Журнал «Медицина неотложных состояний» 4 (75) 2016
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Brachial Plexus Block Successfully Relieves a Brachial Artery Spasm During Transradial PCI
Авторы: Yevstratov Eugene, Krupskaya Natalia
Pain Clinic of St. Katherine Hospital of Cardiology Anaesthesiology, Odessa Regional Hospital, Odessa, Ukraine
Разделы: Медицинские форумы
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The radial artery approach for coronary angiography and angioplasty has been shown to be a safe alternative to the femoral approach. Although this technique is increasingly preferred, brachial artery spasm (BAS), a potential complication, limits its widespread use. BAS may be resistant to vasodilator medications, which are usually useful in this situation, and may cause serious complications. We performed coronary artery angiography by 5Fr catheters.
Regional anesthesia for an ambulatory practice in this category of patients requires local anesthetics with a clear profile: fast onest, well-defined duration an early reco–very from paralysis but with long analgesia for painfree discharge. Nearly any regional anesthesia technique is suitable, however, the new local anesthetics ropivacaine and levobupivacaine are long acting agents and differ concerning the differential blockade. In all our cases was performed a single shot technique under ultrasonography guiduance by the same anesthesiologist during procedure.
Brachial plexus block (BPB): single shot techniques in adults, 15 ml 0.250% solution of ropivacaine can be used to provide this technique with selective nerve sti–mulation, leads to short-acting blockade of the nerve and long-acting sensitive blockade1.This technique allows to reduce volumes and the risk of systemic toxicity. Commonly we are used a both approaches anterior interscalenius block with stellate ganglion block,and posterior acces of BPB anterior access the neck slightly flexed, keep the nerve stimulator output constant between 0.5 and 1.5 mA under ultrasonography guiduance 8–11 MHz2. The posterior approach provides less motor block than the anterior approach. Patients on anticoagulants who undergo (BPB) should be managed with the precautions and require accuracy and profetional skills from an –anaesthesilogist. Ultrasonography guidance will be helpful to performe BPB avoid blood vessel puncture.