Resumen
Objetivo: Comparar la latencia del bloqueo infraclavicular entre el uso de bupivacaína sola y bupivacaína asociada a lidocaína en cirugías de fractura del antebrazo. Métodos: Estudio clínico aleatorizado realizado en el Hospital Maradei (Belém, PA, Brasil), con la inclusión de 42 pacientes. Se evaluaron el perfil epidemiológico, la intensidad del dolor (EVA) y la fuerza muscular (BMRC) a los 5 y 10 minutos posteriores al bloqueo en los grupos control (bupivacaína al 0,5%) e intervención (bupivacaína al 0,25% asociada a lidocaína al 1%). Resultados: Los grupos fueron comparables en cuanto al sexo y el IMC; no obstante, el grupo de intervención presentó una mayor proporción de pacientes ASA I (76,2%; p=0,0443) y de pacientes con diabetes mellitus. Se observó una reducción estadísticamente significativa del dolor en el grupo de intervención a los 5 minutos (p=0,0028) y a los 10 minutos (p=0,0038). No se identificaron diferencias significativas en la fuerza muscular entre los grupos (p>0,05). Conclusión: La asociación anestésica aceleró la latencia sensitiva sin adelantar el bloqueo motor inmediato. El estudio resalta la seguridad de la técnica y señala la necesidad de futuras investigaciones sobre la duración total de la analgesia en esta población.
Referencias
AGUILERA G, et al. 0.25% bupivacaine–1% lidocaine vs 0.5% bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a randomized controlled trial. Regional Anesthesia and Pain Medicine, 2025; 50(8): 627–634.
ALMASI R, et al. Onset times and duration of analgesic effect of various concentrations of local anesthetic solutions in standardized volume used for brachial plexus blocks. Heliyon, 2020; 6(9): e04718.
ARP AS, et al. The anesthetic effects of lidocaine with epinephrine in digital nerve blocks: a systematic review. Journal of the American Podiatric Medical Association, 2023; 113(4): 21–066.
BAŞKAN S et al. Determinação do volume mínimo efetivo de bupivacaína para bloqueio do plexo braquial infraclavicular guiado por ultrassom: estudo prospectivo, observador-cego e controlado. Brazilian Journal of Anesthesiology, 2022; 72(2):280-285.
CAMPAGNE D. Fraturas da diáfise da ulna e do rádio. Manual MSD – versão para profissionais de saúde. 2022. Disponível em: https://www.msdmanuals.com/. Acesso em: 16 abr. 2025.
CANSIAN JM, et al. Comparative effectiveness of bupivacaine and lidocaine-bupivacaine mixtures in brachial plexus block: a systematic review and meta-analysis. Anesthesia and Pain Medicine, 2025; 20(3):252-265.
CESUR S, et al. A randomized comparison between ultrasound-guided costoclavicular and infraclavicular block for upper extremity surgery. Turkish Journal of Medical Sciences, 2021; 51(4):1883-1888.
COTTER JT, et al. Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery: an analysis of 9,342 blocks. Canadian Journal of Anesthesia, 2004; 51(8):810-816.
DE CASSAI A, et al. Regional anesthesia in obese patients: challenges, considerations, and solutions. Saudi Journal of Anaesthesia, 2025; 19(2):221-226.
GABRIEL RA, et al. The association of body mass index with same-day hospital admission, postoperative complications, and 30-day readmission following day-case eligible joint arthroscopy: a national registry analysis. Journal of Clinical Anesthesia, 2020; 59:26-31.
GEBHARD RE, et al. Diabetes mellitus, independent of body mass index, is associated with a higher success rate for supraclavicular brachial plexus blocks. Regional Anesthesia and Pain Medicine, 2009; 34(5):404-407.
MAGA JM, et al. Outpatient regional anesthesia for upper extremity surgery update (2005 to present) distal to shoulder. International Anesthesiology Clinics, 2012; 50(1):47-55.
MUIR D, et al. Supraclavicular versus infraclavicular brachial plexus block in upper limb orthopaedic surgery: a systematic review and meta-analysis of randomised controlled trials. European Journal of Orthopaedic Surgery & Traumatology, 2024; 34(8): 4123–4131.
PATEL DS et al. Common fractures of the radius and ulna. American Family Physician, 2021; 103(6):345-354.
PICARD L, et al. Impact of regional block failure in ambulatory hand surgery on patient management: a cohort study. Journal of Clinical Medicine, 2020; 9(8):2453.
RAFI BM, TIWARI V. Forearm fractures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK574580/. Acesso em: 20 abr. 2025.
RUBENSTEIN WJ et al. The impact of body mass index on complications after shoulder arthroscopy: should surgery eligibility be determined by body mass index cutoffs? Arthroscopy, 2019; 35(3):741-746.
SILVA NETO OB, et al. Efeitos do uso de vasoconstritores no bloqueio de nervos digitais: revisão sistemática com metanálise. Revista do Colégio Brasileiro de Cirurgiões, 2019; 46(6):e20192269.
SRIPRIYA R, et al. Equal mixture of 2% lidocaine with adrenaline and 0.5% bupivacaine provided faster onset of complete conduction blockade during ultrasound-guided supraclavicular brachial plexus block: a randomized double-blinded clinical trial. Regional Anesthesia and Pain Medicine, 2024; 49(2): 104–109.
STEENSBÆK MT, et al. Effectiveness of combining lidocaine and ropivacaine on the duration of analgesia and anesthesia of an infraclavicular brachial plexus block. Local and Regional Anesthesia, 2025; 18: 17–25.
WAHEED Z, et al. General anesthetic care of obese patients undergoing surgery: a review of current anesthetic considerations and recent advances. Cureus, 2023; 15(7):e41565.
