The Experts below are selected from a list of 3240 Experts worldwide ranked by ideXlab platform
Andrew T. Gray - One of the best experts on this subject based on the ideXlab platform.
-
sonographic imaging of the Obturator Nerve for regional block
Regional Anesthesia and Pain Medicine, 2007Co-Authors: Julie Soong, Ingeborg Schafhalterzoppoth, Andrew T. GrayAbstract:Background and Objectives Today, there is a growing appreciation of the importance of the Obturator Nerve in clinical anesthesia. The aim of this study is to describe the ultrasound appearance of the Obturator Nerve for potential utility in guiding these Nerve blocks. Methods We scanned left and right inguinal regions of 20 volunteers lateral and distal to the pubic tubercle (PT) and assessed visibility, size and shape, and depth from the skin of common Obturator Nerves and their associated divisions. In addition to the volunteer study, we retrospectively reviewed a clinical series of Obturator Nerve blocks performed with ultrasound guidance and Nerve stimulation. Results The Obturator Nerve can be sonographically visualized by scanning along the known course of the Nerve; the anterior division characteristically converges toward the posterior division along the lateral border of the adductor brevis muscle to form the common Obturator Nerve more proximally. In the set of 20 volunteers, 25% (10/40) of common, 85% (34/40) of anterior, and 87.5% (35/40) of posterior Obturator Nerves were sonographically identified. The common Obturator Nerve was visualized 1.3 ± 1.5 cm distal and 2.3 ± 1.2 cm lateral to the PT. Divisions were visualized 2.1 ± 2.0 cm distal and 2.1 ± 1.2 cm lateral to the PT. The Nerves (common, anterior, and posterior) averaged 2.7 ± 1.2 mm, 1.4 ± 0.6 mm, and 1.7 ± 0.6 mm in anterior-posterior dimension and 9.0 ± 4.3 mm, 9.6 ± 3.9 mm, and 10.9 ± 4.1 mm in medial-lateral dimension and were 25.9 ± 7.6 mm, 15.5 ± 3.9 mm, and 29.3 ± 7.9 mm below the skin surface. The common Obturator Nerve and its anterior and posterior divisions are all relatively flat Nerves with average anterior-posterior/medial-lateral dimension ratios of 0.32, 0.18, and 0.18, respectively. In the clinical series, Nerve identification was confirmed with Nerve stimulation (n = 6 block procedures, mean threshold stimulating current for evoked adductor contraction = 0.70 ± 0.14 mA). Conclusions The Obturator Nerve and its divisions are the flattest peripheral Nerves yet described with ultrasound imaging. Knowledge of the Obturator Nerve’s ultrasound appearance facilitates localization of this Nerve for regional block and may increase success of such procedures.
-
Sonographic Imaging of the Obturator Nerve for Regional Block
Regional anesthesia and pain medicine, 2007Co-Authors: Julie Soong, Ingeborg Schafhalter-zoppoth, Andrew T. GrayAbstract:Today, there is a growing appreciation of the importance of the Obturator Nerve in clinical anesthesia. The aim of this study is to describe the ultrasound appearance of the Obturator Nerve for potential utility in guiding these Nerve blocks. We scanned left and right inguinal regions of 20 volunteers lateral and distal to the pubic tubercle (PT) and assessed visibility, size and shape, and depth from the skin of common Obturator Nerves and their associated divisions. In addition to the volunteer study, we retrospectively reviewed a clinical series of Obturator Nerve blocks performed with ultrasound guidance and Nerve stimulation. The Obturator Nerve can be sonographically visualized by scanning along the known course of the Nerve; the anterior division characteristically converges toward the posterior division along the lateral border of the adductor brevis muscle to form the common Obturator Nerve more proximally. In the set of 20 volunteers, 25% (10/40) of common, 85% (34/40) of anterior, and 87.5% (35/40) of posterior Obturator Nerves were sonographically identified. The common Obturator Nerve was visualized 1.3 +/- 1.5 cm distal and 2.3 +/- 1.2 cm lateral to the PT. Divisions were visualized 2.1 +/- 2.0 cm distal and 2.1 +/- 1.2 cm lateral to the PT. The Nerves (common, anterior, and posterior) averaged 2.7 +/- 1.2 mm, 1.4 +/- 0.6 mm, and 1.7 +/- 0.6 mm in anterior-posterior dimension and 9.0 +/- 4.3 mm, 9.6 +/- 3.9 mm, and 10.9 +/- 4.1 mm in medial-lateral dimension and were 25.9 +/- 7.6 mm, 15.5 +/- 3.9 mm, and 29.3 +/- 7.9 mm below the skin surface. The common Obturator Nerve and its anterior and posterior divisions are all relatively flat Nerves with average anterior-posterior/medial-lateral dimension ratios of 0.32, 0.18, and 0.18, respectively. In the clinical series, Nerve identification was confirmed with Nerve stimulation (n = 6 block procedures, mean threshold stimulating current for evoked adductor contraction = 0.70 +/- 0.14 mA). The Obturator Nerve and its divisions are the flattest peripheral Nerves yet described with ultrasound imaging. Knowledge of the Obturator Nerve's ultrasound appearance facilitates localization of this Nerve for regional block and may increase success of such procedures.
Francis Sahngun Nahm - One of the best experts on this subject based on the ideXlab platform.
-
Obturator Nerve block with botulinum toxin type B for patient with adductor thigh muscle spasm -a case report-.
