Year 2014 Vol. 22 No 6

ANESTHESIOLOGY-REANIMATOLOGY

A.V. BRUKHNOU, V.G. PIACHERSKI, A.V. MARACHKOU, Z.V. KOKHAN

REGIONAL INTERSCALENE BRACHIAL PLEXUS BLOCK ACCESS USING MINIMAL DOSES OF LOCAL ANESTHETIC

HI "Mogilev Regional Hospital"
The Republic of Belarus

Objectives. To work out an effective method of the ultrasound-assisted regional interscalene brachial plexus block access using minimal doses of local anesthetic.
Methods. Two groups of patients were formed. In group A 40 brachial plexus blocks using interscalene access with minimal doses of local anesthetic have been performed at the level of the ventral roots of spinal nerves C5, C6, C7, C8, Th1. Local anesthetic (ropivacaine 0,75%) was injected per one milliliter to each of five roots, the total volume of local anesthetic injected 5 ml. In the control group B (27 cases) the block was done using interscalene access at the level of the brachial plexus trunks with 30 ml of 0,75% ropivacaine. In group A when the area of surgical intervention extended to the area of innervation by the branches of superficial cervical plexus (the operations on the clavicle), additionally, the block of the superficial cervical plexus branches has been performed. In group B the additional block of the superficial cervical plexus branches during surgical procedures on the clavicle was not required.
Results. According to the results of the blocks in all 67 patients the motor block was evaluated as + and ++; the sensory block was evaluated in the areas of the intended surgery and, in all cases the patients reported the inability to differentiate the thermal stimulus and did not feel the needle injection. Anesthesia in both groups was found to be effective for a planned surgery; the transition to another type of anesthesia was not required.
Conclusion. The presented method for the selective block of the brachial plexus at the level of the ventral spinal nerve roots C5, C6, C7, C8, Th1 using minimal dose of local anesthetic (5 ml of 0,75% ropivacaine) is considered to be adequate to in terms of anesthesia to the brachial plexus block (30 ml of 0,75% ropivacaine) at the trunk level. Herewith the probability of systemic toxicity development of local anesthetic effect has reduced; this also applies to reduce financial costs of regional blockades.

Keywords: brachial plexus block, minimal volume, complications, ropivacaine
p. 715-720 of the original issue
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Address for correspondence:
212026, Respublika Belarus',
g. Mogilev, ul. B.-Biruli, d. 12,
UZ Mogilevskaia oblastnaia bol'nitsa,
otdelenie anesteziologii i reanimatsii,
tel. mob.: +375 29 630-75-48,
e-mail: andreibruhnov@gmail.com,
Brukhnov Andrei Viktorovich
Information about the authors:
Bruhnov AV. An anesthesiologist of department of anesthesiology and Intensive care of Mogilev Regional Hospital.
Pechersky VG. An anesthesiologist of department of anesthesiology and intensive care of Mogilev Regional Hospital.
Marochkov AV. MD, professor, a head of the department of anesthesiology and intensive care "Mogilev Regional Hospital."
Kohan ZV. An anesthesiologist of department of anesthesiology and Intensive care of Mogilev Regional Hospital.
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