Bloqueio do nervo pudendo e simulação obstétrica
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v23.i3.8694Palavras-chave:
Analgesia de parto, bloqueio nervo pudendo, simulação obstétricaResumo
A primeira descrição do bloqueio do nervo pudendo foi em 1908. Esta é uma técnica indicada para analgesia nas fases mais adiantadas do trabalho de parto. O uso de técnicas analgésicas eficazes desde os estadios mais precoces do trabalho de parto, como as técnicas do neuro-eixo, deixaram o bloqueio do pudendo para segundo plano. No entanto, é de fácil execução, habitualmente pelo obstetra, e com baixo risco de hemorragia ou infeção.O bloqueio do pudendo é um procedimento com poucas oportunidades de treino na prática clínica, pelo que o retomar da prática na sua execução através do uso de simuladores obstétricos torna-se pertinente. Ainda, a sua utilização em cenários simulados permite a familiarização de equipas multidisciplinares na sua aplicação em diversos contextos, emergentes ou não emergentes.
Os principais objetivos deste trabalho são (1) efetuar uma revisão sobre o bloqueio do nervo pudendo na analgesia de parto, focando as principais vantagens e limitações, (2) repensar a sua utilização na ausência ou contraindicação de outras técnicas analgésicas, (3) reavivar a técnica de execução através da simulação aplicada à Obstetrícia.
Downloads
Referências
Müller B. Narkologie. Band II, 88. Berlin: Trankel; 1908. p.15.
King R. Perineal anesthesia in labor. Surg Gynecol Obstet 1916; 23: 615-618.
Rocker I. Obstetric indications for the use of pudendal nerve block analgesia. Br Medical Journal 1956; 14:78-81.
Klink EW. Perineal nerve block: an anatomical and clinical study in the female. Obstet Gynec 1953; 1:137-46.
Kohl GC. New method of pudendal nerve block. Northwest Med 1954; 53:1012-3.
Miller R, Eriksson L, Fleisher L, Wiener-Kronish J, Young W. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2010.
Friedman EA. Labor: Clinical evaluation and management. 2ª ed. New York: Appleton; 1978.
Peisner DB, Rosen MG. Transition from latent to ative labor. Obstet Gynecol 1986; 68:448-51.
Harrison RF, Shore M, Woods T, Mathews G, Gardiner J, Un win A. A comparative study of transcutaneous electrical nerve stimulation (TENS), entonox, pethidine promazine and lumbar epidural for pain relief in labor. Acta Obstet Gynecol Scand 1987; 66:9-14.
Volmanen P, Palomäki O, Ahonen J. Alternatives to neuraxial analgesia for labor. Curr Opin Anaesthesiol 2011; 24:235-41.
Rosen MA. Nitrous oxide for relief of labor pain: A systematic review. Am J Obstet Gynecol 2002; 186:110-26.
Schnabel A, Hahn N, Broscheit J, Muellenbach RM, Rieger L, Roewer N, et al. Remifentanil for labour analgesia: a meta-analysis of randomised controlled trials. Eur J Anaesthesiol 2012; 29:177-85.
Carstoniu J, Levytam S. Nitrous oxide in early labor-safety and analgesic effi cacy assessed by a double-blind, placebo-controlled study. Anesthesiology 1994; 80:30-5.
Cambic CR, Wong CA. Labour analgesia and obstetric outcomes. Br J Anaesth 2010; 105: 50-60.
Chestnut D, Polley L, Tsen L, Wong C. Chestnut’s Obstetric Anesthesia: Principles and Practice. Philadelphia: Mosby Elsevier; 2009.
Stav K, Dwyer P, Roberts L. Pudendal neuralgia: fact or fiction?. Obstet Gynecol Surv 2009; 64:190-9.
Standring S. Gray’s Anatomy: the anatomical basis of Medicine and Surgery. Philadelphia: Churchill Livingstone; 1995.
Zador G, Lindmark, G, Nilsson BA. Pudendal block in normal vaginal deliveries. Acta Obstet Gynecol Scand 1974; 34:51-64.
Kuhnert BR, Knapp DR, Kuhnert PM, Prochaska AL. Maternal, fetal and neonatal metabolism of lidocaine. Clin Pharmacol Ther 1979; 26:213-20.
Merkow AJ, McGuiness GA, Erenberg A, Kennedy RL. The neonatal neurobehavioral effects of bupivacaine, mepivacaine and 2-chloroprocaine used for pudendal block. Anesthesiology 1980; 52:309-12.
Langhoff-Roos J, Lindmark G. Analgesia and maternal side effects of pudendal block at delivery. A comparison of three local anesthetics. Acta Obstet Gynecol Scand 1985; 64:269-72.
Schierup L, Schmidt JF, Torp-Jensen A, Rye BA. Pudendal block in vaginal deliveries. Mepivacaine with and without epinephrine. Acta Obstet Gynecol Scand 1988; 67:195-7.
