Volumes anestésicos efetivos no bloqueio do nervo isquiático: comparação entre as abordagens parassacral e infraglútea-arabiceptal com bupivacaína a 0,5% com adrenalina e ropivacaína a 0,5%

Pablo Escovedo Helayel; Diogo Brüggemann da Conceição; Julian Alexander Knaesel; Maurício Sperotto Ceccon; Adilson José Dal Mago; Getúlio Rodrigues de Oliveira Filho

doi:10.1590/S0034-70942009000500001

Scientific Article

Volumes anestésicos efetivos no bloqueio do nervo isquiático: comparação entre as abordagens parassacral e infraglútea-arabiceptal com bupivacaína a 0,5% com adrenalina e ropivacaína a 0,5%

Effective anesthetic volumes in sciatic nerve block: comparison between the parasacral and infragluteal-parabiceps approaches with 0.5% bupivacaine with adrenaline and 0.5% ropivacaine

Pablo Escovedo Helayel; Diogo Brüggemann da Conceição; Julian Alexander Knaesel; Maurício Sperotto Ceccon; Adilson José Dal Mago; Getúlio Rodrigues de Oliveira Filho

http://dx.doi.org/10.1590/S0034-70942009000500001 Braz J Anesthesiol, vol.59, n5, p.521-530, 2009

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: O volume e a massa das soluções de anestésico local (AL) influenciam a taxa de sucesso dos bloqueios periféricos. Desta forma, o objetivo principal do estudo foi determinar os volumes de anestésico local para o bloqueio do nervo isquiático (BNI) nas abordagens parassacral e infraglútea-parabiceptal. MÉTODO: Cento e um pacientes foram alocados aleatoriamente em 4 grupos e submetidos ao BNI nas abordagens infraglútea-parabiceptal ou parassacral, utilizando ropivacaína a 0,5% ou bupivacaína a 0,5% com adrenalina 5 µg.mL-1. Sucesso foi definido como bloqueio sensitivo e motor completo do nervo isquiático 30 minutos após a injeção do AL. Os volumes foram calculados pelo método up-and-down. RESULTADOS: Na abordagem parassacral o volume efetivo médio da ropivacaína foi 17,6 mL (IC 95%: 14,9 - 20,8) e da bupivacaína 16,4 mL (IC 95%: 12,3 - 21,9). Na abordagem infraglútea-parabiceptal o volume efetivo médio da ropivacaína foi 21,8 mL (IC 95%: 18,7 - 25,5) e bupivacaína 20,4 mL (IC 95%: 18,6 - 22,5). Volumes foram significativamente menores (p < 0,01) na abordagem parassacral comparativamente à infraglútea-parabiceptal. Na estimativa da regressão de Probits para volumes efetivos em 95% dos pacientes, os volumes na abordagem parassacral foram 21,8 mL para ropivacaína e 20,5 mL para bupivacaína; e na infraglútea- parabiceptal foram 27,2 mL na ropivacaína e 25,5 mL na bupivacaína. O volume efetivo em 99% dos pacientes no BNI parassacral para ropivacaína foi 24 mL e para bupivacaína 22,5 mL; e 29,9 mL de ropivacaína e 28,0 mL de bupivacaína no grupo infraglúteoparabiceptal. CONCLUSÕES: Foram necessários volumes significativamente menores na abordagem parassacral do BNI comparativamente à abordagem infraglúteaparabiceptal, mas os volumes anestésicos não diferiram entre os AL.

Palavras-chave

ANESTÉSICO, LOCAL, ANESTÉSICO, LOCAL, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: The volume and mass of local anesthetics (LA) affect the success rate of peripheral nerve blocks. Thus, the main objective of this study was to determine the volumes of local anesthetics in parasacral and infragluteal-parabiceps sciatic nerve block (SNB). METHODS: One hundred and one patients undergoing infragluteal-parabiceps or parasacral SNB with 0.5% ropivacaine or 0.5% bupivacaine with 5 µg.mL-1 of adrenaline were randomly divided into 4 groups. Success was defined as complete sensitive and motor blockades of the sciatic nerve 30 minutes after the administration of the LA. Volumes were calculated by the up-and-down method. RESULTS: In the parasacral approach, the mean effective volume of ropivacaine was 17.6 mL (95% CI: 14.9-20.8) and of bupivacaine it was 16.4 mL (95% CI: 12.3-21.9). In the infragluteal-parabiceps approach, the mean effective volume of ropivacaine was 21.8 mL (95% CI: 18.7-25.5), and that of bupivacaine was 20.4 mL (95% CI: 18.6-22.5). Volumes were significantly lower (p < 0.01) in the parasacral than in the infragluteal-parabiceps approach. In Probit regression, the estimated effective volume in 95% of the patients in the parasacral approach was 21.8 mL for ropivacaine, and 20.5 mL for bupivacaine; in the infragluteal-parabiceps approach the volumes were 27.2 mL for ropivacaine and 25.5 mL for bupivacaine. The effective volume in 99% of the patients in parasacral SNB was 24 mL for ropivacaine, and 24 mL for bupivacaine; and in the infragluteal-parabiceps approach, 29.9 mL for ropivacaine, and 28.0 mL for bupivacaine. CONCLUSIONS: In sciatic nerve block, significantly smaller volumes were necessary in the parasacral than in the infragluteal-parabiceps approach, but volumes did not differ between both LAs.

