Brazilian Journal of Anesthesiology
https://www.bjan-sba.org/journal/rba/article/doi/10.1590/S0034-70942006000300003
Brazilian Journal of Anesthesiology
Scientific Article

Bloqueio do nervo isquiático por abordagem posterior simplificada no ponto médio do sulco glúteo-femoral: estudo com diferentes volumes de lidocaína a 1%

Simplified posterior sciatic nerve block at mid gluteofemoral dulcus: comparison of different 1% lidocaine volumes

Neuber Martins Fonseca; Beatriz Lemos Mandim; Roberto Araújo Ruzi; Fabiana Rosa Tavares

Downloads: 0
Views: 848

Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio do nervo isquiático por via subglútea foi descrito com sucesso em estudo anterior, sendo mais uma opção entre as várias abordagens possíveis. O nervo isquiático torna-se superficial na borda inferior do músculo glúteo máximo, permitindo seu acesso com fácil localização, pouco desconforto e baixo risco de punção acidental de grandes vasos. O objetivo deste estudo foi avaliar o bloqueio do nervo isquiático por esta abordagem simplificada com diferentes volumes de lidocaína a 1%. MÉTODO: Foram estudados 40 pacientes com intervenções cirúrgicas na perna ou no pé distribuídos em dois grupos. Após monitorização, eles foram posicionados em decúbito ventral e realizado bloqueio no ponto médio do sulco glúteo-femoral, com auxílio de neuroestimulador e agulha de 5 cm eletricamente isolada, utilizando 300 mg (G1) ou 200 mg (G2) de lidocaína a 1% sem adrenalina. RESULTADOS: Obteve-se anestesia adequada em todos os casos com o volume e a concentração usados. O tempo de execução do bloqueio foi de 8,6 ± 5,7 min (G1) e 5,6 ± 5,7 min (G2). A latência foi de 5,98 ± 1,4 min (G1) e 6,7 ± 2,9 min (G2). A duração sensitiva e motora do bloqueio foi de 243 ± 37 min e 152 ± 30 min (G1) e 235 ± 39 min e 149 ± 59 min (G2), respectivamente. Não foram observadas diferenças estatísticas significativas entre os grupos estudados. CONCLUSÕES: Essa abordagem é eficaz e de fácil execução, podendo a dose total de anestésico ser reduzida sem comprometimento da qualidade.

Palavras-chave

ANATOMIA, ANESTESIA, Regional, ANESTÉSICOS, Local, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Subgluteus sciatic nerve block has been successfully described in a previous study and is one more option among several possible approaches. The sciatic nerve becomes superficial at inferior gluteus maximus muscle where it is easily located and accessed with minor discomfort and low risk of accidental great vessels puncture. Our study aimed at evaluating this simplified sciatic nerve block approach with different 1% lidocaine volumes. METHODS: Participated in this study 40 patients submitted to leg or foot procedures, who were distributed in two groups. Patients were placed in the prone position after monitoring and blockade was induced at mid gluteofemoral sulcus with the aid of neurostimulator and with beveled insulated 5 cm needle, with 300 mg (G1) or 200 mg (G2) of 1% plain lidocaine. RESULTS: Used volumes and concentrations have promoted adequate anesthesia in all patients. Blockade time was 8.6 ± 5.7 min (G1) and 5.6 ± 5.7 min (G2). Onset time was 5.98 ± 1.4 min (G1) and 6.7 ± 2.9 min (G2). Sensory and motor block duration was 243 ± 37 min and 152 ± 30 min (G1), and 235 ± 39 min and 149 ± 59 min (G2), respectively. There were no statistically significant differences between groups. CONCLUSIONS: This is an effective and easy approach and total anesthetic dose may be decreased without impairing quality.

Keywords

ANATOMY, ANESTHESIA, Regional, ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional

References

Ichiyanagi K. Sciatic nerve block: lateral approach with patient supine. Anesthesiology. 1959;20:601604.

Labat G. Its Technique and Clinical Applications: Regional Anaesthesia. 1924:4555.

Raj PP, Parks RI, Watson TD. A new single-position supine approach to sciatic-femoral nerve block. Anesth Analg. 1975;54:489-493.

Beck GP. Anterior approach to sciatic nerve block. Anesthesiology. 1963;24:222-224.

