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array:24 [ "pii" => "S2341192920300809" "issn" => "23411929" "doi" => "10.1016/j.redare.2019.10.010" "estado" => "S300" "fechaPublicacion" => "2020-06-01" "aid" => "1120" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2020;67:343-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935620300426" "issn" => "00349356" "doi" => "10.1016/j.redar.2019.10.011" "estado" => "S300" "fechaPublicacion" => "2020-06-01" "aid" => "1120" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Anestesiol Reanim. 2020;67:343-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Adición de bloqueo serrato-intercostal/BRILMA para cirugía de acceso arteriovenoso: 2 casos clínicos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "343" "paginaFinal" => "346" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Addition of serratus-intercostal plane block/BRILMA for arteriovenous access surgery" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1108 "Ancho" => 1207 "Tamanyo" => 121787 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Procedimiento quirúrgico axilar en el segundo caso.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. 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"apellidos" => "Robador-Martínez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192920300809" "doi" => "10.1016/j.redare.2019.10.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300809?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935620300426?idApp=UINPBA00004N" "url" => "/00349356/0000006700000006/v1_202006250758/S0034935620300426/v1_202006250758/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2341192920300846" "issn" => "23411929" "doi" => "10.1016/j.redare.2020.06.001" "estado" => "S300" "fechaPublicacion" => "2020-06-01" "aid" => "1127" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2020;67:347-50" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Dilemmas in primary spinal glioblastoma management during pregnancy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "347" "paginaFinal" => "350" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dilemas en el manejo de glioblastoma espinal primario durante el embarazo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 805 "Ancho" => 805 "Tamanyo" => 54277 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">T2-weighted sagittal cervicothoracic MRI showing the spinal GMB extending from C6 to T3.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Aguiar, E. Ferreira, R. Pontes, A. Panzina, M. Paiva, A. Milheiro" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Aguiar" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Ferreira" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Pontes" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Panzina" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Paiva" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Milheiro" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935620300499" "doi" => "10.1016/j.redar.2020.02.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935620300499?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300846?idApp=UINPBA00004N" "url" => "/23411929/0000006700000006/v1_202008190659/S2341192920300846/v1_202008190659/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2341192920300780" "issn" => "23411929" "doi" => "10.1016/j.redare.2019.11.008" "estado" => "S300" "fechaPublicacion" => "2020-06-01" "aid" => "1097" "documento" => "article" "crossmark" => 1 "subdocumento" => "pgl" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2020;67:325-42" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CONSENSUS STATEMENT</span>" "titulo" => "Recommendations for the evaluation and management of the anticipated and non-anticipated difficult airway of the <span class="elsevierStyleItalic">Societat Catalana d’Anestesiologia, Reanimació i Terapèutica del Dolor</span>, based on the adaptation of clinical practice guidelines and expert consensus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "325" "paginaFinal" => "342" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recomendaciones para la evaluación y manejo de la vía aérea difícil prevista y no prevista de la <span class="elsevierStyleItalic">Societat Catalana d’Anestesiologia, Reanimació i Terapèutica del Dolor</span>, basadas en la adaptación de guías de práctica clínica y consenso de expertos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1076 "Ancho" => 2175 "Tamanyo" => 156988 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">(A) Recommended position for airway management, combining chest elevation, slight neck flexion and head extension. (B) Pre-oxygenation is recommended in patients who require optimised airway management, combining the previous position and oxygen delivery through nasal cannula and a properly sealed face mask.