Sá Miguel, Graça Rita, Reis Hugo, Cardoso José Miguel, Sampaio José, Pinheiro Célia, Machado Duarte
Centro Hospitalar de Trás-dos-Montes e Alto Douro, Departamento de Anestesiologia e Terapêutica da Dor, Vila Real, Portugal.
Centro Hospitalar de Trás-dos-Montes e Alto Douro, Departamento de Anestesiologia e Terapêutica da Dor, Vila Real, Portugal.
Braz J Anesthesiol. 2018 Jul-Aug;68(4):400-403. doi: 10.1016/j.bjan.2016.11.001. Epub 2017 May 24.
The superior gluteal nerve is responsible for innervating the gluteus medius, gluteus minimus and tensor fascia latae muscles, all of which can be injured during surgical procedures. We describe an ultrasound-guided approach to block the superior gluteal nerve which allowed us to provide efficient analgesia and anesthesia for two orthopedic procedures, in a patient who had significant risk factors for neuraxial techniques and deep peripheral nerve blocks.
An 84-year-old female whose regular use of clopidogrel contraindicated neuraxial techniques or deep peripheral nerve blocks presented for urgent bipolar hemiarthroplasty in our hospital. Taking into consideration the surgical approach chosen by the orthopedic team, we set to use a combination of general anesthesia and superficial peripheral nerve blocks (femoral, lateral cutaneous of thigh and superior gluteal nerve) for the procedure. A month and a half post-discharge the patient was re-admitted for debriding and correction of suture dehiscence; we performed the same blocks and light sedation. She remained comfortable in both cases, and reported no pain in the post-operative period.
Deep understanding of anatomy and innervation empowers anesthesiologists to solve potentially complex cases with safer, albeit creative, approaches. The relevance of this block in this case arises from its innervation of the gluteus medius muscle and posterolateral portion of the hip joint. To the best of our knowledge, this is the first report of an ultrasound-guided superior gluteal nerve block with an analgesic and anesthetic goal, which was successfully achieved.
臀上神经负责支配臀中肌、臀小肌和阔筋膜张肌，这些肌肉在外科手术过程中均可能受到损伤。我们描述了一种超声引导下阻滞臀上神经的方法，该方法使我们能够为一名存在神经轴技术和深部周围神经阻滞显著风险因素的患者，在两种骨科手术中提供有效的镇痛和麻醉。
一名84岁女性，因经常使用氯吡格雷，禁忌采用神经轴技术或深部周围神经阻滞，来我院接受紧急双极半髋关节置换术。考虑到骨科团队选择的手术入路，我们决定在该手术中联合使用全身麻醉和浅表周围神经阻滞（股神经、股外侧皮神经和臀上神经）。出院一个半月后，患者因清创和纠正缝线裂开再次入院；我们实施了相同的神经阻滞和轻度镇静。在这两种情况下，她都感觉舒适，且术后均未报告疼痛。
对解剖结构和神经支配的深入理解，使麻醉医生能够采用更安全、尽管具有创新性的方法来解决潜在的复杂病例。该阻滞在本病例中的相关性源于其对臀中肌和髋关节后外侧部分的神经支配。据我们所知，这是首次关于超声引导下以镇痛和麻醉为目标的臀上神经阻滞的报告，且已成功实现。
