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Previous issue date: 2016-04-28 / Funda??o Carlos Chagas Filho de Amparo ? Pesquisa do Estado do RJ - FAPERJ / The brachial plexus block (BPB) remains one of the most intriguing topics of contemporary
anesthesia because, due to the complex organization of this structure is associated with a
significant number of failures. The aim of this study was to evaluate the effectiveness of
ultrasound-guided associated with peripheral nerve stimulation BPB in rabbits. Initially, 80
plexus were dissected, so as to enable researchers in the gross anatomy of the region. Later, in
the in vivo study, we used 40 male rabbits which were randomly divided into two groups:
Group 1: Ultrasound-guided associated with peripheral nerve stimulation (US/ENP) BPB;
Group 2: Peripheral nerve stimulation-guided (ENP) BPB. Under general anesthesia, axillary
BPB was performed, under lidocaine 2% without vasoconstrictor injection at the maximum
dose of 0,7ml.kg-1. The motor latency, motor block and volume difference between the BPB
between the techniques were evaluated by recording motor action potentials compounds of
the radial nerve. The measurement of skin temperature (ST), by infrared thermography, was
carried out in areas of interest, previously stipulated in the forepaw, digits and forearm, in
order to verify the correlation of the variation in the effectiveness of BPB. In 92.5% of the
animals the nerves resulting consisted of connections between the ventral rami of the last four
cervical spinal nerves (C5, C6, C7, C8) and first thoracic (T1). No significant difference was
observed in time performance of US/ENP-guided BPB (4.3 ? 0.73 min) or ENP-guided BPB
(6.4 ? 0.68 minutes), however, significantly less volume administration was necessary to local
anesthetic in the US/ENP-guided BPB (0.61 ? 0.15 mL vs 1.22 ? 0.17; P <0.0001). Despite
the lower volume used, it was observed that the US/ENP group had shorter on set time block
(1.1 ? 0.45) compared to ENP group (1.95 ? 0.79; P <0.01). The US/ENP-guided BPB or
ENP-guided BPB resulted in a substantial and significant increase in ST areas of interest in
the radial, musculocutaneous, median and ulnar nerves (P < 0.001), however this increase was
outstanding in hand and digits regions Thus it is concluded that the US/ENP-guided BPB is
an effective and easy technique to reproduce in this experimental model which required lower
volume of local anesthetic, provided a smaller motor latency and a higher motor blockade
time when compared to the ENP-guided BPB. The increase in ST is a highly effective tool for
assessing the effectiveness of BPB with predictive value, sensitivity and specificity of 100%.
Furthermore, future clinical studies are needed to verify its correlation with the anaesthetized
area. / O bloqueio do plexo braquial (BPB) permanece como um dos temas mais intrigantes da
anestesia contempor?nea, pois, devido a complexa organiza??o desta estrutura, est? associado
a um n?mero expressivo de insucessos. Com o estudo objetivou-se avaliar a efic?cia do
bloqueio do BPB guiado por ultrassonografia associado a estimula??o de nervos perif?rico em
coelhos. Inicialmente foram dissecados 80 plexos braquiais, de 40 cad?veres, de modo a
capacitar os pesquisadores na anatomia macrosc?pica da regi?o. Posteriormente, no estudo in
vivo, foram utilizados 40 coelhos do sexo masculino os quais foram aleatoriamente alocados
em dois grupos experimentais: Grupo 1: BPB guiado por ultrassonografia associado a
estimula??o de nervos perif?ricos (US/ENP); Grupo 2: BPB guiado por estimula??o de nervos
perif?rivos (ENP). Sob anestesia geral, o BPB foi realizado, por via axilar, atrav?s da inje??o
de lidoca?na 2% sem vasoconstrictor, na dose m?xima de 0,7ml.kg-1. A diferen?a entre o
tempo de lat?ncia motora, tempo de bloqueio motor e do volume necess?rio para o BPB entre
as t?cnicas foram avaliadas atrav?s da grava??o dos potenciais de a??o motores compostos do
nervo radial. A mensura??o da temperatura cut?nea (TC), por termografia infravermelha, foi
realizada em ?reas de interesse (AIEs), previamente estipuladas, nas m?os, d?gitos e
antebra?os, de modo a verificar a correla??o de sua varia??o com a efic?cia do BPB. Em
92,5% dos animais os nervos resultantes foram constitu?dos das conex?es entre os ramos
ventrais dos 4 ?ltimos nervos espinhais cervicais (C5, C6, C7, C8) e o primeiro tor?cico (T1).
N?o houve diferen?a significativa no tempo de performance do BPB guiado por US/ENP (4,3
? 0,73 min) ou por ENP (6,4 ? 0,68 min), no entanto, foi necess?rio a administra??o de um
volume significativamente menor de anest?sico local no grupo guiado por US/ENP (0,61 ?
0,15 ml versus 1,22 ? 0,17; P < 0,0001). Apesar do menor volume utilizado, observou-se que
o grupo US/ENP apresentou menor tempo para instala??o do bloqueio (1,1 ? 0,45) em
compara??o ao grupo ENP (1,95 ? 0,79; P < 0,01). O BPB guiado por US/ENP ou por ENP
resultou em um aumento substancial e significativo da TC nas AIEs dos nervos radial,
musculocut?neo ulnar e mediano (P < 0,001), no entanto, este aumento foi mais contudente na
regi?o da m?o e d?gitos. Nas AIEs dos nervos radial, mediano e ulnar na regi?o dorsolateral
das m?os, foram observadas as maiores varia??es de temperatura no grupo US/ENP em
compara??o ao ENP (radial 3,1 versus 2,0oC; mediano 4,5 versus 3,1 oC e ulnar 4,1 versus 3,6
oC). Dessa forma conclui-se que o BPB guiado por US/ENP ? uma t?cnica eficaz e de f?cil
reprodutibilidade no modelo experimental utilizado a qual requereu menor volume de
anest?sico local, proporcionou menor tempo de lat?ncia motora e maior tempo de bloqueio
motor quando comparado ao bloqueio guiado por ENP. O aumento da TC ? uma ferramenta
altamente eficaz na avalia??o da efic?cia do BPB com valor preditivo, sensibilidade e
especificidade de 100%. Outrossim,futuros estudos cl?nicos s?o necess?rios para verificar sua
correla??o com a ?rea anestesiada.
| Identifer | oai:union.ndltd.org:IBICT/oai:localhost:jspui/1473 |
| Date | 28 April 2016 |
| Creators | Moreira, Rodrigo Mencalha |
| Contributors | Figueiredo, Marcelo Abidu, Otero, Pablo Ezequiel, Sampaio, Marco Aur?lio Pereira, Souza, Diogo Benchimol de, Santos, Paulo Sergio Patto dos, Figueiredo, Nubia Ver?osa |
| Publisher | Universidade Federal Rural do Rio de Janeiro, Programa de P?s-Gradua??o em Medicina Veterin?ria (Patologia e Ci?ncias Cl?nicas), UFRRJ, Brasil, Instituto de Veterin?ria |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFRRJ, instname:Universidade Federal Rural do Rio de Janeiro, instacron:UFRRJ |
| Rights | info:eu-repo/semantics/openAccess |
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