[Axillary local anesthetic spread after the thoracic interfacial ultrasound block - a cadaveric and radiological evaluation].

Autor:	Torre PA; Tajo University Hospital, Madri, Espanha., Jones JW Jr; University of Tennessee Health Science Center/Regional One Health, College of Medicine, Department of Anesthesiology, TN, EUA., Álvarez SL; Hospital Complexo Hospitalario de A Coruña, Coruña, Espanha., Garcia PD; Hospital Complexo Hospitalario de A Coruña, Coruña, Espanha., Miguel FJG; Hospital General de Segovia, Departamento de Anestesia, Segovia, Espanha., Rubio EMM; Tajo University Hospital, Departamento de Anestesia, Madri, Espanha., Boeris FC; Hospital Universitario Parc Tauli Sabadell, Sabadell, Espanha., Sacramento MK; Hospital Universitário de Guadalajara, Guadalajara, Espanha., Duany O; Primary Care and Chronic Pain Management Attending, Department of Veterans Affairs, Muskogee, OK, EUA., Pérez MF; Hospital Universitario de Móstoles, Madri, Espanha. Electronic address: mfajardoperez@yahoo.es., Gordon BQ; Hospital Universitario de Móstoles, Departamento de Anestesia, Madri, Espanha.
Jazyk:	portugalština
Zdroj:	Revista brasileira de anestesiologia [Rev Bras Anestesiol] 2017 Nov - Dec; Vol. 67 (6), pp. 555-564. Date of Electronic Publication: 2017 Sep 01.
DOI:	10.1016/j.bjan.2016.10.009
Abstrakt:	Background: Oral opioid analgesics have been used for management of peri- and postoperative analgesia in patients undergoing axillary dissection. The axillary region is a difficult zone to block and does not have a specific regional anesthesia technique published that offers its adequate blockade. Methods: After institutional review board approval, anatomic and radiological studies were conducted to determine the deposition and spread of methylene blue and local anesthetic injected respectively into the axilla via the thoracic inter-fascial plane. Magnetic Resonance Imaging studies were then conducted in 15 of 34 patients scheduled for unilateral breast surgery that entailed any of the following: axillary clearance, sentinel node biopsy, axillary node biopsy, or supernumerary breasts, to ascertain the deposition and time course of spread of solution within the thoracic interfascial plane in vivo. Results: Radiological and cadaveric studies showed that the injection of local anesthetic and methylene blue via the thoracic inter-fascial plane, using ultrasound guide technique, results in reliable deposition into the axilla. In patients, the injection of the local anesthetic produced a reliable axillary sensory block. This finding was supported by Magnetic Resonance Imaging studies that showed hyper-intense signals in the axillary region. Conclusions: These findings define the anatomic characteristics of the thoracic interfascial plane nerve block in the axillary region, and underline the clinical potential of this novel nerve block. (Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)
Databáze:	MEDLINE
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