Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000500008
Brazilian Journal of Anesthesiology
Clinical Information

Identificação tomográfica da bainha epineural dos nervos poplíteos durante anestesia regional intermitente do pé: relato de caso

Tomographic identification of popliteal nerves epineural sheath during foot intermittent regional anesthesia: case report

Karl Otto Geier

http://dx.doi.org/10.1590/S0034-70942002000500008 Braz J Anesthesiol, vol.52, n5, p.581-587, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: Bloqueios nervosos regionais dos membros inferiores são comumente realizados para procedimentos cirúrgicos e analgesia pós-operatória. O objetivo deste estudo é demonstrar um raro e casual registro tomográfico sobre o posicionamento de cateter na fossa poplítea, originalmente destinado ao nervo ciático, e a dispersão da solução anestésica durante analgesia intermitente num trauma de pé. RELATO DO CASO: Paciente do sexo masculino, 54 anos, estado físico ASA III, com trauma grave do pé esquerdo foi submetido a bloqueio do nervo ciático através de cateter colocado no ápice do triângulo poplíteo. Como injeções de 10 ml de bupivacaína a 0,375% com epinefrina a 1:400.000 permitiram curativos e desbridamentos diários com preservação da sensibilidade plantar, o fenômeno foi investigado radiologicamente. Estudos radiográficos e tomográficos contrastados da região poplítea permitiram mostrar o posicionamento do cateter e a dispersão da solução anestésica sob a bainha de cada um dos componentes do nervo ciático. CONCLUSÕES: Os relevantes achados tomográficos contrastados da região poplítea comprovaram recente estudo anatômico sobre a individualização da bainha neural, envolvendo os nervos poplíteos com implicações no desfecho do bloqueio nesta região. A analgesia obtida por cateter mantido na fossa poplítea demonstrou ser efetiva apenas no dermátomo do nervo fibular superficial (dorso medial do pé e hálux).

Palavras-chave

ANALGESIA, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Lower limb regional nervous blocks are common procedures for surgery and postoperative analgesia. This study aimed at describing a rare and casual tomographic image of a catheter in the popliteal fossa, which was originally directed to the sciatic nerve, and of anesthetic solution spread during intermittent analgesia for foot trauma. CASE REPORT: Male patient, 54 years old, physical status ASA III, with severe left foot trauma and submitted to sciatic nerve block through a catheter inserted in the apex of the popliteal triangle. Since 10 ml injections of 0.375% bupivacaine with epinephrine 1:400,000 allowed for daily dressings and débridement while preserving plantar sensitivity, the phenomenon was radiologically investigated. Enhanced radiographic and tomographic studies of the popliteal region were able to show catheter positioning and anesthetic spread under the sheath of each component of the sciatic nerve. CONCLUSIONS: Relevant enhanced tomographic findings of the popliteal region have proven a recent anatomic study on the individualization of the neural sheath involving popliteal nerves with implications in blockade outcome. Anesthesia obtained by a catheter in the popliteal fossa was effective only in the superficial fibular nerve dermatome (medial dorsum of foot and hallux).

Keywords

ANALGESIA, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES

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