Rorie DK, Byer DE, Nelson DO. Assessment of block of the sciatic nerve in the popliteal fossa. Anesth Analg. 1980;59:371-376.

McLeod DH, Wong DH, Claridge RJ. Lateral popliteal sciatic nerve block compared with subcutaneous infiltration for analgesia following foot surgery. Can J Anaesth. 1994;41:673-676.

Chelly JE, Delaunay L. A new anterior approach to the sciatic nerve block. Anesthesiology. 1999;91:1655-1660.

di Benedetto P, Bertini L, Casati A. A new posterior approach to the sciatic nerve block: a prospective, randomized comparison with the classic posterior approach. Anesth Analg. 2001;93:1040-1044.

Hadzic A, Vloka JD, Kuroda MM. The practice of peripheral nerve blocks in the United States: a national survey. Reg Anesth Pain Med. 1998;23:241-246.

Bouaziz H, Mercier FJ, Narchi P. Survey of regional anesthetic practice among French residents at time of certification. Reg Anesth. 1997;22:218-222.

Smith MP, Sprung J, Zura A. A survey of exposure to regional anesthesia techniques in American anesthesia residency training programs. Reg Anesth Pain Med. 1999;24:11-16.

Fonseca NM, Ferreira FX, Ruzi RA. Abordagem simplificada do nervo isquiático por via posterior, no ponto médio do sulco glúteo-femoral, com uso de neuroestimulador. Rev Bras Anestesiol. 2002;52:764-773.

Sukhani R, Candido KD, Doty R Jr. Infragluteal-parabiceps sciatic nerve block: an evaluation of a novel approach using a single-injection technique. Anesth Analg. 2003;96:868-873.

Mansour NY, Bennetts FE. An observational study of combined continuous lumbar plexus and single-shot sciatic nerve blocks for post-knee surgery analgesia. Reg Anesth. 1996;21:287-291.

McClellan KJ, Faulds D. Ropivacaine: an update of its use in regional anaesthesia. Drugs. 2000;60:1065-1093.

Casati A, Fanelli G, Borghi B. Ropivacaine or 2% mepivacaine for lower limb peripheral nerve blocks. Study Group on Orthopedic Anesthesia of the Italian Society of Anesthesia, Analgesia, and Intensive Care. Anesthesiology. 1999;90:1047-1052.

Casati A, Magistris L, Fanelli G. Small-dose clonidine prolongs postoperative analgesia after sciatic-femoral nerve block with 0.75% ropivacaine for foot surgery. Anesth Analg. 2000;91:388-392.

Coventry DM, Todd JG. Alkalinisation of bupivacaine for sciatic nerve blockade. Anaesthesia. 1989;44:467470.

Petitjeans F, Mion G, Puidupin M. Tachycardia and convulsions induced by accidental intravascular ropivacaine injection during sciatic block. Acta Anaesthesiol Scand. 2002;46:616-617.

Ruetsch YA, Fattinger KE, Borgeat A. Ropivacaine-induced convulsions and severe cardiac dysrhythmia after sciatic block. Anesthesiology. 1999;90:1784-1786.

Taboada M, Alvarez J, Cortes J. The effects of three different approaches on the onset time of sciatic nerve blocks with 0.75% ropivacaine. Anesth Analg. 2004;98:242-247.

Fanelli G, Casati A, Garancini P. Nerve stimulator and multiple injection technique for upper and lower limb blockade: failure rate, patient acceptance, and neurologic complications. Study Group on Regional Anesthesia. Anesth Analg. 1999;88:847-852.

Smith BE, Allison A. Use of a low-power nerve stimulator during sciatic nerve block. Anaesthesia. 1987;42:296-298.

Auroy Y, Narchi P, Messiah A. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997;87:479-486.

Liguori GA. Complications of regional anesthesia: nerve injury and peripheral neural blockade. J Neurosurg Anesthesiol. 2004;16:84-86.

Shah S, Hadzic A, Vloka JD. Neurologic complications after anterior sciatic nerve block. Anesth Analg. 2005;100:1515-1517.

Vloka JD, Hadzic A, Lesser JB. A common epineural sheath for the nerves in the popliteal fossa and its possible implications for sciatic nerve block. Anesth Analg. 1997;84:387-390.

5dd42f0c0e8825a831c63495 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections