Bloqueio "3 em 1" por via anterior: bloqueio parcial, completo ou superdimensionado? Correlação entre anatomia, clínica e radio imagens

Abstract

In spite of the small sample size, single injection (G1) has always provided 2-in-1 or 2.5-in-1 blockade without the participation of the obturator nerve. With short catheters (G2) 3-in-1 blockade was classified as total in 6.6% of cases (one patient). With long catheters (G3), however, results seem to be more predictable as compared to the other groups, especially when the catheter reaches the lumbosacral paravertebral space, resulting in total 3-in-1 blockade in 20% of cases (3 patients) or more uncommonly, in overdimensioned 3-in-1 blockade in 13.2% of cases (2 patients).

Effectiveness of Ultrasound-guided Single-injection Triple Nerve Block Before Cementless Bipolar Hip Hemiarthroplasty in Femoral Neck Fractures

“…The 3-in-1 block, as originally described by Winnie et al 11) , contends a single perivascular injection distal to the inguinal ligament achieves blockage of the entire lumbar plexus 12) . The current consensus, however, is that this approach does not provide proper anesthesia to the obturator nerve 13 14) . The femoral nerve block and the fascia iliaca compartment block have also been shown to be effective in hip replacement surgeries 10) but often result in inadequate blockage of the lateral femoral cutaneous nerve and obturator nerve.…”

Effects of two different topographic approaches for combined sciatic and femoral nerve block in calves, guided by ultrasound and neurostimulation

“…The greater propensity to fall in the PA treatment was probably due to the ascendant block through the psoas compartment or the iliac fascia ( Geier, 2004 ; Portela et al., 2013 ; Winnie et al., 1973 ), as discussed previously, blocking not only the femoral nerve but also the obturator nerve. In a study using the ventral to the ilium approach for femoral nerve block in cattle, 40% of the animals presented with intense ataxia, promoting recumbency, and inability to stay in a quadrupedal position ( Re et al., 2014 ).…”

“…A possible explanation for the observation of these unsensitised areas that do not correspond to the dermatomes that are supplied exclusively by the femoral nerve, with the proximal approach, can be that the local anaesthetic applied to owe to the use of an approach ventral to the ilium, spread between the psoas compartment and then unsensitised other neural components of the lumbar branches. By comparatively analysing the femoral nerve block technique using the approach ventral to the ilium approach ( Re et al., 2014 ), performed in this experiment, with the lateral pre-iliac approach performed in dogs ( Portela et al., 2013 ), and the “3-in-1″ approach in humans ( Geier, 2004 ; Winnie et al., 1973 ), we can conclude that the needle's perineural positioning would be similar and that all these techniques can give access to the psoas compartment and/or to the iliac fascia, amplifying the obtained block. Portela et al.…”

“…(2018) in a cadaveric study with dogs, administering 0.1 ml/kg of the lidocaine-methylene blue solution, realised that in all approaches there was staining of the femoral innervation, and the cranial dispersion of the solution in the psoas compartment reached the topographic level of up to L5, with the obturator nerve dyed in three out of four approaches performed. In humans, the “3-in-1″ block, also known as the iliac fascia block, is a technique that shows potential for femoral, obturator, and lateral cutaneous nerve of the thigh block ( Geier, 2004 ; Winnie et al., 1973 ), and the efficiency to block all three nerves is dependant on the volume applied ( Geier, 2004 ).…”