Keywords

ANESTHETIC, Local, ANESTHETIC, Local, ANESTHETIC TECHNIQUES, Regional

Referências

Casati A, Fanelli G, Magistris L. Minimum local anesthetic volume blocking the femoral nerve in 50% of cases: a double-blinded comparison between 0.5% ropivacaine and 0.5% bupivacaine. Anesth Analg. 2001;92:205-208.

Vester-Andersen T, Husum B, Lindeburg T. Perivascular axillary block IV: blockade following 40, 50 or 60 ml of mepivacaine 1% with adrenaline. Acta Anaesthesiol Scand. 1984;28:99-105.

Morris GF, Lang SA, Dust WN. The parasacral sciatic nerve block. Reg Anesth. 1997;22:223-228.

Taboada M, Alvarez J, Cortes J. Is a double-injection technique superior to a single injection in posterior subgluteal sciatic nerve block?. Acta Anaesthesiol Scand. 2004;48:883-887.

Cuvillon P, Ripart J, Jeannes P. Comparison of the parasacral approach and the posterior approach, with single and double-injection techniques, to block the sciatic nerve. Anesthesiology. 2003;98:1436-1441.

Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med. 2004;29:564-575.

Helayel PE, Lobo G, Vergara R. Volumes efetivos de anestésicos locais para o bloqueio do compartimento da fáscia ilíaca: Estudo comparativo duplamente encoberto entre ropivacaína a 0,5% e bupivacaína a 0,5%. Rev Bras Anestesiol. 2006;56:454-460.

Soares LF, Barros ACM, Almeida GP. Volume anestésico mínimo para o bloqueio retrobulbar extraconal: comparação entre soluções a 0,5% de bupivacaína racêmica de levobupivacaína e da mistura enantiomérica S75/R25 de bupivacaína. Rev Bras Anestesiol. 2005;55:263-268.

Casati A, Borghi B, Fanelli G. A double-blinded, randomized comparison of either 0.5% levobupivacaine or 0.5% ropivacaine for sciatic nerve block. Anesth Analg. 2002;94:987-990.

Fanelli G, Casati A, Beccaria P. A double-blind comparison of ropivacaine, bupivacaine, and mepivacaine during sciatic and femoral nerve blockade. Anesth Analg. 1998;87:597-600.

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

Gaertner E, Lascurain P, Venet C. Continuous parasacral sciatic block: a radiographic study. Anesth Analg. 2004;98:831-834.

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

Dixon WJ, Massey F. Introduction to Statistical Analysis. 1983.

Dixon WJ. Staircase bioassay: the up-and-down method. Neurosci Biobehav Rev. 1991;15:47-50.

Kraemer HC, Thiemann S. How Many Subjects?: Statistical power analysis in research. 1987.

Robertson JL, Preisler HK. Pesticides Bioassays with Arthropods. 1992.

de Visme V, Picart F, Le Jouan R. Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly. Reg Anesth Pain Med. 2000;25:158-162.

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.

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.

Bailey SL, Parkinson SK, Little WL. Sciatic nerve block: A comparison of single versus double injection technique. Reg Anesth. 1994;19:9-13.

Capogna G, Celleno D, Fusco P. Relative potencies of bupivacaine and ropivacaine for analgesia in labour. Br J Anaesth. 1999;82:371-373.

Lichtman AH. The up-and-down method substantially reduces the number of animals required to determine antinociceptive ED50 values. J Pharmacol Toxicol Methods. 1998;40:81-85.

Lacassie HJ, Columb MO, Lacassie HP. The relative motor blocking potencies of epidural bupivacaine and ropivacaine in labor. Anesth Analg. 2002;95:204-208.

Volumes anestésicos efetivos no bloqueio do nervo isquiático: comparação entre as abordagens parassacral e infraglútea-arabiceptal com bupivacaína a 0,5% com adrenalina e ropivacaína a 0,5%

Effective anesthetic volumes in sciatic nerve block: comparison between the parasacral and infragluteal-parabiceps approaches with 0.5% bupivacaine with adrenaline and 0.5% ropivacaine

Pablo Escovedo Helayel; Diogo Brüggemann da Conceição; Julian Alexander Knaesel; Maurício Sperotto Ceccon; Adilson José Dal Mago; Getúlio Rodrigues de Oliveira Filho

Resumo

Palavras-chave

Abstract

Keywords

Referências

Links

Compartilhar

Braz J Anesthesiol