The effect of supraclavicular

improvement brachial plexus block

in Pho Noi General hospital, Hung Yen province .

Nguyen Kim Doanh, Cong Quyet Thang, Tran Thi

Kiem .

1 -Evaluating the effect of the method 1 -Evaluating the effect of the method supraclavicular brachial plexus block supraclavicular brachial plexus block improvement in surgery upper limb .improvement in surgery upper limb .

2 -Evaluating the reduction of 2 -Evaluating the reduction of unwanted effects :unwanted effects :

+ Avoiding the diaphragm nerves and + Avoiding the diaphragm nerves and middle neck sympathetic nerve middle neck sympathetic nerve plexus actively.plexus actively.

+Having good anesthesia level in +Having good anesthesia level in supraclavicular and upper limb supraclavicular and upper limb surgery[1]F.130 . surgery[1]F.130 .

[1]Atlas Frank H. Netter,MD-2010.[1]Atlas Frank H. Netter,MD-2010.

STUDYING TARGETSSTUDYING TARGETS

-Object : Total 96 combined bone -Object : Total 96 combined bone patients :patients :

arm 29; clavicle 34; forearm bone 17; arm 29; clavicle 34; forearm bone 17; nerve, soft tissue 16 . nerve, soft tissue 16 .

-Method: N1(48)-Lido: 6mg/kg+Fen: -Method: N1(48)-Lido: 6mg/kg+Fen: 2µkg. 2µkg.

                                  N2(48)-Lido: 8mg/kg. N2(48)-Lido: 8mg/kg.

-Time: 05 / 2011-07 / 2014. -Time: 05 / 2011-07 / 2014.

-Location: -Location: Anesthesia departmentAnesthesia department in Pho Noi General Hospital - Hung in Pho Noi General Hospital - Hung Yen Province .Yen Province .

Object and Method ResearchObject and Method Research

Scientific base - TechniqueScientific base - Technique-Anatomy: Brachial nerve plexus[1]Figure 32 -Anatomy: Brachial nerve plexus[1]Figure 32

+Anesthetic to:C5,6,7,8,T1(large area) . +Anesthetic to:C5,6,7,8,T1(large area) .

+Forearm surgery: 1-point injection between +Forearm surgery: 1-point injection between 1.5 cm above the clavicle (the no arteries 1.5 cm above the clavicle (the no arteries area[1] Figure 32) . Lido:6mg/kg+Fen2µg; area[1] Figure 32) . Lido:6mg/kg+Fen2µg; V:40ml . V:40ml .

-upper clavicle nerve, deep neck plexus C3,4. -upper clavicle nerve, deep neck plexus C3,4.

+ Arms surgery :2-point injection ; avoid + Arms surgery :2-point injection ; avoid location of diaphragm nerve .location of diaphragm nerve .

+ Upper clavicle surgery : 3-point + Upper clavicle surgery : 3-point injection[1]F.24. injection[1]F.24.

-Lido: 2mg + Fen: 1µg/kg; V: 20ml .-Lido: 2mg + Fen: 1µg/kg; V: 20ml .

CRITERIAL EVALUATIONCRITERIAL EVALUATION

-Pulse, mean blood pressure, -Pulse, mean blood pressure, respiration, SpO2: respiration, SpO2:

+T1 (before anesthesia 5-15 minutes) . +T1 (before anesthesia 5-15 minutes) .

+T2 (After surgery 5 minutes);T3 (End +T2 (After surgery 5 minutes);T3 (End of surgery) of surgery)

+T4 (Finish motor inhibition); T5 +T4 (Finish motor inhibition); T5 (finish sense of inhibition) .(finish sense of inhibition) .

-Time waiting for surgery and the -Time waiting for surgery and the degree of inhibition of pain sensation, degree of inhibition of pain sensation, movement; operation time . movement; operation time .

-The Complications, unwanted effects .-The Complications, unwanted effects .

RESULTSRESULTS

-Time waiting surgery.N1:7.37±2.47;-Time waiting surgery.N1:7.37±2.47;[6]:8,23±2,55 .[6]:8,23±2,55 .

-Time inhibit pain sensation. -Time inhibit pain sensation. N1(Li+Fe):215±28.7 . [6]:198±40,3; N1(Li+Fe):215±28.7 . [6]:198±40,3; N2(Lido):175 ± 17.5[6]:148±22,2. N2(Lido):175 ± 17.5[6]:148±22,2.

-Time surgery:N1: 67 ± 18.8; N2: -Time surgery:N1: 67 ± 18.8; N2: 65±15.8(min) .65±15.8(min) .

-Surgical position: Clavicle 34; Arm 29. Forearm -Surgical position: Clavicle 34; Arm 29. Forearm 17; Soft tissue 16 .17; Soft tissue 16 .

-Unwanted effects:Horner syndrome; -Unwanted effects:Horner syndrome; Respiratory failure due to diaphragmatic nerve Respiratory failure due to diaphragmatic nerve paralysis; paralysis X nerve : 0%. Hit on the paralysis; paralysis X nerve : 0%. Hit on the top of lungs, poisoning Lido, fentanyl : O% . top of lungs, poisoning Lido, fentanyl : O% .

-Hit into vessel: 4,15%(n = 96).-Hit into vessel: 4,15%(n = 96).

