Taylor Burnham, Aaron Conger, Fabio Salazar, Russell Petersen, Richard Kendall, Shellie Cunningham, Masaru Teramoto, Zachary L McCormick
BACKGROUND: Cervical medial branch radiofrequency ablation (CMBRFA) is an effective treatment for facetogenic pain in patients selected by Spine Intervention Society (SIS) guidelines of 100% symptom improvement with dual medial branch blocks (MBBs) ± placebo block. Patient selection for CMBRFA using ≥80% symptom improvement after dual concordant MBBs is common; however, this has not been studied. OBJECTIVE: To evaluate the effectiveness of CMBRFA and compare outcomes in individuals selected by 80-99% vs 100% symptom improvement with dual concordant MBBs...
February 5, 2020: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Diego A Portela, Douglas Castro, Marta Romano, Aitor Gallastegui, Fernando Garcia-Pereira, Pablo E Otero
OBJECTIVE: To investigate the distribution and nerve staining of two volumes of lidocaine-dye solution after ultrasound-guided erector spinae plane (ESP) injections in canine cadavers. STUDY DESIGN: Experimental cadaveric study. ANIMALS: A total of nine canine cadavers. METHODS: ESP injections were performed between the longissimus thoracis muscle and the dorsolateral edge of the ninth thoracic transverse process. Two cadavers were transversally cryosectioned after unilateral ESP injections [0...
October 30, 2019: Veterinary Anaesthesia and Analgesia
Georg C Feigl, Mathias Schmid, Peter K Zahn, Carla A Avila González, Rainer J Litz
BACKGROUND: Incomplete peripheral nerve blocks distal to the popliteal region are commonly considered a sciatic and femoral/saphenous nerve block failure. The existence of a much more distal innervation area of the posterior femoral cutaneous nerve (PFCN) as described has not been assumed yet. We therefore investigated the distal termination of the PFCN in the lower leg. METHODS: In 83 human lower extremities embalmed with Theil's method, the course of the PFCN was investigated from the sub-gluteal fold to the most distal macroscopically dissectible branch...
March 2020: British Journal of Anaesthesia
Philip Kaller, Gloria Hohenberger, Patrick Holweg, Franz Josef Seibert, Martin Ornig
OBJECTIVE: The so-called ankle block represents a local anesthesia form which enables easy performance of all surgical procedures of the foot and ankle. INDICATIONS: Interventions distal to the medial and lateral malleoli. CONTRAINDICATIONS: Acute and chronic infections in the area of injection; allergy to the local anesthesia. SURGICAL TECHNIQUE: All five sensory foot nerves are blocked. The two deep lying nerves, the tibial nerve and the deep fibular nerve, can be directly anesthetized perineurally using anatomical landmarks...
February 2020: Operative Orthopädie und Traumatologie
Christian Woiciechowsky, Leonie Mercedes Richter
BACKGROUND AND STUDY AIMS:  Low back pain is well documented as an extremely common health problem. The most frequently used treatment is radiofrequency denervation for chronic low back pain. However, different clinical studies could only show a limited to no improvement regarding the decrease of pain intensity and duration of the effect. The main reasons for these limited effects seem to be due to the size of the lesion and difficulties in locating the exact placement of the cannula near the medial branch as well as or additional pathologies...
May 2020: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Pablo E Otero, Santiago E Fuensalida, Pedro C Russo, Natali Verdier, Carlos Blanco, Diego A Portela
This study aimed to describe the anatomical distribution of dye injected in the erector spinae plane (ESP) in a porcine living model, which could aid to reveal factors potentially relevant to the unexplained clinical effects of the ESP block. Six pigs received 0.6 mL/kg of 0.25% new methylene blue at the level of the sixth thoracic vertebra through either a cranial-to-caudal or a caudal-to-cranial in-plane ultrasound-guided bilateral ESP injection 20 min before euthanasia.Spread of dye evaluated through transverse cryosections (four injections) extended from T5 to T10 and from T5 to T8 when a cranial-to-caudal direction of injection was used, and from T5 to T9 and from T5 to T8 when the opposite direction of injection was used...
March 2020: Regional Anesthesia and Pain Medicine
Oluwatobi O Onafowokan, Nicola F Fine, Francis Brooks, Oliver M Stokes, Timothy Wr Briggs, Mike Hutton
AIMS: To examine the strength of evidence available for multiple facet joint injections (FJIs) and medial branch blocks (MBBs), and to report on the variations in the NHS England framework using the getting it right first time (GIRFT) data. METHODS: Systematic review using patient, intervention, comparison, outcome and study strategy. The literature search using Cochrane, MEDLINE and EMBASE databases using MeSH terms: lumbar spine, spinal injection and facet joint ("Appendix A")...
