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perineural injections

Huy Q Truong, Xicai Sun, Emrah Celtikci, Hamid Borghei-Razavi, Eric W Wang, Carl H Snyderman, Paul A Gardner, Juan C Fernandez-Miranda
OBJECTIVE Multiple approaches have been designed to reach the medial middle fossa (for lesions in Meckel's cave, in particular), but an anterior approach through the greater wing of the sphenoid (transalisphenoid) has not been explored. In this study, the authors sought to assess the feasibility of and define the anatomical landmarks for an endoscopic anterior transmaxillary transalisphenoid (EATT) approach to Meckel's cave and the middle cranial fossa. METHODS Endoscopic dissection was performed on 5 cadaver heads injected intravascularly with colored silicone bilaterally to develop the approach and define surgical landmarks...
February 2, 2018: Journal of Neurosurgery
Andrzej Krol, Arber Vala, Leonidas Phylactides, Matthew Szarko, Miguel A Reina, Jose de Andrés
BACKGROUND: The aim of the study was to investigate the difference between intraneural and perineural injection pressures in human cadavers. Targeted nerves included the cervical roots, the supraclavicular and infraclavicular brachial plexus, the sciatic-subgluteal nerve and the common peroneal and tibial nerves. METHODS: Ten readings were obtained for each nerve location. 1mL of 0.9% NaCl was injected over ten seconds - deliberately slower than in clinical practice to eliminate the risk of aberrant readings relating to the speed of injection...
January 16, 2018: Minerva Anestesiologica
N Pfund, A Oh, A Cyna
Perineural (Tarlov) cysts are cerebrospinal fluid-containing perineural sacs that are usually located in the sacral spine. While often asymptomatic, they can cause progressive neurological symptoms including pain, paraesthesia and weakness. We present a case of a 24-year-old patient who had uneventful spinal anaesthesia at the L3-4 level for an elective caesarean section. Prior to her procedure, she had reported a two-year history of intermittent back pain and lower-limb paraesthesia, secondary to an S1 segment perineural cyst...
December 14, 2017: International Journal of Obstetric Anesthesia
Stanley K H Lam, Kenneth Dean Reeves, An-Lin Cheng
Deep nerve hydrodissection uses fluid injection under pressure to purposely separate nerves from areas of suspected fascial compression, which are increasingly viewed as potential perpetuating factors in recalcitrant neuropathic pain/complex regional pain. The usage of 5% dextrose water (D5W) as a primary injectate for hydrodissection, with or without low dose anesthetic, could limit anesthetic-related toxicity. An analgesic effect of 5% dextrose water (D5W) upon perineural injection in patients with chronic neuropathic pain has recently been described...
2017: BioMed Research International
Hyun Yi, Shue Liu, Yuta Kashiwagi, Daigo Ikegami, Wan Huang, Hirotsugu Kanda, Takafumi Iida, Ching-Hang Liu, Keiya Takahashi, David A Lubarsky, Shuanglin Hao
Chronic pain is increasingly recognized as an important comorbidity of HIV-infected patients, however, the exact molecular mechanisms of HIV-related pain are still elusive. CCAAT/enhancer binding proteins (C/EBPs) are expressed in various tissues, including the CNS. C/EBPβ, one of the C/EBPs, is involved in the progression of HIV/AIDS, but the exact role of C/EBPβ and its upstream factors are not clear in HIV pain state. Here, we used a neuropathic pain model of perineural HIV envelope glycoprotein gp120 application onto the rat sciatic nerve to test the role of phosphorylated C/EBPβ (pC/EBPβ) and its upstream pathway in the spinal cord dorsal horn (SCDH)...
January 17, 2018: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Ke-Vin Chang, Wei-Ting Wu, Levent Özçakar
High-resolution ultrasound (US) enables prompt depiction of muscles, tendons, ligaments, and peripheral nerves. It seems to be the best imaging modality for guiding perineural injections. The most complicated neurovascular network of the musculoskeletal system surrounds the cervical spine; so injection to that region is never an easy task. This article elaborates the regional anatomy and the use of US scanning and guidance for cervical interventions; for example, cervical root, superficial cervical plexus, stellate ganglion, cervical medial branch, greater occipital nerve, and third occipital nerve...
February 2018: Physical Medicine and Rehabilitation Clinics of North America
Sheng Yi, Qi-Hui Wang, Li-Li Zhao, Jing Qin, Ya-Xian Wang, Bin Yu, Song-Lin Zhou
Differential expression of miRNAs occurs in injured proximal nerve stumps and includes miRNAs that are firstly down-regulated and then gradually up-regulated following nerve injury. These miRNAs might be related to a Schwann cell phenotypic switch. miR-30c, as a member of this group, was further investigated in the current study. Sprague-Dawley rats underwent sciatic nerve transection and proximal nerve stumps were collected at 1, 4, 7, 14, 21, and 28 days post injury for analysis. Following sciatic nerve injury, miR-30c was down-regulated, reaching a minimum on day 4, and was then upregulated to normal levels...
