Guay J. Méta-analyse : intérêt du neurostimulateur dans l'amélioration du taux de succès du bloc axillaire.
ACTA ACUST UNITED AC 2005;
24:239-43. [PMID:
15792555 DOI:
10.1016/j.annfar.2005.01.002]
[Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Accepted: 01/04/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE
To evaluate the effectiveness of the neurostimulator to improve the success rate of a brachial plexus blockade by the axillary approach.
STUDY DESIGN
Metaanalysis.
METHODS
Ten prospective randomized studies comparing a neurostimulating technique (NST) of brachial plexus blockade performed by the axillary approach to another technique were kept for analysis. A successful block was defined as blockade of the four following nerves: radial, median, ulnar and musculocutaneous. Data were entered on an intention to treat basis and were analyzed with a random model. A p<0.05 was considered significant.
RESULTS
Data were heterogenous (p < 0.001) and the Cochran-Mantel-Haenzel test showed that the neurostimulator does not improve the success rate of brachial plexus blocks performed by the axillary approach when all available studies are considered as a whole (p = 1). For the subgroup of studies where four nerves were stimulated however, the NST decreases the incidence of failed block by 25% (95% CI = 7-42%) (p < 0.0001). There were 12 patients with systemic signs of local anesthetics toxicity when a NST was used compared to 28 when it was not (p = 0.04), relative risk of 0.7 (95% CI= 0.6-0.8).
CONCLUSION
This study shows that the neurostimulator improves the success rate of brachial plexus blocks performed by the axillary approach only when three nerves or more are stimulated and its use decreases the incidence of systemic local anaesthetics toxicity.
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