Factors associated with failed brachial plexus regional anesthesia for upper limb surgery
Introduction: Brachial plexus block as an anesthetic technique for upper limb surgery has some advantages over general anesthesia. The technique is widely used in our practice, with high effectiveness and adequate safety profile. However, the relationship between block failure and failure-determining factors has not been measured.
Objectives: To identify and quantify brachial plexus block failure-associated factors for upper limb surgery as an initial observation aimed at developing prevention-oriented risk profiles and strategies.
Materials and methods: An analytical observational study was conducted by collecting data from electronic medical records of upper limb surgery using brachial plexus block from the San Ignacio University Hospital between 2011 and 2012. Block failures were identified using standardized clinical criteria, measuring potentially associated factors. Dichotomous comparisons were made and uni-and multivariate logistic regression analysis was performed to identify potential statistically significant variables, based on failed cases and successful controls.
Results: None of the proposed factors was independently associated with failure of brachial plexus block. A qualitative description of failed cases presented confounding factors associated with local practices and the failure characteristics did not show a clinically plausible trend.
Conclusions: There were no factors determined by patient, anesthetic procedure, surgical procedure and operator that could be independently associated with brachial plexus block failure. The suggestion is to fine-tune the definition of failures, not just in the research environment, but in the current clinical practice; to improve the anesthesia records to rise the numbers and the quality of data bases for a quantitative determination of the risk of peripheral regional anesthesia failure and design prevention strategies focused on risk groups.
2. O'Donnell BD, Ryan H, O'Sullivan O, Iohom G. Ultrasound-guided axillary brachial ple-xus block with 20 milliliters local anesthetic mixture versus general anesthesia for upper limb trauma surgery: an observer-blinded, prospective, randomized controlled trial. Anesth Analg. 2009;109:279-83.
3. Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2005:1634-42.
4. Bruce BG, Green A, Blaine T, Wesner L. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am Aca Orthop Surg. 2012;20:38-47.
5. Cotter JT, Nielsen KC, Guller U, Steele SM, Klein SM, Greengrass R, et al. Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery - an analysis of 9342 blocks. Can J Anaesth. 2004;51:810-6.
6. Hadzic A, Arliss J, Kerimoglu B, Karaca PE, Yufa M, Claudio RE, et al. A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day-case surgeries. Anesthesiology. 2004;101:127-32.
7. Hadzic A, Williams B, Karaca PE, Hobeika P, Unis G, Dermksian J, et al. For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology. 2005;102:1001-7.
8. Chan VW, Peng PW, Kaszas Z, Middleton WJ, Muni R, Anastakis DG, et al. A comparative study of general anesthesia, intravenous regional anesthesia, and axillary block for outpatient hand surgery: clinical outcome and cost analysis. Anesth Analg. 2001;93:1181-4.
9. McCartney CJL, Brull R, Chan VWS, Katz J, Abbas S, Graham B, et al. Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery. Anesthesiology. 2004;101:461-7.
10. Liu SS, Wu CL. Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence. Anesth Analg. 2007;104:689-702.
11. Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R, et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med. 2008;33:253-8.
12. Warman P, Nicholls B. Ultrasound-guided nerve blocks: efficacy and safety. Best Pract Res Clin Anaesthesiol. 2009;23:313-26.
13. Marhofer P, Schrogendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med. 1998;23:584-8.
14. Salinas F, Hanson N. Evidence-based medicine for ultrasound-guided regional anesthesia Anesthesiol Clin. 2014;32:771-87.
15. Fuzier R, Lavidale M, Bataille B, Richez S, Maguès P. Anxiété: facteur prédictif d'échec du bloc axillaire sous neurostimulation? Ann Fr Anesth Reanim. 2010;29:776-81.
16. Hanouz J-L, Grandin W, Lesage A, Oriot G, Bonnieux D, Gérard J-L. Multiple injection axillary brachial plexus block: influence of obesity on failure rate and incidence of acute complications. Anesth Analg. 2010;111:1.
17. Franco CD, Gloss FJ, Voronov G, Tyler SG, Stojiljkovic LS. Supraclavicular block in the obese population: an analysis of 2020 blocks. Anesth Analg. 2006;102:1252-4.
