Critérios de avaliação do bloqueio anestésico 3 em 1: É comum o envolvimento do nervo obturador?

Karl Otto Geier

doi:10.1590/S0034-70942003000400010

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Critérios de avaliação do bloqueio anestésico 3 em 1: É comum o envolvimento do nervo obturador?

Evaluation criteria for 3-in-1 anesthetic block: Is the involvement of the obturator nerve common?

Karl Otto Geier

http://dx.doi.org/10.1590/S0034-70942003000400010 Braz J Anesthesiol, vol.53, n4, p.501-511, 2003

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Resumo

JUSTIFICATIVA E OBJETIVOS: No bloqueio 3:1 é controvertida a participação do nervo obturador. Intervenções cirúrgicas de superfície na face medial da coxa incidem sobre os dermátomos dos nervos femoral e obturador, de limites imprecisos, sobrepostos ou mesmo ausentes. A correlação entre o desfecho clínico com outros meios de diagnóstico podem ser conclusivos sobre o acometimento do nervo obturador. CONTEÚDO: Comumente o desfecho de um bloqueio regional é pesquisado mais pela insensibilidade dos dermátomos que a atividade motora dos miótomos. A partir de conhecimentos anatômicos sobre o percurso dos componentes plexulares do bloqueio 3:1, critérios clínicos complementados por outros meios de diagnóstico esclarecem o envolvimento do nervo obturador. CONCLUSÕES: A simbiose entre o desfecho clínico do bloqueio 3:1 com os diversos meios de complementação diagnóstica são interpretativos e conclusivos e, de acordo com o que a literatura nos indica sobre a participação do nervo obturador, o bloqueio 3:1 com injeção única, não justifica o seu nome.

Palavras-chave

TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: The participation of the obturator nerve in 3:1 blockades is controversial. Superficial surgical interventions in the medial face of the thigh strike femoral and obturator nerves dermatomes with imprecise, overlapped or even absent limits. The correlation between clinical outcome and other diagnostic methods may be conclusive about the involvement of the obturator nerve. CONTENTS: In general, regional block outcomes are confirmed more by the lack of dermatome sensitivity than by miotomes motor activity. As from the anatomic understanding of the pathway of plexus components of 3:1 blocks, clinical criteria aided by other diagnostic methods explain obturator nerve involvement. CONCLUSIONS:The symbiosis between 3:1 block outcome and different diagnostic methods is interpretative and conclusive and, according to literature indications about the obturator nerve participation, 3:1 block with single injection does not justify its name.

Keywords

ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES

References

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

Dalens B, Tanguy A, Vanneuville G. Lumbar plexus block in children - comparison of two procedures in 50 patients. Anesth Analg. 1988;67:750-758.

Ang ET, Parent H, Lassale B. Lê bloc crural 3 em !et ën evental: etudes anatomique et radiologique de la diffusion da la solution anesthesique. Ann Fr Ánesth Réanim. 1993;12(^sSupl):R27.

Ang ET, Delencourt C, Djenadi K. Block du plexus lombaire chez lê cadavre: etude comparee 4 methodes dïnjection. Ann Fr Anesth Réanim. 1995;14:R148 (Supl).

Spillane WF. 3-in-1 blocks and continuous 3-in-1 blocks. Reg Anesth. 1992;17:175-176.

Parkinson SK, Mueller JB, Little WL. Extent of blockade with various approaches to the lumbar plexus. Anesth Analg. 1989;68:243-248.

Bouaziz H, Vial F, Jochum D. An evaluation of the cutaneous distribution after obturator nerve block. Anesth Analg. 2002;94:445-449.

Parkinson SK, Mueller JB, Little WL. Lumbar plexus blocks and lumbar plexus nerve blocks. Anesth Analg. 1989;69:852-854.

Geiger P, Wild M, Bartl A. 3-in-1 Block - Reality or Fantasy?. ;12:74.

Cauhèpe C. Olivier M, Colombani R. Le bloc trois-en-un: mythe ou réalité?. Ann Fr Anesth Réanim. 1989;8:376-378.

