Guadalupe Zaragoza-Lemus1, Verónica Hernández-Gasca2, Alejandro Espinosa-Gutiérrez3. 1. Servicio de Anestesiología, Instituto Nacional de Rehabilitación, México DF, México. Electronic address: zararegional@hotmail.com. 2. Servicio de Anestesiología, Instituto Nacional de Rehabilitación, México DF, México. 3. Servicio de Cirugía de Mano y Microcirugía, Instituto Nacional de Rehabilitación, México DF, México.
Abstract
BACKGROUND: Continuous perineural infusion of local anesthetic provides better postoperative analgesia than intravenous administration of opioids or NSAIDs in upper limb surgery. The infraclavicular approach is a good option due to the muscular stability to catheter; the abduction of the arm apparently makes more superficial the brachial plexus and which elevates clavicle cephalad. AIM: The aim of this study was to identify whether the abduction of the arm for to decreases the skin-plexus distance, facilitating it catheter insertion in a perineural way for a better analgesia. This relation between the arm and the colocation of catheter has not yet been established. MATERIAL AND METHODS: We included 58 adult patients, undergoing forearm and hand surgery, initially divided into two groups, adduction and abduction. It was placed continuous infraclavicular block guided by ultrasound, it allow the catheter tip was adjacent to the posterior cord. In the group patients with high technical difficulties were allowed to reposition the arm abduction, recording number of punctures, redirects, ease of insertion of the catheter and skin-plexus distance. RESULTS: The abduction of the arm moved the clavicle toward cephalad and separated it from the linear transducer, this allowed to maneuver the needle right angle and redirect it, the distance skin-plexus did not decrease significantly with arm position. CONCLUSIONS: Arm abduction allows better scanning facilitates the infraclavicular puncture and catheter introduction.
BACKGROUND: Continuous perineural infusion of local anesthetic provides better postoperative analgesia than intravenous administration of opioids or NSAIDs in upper limb surgery. The infraclavicular approach is a good option due to the muscular stability to catheter; the abduction of the arm apparently makes more superficial the brachial plexus and which elevates clavicle cephalad. AIM: The aim of this study was to identify whether the abduction of the arm for to decreases the skin-plexus distance, facilitating it catheter insertion in a perineural way for a better analgesia. This relation between the arm and the colocation of catheter has not yet been established. MATERIAL AND METHODS: We included 58 adult patients, undergoing forearm and hand surgery, initially divided into two groups, adduction and abduction. It was placed continuous infraclavicular block guided by ultrasound, it allow the catheter tip was adjacent to the posterior cord. In the group patients with high technical difficulties were allowed to reposition the arm abduction, recording number of punctures, redirects, ease of insertion of the catheter and skin-plexus distance. RESULTS: The abduction of the arm moved the clavicle toward cephalad and separated it from the linear transducer, this allowed to maneuver the needle right angle and redirect it, the distance skin-plexus did not decrease significantly with arm position. CONCLUSIONS: Arm abduction allows better scanning facilitates the infraclavicular puncture and catheter introduction.