Não obstante o bloqueio pleural ter sido difundido extensivamente a partir de meados da década de 1980 1 , convertendo-se numa panacéia analgésica para uma extensa lista de doenças 2 , resultados contraditórios de autores de língua inglesa, alegando pouca efetividade de origem desconhecida, induziram-no ao esquecimento. Apesar da escassez de divulgações dos últimos anos sobre o Bloqueio Pleural, surge no nosso meio, mais um estudo evidenciando a sua utilidade em analgesia pós-operatória abdominal 3 . Embora a tendên-cia crescente de colecistectomia por videolaparoscopia, o estudo comparativo da analgesia pós-operatória envolvendo os bloqueios regionais periféricos intercostal e pleural em incisão sub-costal 3 , confirma a mesma conclusão de um estudo previamente divulgado 4 . Reforçando os trabalhos acima citados, o bloqueio pleural revelou-se eficiente também, em anestesia para o mesmo procedimento cirúrgico 5 . Concordo que a "busca por técni-cas de analgesia pós-operatória" 3 deve ser "de consenso geral" 3 entre nós; entretanto, entendo que a técnica analgésica do bloqueio pleural deve fazer parte integrante do nosso armamentário anestesiológico.Atenciosamente.Dr. Karl Otto Geier Rua Cel. Camisão, 172 90540-030 Porto Alegre, RS E-mail: karlotto@terra.com.br
Pleural BlockMr. Editor, Though pleural block has been widely spread as from the mid 1980's 1 , becoming an analgesic panacea for an extensive list of diseases 2 , contradictory English speaking authors results claiming low effectiveness of unknown reason have led physicians to overlook such technique. In spite of the lack of recent publications on Pleural Block, one more study was published in Brazil evidencing its usefulness for postoperative abdominal analgesia 3 . Although the increasing trend toward videolaparoscopic cholecystectomy, the comparative study of postoperative analgesia involving peripheral intercostal and pleural blocks in sub-costal incisions 3 confirms the same conclusions of a previous study 4 .Reinforcing the above-mentioned studies, pleural block has shown to be effective also in anesthesia for the same surgical procedure 5 . I agree that "the search for postoperative analgesia techniques" 3 should be "consensus" 3 among us; however, I understand that the pleural block technique should be an integral part of our anesthetic armamentarium.
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).
Relevant enhanced tomographic findings of the popliteal region have proven a recent anatomic study on the individualization of the neural sheath involving popliteal nerves with implications in blockade outcome. Anesthesia obtained by a catheter in the popliteal fossa was effective only in the superficial fibular nerve dermatome (medial dorsum of foot and hallux).
Justificativa e Objetivos
com o objetivo de fazer analgesia controlada pelo paciente (ACP), por via peridural, no pós-operatório. Como a A C P n ã o a p r e s e n t o u r e s u l ta d o s n o p ó s -o p e r a t ó r i o
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