Pulse Pulse (times/min)(times/min)

Results: Blood pressure, respiratory Results: Blood pressure, respiratory frequency,Sp02frequency,Sp02

The mean blood The mean blood pressure (mmHg)pressure (mmHg)

respirationrespiration Frequency Frequency

(times/min)(times/min)SpO2(%)SpO2(%)

Comment: Blood pressure changes, Comment: Blood pressure changes, respiratory frequency in both groups respiratory frequency in both groups with p > 0.05 are within permissible with p > 0.05 are within permissible limits, no statistically significantlimits, no statistically significant

DISCUSSION-1.DISCUSSION-1.-Pulse, mean blood pressure, respiratory -Pulse, mean blood pressure, respiratory

rate, SpO2 in two groups: modification in rate, SpO2 in two groups: modification in patients within the limits, no statistical patients within the limits, no statistical significance(p>0.05). significance(p>0.05).

-Time anesthetic inhibit. -Time anesthetic inhibit. N1: 215±28.7; N1: 215±28.7;

[6]198±40,3[6]198±40,3 ≠ N2: 175 ± 17.5; ≠ N2: 175 ± 17.5; [6]148±22,2(min) . [6]148±22,2(min) .

-Time waiting surgery. N1: 7.37± 2.47;-Time waiting surgery. N1: 7.37± 2.47;[6]:8,23±2,55 [6]:8,23±2,55

≠ ≠ N2: 7.46 ± 2.45;N2: 7.46 ± 2.45;[6]:10,50±2,72(min). [6]:10,50±2,72(min).

-Surgical position: clavicle 34; arm 29 and -Surgical position: clavicle 34; arm 29 and forearm bones 17; Soft tissue, blood forearm bones 17; Soft tissue, blood vessels, nerves 16 .vessels, nerves 16 .

DISCUSSION-2.DISCUSSION-2.Compared with other studies[2,6,7].Compared with other studies[2,6,7].

[2]Technical classic Winnie: respiratory [2]Technical classic Winnie: respiratory distress 85-100%. distress 85-100%.

This study : O%, similar to[2,6,7] This study : O%, similar to[2,6,7]

-C.Bernerd syndrome[2]-C.Bernerd syndrome[2]90%;[6]3.75%;90%;[6]3.75%;[7]6.8%. [7]6.8%.

-Nerve paralysis recurrent branch--Nerve paralysis recurrent branch-XX[2]12.5%; [7]3.4%;[2]12.5%; [7]3.4%;

-To hit into blood vessels: this study 4.15%;-To hit into blood vessels: this study 4.15%;

[2]: 5%;[6]: 6.25%;[9]: 14% .[2]: 5%;[6]: 6.25%;[9]: 14% .*Interscalene technique : *Interscalene technique :

-[2](2001)Ng.V.Hạc;[7](2011) Ng.H.Sơn-Lido8mg/kg/P.-[2](2001)Ng.V.Hạc;[7](2011) Ng.H.Sơn-Lido8mg/kg/P.

-[6](2011)Ng.N.Bính-Li+Sufentanil:2-[6](2011)Ng.N.Bính-Li+Sufentanil:2µg/kg/Pµg/kg/P(N=80) .(N=80) .

DISCUSSION-3.DISCUSSION-3.

Axillary technic line .Axillary technic line .

-[5]-[5]7676//81%81%: axillary n/musculocutaneous : axillary n/musculocutaneous nerve ; nerve ;

V.Andersen(1983): V.Andersen(1983): 7272//76%76% , Lido: 1%; , Lido: 1%; V:80ml . V:80ml .

-[9]: -[9]: 89.989.9//97.9%.97.9%. Lido: 1% (6mg/kg).V: Lido: 1% (6mg/kg).V: 40ml . 40ml .

+Due improved injection site .+Due improved injection site .

+Vascular lesions by 14% .+Vascular lesions by 14% .

[5]Ng.H.Hoa(2003)-Lido:7mg+Clonidine:1µg.[5]Ng.H.Hoa(2003)-Lido:7mg+Clonidine:1µg.

[9]H.V.Chuong(2000)-Lidocain:6mg/kg/P.[9]H.V.Chuong(2000)-Lidocain:6mg/kg/P.

DISCUSSION-4

Supraclavicular technic line . -[8](n=60) achieved numbness of º3:

50%(Mar: 2 mg/kg); 70%(Mar+Fen: 2µg/kg); V:20ml .

-[7]: 100% (Mar: 2 mg/kg); V:40ml, similar to the results of research .

*Comment: V40ml suitable for the all upper limb surgery.

-[8]Ng.M.Tu(2003):Marcaine & Fentanyl . -Pham Hung[7](2014)pp.28-Anesthesia by

Marcain .

Conclusion.

The anaesthetic method improvement:The anaesthetic method improvement:

-The changes of blood pressure, -The changes of blood pressure, respiration in normal. respiration in normal. To get good numbness for surgery & get safe 100%.

-Actively avoid diaphragmatic nerve & sympathetic middle neck plexus: C.Bernerd syndrome, respiratory failure due to diaphragmatic nerve paralysis, paralysis recurrent vice-X nerve hasn’t happened.

-We’d like: Pharmacy firm produce Marcaine 5mg/ampoule