D. Nieuwveld, V. Mojica, A. E. Herrera, J. Pomés, A. Prats, Xavier Sala Blanch
Objetivo Describir el bloqueo costoclavicular ecoguiado con acceso medial, evaluando su desarrollo mediante la evaluación motora, sensitiva y simpática.
Materiales y métodos Descripción inicial de la técnica y punción ecoguiada con contraste en cadáver, evaluando la distribución de un volumen de 20 ml mediante tomografía computarizada (TC) y secciones sagitales de la pieza anatómica. Posteriormente, una fase clínica con inclusión de 11 pacientes a quienes se evaluó la instauración del bloqueo motor, sensitivo y simpático. Este último a través de la medición del flujo humeral, el índice de perfusión digital y la temperatura cutánea distal.
Resultados En el cadáver se realizó el acceso sin dificultades y se evidenció una adecuada distribución periclavicular de medio de contraste en la TC y en las secciones, alcanzando desde el espacio interescalénico hasta los troncos secundarios. El 91% de los pacientes presentó bloqueo quirúrgico a los 25 min. Todos los parámetros de bloqueo simpático evaluados aumentaron significativamente. El flujo arterial humeral aumentó de 108 ± 86 a 188 ± 141 ml/min (p = 0,05). La temperatura cutánea de 32,1 ± 2 a 32,8 ± 9 °C (p = 0,03) y el índice de perfusión de 4 ± 3 a 9 ± 5 (p = 0,003).
Conclusiones El abordaje medial del bloqueo costoclavicular ecoguiado fue anatómicamente factible y con elevada eficacia clínica tras 20 ml de mepivacaína al 1,5%. El bloqueo simpático obtenido puede evaluarse mediante los 3 parámetros estudiados.
Introduction Ultrasound-guided infraclavicular block in the costoclavicular space located between the clavicle and the first rib, reaches the secondary trunks when they are clustered together and lateral to the axillary artery. This block is most often performed through a lateral approach, the difficulty being finding the coracoid process an obstacle and guiding the needle towards the vessels and pleura. A medial approach, meaning from inside to outside, will avoid these structures. Traditionally the assessment of a successful block is through motor or sensitive responses but a sympathetic fibre block can also be evaluated measuring the changes in humeral artery blood flow, skin temperature and/or perfusion index.
Objective To describe the medial approach of the ultrasound-guided costoclavicular block evaluating its development by motor and sensitive response and measurement of sympathetic changes.
Materials and methods Description of the technique and administration of 20 ml of contrast in a fresh cadaver model, evaluating the distribution with CT-scan and sagittal sections of the anatomic piece. Subsequently in a clinical phase, including 11 patients, we evaluated the establishment of motor, sensitive and sympathetic blocks. We evaluated the sympathetic changes reflected by humeral artery blood flow, skin temperature and distal perfusion index.
Results In the anatomical model the block was conducted without difficulties, showing an adequate periclavicular distribution of the contrast in the CT-scan and in sagittal sections, reaching the interscalenic space as far as the secondary trunks. Successful blocks were observed in 91% of patients after 25 minutes. All the parameters reflecting sympathetic block increased significantly. The humeral artery blood flow showed an increase from 108 ± 86 to 188 ± 141 ml/min (P=.05), skin temperature from 32.1 ± 2 to 32.8 ± 9 °C (P=.03) and perfusion index from 4 ± 3 to 9 ± 5 (P=.003).
Conclusions The medial approach of the ultrasound-guided costoclavicular block is anatomically feasible, with high clinical effectiveness using 20 ml of 1.5% mepivacaine. The sympathetic block can be evaluated with all three parameters studied.
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