</p>" ] ] ] "autores" => array:2 [ 0 => array:2 [ "autoresLista" => "A.M. López, I. Belda, S. Bermejo, L. Parra, C. Áñez, R. Borràs, S. Sabaté, N. Carbonell, G. Marco, J. Pérez, E. Massó, J.Mª Soto, E. Boza, J.M. Gil, M. Serra, V. Tejedor, A. Tejedor, J. Roza, A. Plaza, B. Tena, R. Valero" "autores" => array:22 [ 0 => array:2 [ "nombre" => "A.M." "apellidos" => "López" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Belda" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Bermejo" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Parra" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Áñez" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Borràs" ] 6 => array:2 [ "nombre" => "S." "apellidos" => "Sabaté" ] 7 => array:2 [ "nombre" => "N." "apellidos" => "Carbonell" ] 8 => array:2 [ "nombre" => "G." "apellidos" => "Marco" ] 9 => array:2 [ "nombre" => "J." "apellidos" => "Pérez" ] 10 => array:2 [ "nombre" => "E." "apellidos" => "Massó" ] 11 => array:2 [ "nombre" => "J.Mª" "apellidos" => "Soto" ] 12 => array:2 [ "nombre" => "E." "apellidos" => "Boza" ] 13 => array:2 [ "nombre" => "J.M." "apellidos" => "Gil" ] 14 => array:2 [ "nombre" => "M." "apellidos" => "Serra" ] 15 => array:2 [ "nombre" => "V." "apellidos" => "Tejedor" ] 16 => array:2 [ "nombre" => "A." "apellidos" => "Tejedor" ] 17 => array:2 [ "nombre" => "J." "apellidos" => "Roza" ] 18 => array:2 [ "nombre" => "A." "apellidos" => "Plaza" ] 19 => array:2 [ "nombre" => "B." "apellidos" => "Tena" ] 20 => array:2 [ "nombre" => "R." "apellidos" => "Valero" ] 21 => array:1 [ "colaborador" => "Secció de via aèria (SEVA) de la SCARTD" ] ] ] 1 => array:2 [ "autoresLista" => "" "autores" => array:1 [ 0 => array:1 [ "colaborador" => "Listado de autores y miembros de la Secció de via aèria (SEVA) de la SCARTD" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S003493561930249X" "doi" => "10.1016/j.redar.2019.11.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S003493561930249X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300780?idApp=UINPBA00004N" "url" => "/23411929/0000006700000006/v1_202008190659/S2341192920300780/v1_202008190659/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Addition of serratus-intercostal plane block/BRILMA for arteriovenous access surgery" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "343" "paginaFinal" => "346" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Sanllorente-Sebastián, E. Rodríguez-Joris, R. Avello-Taboada, L. Fernández-López, V. Ayerza-Casas, D. Robador-Martínez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Sanllorente-Sebastián" "email" => array:1 [ 0 => "bibliotecas2010@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Rodríguez-Joris" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Avello-Taboada" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Fernández-López" ] 4 => array:2 [ "nombre" => "V." "apellidos" => "Ayerza-Casas" ] 5 => array:2 [ "nombre" => "D." "apellidos" => "Robador-Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adición de bloqueo serrato-intercostal/BRILMA para cirugía de acceso arteriovenoso: 2 casos clínicos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1150 "Ancho" => 1207 "Tamanyo" => 153774 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Location of the surgical incisions in the axilla and arm in the first patient.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The first-choice strategy for creating vascular access (VA) in patients with end-stage renal disease (ESRD) is to create an autogenous arteriovenous (AV) fistula as far distal as possible.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Regional anaesthesia (RA) can be used for this purpose. Intercostobrachial (ICB) nerve block is essential when surgical access involves the axilla or upper arm, and also for the creation of an AF for haemodialysis. Serrato-intercostal plane block (SIPB/BRILMA) is a recently described technique to block the lateral and medial intercostal branches and the ICB nerve.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this article, we describe 2 cases in which SIPB/BRILMA was combined with supraclavicular brachial plexus block (BPB) to anaesthetise the ICB and the axillary compartment during surgery to create an AVF. Both patients gave their informed consent for publication.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case 1</span><p id="par0020" class="elsevierStylePara elsevierViewall">An 82-year old woman (weight: 68<span class="elsevierStyleHsp" style=""></span>kg, height: 154<span class="elsevierStyleHsp" style=""></span>cm; BMI: 28.6) with a medical history of chronic kidney failure, non-insulin-dependent diabetes mellitus and hypothyroidism, who was scheduled for surgery to create a humero-axillary fistula.