18. Song IA, Gil S, Choi E, Sim E, Min W, Ro Y-J, et al. Axillary approach versus the infraclavicular approach in ultrasound-guided brachial plexus block: comparison of anesthetic time. Korean J Anesthesiol. 2011;61:12.
19. Roussel J, Thirkannad S. Comparison of 3 ultrasound-guided brachial plexus block approaches for cubital tunnel release surgery in 120 ambulatory patients. AANA J. 2014;82:121-6.
20. English L, Holme JM, Burkard JF, Vacchiano C, Shin A, Pellegrini J, et al. Effect of needle size on success of transarterial axillary block. AANA J. 2004:57-60.
21. Sandhu NS, Capan LM. Ultrasound-guided infraclavicular brachial plexus block. Br J Anaesth. 2002;89:254-9.
22. Zencirci B. Comparision of nerve stimulator and ultrasonography as the techniques applied for brachial plexus anesthesia. Int Arch Med. 2011;4:4.
23. Grueso Angulo R, Sanín Hoyos A, Bonilla Ramírez AJ, García Carreño A, Cubillos Salcedo J. Comparación entre la técnica de multi-inyección y la inyección única con localización del nervio mediano en el bloqueo infraclavicular para cirugía del miembro superior Rev Colomb Anestesiol. 2010;38: 22-32.
24. Rodríguez J, Bárcena M, Taboada-Muñiz M, Lagunilla J, Álvarez J. A comparison of single versus multiple injections on the extent of anesthesia with coracoid infraclavicular brachial plexus block. Anesth Analg. 2004;99:1225-30.
25. Neal JM, Gerancher CJ, Hebl JR, Ilfeld BM, Mccartney CJL, Franco CD, et al. Upper extremity. Reg Anesth Pain Med. 2009;34:134-70.
26. Yazer MS, Finlayson RJ, Tran DQH. A randomized comparison between infraclavicular block and targeted intracluster injection supraclavicular block. Reg Anesth Pain Med. 2015;40:11-5.
27. Chan VWS, Perlas A, McCartney CJL, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. 2007;54:176-82.
28. Dingemans E, Williams SR, Arcand G, Chouinard P, Harris P, Ruel M, et al. Neurostimulation in ultrasound-guided infraclavicular block: a prospective randomized trial. Anesth Analg. 2007;104:1275-80.
29. Antonakakis JG, Ting PH, Sites B. Ultrasound-guided regional anesthesia for peripheral nerve blocks: an evidence-based outcome review. Anesthesiol Clin Elsevie Ltd. 2011;29: 179-91.
30. Orebaugh S, Williams B, Kentor M. Ultrasound guidance with nerve stimulation reduces the time necessary for resident peripheral nerve blockade. Reg Anesth Pain Med. 2007;32:448-54.
31. López-Morales S, Moreno-Martín A, Leal del Ojo JD, Rodriguez-Huertas F. Bloqueo axilar ecoguiado frente a bloqueo infraclavicular ecoguiado para la cirugía de miembro superior. Rev Esp Anestesiol Reanim. 2013;60:313-9.
32. Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: Part 1. Br J Anaesth. 2010;104:538-46.
33. Lewis SR, Price A, Walker KJ, McGrattan K, Smith AF. Ultrasound guidance for upper and lower limb blocks. Cochrane Data Base Syst Rev. 2015:9. [ Links ]
34. Casati A, Danelli G, Baciarello M, Corradi M, Leone S, Di Cianni S, et al. A prospective, randomize comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology. 2007;106:992-6.
35. Gianesello L, Pavoni V,Coppini R, Buoninsegni LT, Gori G, Mori E, et al. Comfort and satisfaction during axillary brachial plexus block in trauma patients: comparison of techniques. J Clin Anesth. 2010;22:7-12.
36. Ferraro LHC, Takeda A, dos Reis Falcão LF, Rezende AH, Sadatsune EJ, Tardelli MA. Determination of the minimum effective volume of 0.5% bupivacaine for ultrasound-guided axillary brachial plexus block. Rev Bras Anestesiol. 2014;64:49-53.
37. Hadzic A, Dewaele S, Gandhi K, Santos A. Volume and dose of local anesthetic necessary to block the axillary brachial plexus using ultrasound guidance. Anesthesiology. 2009;111:8-9.
38. Kumar A, Sharma D, Sibi E, Datta B, Gogoi B. Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique. Indian J Anaesth. 2014;58:700.
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