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La neurostimulation n’augmente pas le taux de succès du bloc du nerf saphène

[Neurostimulation does not increase the success rate of saphenous nerve blocks]

Du Département d’Anesthésie et de Réanimation, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.

Adresser la correspondance à: Dr Clément Chassery, Département d’Anesthésie et de réanimation, Service de Chirurgie orthopédique et traumatologique, CHU Rangueil-Larrey, Av Prof. Jean Poulhes, Toulouse 31403 cedex 4, France. Téléphone: 05 61 32 27 12; Courriel: chassery.c{at}chu-toulouse.fr

Purpose: To evaluate neurostimulation of motor components of the vastus medialis muscle and the rectus femoris muscle, with a view to blocking the medial sensory fibres of the saphenous nerve.

Method: First we dissected four femoral trigones, in order to select our puncture point. We were able to observe that, at the flexion crease of the thigh, the different fibers that make up the femoral nerve were clustered together and the saphenous nerve and the vastus medialis nerve had not yet separated from the femoral stem. Secondly, we conducted a prospective clinical study among 71 patients who had undergone surgery on the lower third of the leg with a sciatic block and a saphenous nerve block. The saphenous nerve block was performed using 10 mL of local anesthetic, by puncturing the flexion crease of the thigh in a bid to obtain one of two muscle responses: medial (contraction of the vastus medialis muscle) or anterior (contraction of the rectus femoris muscle and elevation of the patella).

Results: There was an overall success rate of 80% with the saphenous nerve block, with no statistical difference existing between the two response types. Average duration for the block to be completed was two minutes and it took an average of 15 min before the anesthesia took effect. No complications were encountered, apart from a puncture of the femoral artery, which was clinically inconsequential.

Conclusion: Neurostimulation of the vastus medialis muscle has the same effect as neurostimulation of the rectus femoris muscle with respect to anesthesia of the saphenous nerve. Neurostimulation of the medial compartment of the femoral nerve saves local anesthetic, compared to a standard femoral block.

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