</p><p id="par0025" class="elsevierStylePara elsevierViewall">After standard monitoring, 2<span class="elsevierStyleHsp" style=""></span>l/min of oxygen were administered through nasal cannula, following which 50<span class="elsevierStyleHsp" style=""></span>μg of fentanyl and 1<span class="elsevierStyleHsp" style=""></span>mg of midazolam were administered to achieve a mild degree of sedation.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Then SIPB was performed under aseptic conditions with the patient in a slightly contralateral decubitus position and with the arm in abduction. The serrato-intercostal plane was identified at the level of the second rib using a 12<span class="elsevierStyleHsp" style=""></span>MHz transducer (LOGIQe, GE Healthcare) placed in the axillary midline. We visualised three layers: the subcutaneous tissue in the superficial plane; the serratus muscle and ribs in the median plane; and the pleura and lung in the deep plane. A 22<span class="elsevierStyleHsp" style=""></span>g echogenic needle (Stimuplex Ultra 360, B. Braun Medical) was introduced in plane in a caudocranial direction until it contacted the second rib. After negative aspiration, 18<span class="elsevierStyleHsp" style=""></span>ml of ropivacaine 0.375% was injected under the serratus muscle and above the ribs, observing its spread along the plane (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Following this, the probe was placed in the supraclavicular fossa to perform a supraclavicular BPB. Once the brachial plexus had been identified, an echogenic 35<span class="elsevierStyleHsp" style=""></span>mm needle was inserted in plane in a lateromedial direction as far as the plexus, and 18<span class="elsevierStyleHsp" style=""></span>ml of ropivacaine was injected. Intravenous paracetamol was also administered to complete the multimodal approach.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A humero-axillary fistula was created using a PTFE prosthesis. The longitudinal incisions in the axilla and elbow were made in the left arm, and the prosthesis was tunnelled subcutaneously (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Surgery lasted 70<span class="elsevierStyleHsp" style=""></span>min.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Spontaneous ventilation was maintained throughout the procedure and there was no need for local or topical anaesthesia supplementation.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case 2</span><p id="par0050" class="elsevierStylePara elsevierViewall">A 68-year old man (weight: 68<span class="elsevierStyleHsp" style=""></span>kg, height: 170<span class="elsevierStyleHsp" style=""></span>cm; BMI: 23.8) was scheduled for AVF creation. Medical reports revealed chronic kidney disease due to thrombosis of the right renal artery and stent occlusion in the left renal artery, dyslipidaemia, moderate COPD, and pulmonary hydatidosis in childhood.</p><p id="par0055" class="elsevierStylePara elsevierViewall">As in the first case, a SIPB/BRILMA was performed together with supraclavicular block. A Gore Acuseal prosthesis was implanted and tunnelled (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Surgery lasted 105<span class="elsevierStyleHsp" style=""></span>min. Paracetamol, 75<span class="elsevierStyleHsp" style=""></span>μg fentanyl, 1<span class="elsevierStyleHsp" style=""></span>mg midazolam and 20<span class="elsevierStyleHsp" style=""></span>mg propofol were administered for sedation. A booster dose of 5<span class="elsevierStyleHsp" style=""></span>ml mepivacaine 1% was administered by the surgeons due to moderate pain during the skin incision in the forearm. Spontaneous ventilation was maintained.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">There are several different anaesthetic approaches for arteriovenous access. Although systemic drugs may show unpredictable pharmacokinetic and pharmacodynamic effects in patients with ESRD, the vast majority receive general anaesthesia (GA). In recent years, however, evidence has shown that RA may be more effective, since good outcomes in AVF creation and maturation depend as much on the surgical approach as on the anaesthetic technique. RA has advantages in terms of opioid use, length of stay, regional vascular flow, reduced maturation time, fistula patency, and re-operation rate. In fact, the vasodilatory effect of RA can even modify the initial surgical plan by permitting the creation of a more distal AVF.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3,4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Patient comfort and appropriate surgical conditions for fistula creation can be achieved with BPB. However, due to the complex sensory innervation of the axilla, BPB alone cannot ensure complete anaesthesia for proximal arm arteriovenous access involving the axilla or upper arm, and the ICB nerve and axillary compartment must also be anaesthetised in order to prevent perioperative pain.