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

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

doi:10.1590/S0034-70942011000500003

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

http://dx.doi.org/10.1590/S0034-70942011000500003 Braz J Anesthesiol, vol.61, n5, p.538-543, 2011

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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

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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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