Brazilian Journal of Anesthesiology
https://www.bjan-sba.org/journal/rba/article/doi/10.1590/S0034-70942011000500003
Brazilian Journal of Anesthesiology
Scientific Article

Bloqueio dos nervos tibial e fibular comum em fossa poplítea com punção única utilizando o estimulador percutâneo de nervos: considerações anatômicas e descrição ultrassonográfica

Tibial and common fibular nerveblock in the popliteal fossa with single puncture using percutaneous nerve stimulator: anatomical considerations and ultrasound description

Viviane de Oliveira Rangel; Raphael de Almeida Carvalho; Beatriz Lemos da Silva Mandim; Rodrigo Rodrigues Alves; Roberto Araújo Ruzi; Neuber Martins da Fonseca

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Resumo

JUSTIFICATIVA E OBJETIVOS: As técnicas de bloqueios de nervos periféricos têm ganhado popularidade nas últimas duas décadas, tornando-se crescente opção anestésica para a cirurgia de membros. Este estudo propõe uma técnica de abordagem dos nervos tibial e fibular comum na fossa poplítea por punção única e utilizando o estimulador percutâneo de nervos, considerando a correlação com estudo anatômico e ultrassonográfico. MÉTODO: Estudo prospectivo, observacional e aleatório realizado com 28 pacientes escalados para cirurgias no pé. Após localização dos nervos tibial e fibular comum por meio de estimulação percutânea, realizou-se punção no ponto de estímulo do nervo tibial com agulha de 5 cm (B.Braun, Stimuplex 50) e foram injetados 10 mL de levobupivacaína. A agulha foi recuada e redirecionada para o ponto de estímulo do nervo fibular comum em busca da resposta motora correspondente, injetando-se 10 mL do anestésico. Realizado estudo fotográfico da região poplítea por ultrassonografia para correlação da anatomia com a técnica utilizada. RESULTADOS: Obteve-se anestesia adequada em todos os casos. O tempo médio para a localização dos nervos tibial e fibular comum, utilizando o estimulador percutâneo de nervos, foi de 57,1 e 32,8 segundos, respectivamente, e com o estimulador de nervos foi de 2,22 e 1,79 minutos. A profundidade média da agulha para o nervo tibial foi de 10,7 mm. CONCLUSÕES: A abordagem dos nervos tibial e fibular comum com punção única na fossa poplítea utilizando o estimulador percutâneo de nervos é uma boa opção para anestesia e analgesia para cirurgias do pé.

Palavras-chave

ANATOMIA, ANATOMIA, EQUIPAMENTOS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Techniques of peripheral nerve block have gained popularity over the last two decades becoming a growing anesthetic option for limb surgeries. This study proposes a technical approach of the tibial and common fibular nerves in the popliteal fossa with single puncture using percutaneous nerve stimulator, considering the correlation with an anatomical and ultrasound study. METHODS: This prospective, observational, randomized study was performed with 28 patients scheduled for foot surgeries. After localizing the tibial and common fibular nerves through percutaneous stimulation, the puncture was performed at the point of tibial nerve stimulation with a 5-cm needle (B.Braun, Stimuplex 50), and 10 mL of levobupivacaine were injected. The needle was pulled back and redirected to the point of common fibular nerve stimulation looking for the corresponding motor response, and 10 mL of the local anesthetic were injected. Imaging study of the popliteal region was performed by ultrasound to correlate the anatomy with the technique used. RESULTS: Adequate anesthesia was obtained in all cases. The mean time to localize the tibial and common fibular nerves suing the percutaneous stimulator was 57.1 and 32.8 seconds, respectively, and with the nerve stimulator it was 2.22 and 1.79 minutes, respectively. The mean depth of the needle into the tibial nerve was 10.7 mm. CONCLUSIONS: The approach for tibial and common fibular nerves with single puncture in the popliteal fossa using peripheral nerve stimulator is a good option for anesthesia and analgesia for foot surgeries.

Keywords

Transcutaneous Electric Nerve Stimulation, Tibial Nerve, Peroneal Nerve, Ultrasonography, Interventional; Anesthesia, conduction

References

Enneking FK, Wedel DJ. The art and science of peripheral nerve blocks. Anesth Analg. 2000;90:1-2.

Klein SM, Nielsen KC, Greengrass RA. Ambulatory discharge after long-acting peripheral nerve blockade: 2382 blocks with ropivacaine. Anesth Analg. 2002;94:65-70.

Macaire P. Pain treatment at home using regional catheter techniques. Acta Anaesth Belg. 2004;55(^ssuppl):65-69.

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

Vloka D, Hadzic A, Kitain E. Anatomic considerations for sciatic nerve block in the popliteal fossa through the lateral approach. Reg Anesth. 1996;21:414-418.

Vloka DJ, Hadzic A, April E. The division of the sciatic nerve in the popliteal fossa: anatomical implications for popliteal nerve blockade. Anesth Analg. 2001;92:215-217.

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

Sukhani R, Nader A, Candido KD. Nerve Stimulater: Assisted evoked motor response predicts the latency and success of a singleinjection sciatic block. Anesth Analg. 2004;99:584-588.

Geier KO. Identificação tomográfica da bainha epineural dos nervos poplíteos durante anestesia regional intermitente do pé: relato de caso. Rev Bras Anestesiol. 2002;52:581-587.

Murch X, Pineda O, Garcia MM. The posterior approach to the sciatic nerve in the popliteal fossa: a comparison of single- versus double-injection. Anesth Analg. 2006;103:1571-1573.

Urmey WF, Grossi P. Percutaneous electrode guidance: a noninvasive technique for prelocation of peripheral nerves to facilitate peripheral plexus or nerve block. Reg Anesth Pain Med. 2002;27:261-267.

Capdevila X, Lopez S, Bernard N. Percutaneous electrode guidance using the insulated needle for prelocation of peripheral nerves during axillary plexus block. Reg Anesth Pain Med. 2004;29:206-211.

Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anesthesia. Br J Anesth. 2005;94:7-17.

McCartney CJL, Brauner VWS. Ultrasound guidance for a lateral approach to the sciatic nerve in popliteal fossa. Anesthesia. 2004;59:1023-1025.

Morau D, Levy F, Bringuier SP. Ultrasound: guided evaluation of the local spread parameters required for a rapid surgical popliteal s ciatic nerve block. Reg Anesth Pain Med. 2010;35:559-564.

Prasad A, Perlas A, Ramlogan R. Ultrasound: guided popliteal block distal to sciatic nerve bifurcation shortens onset time: a prospective randomized double-blinded study. Reg Anesth Pain Med. 2010;35:267-271.

Sinha A, Chan VWS. Ultrasound imaging for popliteal sciatic nerve block. Reg Anesth Pain Med. 2004;29:130-134.

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.

Winnie AP. Anestesia de Plexus: Técnicas perivasculares de bloqueo del plexo braquial. 1986.

Xavier M, Olga P, Maria MG. The posterior approach to the sciatic nerve in the popliteal fossa: a comparison of single- versus double-injection technique. Anesth Analg. 2006;103:1571-3.

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. Anesth Analg. 1999;88:847-852.

Taboada M, Alvarez J, Cortés 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.

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

Pither CE, Raj P, Ford DJ. The use of nerve stimulatiors for regional anesthesia: a review of experimental characteristics, technique and clinical implications. Reg Anesth. 1985;10:49-58.

Auroy Y, Narchi P, Messiah A. Serious complications related to regional anesthesia. 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.

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