October 2017: Neural Regeneration Research
Bhagavatula Indira Devi, Subhas K Konar, Dhananjaya I Bhat, Dhaval P Shukla, R Bharath, M S Gopalakrishnan
AIM: This study was undertaken to address the epidemiological characteristics, operative details, and surgical outcome of peripheral nerve injuries in children treated in a tertiary hospital in India (NIMHANS, Bangalore). MATERIALS AND METHODS: This is a retrospective study of epidemiology, operative findings, and surgical outcomes over the period of 2000-2016. Our series includes 102 children with peripheral nerve injuries of various causes. RESULTS: Intramuscular injections were the most common cause (52...
November 23, 2017: Pediatric Neurosurgery
Salman Thobhani, Lauren Scalercio, Clint E Elliott, Bobby D Nossaman, Leslie C Thomas, Dane Yuratich, Kim Bland, Kristie Osteen, Matthew E Patterson
BACKGROUND: Novel regional techniques, including the adductor canal block (ACB) and the local anesthetic infiltration between the popliteal artery and capsule of the knee (IPACK) block, provide an alternative approach for controlling pain following total knee arthroplasty (TKA). This study compared 3 regional techniques (femoral nerve catheter [FNC] block alone, FNC block with IPACK, and ACB with IPACK) on pain scores, opioid consumption, performance during physical therapy, and hospital length of stay in patients undergoing TKA...
2017: Ochsner Journal
Scott M Fried, Levon N Nazarian
BACKGROUND: Recurrent carpal tunnel syndrome is often associated with perineural scarring around the median nerve. Surgical options include relatively invasive procedures, such as fat pad grafting, ligament reconstruction, muscle transfer, and nerve wraps. All have limited success because of the possibility of repeated recurrent scarring postoperatively. METHODS: We discuss a technique involving injection with external hydroneurolysis of the median nerve under ultrasound guidance for recurrent carpal tunnel...
September 1, 2017: Hand: Official Journal of the American Association for Hand Surgery
Wenling Zhao, Qinqin Yin, Jin Liu, Wensheng Zhang, Linghui Yang
An experimental set-up was designed to observe whether adding dexmedetomidine to QX-314 would enhance the onset and duration of sensory and motor function in a rat sciatic nerve block model. Fifty-six Sprague-Dawley rats received unilateral sciatic nerve blocks with 0.2 ml of 35 mM QX-314 alone, dexmedetomidine (5.3 μM [1 μg•kg-1], 26.4 μM [5 μg•kg-1], 52.8 μM [10 μg•kg-1]) alone, or a combination of the two. Thermal nociception and motor function were assessed by a blinded investigator, sciatic nerves and perineural tissues were harvested at 14 days after injection...
September 8, 2017: Canadian Journal of Physiology and Pharmacology
Seçkin Tuncer, Tülay Tuncer Peker, İlksen Burat, Erhan Kiziltan, Barkin İlhan, Nizamettin Dalkiliç
In this study, effects of the long-acting amide-type local anesthetic levobupivacaine on axonal conduction and excitability parameters of the rat sciatic nerve were thoroughly examined both in vitro and in vivo. In order to deduce its effects on isolated nerve conduction, compound nerve action potential (CNAP) recordings were performed using the suction method over sciatic nerves of Wistar rats before and after administration of 0.05 % (1.7 mmol L-1) levobupivacaine. Levobupivacaine caused complete CNAP area and amplitude depression by blocking conduction in a time-dependent manner...
September 1, 2017: Acta Pharmaceutica
M Baeriswyl, K R Kirkham, A Jacot-Guillarmod, E Albrecht
Perineural dexamethasone has gained popularity in regional anaesthesia to prolong the duration of analgesia, but its advantage over systemic administration is disputed. The objective of this meta-analysis was to compare the analgesic efficacy of both routes of administration during peripheral nerve block. The methodology followed the PRISMA statement guidelines. The primary outcome was the duration of analgesia analysed according to the type of local anaesthetic administered (bupivacaine or ropivacaine). Secondary outcomes included cumulative opioid consumption in morphine i...
