Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000300004
Brazilian Journal of Anesthesiology
Scientific Article

É realmente necessário o uso do estimulador de nervo periférico no bloqueio do nervo femoral?

Peripheral nerve stimulator for femoral nerve block. Is it really necessary?

Karl Otto Geier

http://dx.doi.org/10.1590/S0034-70942003000300004 Braz J Anesthesiol, vol.53, n3, p.338-345, 2003
PDF
Downloads: 0
Views: 1133

Resumo

JUSTIFICATIVA E OBJETIVOS: Vários são os métodos de localização do nervo femoral no espaço perivascular na região inguinal sendo o mais comum o do estimulador de nervo periférico. O objetivo deste estudo foi o de avaliar a necessidade do bloqueio do nervo femoral com o método do estimulador de nervo periférico, comparando-o com o método da perda de resistência tanto pela técnica de injeção única como pela técnica com catéteres. MÉTODO: Foram realizados 60 bloqueios do nervo femoral divididos em quatro grupos homogêneos (GA, GB, GC e GD). Trinta bloqueios representaram dois grupos pela técnica de injeção única, quinze com agulha descartável 21G (GA) e quinze com agulha isolada adaptada ao estimulador de nervo periférico (GC) e os restantes trinta bloqueios divididos em quinze bloqueios com cateter venoso (GB) e quinze com cateter longo Contiplex® (GD). Todos os bloqueios do nervo femoral foram realizados no espaço perivascular inguinal. O espaço perifemoral foi identificado após a segunda perda de resistência ao ar (fascia ilíaca) (GA e GC), e com 0,3 a 0,4 mA com o estimulador de nervo periférico (GB e GD). Foram avaliados os seguintes parâmetros: tempo para a realização do bloqueio; presença ou ausência de parestesias ou disestesias; dificuldade de punção e falhas. RESULTADOS: Não foram relatadas parestesias nem disestesias. Duas falhas resultaram no grupo A (p < 0,26), no mesmo paciente e duas dificuldades de punção devido aos recentes e vários bloqueios no local. Não houve diferenças significativas quanto à eficácia entre o método da perda de resistência com o do estimulador de nervo periférico. O tempo despendido pelo método do estimulador de nervo periférico foi maior (p < 0,001). CONCLUSÕES: Embora o uso do estimulador de nervo periférico seja o mais utilizado no bloqueio do nervo femoral na região inguinal, neste estudo, o método da perda de resistência mostrou-se uma alternativa bastante eficaz e viável.

Palavras-chave

ANESTESIA, ANESTESIA, EQUIPAMENTOS

Abstract

BACKGROUND AND OBJECTIVES: There are several methods to locate the femoral nerve in the perivascular inguinal space, being the most common the use of a peripheral nerve stimulator. This study aimed at evaluating femoral nerve block performed with peripheral nerve stimulator as compared to the loss of resistance to air technique, both by single injection or with catheter insertion. METHODS: Sixty patients undergoing femoral nerve blocks were divided in four homogeneous groups (GA, GB, GC, GD). Thirty blocks were performed with single injection technique: 15 with disposable 21G needle (GA) and 15 with insulated needle adapted to the peripheral nerve stimulator (GC). The remaining 30 blocks were divided in 15 blocks performed with intravenous catheter (GB) and 15 with long Contiplex® catheter (GD). All femoral nerve blocks were performed in the perivascular inguinal space. Perifemoral space was identified after the second loss of resistance to air (iliac fascia, GA and GC), and with 0.3 to 0.4 mA stimuli from peripheral nerve stimulator (GB and GD). The following parameters were evaluated: time to blockade performance, presence or absence of paresthesias or disesthesias, puncture difficulties and failures. RESULTS: There were no paresthesias or disesthesias. There have been two failures (p < 0.26) in the same GA patient, and two puncture difficulties due to recent and multiple blocks on the same site. There have been no significant efficacy differences between loss of resistance and peripheral nerve stimulator methods. Time for peripheral nerve stimulator block was longer (p < 0.001). CONCLUSIONS: Whereas the peripheral nerve stimulator is more widely used in the inguinal region, our study has shown that the loss of resistance to air technique is an effective and feasible alternative.

Keywords

ANESTHESIA, ANESTHESIA, EQUIPMENTS

References

Winnie AP, Zamamurthy S, Durani Z. The inguinal paravascular technique of lumbar plexus anesthesia. the “3:1” block. Anesth Analg. 1973;52:989-996.

Marhofer P, Schroegendorfer K, Koinig H. Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg. 1997;85:854-857.

Selander D, Duhner KG, Lundborg G. Peripheral nerve injury due to injection needles used in regional anesthesia: an experimental study of the acute effects of needle point trauma. Acta Anaesthesiol Scand. 1977;21:182-188.

Rice AS, McMahon SB. Peripheral nerve injury caused by injection needles used in regional anaesthesia: influence of bevel configuration, studied in a rat model. Br J Anaesth. 1992;69:433-438.

Pain Terms: A list with definitions and notes on usage. 1979:249-252.

Devera HV. Use of the nerve stimulator in teaching regional anesthesia techniques. Reg Anesth. 1991;16:188.

Hartrick CT. An argument for the use of the nerve stimulator for peripheral nerve blocks. Reg Anesth. 1993;18:199.

Frazer RS. Regional blockade: training and the use of nerve stimulators. Reg Anesth. 1993;18:199.

VadeBoncouer TR, Riegler FX. In defense of the nerve stimulator. Reg Anesth and Pain Med. 1998;23:229-230.

Greenblatt GM, Denson JS. Needle nerve stimulator-locator. Anesth Analg. 1962;41:599-602.

Montgomery SJ, Raj PP, Nettles D. The use of the nerve stimulator with standard unsheathed needles in nerve blockade. Anesth Analg. 1973;52:827-831.

Bashein G, Haschke RH, Ready B. Electrical nerve location: numerical and eletrophoretic comparison of insulated vs uninsulated needles. Anesth Analg. 1984;63:919-924.

Ford DJ, Pither C, Raj PP. Comparison of insulated and uninsulated needles for locating peripheral nerves with a peripheral nerve stimulator. Anesth Analg. 1984;63:925-928.

Boesenberg AT. Lower limb nerve blocks in children using unsheathed needles and a nerve stimulator. Anaesthesia. 1995;50:206-210.

Fanelli G, Casati A, Garancini . Nerve stimulator and multiple injection technique for upper and lower limb blockage: failure rate, patient acceptance, and neurologic complications. Anesth Analg. 1999;88:847-852.

Selander D. Axillary plexus block: paresthetic or perivascular. Anesthesiology. 1987;66:726-728.

Cockings E, Leicht M, Heavner . Transarterial brachial blockade using high doses of 1.5% mepivacaine. Reg Anesth. 1987;12:159-164.

King RS, Urquhart B. Factors influencing success of brachial plexus block. Reg Anesth. 1990;15:63.

Plevak DJ, Linstromberg JW, Danielson DR. Paresthesia vs non paresthesia: the axillary block. Anesthesiology. 1982;59:A216.

Vloka JD, Hadzic A, Drobnik L. Anatomical landmarks for femoral nerve block: a comparison of four needle insertion sites. Anesth Analg. 1999;89:1467-1470.

5ddd36320e88252e081da3e9 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections