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Paraneural block

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
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
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
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
C W Pfirrmann, P A Oberholzer, M Zanetti, N Boos, D J Trudell, D Resnick, J Hodler
PURPOSE: To relate different types of radiographic contrast material distributions to anatomic compartments by using cadaveric specimens and to relate the injection site to treatment-induced discomfort and therapeutic effect. MATERIALS AND METHODS: The contrast material distributions of selective nerve root blocks (SNRBs) in 36 patients (13 women, 23 men; mean age, 52 years; age range, 22-88 years) were graded by two radiologists in conference as type 1 (tubular appearance), type 2 (nerve root visible as filling defect), or type 3 (nerve root not visible)...
December 2001: Radiology
V A Svetlov, S P Kozlov, A M Marupov, A V Gnezdilov
An original technique of the brachial plexus block from the axillary approach is presented. The recommended technique suggests introduction of a rigid catheter into the paraneural space of the plexus up to the level of the sternoclavicular triangle. This provides for a high efficacy of the anesthesia and prevents development of complications. The methodology was elaborated on the basis of anatomic (n = 20) and clinicoradiological (n = 29) studies. The clinical evidence was obtained from 115 anesthesias for long-term reconstructive and plastic operations on the upper limb...
1990: Vestnik Akademii Meditsinskikh Nauk SSSR
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