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The main nerves involved in the innervation of the axillary compartment are the ICB nerve, the medial cutaneous nerve, the long thoracic nerve, and the thoracodorsal nerve. The walls of the axilla form a pyramid, and depositing local anaesthetic (LA) on the medial wall can facilitate spread to the axillary region through the interfascial muscle planes.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The ICB nerve is purely sensory and innervates the axilla, upper arm, and the lateral and superior chest wall. As it arises from the second intercostal nerve, it is not blocked when performing BPB for AVF surgery.</p><p id="par0080" class="elsevierStylePara elsevierViewall">A review of the literature shows selective and non-selective descriptions of ICB nerve block techniques. Among the selective descriptions, subcutaneous ring infiltration of LA proximal to the axilla to peripherally block nerve endings continues to be the most popular technique. However, several cadaver studies and surgical interventions have documented the high incidence of ICB nerve ramifications and bifurcations, showing that superficial LA infiltration may be insufficient for dissection at the level of the axilla or the upper arm.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Nonselective proximal approaches have previously been described. For example, the ICB nerve has been blocked along with other nerves, such as the pectoral, intercostal, and long thoracic, with the recently described PECS-II block by depositing LA between the pectoralis minor and serratus muscle for AVF creation with axillary or upper arm dissection<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and also for excision of an axillary lipoma.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The SIPB/BRILMA (intercostal branch block in the axillary midline) has also been described for analgesia of the axillary compartment, and has been used as sole anaesthetic together with sedation for sentinel node dissection and mastectomy in breast cancer surgery.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> We feel safer performing SIPB/BRILMA than depositing LA above the serratus muscle because we are more experienced in the former technique and, according to Torre et al.,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> it is easier to perform because the ribs are easily observed and provide a clearer target than the intermuscular plane. A modification of the SIPB/BRILMA for nephrectomy and upper abdominal surgery in which the LA is deposited at the level of the eighth rib has also been published, with promising results.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">This, to the best of our knowledge, is the first report in which the ICB nerve was blocked with a combination of SIPB/BRILMA and supraclavicular block for anaesthesia during surgery for arteriovenous access creation. Anaesthesia of the axillary compartment using an anterior subpectoral-intercostal block in a medial to lateral direction together with BPB has also been described by Seidel et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> in cadavers. One of the disadvantages of most combined techniques, apart from BPB, is the need for an additional puncture.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Fascial plane blocks of the thorax are effective superficial ultrasound-guided procedures with several advantages: unlike central blocks they reduce the risk of hypotension by avoiding the thoracic sympathetic ganglia; they reduce the risk of nerve puncture; and they can cover multiple dermatomes with a single injection. The theoretical risks of SIPB/BRILMA include the usual risks of RA techniques (vascular puncture, block failure) and specific risks related to the puncture site (pleural or pulmonary puncture).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Another important issue in RA is the systemic absorption of LA. This has not yet been studied in fascial plane blocks of the thorax, but it may be similar to the high level of absorption observed in intercostal block.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In ESRD patients, maximum LA doses should be reduced by 25% to avoid systemic toxicity; the maximum dose should be calculated and strictly followed. Reducing the injected volume of LA and its concentration can help minimise systemic levels of LA.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3</span></a> Fascial blocks usually require large volumes of LA, but a range of LA doses and concentrations have been published.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The optimal LA volume for the SIPB/BRILMA has yet to be determined, so we administered 20<span class="elsevierStyleHsp" style=""></span>ml, which facilitates spread to the axillary compartment, at a concentration of 0.375%, which provides surgical anaesthesia. Nevertheless, we also added a multimodal analgesic approach to complement RA.