January 1, 2020: European Spine Journal
John Tran, Vincent W S Chan, Philip W H Peng, Anne M R Agur
BACKGROUND AND OBJECTIVES: Quadriceps sparing adductor canal block has emerged as a viable intervention to manage pain after total knee arthroplasty. Recent studies have defined ultrasound (US) landmarks to localize the proximal and distal adductor canal. US-guided proximal adductor canal injection has not been investigated using these sonographic landmarks. The objectives of this cadaveric study were to evaluate dye injectate spread and quantify the capture rates of nerves supplying articular branches to the knee joint capsule using a proximal adductor canal injection technique...
December 25, 2019: Regional Anesthesia and Pain Medicine
Vladimir N Nikolenko, Leonid A Gridin, Marine V Oganesyan, Negoriya A Rizaeva, Yury S Podolskiy, Valentina A Kudryashova, Ekaterina V Kochurova, Roman K Kostin, Ekaterina E Tyagunova, Lyudmila M Mikhaleva, Marco Avila-Rodriguez, Siva G Somasundaram, Cecil E Kirkland, Gjumrakch Aliev
BACKGROUND: There Is A Dearth Of Published Information On The Posterior Perforated Substance As Compared To The Anterior Perforated Substance. We Managed To Glean Facts About The Posterior Perforated Substance That Can Serve As A Landmark For Surgical Operations In The Adjacent Regions Of The Midbrain And The Vessels Passing Through It. Moreover, Posterior Perforated Substance Contains The Interpeduncular Nucleus Responsible For The Mental State Of The Individual. OBJECTIVES: 1) To Describe The Topography Of The Blood Vessels Supplying The Posterior Perforated Substance Area From The Surgical Point Of View; 2) To Investigate The Functions Of The Interpeduncular Nucleus...
November 27, 2019: Current Topics in Medicinal Chemistry
W Song, W Wang, L Zhan
Thymectomy is sometimes carried out via median sternotomy; however, patients undergoing thymectomy via median sternotomy may experience severe postoperative pain. In this study, an ultrasound-guided regional anesthetic technique called a parasternal block, which can be used to relieve postoperative surgical pain after thymectomy via median sternotomy by blocking the medial nerve branch of the anterior cutaneous branch is presented. In this patient bilateral parasternal blocks provided long-lasting analgesia (18 h) with no side effects...
December 2019: Der Anaesthesist
Carl P C Chen, Jean-Lon Chen, Chan-Shien Ho, Areerat Suputtitada
No abstract text is available yet for this article.
March 2020: Anesthesiology
Yagiz Ugur Yolcu, Vance T Lehman, Atiq Ur Rehman Bhatti, Anshit Goyal, Mohammed Ali Alvi, Mohamad Bydon
Facet joint osteoarthritis/arthropathy of the spine is a common cause of back and neck pain which frequently overlaps clinically with other pathologies of the spine. Due to the possible overlap, it is crucial to have an accurate diagnostic strategy, especially when determining the management approach. To this date, various strategies were suggested and adopted, with a number of these still being utilized in clinics. Over the years, due to the disadvantages of single modality imaging methods (Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), Single-photon Emission Computerized Tomography (SPECT)) the interest on radiological examination started to move towards hybrid imaging techniques...
October 23, 2019: World Neurosurgery
John-Paul B Etheridge, Frederick De Villiers, Jan Venter, Pam Squire, Brenda Farnquist, Roderick J Finlayson
BACKGROUND: Although the value of ultrasound-guided (USG) lumbar medial branch blocks (MBB) has previously been examined in several clinical trials, blocking the L5 dorsal ramus (DR) remains a technical challenge and we sought to examine the accuracy of a novel technique targeting this level. METHODS: In this prospective cohort study, 115 patients scheduled for an L4 MBB and L5 DR block underwent an ultrasound scan to assess their lower spine sonoanatomy. Subjects in whom the necessary landmarks could be visualized underwent a USG L5 DR block using a pivot technique, which involved redirecting a needle from its position on the L5 transverse process after an L4 MBB...
