Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942010000400010
Brazilian Journal of Anesthesiology
Clinical Information

Bloqueio dos nervos femoral e isquiático guiados por ultrassom em paciente anticoagulado: case reports

Ultrasound-guided femoral and sciatic nerve blocks in an anticoagulated patient: relato de casos

Leonardo Henrique Cunha Ferraro; Maria Angela Tardelli; Américo Masafuni Yamashita; José Daniel Braz Cardone; Juliana Midori Kishi

http://dx.doi.org/10.1590/S0034-70942010000400010 Braz J Anesthesiol, vol.60, n4, p.425-428, 2010
PDF Português
PDF English
Downloads: 2
Views: 1093

Resumo

JUSTIFICATIVA E OBJETIVOS: O uso de ultrassom para guiar a punção em bloqueios de nervos periféricos tem-se tornado cada vez mais frequente. Com a menor probabilidade de promover lesões vasculares, o ultrassom torna-se uma ferramenta interessante na realização de bloqueios periféricos, especialmente nos pacientes em uso de anticoagulantes ou com distúrbios da coagulação. O objetivo foi relatar dois casos em que se realizaram os bloqueios isquiático e femoral guiados por ultrassom em pacientes anticoagulados. RELATO DOS CASOS: No primeiro caso, a cirurgia realizada consistiu na amputação de antepé esquerdo devido a necrose e sinais de infecção e, no segundo caso, em limpeza cirúrgica de joelho esquerdo. Os pacientes apr esentavam distúrbios de coagulação com atividade de protrombina e tempo de tromboplastina ativado acima dos valores da normalidade. Ambos os pacientes foram submetidos a bloqueio femoral e isquiático guiados por ultrassom, evoluindo sem alteração motora ou sensitiva nos territórios desses nervos e sem hematoma no local da punção. CONCLUSÕES: A anticoagulação impõe certas restrições à aplicação das técnicas anestésicas regionais clássicas. Com o avanço dos equipamentos e métodos de ultrassom, hoje é possível identificar com alta precisão estruturas vasculares e neurais. Isso possibilita que a punção guiada por ultrassom seja mais precisa, tanto para atingir a área de interesse como para minimizar os riscos de lesão vascular acidental. Até o presente, não se recomenda a realização de bloqueio periférico em pacientes anticoagulados ou portadores de coagulopatias. Entretanto, considerando que há poucos relatos sobre bloqueios regionais com ultrassom em situações de coagulopatias, a segurança de tal técnica nessas condições ainda não foi estabelecida.

Palavras-chave

DROGAS, EQUIPAMENTOS, Ultrassom, SANGUE, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: The use of the ultrasound to guide the puncture in peripheral nerve blocks has become increasingly more frequent. With the lower probability of promoting vascular damage the ultrasound has become an interesting tool in peripheral nerve blocks especially in patients in use of anticoagulants or with coagulopathies. The objective of this article was to report two cases in which ultrasound-guided sciatic and femoral nerve blocks were performed in anticoagulated patients. CASE REPORTS: In the first case, the patient underwent amputation of the left forefoot due to necrosis and signs of infection, and in the second case, surgical cleaning of the left knee. Patients had changes in coagulation with levels of activity of prothrombin and activated partial thromboplastin time above normal limits. Both patients underwent ultrasound-guided femoral and sciatic nerve blocks, evolving without motor or sensorial changes in the territories of those nerves and without hematoma at the site of puncture. CONCLUSIONS: Anticoagulation imposes some restrictions to classical regional anesthetic techniques. With the development of ultrasound equipment and methods, it is now possible to accurately identify vascular and neural structures. This allows ultrasound-guided puncture to be more precise, both to achieve the area of interest and to minimize the risks of accidental vascular damage. Until now, peripheral block was not recommended in anticoagulated patients or in those with coagulopathies. However, considering that few reports on ultrasound-guided regional blocks in coagulopathies can be found in the literature, the safety of this technique in this condition has yet to be established.

Keywords

ANESTHETIC TECHNIQUES, Regional, BLOOD, DRUGS, EQUIPMENT, Ultrasound

References

Kapral S, Greher M, Huber G. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med. 2008;33:253-258.

Perlas A, Brull R, Chan VWS. Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Reg Anesth Pain Med. 2008;33:259-265.

Sauter AR, Dodgson MS, Stubhaug A. Electrical nerve stimulation or ultrasound guidance for lateral sagittal infraclavicular blocks: a randomized, controlled, observer-blinded, comparative study. Anesth Analg. 2008;106:1910-1915.

Chan VW, Perlas A, McCartney CJ. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. 2007;54:176-182.

Domingo-Triado V, Selfa S, Martinez F. Ultrasound guidance for lateral midfemoral sciatic nerve block: a prospective, comparative, randomized study. Anesth Analg. 2007;104:1270-1274.

Williams SR, Chouinard P, Arcand G. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg. 2003;97:1518-1523.

Abrahams MS, Aziz MF, Fu RF. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009;102:408-417.

Warman P, Nicholls B. Ultrasound-guided nerve blocks: efficacy and safety. Best Pract Res Clin Anaesthesiol. 2009;23:313-326.

Koscielniak-Nielsen ZJ. Ultrasound-guided peripheral nerve blocks: what are the benefits?. Acta Anaesthesiol Scand. 2008;52:727-737.

Bigeleisen PE. Ultrasound-guided infraclavicular block in an anticoagulated and anesthetized patient. Anesth Analg. 2007;104:1285-1287.

Khelemsky Y, Rosenblatt MA. Ultrasound-guided supraclavicular block in a patient anticoagulated with argatroban. Pain Pract. 2008;8.

Horlocker TT, Wedel DJ, Benzon H. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med. 2003;28:172-197.

Vandermeulen EP, Van Aken H, Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg. 1994;79:1165-1177.

Behr J. Optimizing preoperative lung function. Curr Opin Anaesthesiol. 2001;14:65-69.

Smetana GW. Preoperative pulmonary evaluation. N Engl J Med. 1999;340:937-944.

Nishiyama T, Hanaoka K. Does common cold increase perioperative respiratory complications in adults?. Masui. 2005;54:643-647.

5dceb69e0e88250a05bf58f1 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