Novikova N, Cluver C. Local anaesthetic nerve block for pain management in labour. Cochrane Database Syst Rev 2012; 4:CD009200.
Romanzi L. Techniques of pudendal nerve block. J Sex Med 2010; 7:1716-9.
Prat-Pradal D, Metge L, Gagnard-Landra C, Mares P, Dauzat M, Godlewski G. Anatomical basis of transgluteal pudendal nerve block. Surg Radiol Anat 2009; 31:289-93.
Abdi S, Shenouda P, Patel N, Saini B, Bharat Y, Calvillo O. A novel technique for pudendal nerve block. Pain Physician 2004; 7:319-22.
Arslan M, Yazici G, Dilek U. Pudendal nerve block for pain relief in episiotomy repair. Int J Gynaecol Obstet 2004; 87:151-2.
Schokman FC, Correy JF. Pudendal block: an obstetric procedure that needs critical evaluation. Asia Oceania J Obstet Gynaecol 1987; 13:495.
Draycott TJ, Crofts JF, Ash JP, Wilson LV, Yard E, Sibanda Thabani, et al. Improving Neonatal Outcome Through Practical Shoulder Dystocia Training. Obstet Gynecol 2008; 112:14-20.
Draycott T, Sibanda T, Owen L, Akande V, Winter C, Reading S, et al. Does training in obstetric emergencies improve neonatal outcome? BJOG 2006; 113:177-82.
Sørensen JL, Van der Vleuten C, Lindschou J, Gluud C, Ostergaard D, Leblanc V, et al. ‘In situ simulation’ versus ‘off site simulation’ in obstetric emergencies and their effect on knowledge, safety attitudes, team performance, stress, and motivation: study protocol for a randomized controlled trial. Trials 2013; 14:220.
Dadiz R, Weinschreider J, Schriefer J, Arnold C, Greves CD, Crosby EC, et al. Interdisciplinary Simulation-Based Training to Improve Delivery Room Communication. Simul Healthc 2013; 8:279-81.
Deering S, Rowland J. Obstetric emergency simulation. Semin Perinatol 2013; 37:179-88.
Burden C, Preshaw J, White P, Draycott TJ, Grant S, Fox R. Usability of virtual-reality simulation training in obstetric ultrasonography: a prospective cohort study. Ultrasound Obstet Gynecol 2013; 42:213-7.
Scholz C, Mann C, Kopp V, Kost B, Kainer F, Fischer MR. High-fidelity simulation increases obstetric self-assurance and skills in undergraduate medical students. J Perinat Med 2012 Jul 13. doi: 10.1515/jpm-2012-0052.
Marques JB, Reynolds A. Shoulder dystocia: an obstetrical emergency. Acta Med Port 2011; 24:613-20.
Pratt SD. Recent trends in simulation for obstetric anesthesia. Curr Opin Anaesthesiol 2012; 25:271-6.
Owen H. Early use of simulation in medical education. Simul Healthc 2012; 7:102-16.
Pratt SD. Focused review: simulation in obstetric anesthesia. Anesth Analg 2012; 114:186-90.
Argani CH, Eichelberger M, Deering S, Satin AJ. The case for simulation as part of a comprehensive patient safety program. Am J Obstet Gynecol 2012; 206:451-5
Marzano D, Frankel J, Smith SB, Andreatta P. A simulation-based scenario to help prepare learners in the management of obstetric emergencies. Simul Healthc 2011; 6:364-9.
To WW. Training in emergency obstetric skills: is it evidence-based? Hong Kong Med J 2011; 17:141-6.
van de Ven J, Houterman S, Steinweg RA, Scherpbier AJ, Wijers W, Mol BW, et al. TOSTI-Trial Group. Reducing errors in health care: cost-effectiveness of multidisciplinary team training in obstetric emergencies (TOSTI study); a randomised controlled trial. BMC Pregnancy Childbirth 2010; 10:59.
Gum L, Greenhill J, Dix K. Clinical simulation in maternity (CSiM): interprofessional learning through simulation team training. Qual Saf Health Care 2010; 19:e19.
Ennen CS, Satin AJ. Training and assessment in obstetrics: the role of simulation. Best Pract Res Clin Obstet Gynaecol 2010; 24:747-58.
Morgan PJ, Pittini R, Regehr G, Marrs C, Haley MF. Evaluating teamwork in a simulated obstetric environment. Anesthesiology 2007; 106:907-15.
Downloads
Publicado
Como Citar
Edição
Secção
Licença
Copyright and access
This journal offers immediate free access to its content, following the principle that providing free scientific knowledge to the public provides greater global democratization of knowledge.
The works are licensed under a Creative Commons Attribution Non-commercial 4.0 International license.
Nascer e Crescer – Birth and Growth Medical Journal do not charge any submission or processing fee to the articles submitted.