August 1, 2017: British Journal of Anaesthesia
Kumar Abhinav, David Panczykowski, Wei-Hsin Wang, Carl H Synderman, Paul A Gardner, Eric W Wang, Juan C Fernandez-Miranda
BACKGROUND: The maxillary nerve (V2) can be approached via the open middle fossa approach. OBJECTIVE: To delineate the anatomy of V2 and its specific segments with respect to the endonasal landmarks. We present the endoscopic endonasal interdural middle fossa approach to V2 and its potential application for the treatment of perineural spread in sinonasal/skull base tumors. METHODS: Five human head silicon-injected specimens underwent bilateral endoscopic endonasal transpterygoid approaches...
August 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
Stephanie Stauffer, Beckie Cordner, Jonathon Dixon, Thomas Witte
OBJECTIVE: The aim of this preliminary proof-of-concept study was to evaluate and compare the success and complication rate of infiltration of the maxillary nerve of cadaver heads using previously described surface landmarks, standard ultrasound and a novel needle guidance positioning ultrasound system (SonixGPS). STUDY DESIGN: Prospective, anatomical, method-comparison study. ANIMALS: Thirty-eight equine cadaver heads. METHODS: Twenty-six veterinary students performed the three methods consecutively on cadaver heads using an 18 gauge, 8...
April 6, 2017: Veterinary Anaesthesia and Analgesia
Ying-Chen Kuo, Chia-Cheng Lee, Lin-Fen Hsieh
Carpal tunnel syndrome (CTS) is a common and sometimes challenging condition, which causes pain; paresthesia; tingling of the thumb, index and long fingers; and even thenar weakness in the hands. The effectiveness of corticosteroid injections seems to be transient, and there is a lack of information around long-term effects in previous studies. In recent years, platelet-rich plasma (PRP) has proven to bean alternative as it encourages tissue regeneration. We hereby describe a patient with CTS showing significant improvements in electrophysiological parameters after receiving PRP injections...
October 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Leonardo Henirque Cunha Ferraro, Alexandre Takeda, Paulo César Castello Branco de Sousa, Fernanda Moreira Gomes Mehlmann, Jorge Kiyoshi Mitsunaga Junior, Luiz Fernando Dos Reis Falcão
INTRODUCTION: Randomized prospective study comparing two perivascular techniques with the perineural technique for ultrasound-guided axillary brachial plexus block (US-ABPB). The primary objective was to verify if these perivascular techniques are noninferior to the perineural technique. METHOD: 240 patients were randomized to receive the techniques: below the artery (BA), around the artery (AA) or perineural (PN). The anesthetic volume used was 40mL of 0.375% bupivacaine...
June 23, 2017: Revista Brasileira de Anestesiologia
Jun Yao, Lu-Lin Zhang, Xu-Mei Huang, Wen-Yao Li, She-Gan Gao
AIM: To detect the expression of pleiotrophin (PTN) and N-syndecan in pancreatic cancer and analyze their association with tumor progression and perineural invasion (PNI). METHODS: An orthotopic mouse model of pancreatic cancer was created by injecting tumor cells subcapsularly in a root region of the pancreas beneath the spleen. Pancreatic cancer tissues were taken from 36 mice that survived for more than 90 d. PTN and N-syndecan proteins were detected by immunohistochemistry and analyzed for their correlation with pathological features, PNI, and prognosis...
June 7, 2017: World Journal of Gastroenterology: WJG
Natsuki Yonezawa, Tsutomu Minamikawa, Kazuhiro Kitajima, Yusuke Takahashi, Ryohei Sasaki, Ken-Ichi Nibu, Takahide Komori
The aim of this study was to investigate the prognostic value of dual-time-point (DTP) (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) imaging in primary oral tongue squamous cell carcinoma (OTSCC). The study included 52 patients who underwent preoperative (18)F-FDG PET scans at two time points, namely 1 h and 2 h after injection. The following PET parameters were calculated: maximum standardized uptake value (SUVmax) for both time points (SUV early, SUV delayed); retention index (RI); and SUVmax increment (ΔSUVmax)...
February 2017: Nagoya Journal of Medical Science
Hirokazu Iwamuro, Taro Yanagawa, Sachiko Takamizawa, Makoto Taniguchi
BACKGROUND: Perineural cysts are sometimes found incidentally with magnetic resonance imaging, and clinical symptoms requiring treatment are rare. Perineural cysts typically exhibit delayed filling with contrast medium on myelography, which is one of the criteria used by Tarlov to distinguish perineural cysts from meningeal diverticula. We present a case of multiple thoracolumbar perineural cysts, one of which was considered the cause of intermittent intercostal neuralgia with atypical findings on postmyelographic computed tomography seen as selective filling of contrast medium...
June 13, 2017: BMC Medical Imaging
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