Imbelloni LE. Bloqueio 3 em 1 com bupivacaína a 0,25% para analgesia pós-operatória em cirurgias ortopédicas. Rev Bras Anestesiol. 2000;50:221-224.

Paul W, Drechsler HJ. Clinical efficacy and radiological representation of continuous 3-in-1 block placed by the Seldinger technique. The International Monitor. Med Intern. 1992;4:1: 31-32.

Ganapathy S, Wasserman RA, Watson JT. Modified continuous femoral three-in-one block for postoperative pain after total knee arthroplasty. Anesth Analg. 1999;89:1197-1202.

Imbeloni LE. Bloqueio 3 em 1 com bupivacaína a 0,25% para analgesia pós-operatória em cirurgias ortopédicas. Rev Bras Anestesiol. 2001;51:176-182.

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

Marhofer P, Schrögendorfer K, Wallner T. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Medicine. 1998;23:584-588.

Drolet P, Girard M, Salmon J. Anesthésie Loco-Régionale du Membre Inférieur. Anesthésie Loco-Régionale et Traitement de la Douleur. 1996:179-209.

Netter FH. Atlas of Human Anatomy. 1997:250,345,385.

Ritter JW. Femoral nerve Sheath for inguinal paravascular lumbar plexus block is not found in human cadavers. J Clin Anesth. 1995;7:470-447.

Sharrock NE. Inadvertent 3-in-1 block following injection of the lateral cutaneous nerve of the thigh. Anesth Analg. 1980;59:887-888.

Lonsdale M. 3-in-1 block: confirmation of Winnies anatomical hypothesis. Anesth Analg. 1988;67:601-602.

Liu SS, Ware PD. Differential sensory block after spinal bupivacaine in volunteers. Anesth Analg. 1997;84:115-119.

Raymond AS. Subblocking concentrations of local anesthetics: effects on impulse generation and conduction in single myelinated sciatic nerve axons in frog. Anesth Analg. 1992;75:906-921.

Spalteholz W. Atlas de Anatomia Humana. 1967:898.

Gray S. Anatomy. 1989:1140-1143.

Zetlaoui PJ. Les blocks du plexus lombaire. Cahiers dÁnesthésiologie. 1994;42:771-780.

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

Gray H. Anatomia. 1977:806.

Geier KO. Bloqueio 3 em 1 com bupivacaina a 0,25% para analgesia pós-operatória em cirurgias ortopédicas. Rev Bras Anestesiol. 2001;51:176-182.

Capdevila X, Biboulet PH, Bouregba M. Comparison of the three-in-one and fascia iliac compartment blocks in adults: clinical and radiographic analysis. Anesth Analg. 1998;86:1039-1044.

Rodrigues Jr GR, Nascimento Jr P, Lemonica L. Bloqueio de Nervos Periféricos. Temas de Anestesiologia. 2000:181-186.

Mansour NY. 3-in-1 or 4-in-1?. Reg Anesth. 1992;17:242-243.

Syngelin FJ, Contreras V, Gouverneur JM. Epidural anesthesia complicating continuous 3-in-1 lumbar plexus blockade. Anesthesiology. 1995;83:217-222.

Marhofer P, Oismüller C, Faryniak B. Three-in-One Blocks with Ropivacaine: Evaluation of Sensory Onset Time and Quality of Sensory Block. Anesth Analg. 2000;90:125-128.

Marhofer P, Nasel C, Sitwohl C. Magnetic resonance imaging of the distribution of local anesthetic during the three-in-one block. Anesth Analg. 2000;90:119-124.

Atanassoff PG, Weiss BM, Brull SJ. Eletromyographic comparison of obturador nerve block to three-in-one block. Anesth Analg. 1995;81:529-533.

Critérios de avaliação do bloqueio anestésico 3 em 1: É comum o envolvimento do nervo obturador?

Evaluation criteria for 3-in-1 anesthetic block: Is the involvement of the obturator nerve common?

Karl Otto Geier

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