Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2015.06.005
Brazilian Journal of Anesthesiology
Clinical Information

Ultrasound-guided peripheral nerve blocks in anticoagulated patients - case series

Bloqueios de nervos periféricos guiados por ultrassom em pacientes anticoagulados - série de casos

Luis Eduardo Silveira Martins; Leonardo Henrique Cunha Ferraro; Alexandre Takeda; Masashi Munechika; Maria Angela Tardelli

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Abstract

Abstract Background and objectives: The advent of ultrasound has brought many benefits to peripheral nerve blocks. It includes both safety and effectiveness, given the possibility of visualizing the neurovascular structures and the needle during the procedure. Despite these benefits, there is no consensus in the literature on the use of this technique in anticoagulated patients or with other coagulation disorders. Moreover, peripheral blocks vary in depth, spreadability, and possibility of local compression. However, few societies take it into account when drawing up its recommendations, establishing a single recommendation for performing peripheral blocks, regardless of the route used. The objective of this series is to expand the discussion on peripheral nerve block in anticoagulated patients. Case reports: This series reports 9 cases of superficial peripheral nerve blocks guided by ultrasound in patients with primary or secondary dyscrasias. All blocks were performed by experienced anesthesiologists in the management of ultrasound, and there was no bruising or neurological injuries in the cases. Conclusions: This case series support the discussion on conducting surface peripheral nerve blocks and easy local knowledge as the axillary, interscalene, femoral, saphenous or popliteal in anticoagulated patients, on dual antiaggregation therapy and/or with other coagulation disorders, provided that guided by ultrasound and performed by an anesthesiologist with extensive experience in guided nerve blocks. However, larger series should be performed to prove the safety of the technique for these patients.

Keywords

Peripheral nerve block, Ultrasound, Coagulation

Resumo

Resumo Justificativa e objetivos: O advento da ultrassonografia trouxe inúmeros benefícios para os bloqueios de nervos periféricos. Agregou tanto segurança quanto eficácia, dada a possibilidade de visualização de estruturas neurovasculares e da agulha durante o procedimento. Apesar desses benefícios, não há consenso na literatura sobre o uso da técnica em pacientes anticoagulados ou com outros distúrbios da coagulação. Além disso, os bloqueios periféricos variam com relação à profundidade, expansibilidade e possibilidade de compressão local. Porém, poucas sociedades levam isso em consideração para elaborar suas recomendações, estabelecem um recomendação única para bloqueios periféricos, independentemente da via usada. O objetivo desta série é ampliar a discussão sobre bloqueio de nervos periféricos em pacientes anticoagulados. Relato de casos: Esta série relata 9 casos de bloqueios de nervos periféricos superficiais guiados por ultrassonografia em pacientes com discrasias primárias ou secundárias. Todos os bloqueios foram feitos por anestesiologistas experientes no manejo do ultrassom, que não foram observados hematomas ou lesões neurológicas nos casos. Conclusões: A série de casos em questão ajuda a discussão sobre bloqueios periféricos superficiais e de fácil compressão local, como o axilar, interescalênico, femoral, safeno ou poplíteo, em pacientes anticoagulados, duplamente antiagregados e/ou com outros distúrbios da coagulação desde que guiados por ultrassom e feitos por anestesiologista com vasta experiência em bloqueios guiados. Entretanto, maiores séries devem ser feitas para comprovar a segurança da técnica para esses pacientes.

Palavras-chave

Bloqueio nervo periférico, Ultrassom, Coagulação

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