located. Pin-prick analgesia (blunt or no sensation) developed faster in Group C in the axillary and musculocutaneous nerve areas; at 30 min 97% had analgesia in the musculocutaneous nerve area, compared to 71% in Group A (p⫽0.013), but at 60 min there was no difference. In the other areas the development of the block was similar. Surgery was successfully performed, except in one Group C patient, who had a tourniquet applied during surgery, which was painful and general anaesthesia was needed. We conclude that both techniques provided adequate anaesthesia for forearm AV-fistula surgery, and the block developed significantly faster in Group C, which would allow earlier start of surgery.
Posters
•
Peripheral Nerve Block
139. Methadone added to local anesthetic for infraclavicular brachial plexus block does not prolong postoperative analgesia J.C. Tornero Tornero1, E. Domenech Pascual1, V. Roque´s Escolar2, B. Escamilla Can˜ete1, P. Ruiz Gimeno1 [email protected] 1Department Anethesiology, Hospital Clı´nico Universitario, Valencia, Spain, 2Department of Anesthesiology, Hospital Arrixaca, Murcia, Spain Background and Aims: Many opioids have been described as local anaesthetic coadjuvants (1-3). Our hypothesis checks whether the use of peripheral methadone in brachial plexus allows the prolongation the postoperative analgesia or not, therefore, allowing the decrease of systemic analgesic needs and their side effects. Methods: Prospective, double-blinded randomized study with 39 patients, ASA I-III, scheduled for superior limb traumatologic surgery. Three groups: 1. Infraclavicular control receiving infraclavicular mepivacaine; 2. Infraclavicular methadone receiving mepivacaine and methadone (0.1 mg/kg); 3. Systemic methadone receiving infraclavicular mepivacaine and subcutaneous methadone. Blockade was performed using the Wilson’s technique(4). All patients received 40 ml of 1.5% mepivacaine. Brachial plexus block was assessed after 10, 20 and 30 minutes. Analyzed parameter: Sensory and motor blockade of cubital, median, radial and musculous-cutaneous nerves, effectiveness, sensitivity duration, anesthesic technique assessment for patients after 24h. Adverse events and complications were recorded. Statistical analyses: ANOVA Test for quantitative parameters and chi-2 test for categorical parameters. Differences were considered statistically significant when P values were ⬍0.05. Results: No statistical difference was found for all parameters including sensory and motor blockade onset for the three groups on whatever the nerves studied (table 1). Conclusions: This study shows that 0.1 mg/kg methadone associated to mepivacaine for the infraclavicular blockade does not yield advantages when neither effectiveness, nor sensitivity duration nor patient’s satisfaction are analyzed.
References 1. 2. 3. 4.
Stewart DJ. J Bone Joint Surg Am 2005;87-A:140-4. Prieto-A´lvarez P. Can J Anaesth 2002;49:25-31. Candido KD. Reg Anesth Pain Med 2002;27:162-7. Wilson JL. Anesth Analg 1998;87:870-3.
146. Brachial plexus block for av-fistula surgery - comparison between infraclavicular coracoid and axillary techniques P.H. Rosenberg, T.T. Niemi [email protected] Department of Anaesthesiology and Intensisve Care Medicine, Helsinki University Hospital, Helsinki, Finland Infraclavicular brachial plexus block may guarantee better success in anaesthetizing the innervation area of surgery for creation of an AV-fistula on the lateral forearm (territory of musculociutaneous nerve) than the axillary approach. Sixty uremic patients were given in random order either an infraclavicular coracoid brachial plexus block (Group C) or an axillary brachial plexus block (Group A) using single nerve stimulation and 35-50 ml of mepivacaine 10 mg/ml with adrenaline. The first twitch response in one of the innervation areas of the four main nerves with current ⬍ 0.5 mA was accepted for locating the plexus. Sensory block was tested (blinded) with pin-prick and motor block by grip strength of the hand. In one obese patient, the coracoid process and the plexus could not be identified. In the majority of patients in both groups (NS) the median nerve was first located. Pin-prick analgesia (blunt or no sensation) developed faster in Group C in the axillary and musculocutaneous nerve areas; at 30 min 97% had analgesia in the musculocutaneous nerve area, compared to 71% in Group A (p⫽0.013), but at 60 min there was no difference. In the other areas the development of the block was similar. Surgery was successfully performed, except in one Group C patient, who had a tourniquet applied during surgery, which was painful and general anaesthesia was needed. We conclude that both techniques provided adequate anaesthesia for forearm AV-fistula surgery, and the block developed significantly faster in Group C, which would allow earlier start of surgery.