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Frecuencia y factores relacionados con parálisis diafragmática posterior a la realización de bloqueos interescalénico, del tronco superior y supraclavicular, guiados por ultrasonido, en un hospital de tercer nivel de Bogotá

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dc.contributor.advisorChinchilla Hermida, Paola Andrea
dc.creatorOsorio, John Jairo
dc.creatorChinchilla Hermida, Paola
dc.creator.degreeEspecialista en Anestesiología HOKspa
dc.creator.degreetypeFull timespa
dc.date.accessioned2019-02-18T15:24:46Z
dc.date.available2019-02-18T15:24:46Z
dc.date.created2019-01-31
dc.date.issued2019
dc.descriptionIntroducción: Los bloqueos realizados por encima de la clavícula están asociados a bloqueo del nervio frénico en diferentes grados conllevando a parálisis diafragmática ipsilateral, estos comprenden bloqueo interescalenico, bloqueo supraclavicular y recientemente se ha descrito el bloqueo de tronco superior donde se administra anestésico local directamente en el tronco formado por las raíces nerviosas de C5 y C6; este bloqueo supone ventajas debido a que requiere menor volumen para conseguir el efecto anestésico o analgésico. El objetivo fue estimar la frecuencia de parálisis diafragmática y sus factores relacionados posterior al uso de bloqueos interescalénico, del tronco superior o supraclavicular, guiados por ultrasonido. Métodos: Estudio de tipo observacional en una cohorte de seguimiento para estimar la incidencia de parálisis diafragmática y factores asociados con su desarrollo en pacientes llevados a cirugía de miembro superior, luego de bloqueos por encima de la clavícula guiados por ultrasonido. Resultados: Se incluyeron 66 pacientes. El bloqueo más frecuentemente realizado fue el supraclavicular (n=38, 57,6%) seguido por el interescalenico (n= 20 30,3%) y por último el del tronco superior (n=10, 15,2%). El volumen promedio fue de 21,29 ml (mediana 20 ml, mínima 10 ml y máximo 40 ml). No hubo diferencias en el volumen utilizado según los grupos de comparación (mediana de 20 en los que presentaron parálisis diafragmática vs mediana de 21 en los que no la desarrollaron). La parálisis diafragmática se presentó en el 39% (n=26). Del total de pacientes a los que se le realizó un bloqueo interescalénico (n=20), la mayoría presentaron parálisis diafragmática asociada (n=14, 70%). De los pacientes con bloqueo del tronco superior (n=10), el 20% desarrolló parálisis secundaria (n=2). Finalmente, del total de pacientes con bloqueo supraclavicular (n=38), el 26,3% presentó parálisis diafragmática. El interescalénico se relacionó con el desarrollo de parálisis diafragmática (RR: 6,61; IC95% 2,07 – 21,10; p=0,001). Conclusión: La incidencia de parálisis diafragmática posterior al uso de bloqueo interescalenico, tronco superior y supraclavicular fue 70%, 20% y 26% respectivamente, sin embargo, la parálisis diafragmática unilateral generalmente se comporta asintomática y se evidencio en nuestro estudio. El bloqueo que más se asocia a parálisis diafragmática fue el interescalenico.spa
dc.description.abstractIntroduction: blockages on the clavicle are associated with phrenic nerve block in different degrees, which leads to ipsilateral diaphragmatic paralysis. These comprise interscalcenic blockage, supraclavicular block, and upper trunk block has recently been described, where local anesthesia is administered directly on the trunk formed by the nerve roots of C5 and C6; This blockage has advantages because it requires less volume to achieve the anesthetic or analgesic effect. The objective was to estimate the frequency of diaphragmatic paralysis and its related factors after the use of interscalenic, superior trunk or supraclavicular blocks, guided by ultrasound. Methods: Observational study in a follow-up cohort to estimate the incidence of diaphragmatic paralysis and factors associated with its development in patients undergoing upper limb surgery, after blockages above the clavicula guided by ultrasound. Results: 66 patients were included. The most frequent block was the supraclavicular (n = 38, 57.6%) followed by interscalenic (n = 20 30.3%) and finally the upper trunk (n = 10, 15.2%). The average volume was 21.29 ml (median 20 ml, minimum 10 ml and maximum 40 ml). There were no differences in the volume used according to the comparison groups (median of 20 in those with diaphragmatic paralysis versus median of 21 in those who did not develop it). Diaphragmatic paralysis occurred in 39% (n = 26). Of the total number of patients who underwent an interscalenic block (n = 20), the majority had associated diaphragmatic paralysis (n = 14, 70%). Of the patients with upper trunk block (n = 10), 20% developed secondary paralysis (n = 2). Finally, of the total of patients with supraclavicular block (n = 38), 26.3% presented diaphragmatic paralysis. The interscalenic was associated with the development of diaphragmatic paralysis (RR: 6.61, 95% CI 2.07 - 21.10, p = 0.001). Conclusion: the incidence of diaphragmatic paralysis after the use of interscalenic block, superior and supraclavicular trunk was 70%, 20% and 26% respectively, however, unilateral diaphragmatic paralysis generally behaves asymptomatically and was evidenced in our study. The block that is most associated with diaphragmatic paralysis was interscalenic.spa
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dc.identifier.doihttps://doi.org/10.48713/10336_19094
dc.identifier.urihttp://repository.urosario.edu.co/handle/10336/19094
dc.language.isospa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de Medicinaspa
dc.publisher.programEspecialización en Anestesiología HOKspa
dc.rightsAtribución-NoComercial-SinDerivadas 2.5 Colombiaspa
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectParesia frénicaspa
dc.subjectBloqueo interescalenicospa
dc.subjectBloqueo supraclavicularspa
dc.subjectBloqueo del tronco superiorspa
dc.subjectEcografíaspa
dc.subject.ddcEnfermedadesspa
dc.subject.keywordPhrenic palsyspa
dc.subject.keywordInterescalene blockspa
dc.subject.keywordSupraclavicular blockspa
dc.subject.keywordUltrasoundspa
dc.subject.lembEnfermedades de los nervios periféricosspa
dc.subject.lembNervio frénicospa
dc.subject.lembEcografíaspa
dc.subject.lembExtremidades superioresspa
dc.titleFrecuencia y factores relacionados con parálisis diafragmática posterior a la realización de bloqueos interescalénico, del tronco superior y supraclavicular, guiados por ultrasonido, en un hospital de tercer nivel de Bogotáspa
dc.title.alternativeFrecuencia y factores relacionados con parálisis diafragmática posterior a la realización de bloqueos interescalénico, del tronco superior y supraclavicular, guiados por ultrasonidospa
dc.typemasterThesiseng
dc.type.documentTrabajo de gradospa
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de gradospa
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