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Joseph E Pichamuthu, Spandan Maiti, Maria G Gan, Nicole M Verdecchia, Steven L Orebaugh, David A Vorp
Nerve blocks are frequently performed by anesthesiologists to control pain. For sciatic nerve blocks, the optimal placement of the needle tip between its paraneural sheath and epineurial covering is challenging, even under ultrasound guidance, and frequently results in nerve puncture. We performed needle penetration tests on cadaveric isolated paraneural sheath (IPS), isolated nerve (IN), and the nerve with overlying paraneural sheath (NPS), and quantified puncture force requirement and fracture toughness of these specimens to assess their role in determining the clinical risk of nerve puncture...
April 25, 2018: Journal of Biomechanics
Eric R Silverman, Amaresh Vydyanathan, Karina Gritsenko, Naum Shaparin, Nair Singh, Sherry A Downie, Boleslav Kosharskyy
Background. A recently described selective tibial nerve block at the popliteal crease presents a viable alternative to sciatic nerve block for patients undergoing total knee arthroplasty. In this two-part investigation, we describe the effects of a tibial nerve block at the popliteal crease. Methods. In embalmed cadavers, after the ultrasound-guided dye injection the dissection revealed proximal spread of dye within the paraneural sheath. Consequentially, in the clinical study twenty patients scheduled for total knee arthroplasty received the ultrasound-guided selective tibial nerve block at the popliteal crease, which also resulted in proximal spread of local anesthetic...
2017: Pain Research & Management: the Journal of the Canadian Pain Society
T Geiser, J Apel, O Vicent, J Büttner
BACKGROUND: Ultrasound guided distal sciatic nerve block (DSB) at bifurcation level shows fast onset and provides excellent success rates. However, its safe performance might be difficult for the unexperienced physician. Just slightly distal to the bifurcation, the tibial nerve (TN) and common fibular nerve (CFN) can be shown clearly separated from each other. Therefore, we investigated if a block done here would provide similar quality results compared to the DSB proximally to the division, with a potentially lower risk of nerve damage...
March 2017: Der Anaesthesist
André P Boezaart
No abstract text is available yet for this article.
November 2014: Regional Anesthesia and Pain Medicine
Martin M Mortazavi, Olivia A Harmon, Nimer Adeeb, Aman Deep, R Shane Tubbs
Over time, various treatment modalities for spinal cord injury have been trialed, including pharmacological and nonpharmacological methods. Among these, replacement of the injured neural and paraneural tissues via cellular transplantation of neural and mesenchymal stem cells has been the most attractive. Extensive experimental studies have been done to identify the safety and effectiveness of this transplantation in animal and human models. Herein, we review the literature for studies conducted, with a focus on the human-related studies, recruitment, isolation, and transplantation, of these multipotent stem cells, and associated outcomes...
January 2015: Clinical Anatomy
Pinelopi Tsouni, Thierry Kuntzer, François Ochsner
Musculoskeletal disorders are a crossroad among diverse specialties: neurology, rehabilitation, orthopedics, occupational medicine and psycho-traumatology. They are integrated into occupational medicine and encompass overuse syndromes, repeated micro-trauma and focal compressive neuropathies linked with professional or sports' activity. Neurological manifestations are omnipresent. Yet, their importance is not always recognized despite frequent resort to neurologists specialized in peripheral nervous system disorders and neurophysiology, as well as, to behavioral cognition specialists...
April 30, 2014: Revue Médicale Suisse
Wallaya Techasuk, Francisca Bernucci, Tracy Cupido, Andrea P González, José A Correa, Roderick J Finlayson, De Q H Tran
BACKGROUND AND OBJECTIVES: The aim of this study was to determine the minimum effective volume (MEV) of combined lidocaine 1.0%-bupivacaine 0.25% with epinephrine 5 μg/mL in 90% of patients (MEV90) for ultrasound-guided subparaneural popliteal sciatic nerve block. METHODS: All subjects received an ultrasound-guided subparaneural popliteal sciatic nerve block (at the neural bifurcation) with combined lidocaine 1.0%-bupivacaine 0.25% and epinephrine 5 μg/mL. Using an out-of-plane technique, a 17-gauge, 8-cm Tuohy needle was advanced until its tip was positioned between the tibial and peroneal nerves inside the paraneural sheath...