March 2020: Regional Anesthesia and Pain Medicine
Aaron Conger, Taylor Burnham, Fabio Salazar, Quinn Tate, Mathew Golish, Russell Petersen, Shellie Cunningham, Masaru Teramoto, Richard Kendall, Zachary L McCormick
OBJECTIVES: Although the effectiveness of lumbar medial branch radiofrequency ablation (RFA) for the treatment of zygapophyseal joint (z-joint)-mediated low back pain has been characterized, few studies have described outcomes in patients selected using a guideline-concordant paradigm of ≥80% pain relief with dual comparative medial branch blocks (MBBs). We investigated long-term treatment outcomes of patients selected according to this paradigm. DESIGN: Cross-sectional cohort study...
October 14, 2019: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Anasuya Ghosh, Subhramoy Chaudhury
The knowledge about detailed morphology and relation of saphenous nerve is important to obtain successful saphenous nerve regional blocks to achieve pre- and post-operative anesthesia and analgesia, nerve entrapment treatments and to avoid damage of saphenous nerve during knee and ankle surgeries. The literature describing detailed morphology of saphenous nerve is very limited. We dissected 42 formalin fixed well embalmed cadaveric lower limbs to explore detailed anatomy, relation and mode of termination of saphenous nerve and measured the distances from the nearby palpable bony landmarks...
September 2019: Anatomy & Cell Biology
V T Lehman, F E Diehn, S M Broski, M A Nathan, B J Kemp, N B Larson, R A Shelerud, J S Brault, M P Halasy, T P Maus
BACKGROUND AND PURPOSE: Prior retrospective studies have suggested that both T2 hyperintensity and gadolinium enhancement on fat-suppressed MR imaging are associated with lumbar facet joint pain, but prospective evaluation of FDG-PET/MR imaging with a standardized protocol and correlation to clinical findings are lacking. The primary aim was to prospectively assess a standardized FDG-PET/MRI protocol in patients with suspected facetogenic low back pain, with determination of the concordance of imaging and clinical findings...
October 2019: AJNR. American Journal of Neuroradiology
S J De Lara González, J Pomés, A Prats-Galino, J Gracia, A Martínez-Camacho, X Sala-Blanch
INTRODUCTION: Thoracic erector spinae plane (ESP) block is now used for postoperative analgesia. However, although reports of lumbar ESP have been published, the anesthetic spread and mechanism of action of this technique remains unclear. We describe the lumbar ESP block technique and evaluate the spread of 20ml of solution administered at the level of the transverse process of L4 in a cadaver model. METHODS: Observational study after 12 lumbar ESP blocks at L4 on a fresh cadaver model (6 bilaterally)...
October 2019: Revista Española de Anestesiología y Reanimación
Victor Varela, Carlos Ruíz, Jaume Pomés, Isaac Pomés, Sara Montecinos, Xavier Sala-Blanch
INTRODUCTION: High-resolution ultrasound (HRU) allows one to identify small nerves, but in the clinical setting, intercostobrachial nerve (ICBN) and medial brachial cutaneous nerve (MBCN) are not identified with conventional portable ultrasound (CPU) devices. The aim of this study is to identify both nerves and describe their relation with specific anatomical structures which could be easily identified with the ultrasound devices available in the clinical setting. METHODS: 21 healthy patients were scanned using HRU bilaterally in the axillary area located over the conjoint tendon to find the ICBN and MBCN and describe their anatomic relations...
August 26, 2019: Regional Anesthesia and Pain Medicine
Hironobu Ueshima, Hiroshi Otake, Eiko Hara, Rafael Blanco
Since the original description in 2011, the array of pectoral nerve blocks has evolved. The pectoral nerve (PECS) block in conjunction with general anesthesia can decrease an additional analgesic in perioperative period for breast cancer surgeries. Current literature on the PECS block has reported 3 several types (PECS I, PECS II, and serratus plane blocks). The PECS I block is the same as to the fi rst injection in the PECS II block. The second injection in the PECS II block and the serratus plane block blocks intercostal nerves (Th2–6) and provides an analgesic for the breast cancer surgery...
June 1, 2019: Asian Journal of Anesthesiology
Laurent Blasco, Pierre Laumonerie, Meagan Tibbo, Olivier Fernandes, Vincent Minville, Raphael Lopez, Pierre Mansat, Fabrice Ferre
OBJECTIVES: The primary aim of our study was to evaluate and compare the accuracy of ultrasound (US)-guided distal suprascapular nerve (dSSN) and proximal SSN (pSSN) blocks. Secondary aims were to compare the phrenic nerve involvement between groups and to describe the anatomical features of the sensory branches of the dSSN. METHODS: pSSN and dSSN blocks were performed in 14 cadavers (28 shoulders). Ten mL of 0.2% ropivacaine colored with methylene blue was injected under US guidance...
July 24, 2019: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
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