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The best ultrasound approach and puncture site in these thoracic fascial blocks, including those used in axillary surgery, have yet to be determined.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">The combination of SIPB/BRILMA and supraclavicular block can provide excellent perioperative anaesthesia in vascular access surgery in ESRD patients.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Additional clinical studies including prospective randomised trials are needed to clearly define its benefit in this setting.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Anaesthesiologists should consider using combination regional blocks in patients undergoing access surgery for haemodialysis when dissection of the axillar or upper arm is necessary.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Funding</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have not received any funding for this study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1375799" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1263652" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1375798" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1263653" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 1" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 2" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack477959" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-09-30" "fechaAceptado" => "2019-10-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1263652" "palabras" => array:5 [ 0 => "Serratus-intercostal" 1 => "Block" 2 => "Arteriovenous fistula" 3 => "Supraclavicular" 4 => "Sedation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1263653" "palabras" => array:5 [ 0 => "Serrato-intercostal" 1 => "Bloqueo" 2 => "Fístula arteriovenosa" 3 => "Supraclavicular" 4 => "Sedación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Arteriovenous access creation is mandatory in patients with end stage renal disease for hemodialysis treatment. It frequently involves upper arm or axillary dissection and general anaesthesia is predominantly used as axillary compartment innervation is complex. Avoiding general anaesthesia may be beneficial in these risk patients. We present two cases where serratus-intercostal plane block (SIPB/BRILMA) was used, along with ultrasound guided supraclavicular block and multimodal analgesia for proximal arm and axillary AV access surgery. Regional anaesthesia combination of supraclavicular and serratus-intercostal/BRILMA block in arteriovenous fistula surgery was successful and should be considered by anaesthesiologist in order to avoid general anaesthesia.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Introducción</span>: La creación de un acceso arteriovenoso es obligatorio en pacientes con enfermedad renal terminal para tratamiento con hemodiálisis. Habitualmente implica disección a nivel axilar o en la parte superior de brazo, y la anestesia general es usada predominantemente debido a que la inervación axilar es compleja. Evitar la anestesia general podría ser beneficioso en estos pacientes de riesgo. Presentamos dos casos en los que se empleó el bloqueo serrato-intercostal/BRILMA, junto con bloqueo supraclavicular ecoguiado y analgesia multimodal para cirugía de acceso arteriovenoso axilar o de brazo proximal. La combinación de técnicas de anestesia regional mediante bloqueo supraclavicular y serrato-intercostal/BRILMA en cirugía de fístula arteriovenosa fue exitosa y debe ser considerada por el anestesiólogo con el fin de evitar la anestesia general.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sanllorente-Sebastián R, Rodríguez-Joris E, Avello-Taboada R, Fernández-López L, Ayerza-Casas V, Robador-Martínez D. Adición de bloqueo serrato-intercostal/BRILMA para cirugía de acceso arteriovenoso: 2 casos clínicos. Rev Esp Anestesiol Reanim. 2020;67:343–346.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 992 "Ancho" => 1341 "Tamanyo" => 176705 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">BRILMA/serratus-intercostal block. Lines: needle; ICM: intercostal muscles; LA: local anaesthetic.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1150 "Ancho" => 1207 "Tamanyo" => 153774 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Location of the surgical incisions in the axilla and arm in the first patient.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1108 "Ancho" => 1207 "Tamanyo" => 121787 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Axillary surgical procedure in the second patient.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How to perform safe anesthesia in patients with end-stage renal disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. 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