March 2014: Regional Anesthesia and Pain Medicine
N A Shchudlo, M M Shchudlo, I V Borisova
An experimental morphological study in 56 animals has been performed in order to analyze the effect of cerebrolysin on the dynamics and long-term results of peripheral nerve regeneration after the transection and microsurgical suturing depending on the scheme of the preparation of paraneural infusion. The regeneration process was evaluated after 2.5; 4; 6 and 12 months. There was a stimulating effect of the preparation on the regenerative growth and differentiation of nerve fiber axial cylinders, vascularization of the distal segment of regenerating nerve and the trophic condition of myelin-forming Schwann cells...
2013: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
(no author information available yet)
The in vivo study on 25 rabbits and clinical study, involving 60 patients with lower limbs' varicose disease and trophic ulcers was carried out. The in-vivo study was based on the chemical distruction of the sympathic trunk by injecting 95% ethanol and 6% phenol paraneurally along the vascular bundle in the ear. The regeneration of the sympathic neural trunk was registered within 2-3 months after the injury. In human patients the US-guided chemical desympathization led to the increase of the capillary circulation (1...
2013: Khirurgiia
Faraj W Abdallah, Vincent W Chan
No abstract text is available yet for this article.
September 2013: Regional Anesthesia and Pain Medicine
Manoj Kumar Karmakar, Ali Nima Shariat, Pawinee Pangthipampai, Junping Chen
BACKGROUND AND OBJECTIVES: The connective tissue layers that surround the sciatic nerve at the popliteal fossa are poorly defined. We present high-definition ultrasound images of the sciatic nerve, which were acquired during ultrasound-guided popliteal sciatic nerve block (SNB), that clearly demonstrate these fascial layers. METHODS: Four patients undergoing hallux valgus surgery received an ultrasound-guided popliteal SNB using a high-definition ultrasound system...
September 2013: Regional Anesthesia and Pain Medicine
Anahi Perlas, Patrick Wong, Faraj Abdallah, Lili-Naz Hazrati, Cyrus Tse, Vincent Chan
BACKGROUND AND OBJECTIVES: The macroscopic anatomy of a common paraneural sheath that surrounds the sciatic nerve in the popliteal fossa has been studied recently in a human cadaveric study. It has been suggested that an injection through this sheath could be an ideal location for local anesthetic administration for popliteal block. The aim of the present study was to evaluate the hypothesis that popliteal sciatic nerve blockade through a common paraneural sheath results in shorter onset time when compared with conventional postbifurcation injection external to the paraneural tissue...
May 2013: Regional Anesthesia and Pain Medicine
Masaki Sato, Yasuhito Mikawa, Akiko Matuda
A selective lumbosacral nerve root block is generally is performed under X-ray fluoroscopy, which has the disadvantage of radiation exposure and the need for fluoroscopy equipment. In this study, we assessed the effectiveness of ultrasound and nerve stimulation-guided S1 nerve root block on 37 patients with S1 radicular syndrome. With the patient in a prone position, an ultrasound scan was performed by placing the probe parallel to the body axis. The needle was pointed slightly medial from the lateral side of the probe and advanced toward a hyperechoic area in the sacral foramina with ultrasound guidance...
October 2013: Journal of Anesthesia
De Q H Tran, Andrea P González, Francisca Bernucci, Kevin Pham, Roderick J Finlayson
BACKGROUND: In this prospective, randomized, observer-blinded trial, we compared ultrasound-guided subparaneural popliteal sciatic nerve blocks performed either at or proximal to the neural bifurcation (B). We hypothesized that the total anesthesia-related time (sum of performance and onset times) would be decreased with the prebifurcation (PB) technique. METHODS: Ultrasound-guided posterior popliteal sciatic nerve block was performed in 68 patients. All subjects received an identical volume (30 mL) and mix of local anesthetic agent (1% lidocaine-0...
