Martins Luis Eduardo Silveira, Ferraro Leonardo Henrique Cunha, Takeda Alexandre, Munechika Masashi, Tardelli Maria Angela
Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brazil.
Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brazil; Sociedade Brasileira de Anestesiologia, São Paulo, SP, Brazil.
Braz J Anesthesiol. 2017 Jan-Feb;67(1):100-106. doi: 10.1016/j.bjane.2015.06.005. Epub 2016 Oct 26.
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.
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.
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.
超声的出现给周围神经阻滞带来了诸多益处。鉴于在操作过程中能够可视化神经血管结构和穿刺针，它兼具安全性和有效性。尽管有这些优点，但对于在抗凝患者或患有其他凝血功能障碍的患者中使用该技术，文献中尚无共识。此外，周围神经阻滞在深度、扩散性和局部压迫可能性方面存在差异。然而，很少有学会在制定建议时考虑到这一点，无论采用何种途径，都制定单一的周围神经阻滞操作建议。本系列的目的是扩大关于抗凝患者周围神经阻滞的讨论。
本系列报告了9例原发性或继发性血液系统异常患者在超声引导下进行浅表周围神经阻滞的病例。所有阻滞均由在超声操作方面经验丰富的麻醉医生进行，病例中未出现瘀斑或神经损伤。
本病例系列支持关于在抗凝患者、接受双联抗血小板治疗和/或患有其他凝血功能障碍的患者中进行浅表周围神经阻滞以及易于掌握局部解剖知识（如腋窝、肌间沟、股部、隐神经或腘窝处）的讨论，前提是在超声引导下由在神经阻滞引导方面经验丰富的麻醉医生进行操作。然而，需要进行更大规模的系列研究来证明该技术对这些患者的安全性。
