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

References

Pauchet V. Anestesia Regional. 1923:198-202.

Mansour NY. Reevaluating the sciatic nerve block: Another landmark for consideration. Reg Anesth. 1993;18:322-323.

Löfström B. Bloqueo de los Nervios Periféricos de la Pierna a Nível del Tobillo. Manual Ilustrado de Anestesia Local. 1969:108-111.

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

Singelyn FJ, Gouverneur JM, Gribomont BF. Popliteal sciatic nerve block aided by a nerve stimulator: a reliable technique for foot and ankle surgery. Reg Anesth. 1991;16:278-2815.

Paqueron X, Bouaziz H, Macalou D. The lateral approach to the sciatic nerve at the popliteal fossa: one or two injections?. Anesth Analg. 1999;89:1221-1225.

Cornish PB, Greenfield LJ. Brachial Plexus Anatomy. Reg Anesth. 1997;22:106-107.

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

Zetlaoui PJ, Bouaziz H. Lateral approach to the sciatic nerve in the popliteal fossa. Anesth Analg. 1998;87:79-82.

Vloka JD, 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.

Spalteholz W. Atlas de Anatomia Humana. 1967:890.

Singelyn FJ, Aye F, Gouverneur JM. Continuous popliteal sciatic nerve block: an original technique to provide postoperative analgesia after foot surgery. Anesth Analg. 1997;84:363-386.

Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravas- cular technique of lumbar plexus anesthesia: the "3:1 block". Anesth Analg. 1973;52:989-996.

Geier KO. Bloqueio do plexo braquial no trauma: analgesia regional prolongada por cateter axilar. Rev Bras Anestesiol. 1995;45:173-182.

Geier KO, Rocha VHB. Bloqueio contínuo do plexo lombar via compartimento ilíaco, combinado com bloqueio contínuo do nervo femoral em trauma grave de membro inferior. Rev Bras Anestesiol. 2001;51(1):53-58.

Geier KO. Analgesia regional prolongada com catéteres periféricos: Relato de casos. Rev Bras Anestesiol. 2002;52:35-46.

Lynch J, Trojan S, Arhhelger S. Intermittent femoral nerve blockade for anterior cruciate ligament repair: Use of a catheter technique in 208 patients. Acta Anaesthesiol Belg. 1991;42:207-212.

Sarma VJ. Long-term continuous axillary plexus blockade using 0.25% bupivacaine. Acta Anaesthesiol Scand. 1990;34:391-393.

Vloka JD, Hadzic A, Singson R. The lateral approach to popliteal nerve block: double injection technique revisited. Anesthesiology. 1999;91(3A):A883.

Mezzatesta JP, Scott DA, Schweitzer AS. Continuous axillary brachial plexus block for postoperative pain relief. Reg Anesth. 1997;22:357-362.

Bonica JJ. Sympathetic and Somatic Segmental and Peripheral Nerve Supply to the Hips and Lower Limbs. The Management of Pain. 1990:1421-1423.

Lehtipalo S, Winso O, Koskinen L-OD. Cutaneous sympathetic vasoconstrictor reflexes for the evaluation of interscalene brachial plexus block. Acta Anaesthesiol Scand. 2000;44:946-952.

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