May 2013: Anesthesia and Analgesia
Henning Lykke Andersen, Sofie L Andersen, Jørgen Tranum-Jensen
BACKGROUND AND OBJECTIVES: There exists little anatomic knowledge regarding the structure and sonographic features of the sheath enveloping the sciatic nerve in the popliteal fossa. We investigated the spread of an injection inside the sheath to (1) determine whether the sheath is a structure distinct from the nerve or part of the epineurium and (2) to develop an ultrasound-guided injection technique. METHODS: Using gross dissection, ultrasound examination, and histologic study, we characterized the tissue layer surrounding the sciatic nerve in the popliteal fossa of 28 unembalmed cadaver legs...
July 2012: Regional Anesthesia and Pain Medicine
A F Brovkina, O Iu Iatsenko
The results of computer tomogram images analysis of 32 patients (32 orbits) with soft tissue orbital tumors are presented. 22 patients appeared to have cavernous hemangioma, 10--optic nerve meningioma. The technique of three dimensional reconstruction of orbital soft tissue is described and its diagnostic value in patients with cavernous hemangioma and optic nerve meningioma is analyzed. The density of lesions and its variability were studied. Indications for two and three dimensional imaging were proposed to differentiate these tumors...
November 2010: Vestnik Oftalmologii
Marin Bulat, Marijan Klarica
According to the traditional hypothesis, the cerebrospinal fluid (CSF) is secreted inside the brain ventricles and flows unidirectionally along subarachnoid spaces to be absorbed into venous sinuses across arachnoid villi and/or via paraneural sheaths of nerves into lymphatics. However, according to recent investigations, it appears that interstitial fluid (ISF) and CSF are formed by water filtration across the walls of arterial capillaries in the central nervous system (CNS), while plasma osmolytes are sieved (retained) so that capillary osmotic counterpressure is generated, which is instrumental in ISF/CSF water absorption into venous capillaries and postcapillary venules...
January 1, 2011: Brain Research Reviews
Masaki Sato, Sumito Simizu, Ryo Kadota, Hirosi Takahasi
STUDY DESIGN: Case series. OBJECTIVE: Evaluation of ultrasound and nerve stimulation-guided L5 nerve root block technique. SUMMARY OF BACKGROUND DATA: Ultrasound-guided peripheral nerve block has become clinically applied. However, selective lumbosacral nerve root block is conducted under radiographic guidance, which involves patients and operators being exposed to radiation. In addition, it cannot be carried out easily during outpatient visits or at the bedside...
November 15, 2009: Spine
Andreas Gravvanis, Dimitris D Dionyssiou, Lekha Chandrasekharan, Ian Francis, Roger W Smith
The computed tomography microangiography revolutionized the planning of abdominal flaps, and enabled us to identify perforators from the deep inferior epigastric system with a medial extramuscular or minimal medial intramuscular trajectory. We define these perforators as paramuscular and paraneural, since their main course is retromuscular and they emerge medial to the medial border of rectus muscle or medial to its motor nerve supply, respectively. Studying the different perforator distributions in the abdomen of 58 patients who underwent breast reconstruction with deep inferior epigastric artery perforator flap, we have recorded that 46...
December 2009: Annals of Plastic Surgery
M Kateva, K Dimitrov
The article describes the possibility of covering large skin defects of the fingers by the use of fasciocutaneous flap from the back of the hand. It is pedicled on a sensory nerve branch and its paraneural tissue. The flap relies on blood supply from the constant para- and intraneural vascular network which gives perforator branches towards the overlying skin as well as on the constant anastomoses between the dorsal and volar arterial pool. We present a patient with a skin defect along the whole radial side of the index who underwent such reconstruction...
2008: Acta Chirurgiae Plasticae
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