MINISTRY OF EDUCATION AND TRAINING MINISTRY OF DEFENCE
108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES
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TRAN THI CAM NHUNG
RESEARCH ON EFFICACY OF INTRAOPERATIVE
ANESTHESIA AND POSTOPERATIVE ANALGESIA BY
MIXTURE OF BUPIVACAINE WITH DEXMEDETOMIDINE
IN BRACHIAL PLEXUS BLOCK
FOR UPPER EXTREMITY BONE SURGERY
Speciality: Anesthesiology
Code: 62720122
ABSTRACT OF MEDICAL DISSERTATION
Hanoi - 2020
THE THESIS HAS DONE IN: 108 INSTITUTE OF CLINICAL
MEDICAL AND PHARMACEUTICAL SCIENCES
Supervisors:
1. Prof. Dr. Nguyen Van Chung
2. Dr.Tong Xuan Hung
Reviewers:
1. Prof. Dr. Nguyen Huu Tu
2. Ass. Prof. Dr. Bui Van Manh
3. Ass. Prof. Dr. Le Van Doan
Archives:
1. National Library of Vietnam
2. Library of 108 Institute of Clinical Medical and
Pharmaceutical Sciences
1
INTRODUCTION
Upper extremity fractures are a common and they appear in
every subject. According to statistics of Nguyen Duc Chinh et al
from 2016 to 2018, 90011 patients of accidents at Viet Duc Hospital,
the proportion of this cases had accounted for 53.2% with lower and
upper extremity injuries. The study of Karl in the United States, the
epidemiology of upper extremity fractures accounted for 677/100000
patients in 2009. Among anesthesia methods for upper extremity
surgery, brachial plexus block is usual technique due to simple but
highly effective anesthesia for this surgery.
To reduce dose of local anesthetic, increase effect this
anesthetic in brachial plexus block, prolong the analgesic effect after
surgery, many authors have had researches adding local anesthetics
with drug such as sufentanil, fentanyl, morphine, dexamethasone,
ketorolac, clonidine, or dexmedetomidine. In Viet Nam, there has
been no any research on a combination of local anesthetic with
dexmedetomidine, so we have conducted a project "Research on
efficacy of intraoperative anesthesia and postoperative analgesia by
mixture of bupivacaine with dexmedetomidine in brachial plexus
block for upper extremity bone surgery”, following two objectives:
1. To compare intraoperative anesthetic and postoperative
analgesic efficacy of 75mg bupivacaine and 100mcg
dexmedetomidine mixture with bupivacaine alone by brachial
plexus block for upper extremity bone surgery.
2. To evaluate on blood pressure, heart rate, sedative effect and
some adverse effects of 75mg bupivacaine and 100mcg
dexmedetomidine mixture by brachial plexus block for upper
extremity bone surgery.
2
Chapter 1
OVERVIEW
1.1. Upper extremity fracture
Causes of the upper extremity fractures are popular due to
domestic accidents, machinery, playground injury or road traffic
accidents. In particular, the author Rubin and his colleagues reported
103465 cases of traffic accidents which had 17263 situations of
upper extremity fractures, the ratio of open fractures accounted for
16.7%, about 18.1% at adults and 13.2.% at children. In the
Netherlands, the frequency of upper extremity fractures had
accounted about 824/100 000 people for 9 years from 2004 to 2012
and tended to grow up following next time, more regularly in a group
of 16-35 years old, more man than female.
1.2 Anesthetic techniques for upper extremity bone surgery
There are many anesthetic techniques for upper extremity
surgeries, such as intravenous regional anesthesia (Bier block),
brachial plexus block, general anesthesia.
Advantages of brachial plexus block are not only simple
technique, but also reducing or losing provisional sensation and
movement of upper extremity. Patients still awaken, recovery early,
lessen caring of health care staff and family’patient. Especially, it is
lower cost than general anesthesia.
1.3 Brachial plexus block
The brachial plexus is formed from five roots, the anterior rami
of the spinal nerves from C5 - T1, they connect together to form 3
trunks, after the roots pass between the scalene muscles they meet
the subclavicular artery and divide into divisions.
3
In the three trunks, the superior trunk arises from the union of
the C5 - C6 root. The middle trunk is formed by the C7 root. The
inferior trunk is formed by the C8 - T1 root. Each trunk continues to
divide into two: the anterior and posterior division. After that, six
dividions connect together and form three cords. The lateral cord is
formed from connection of two anterior divisions from the superior
trunk and the middle trunk. The medial cord is an anterior division of
the inferior trunk and the posterior cord is composed of three
posterior divisions. The three cords give rise to major nerves which
control sensation and movement of upper extremity, are
musculocutaneous nerve, radial nerve, median nerve and ulnar nerve.
The benefit of supraclavicular brachial plexus block is to
anesthetize whole upper extremity. Thus, it should be considered
"spinal block for upper extremity", and indicated for arm, elbow,
forearm and hand surgeries. Because almost the brachial plexus
merges into a mass, blocking this position can do anesthesia for all
branches and rapid onset time of sensory block due to small nerves
and minimum local anesthetic.
Supraclavicular brachial plexus block may have some
complications such as about 0.04 - 1% pneumothorax, subclavicular
artery puncture, Claude Bernard Horner syndrome, phrenic nerve
block rarely.
1.4 Using drug in brachial plexus block of our study
Bupivacaine which is local anesthetic, is exerted to block
recoverable conduction of nerve impulse, through mechanism to
inhibit depolarization of neural membrane by preventing of Na+ to
pass this membrane. Bupivacaine inhibits stronger sensory fibers
than motor fibers, because motor fibers have myelin sheath and