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A retrospective review over 6 yr of patients presenting to the hand clinic was performed to identify cases of postoperative brachial plexopathy (PBP) and to assess both prognosis and early indices of prognosis. Over this period (1989-1995), 22 patients were referred by the hospital's surgical departments to the hand clinic because of PBP. Eight cases followed open heart surgery (OHS) and 14 followed non-cardiac surgery (NCS). Median full recovery took 10 (range 4-16) weeks and 20 (8-50) weeks, respectively. Long-term follow-up revealed one OHS patient with residual tingling and three NCS patients with residual weakness. Brachial plexopathy after median sternotomy was characterized by a predominance of sensory complaint in the lower roots of the plexus. Injury after non-cardiac surgery was reflected by a predominance of motor deficit in the upper and middle roots. Brachial plexus injury after cardiac surgery carries an excellent prognosis for full functional recovery. Although the limited number of cases precludes statistical substantiation, the data suggest that the prognosis of PBP after non-cardiac surgery may be worse in males, diabetics, those with injury to all roots of the plexus and, when in addition to the motor deficit there is sensory loss and pain or dysaesthesia. At a 1 week “prognostic milestone”, 79% of NCS patients with significant symptomatology enjoyed complete recovery although this took as long as 5 months to 1 yr in 50% of patients. At a 6-8 week “prognostic milestone”, 50% of those who had not yet had improvement in the motor deficit suffered residual neurological deficit. All patients recovered to a significant extent even when recovery was not complete and none suffered from late deterioration or chronic pain.

Cancellation of elective surgical cases leads to a waste of resources, financial burden, patient dissatisfaction, extended hospital stay, and unnecessary repetition of preoperative preparations.

La anestesia regional como componente de los protocolos de analgesia multimodal se ha ido convirtiendo de manera creciente en una parte del tratamiento moderno del dolor perioperatorio. Seguramente, la adopción generalizada de la guía ecográfica en la anestesia regional ha jugado un papel importante en dicho crecimiento y ha mejorado significativamente la seguridad del paciente, disminuyendo la incidencia de fallos de los bloqueos y de paradas cardiacas, y reduciendo las tasas de complicaciones. El objetivo de esta revisión sistemática es extraer, analizar y sintetizar información clínica sobre la parada cardiaca relacionada con la bupivacaína y la ropivacaína, para poder tener una imagen más clara de la presentación clínica. La búsqueda bibliográfica identificó 268 publicaciones potencialmente relevantes y se incluyeron 22 informes de casos relevantes en la revisión. En la revisión sistemática se analizan los datos demográficos de los pacientes, los tipos de anestesia regional, la hipotensión, los trastornos del ritmo cardiaco, las convulsiones, la parada cardiaca, el desenlace fatal, las recomendaciones y las limitaciones en la prevención y el tratamiento de la parada cardiaca relacionada con la bupivacaína y la ropivacaína. La toxicidad de la anestesia local inducida tanto por bupivacaína como ropivacaína puede provocar una parada cardiaca. La emulsión lipídica, la telemetría, y la formación en la reanimación de la toxicidad anestésica local parecen ser prometedoras para mejorar la supervivencia, pero se necesita más investigación. Deben garantizarse la mejora y el estímulo de informar sobre la toxicidad de los anestésicos locales, para mejorar la calidad de la información que puede analizarse para llegar a una conclusión más precisa.

A retrospective review over 6 yr of patients presenting to the hand clinic was performed to identify cases of postoperative brachial plexopathy (PBP) and to assess both prognosis and early indices of prognosis. Over this period (1989-1995), 22 patients were referred by the hospital's surgical departments to the hand clinic because of PBP. Eight cases followed open heart surgery (OHS) and 14 followed non-cardiac surgery (NCS). Median full recovery took 10 (range 4-16) weeks and 20 (8-50) weeks, respectively. Long-term follow-up revealed one OHS patient with residual tingling and three NCS patients with residual weakness. Brachial plexopathy after median sternotomy was characterized by a predominance of sensory complaint in the lower roots of the plexus. Injury after non-cardiac surgery was reflected by a predominance of motor deficit in the upper and middle roots. Brachial plexus injury after cardiac surgery carries an excellent prognosis for full functional recovery. Although the limited number of cases precludes statistical substantiation, the data suggest that the prognosis of PBP after non-cardiac surgery may be worse in males, diabetics, those with injury to all roots of the plexus and, when in addition to the motor deficit there is sensory loss and pain or dysaesthesia. At a 1 week "prognostic milestone", 79% of NCS patients with significant symptomatology enjoyed complete recovery although this took as long as 5 months to 1 yr in 50% of patients. At a 6-8 week "prognostic milestone", 50% of those who had not yet had improvement in the motor deficit suffered residual neurological deficit. All patients recovered to a significant extent even when recovery was not complete and none suffered from late deterioration or chronic pain.