Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures [Response To Letter]

IF 1.5 Q3 ANESTHESIOLOGY Local and Regional Anesthesia Pub Date : 2019-11-01 DOI:10.2147/lra.s238432
Chanchal Mangla, H. Kamath, J. Yarmush
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引用次数: 1

Abstract

Department of Anesthesiology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA Dear editor We would like to thank Dr Hendrickson et al for their interest in our work and writing about their opinion. We agree with the comment that mixing local anesthetics might make individual safe doses unknown, so maximum recommended doses of each local anesthetic should not be used. There are no human studies but it can be presumed to be additive based on some animal studies. We mixed local anesthetics in our patients so that we could decrease the volume of more toxic local anesthetics (Bupivacaine) by using some less toxic ones (like chloroprocaine). We also used doses of each local anesthetic of well below the recommended toxic doses and did spacing in our blocks to avoid toxicity. Though axillary blocks along with medial brachial cutaneous and intercostobrachial block can be used, we chose not to perform bilateral axillary blocks because it requires individual blockage of the terminal nerves which might lead to inadequate coverage, and also, performance of the block time and onset time is longer. Instead, we did infraclavicular block on one side, which greatly decreases the chances of phrenic nerve palsy. Dr Hendricken made a very good point of using ropivacaine instead of bupivacaine due to less toxicity, but unfortunately we do not have ropivacaine available at our institution. Lastly, smaller volume of local anesthetics can be used with the use of ultrasound for a successful block. We used 30 mL volume for each block, as we wanted to ensure complete coverage of surgical anesthesia and to avoid any supplementation/ deeper sedation or general anesthesia in case of an incomplete block. Also, our second block was more than two hours later, hence we avoided the overlap of peak plasma concentration of the local anesthetics from first and second blocks.
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氯洛卡因用于双侧桡骨骨折手术的双侧臂丛阻滞[回复信函]
美国纽约布鲁克林纽约长老会布鲁克林卫理公会医院麻醉科尊敬的编辑,我们要感谢Hendrickson博士等人对我们的工作感兴趣,并撰写他们的意见。我们同意这样的评论,即混合局部麻醉剂可能会使个人的安全剂量未知,因此不应使用每种局部麻醉剂的最大推荐剂量。目前还没有人类研究,但根据一些动物研究,可以推测它是加性的。我们在患者身上混合了局部麻醉剂,这样我们就可以通过使用一些毒性较小的局部麻醉剂(如氯普鲁卡因)来减少毒性较大的局部麻醉剂的体积(布比卡因)。我们还使用了远低于推荐毒性剂量的每种局部麻醉剂的剂量,并在我们的区块中进行了间隔以避免毒性。虽然可以使用腋窝阻滞以及内侧臂皮肤和肋间臂阻滞,但我们选择不进行双侧腋窝阻滞,因为它需要单独阻断末端神经,这可能导致覆盖不足,而且阻滞时间和起效时间更长。相反,我们在一侧进行了锁骨下阻滞,这大大降低了膈神经麻痹的几率。Hendricken博士非常重视使用罗哌卡因代替布比卡因,因为毒性较小,但不幸的是,我们机构没有罗哌卡因。最后,较小体积的局部麻醉剂可以与超声波一起使用,以成功阻断。我们为每个阻滞使用了30mL的体积,因为我们希望确保手术麻醉的完全覆盖,并避免在阻滞不完全的情况下进行任何补充/更深的镇静或全身麻醉。此外,我们的第二次阻滞是在两个多小时后,因此我们避免了第一次和第二次局部麻醉剂峰值血浆浓度的重叠。
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来源期刊
CiteScore
6.30
自引率
0.00%
发文量
12
审稿时长
16 weeks
期刊最新文献
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