The Korean Journal of Pain, 2011Co-Authors: Eun Joo Choi, Jong Min Byun, Francis Sahngun NahmAbstract:Obturator Nerve block has been commonly used for pain management to prevent involuntary reflex of the adductor thigh muscles. One of several options for this block is chemical neurolysis. Neurolysis is done with chemical agents. Chemical agents used in the neurolysis of the Obturator Nerve have been alcohol, phenol, and botulinum toxin. In the current case, a patient with spasticity of the adductor thigh muscle due to cervical cord injury had Obturator Nerve neurolysis done with botulinum toxin type B (BoNT-B). Most of the previous studies have used BoNT-A with only a few reports that have used BoNT-B. BoNT-B has several advantages and disadvantages over BoNT-A. Thus, we report herein a patient who successfully received Obturator Nerve neurolysis using BoNT-B to treat adductor thigh muscle spasm.
-
Obturator Nerve Block with Botulinum Toxin Type B for Patient with Adductor Thigh Muscle Spasm
2011Co-Authors: Eun Joo Choi, Jong Min Byun, Francis Sahngun Nahm, Pyung Bok LeeAbstract:Obturator Nerve block has been commonly used for pain management to prevent involuntary reflex of the adductor thigh muscles. One of several options for this block is chemical neurolysis. Neurolysis is done with chemical agents. Chemical agents used in the neurolysis of the Obturator Nerve have been alcohol, phenol, and botulinum toxin. In the current case, a patient with spasticity of the adductor thigh muscle due to cervical cord injury had Obturator Nerve neurolysis done with botulinum toxin type B (BoNT-B). Most of the previous studies have used BoNT-A with only a few reports that have used BoNT-B. BoNT-B has several advantages and disadvantages over BoNT-A. Thus, we report herein a patient who successfully received Obturator Nerve neurolysis using BoNT-B to treat adductor thigh muscle spasm. (Korean J Pain 2011; 24: 164-168)
Julie Soong - One of the best experts on this subject based on the ideXlab platform.
-
sonographic imaging of the Obturator Nerve for regional block
Regional Anesthesia and Pain Medicine, 2007Co-Authors: Julie Soong, Ingeborg Schafhalterzoppoth, Andrew T. GrayAbstract:Background and Objectives Today, there is a growing appreciation of the importance of the Obturator Nerve in clinical anesthesia. The aim of this study is to describe the ultrasound appearance of the Obturator Nerve for potential utility in guiding these Nerve blocks. Methods We scanned left and right inguinal regions of 20 volunteers lateral and distal to the pubic tubercle (PT) and assessed visibility, size and shape, and depth from the skin of common Obturator Nerves and their associated divisions. In addition to the volunteer study, we retrospectively reviewed a clinical series of Obturator Nerve blocks performed with ultrasound guidance and Nerve stimulation. Results The Obturator Nerve can be sonographically visualized by scanning along the known course of the Nerve; the anterior division characteristically converges toward the posterior division along the lateral border of the adductor brevis muscle to form the common Obturator Nerve more proximally. In the set of 20 volunteers, 25% (10/40) of common, 85% (34/40) of anterior, and 87.5% (35/40) of posterior Obturator Nerves were sonographically identified. The common Obturator Nerve was visualized 1.3 ± 1.5 cm distal and 2.3 ± 1.2 cm lateral to the PT. Divisions were visualized 2.1 ± 2.0 cm distal and 2.1 ± 1.2 cm lateral to the PT. The Nerves (common, anterior, and posterior) averaged 2.7 ± 1.2 mm, 1.4 ± 0.6 mm, and 1.7 ± 0.6 mm in anterior-posterior dimension and 9.0 ± 4.3 mm, 9.6 ± 3.9 mm, and 10.9 ± 4.1 mm in medial-lateral dimension and were 25.9 ± 7.6 mm, 15.5 ± 3.9 mm, and 29.3 ± 7.9 mm below the skin surface. The common Obturator Nerve and its anterior and posterior divisions are all relatively flat Nerves with average anterior-posterior/medial-lateral dimension ratios of 0.32, 0.18, and 0.18, respectively. In the clinical series, Nerve identification was confirmed with Nerve stimulation (n = 6 block procedures, mean threshold stimulating current for evoked adductor contraction = 0.70 ± 0.14 mA). Conclusions The Obturator Nerve and its divisions are the flattest peripheral Nerves yet described with ultrasound imaging. Knowledge of the Obturator Nerve’s ultrasound appearance facilitates localization of this Nerve for regional block and may increase success of such procedures.
-
Sonographic Imaging of the Obturator Nerve for Regional Block
Regional anesthesia and pain medicine, 2007Co-Authors: Julie Soong, Ingeborg Schafhalter-zoppoth, Andrew T. GrayAbstract:Today, there is a growing appreciation of the importance of the Obturator Nerve in clinical anesthesia. The aim of this study is to describe the ultrasound appearance of the Obturator Nerve for potential utility in guiding these Nerve blocks. We scanned left and right inguinal regions of 20 volunteers lateral and distal to the pubic tubercle (PT) and assessed visibility, size and shape, and depth from the skin of common Obturator Nerves and their associated divisions. In addition to the volunteer study, we retrospectively reviewed a clinical series of Obturator Nerve blocks performed with ultrasound guidance and Nerve stimulation. The Obturator Nerve can be sonographically visualized by scanning along the known course of the Nerve; the anterior division characteristically converges toward the posterior division along the lateral border of the adductor brevis muscle to form the common Obturator Nerve more proximally. In the set of 20 volunteers, 25% (10/40) of common, 85% (34/40) of anterior, and 87.5% (35/40) of posterior Obturator Nerves were sonographically identified. The common Obturator Nerve was visualized 1.3 +/- 1.5 cm distal and 2.3 +/- 1.2 cm lateral to the PT. Divisions were visualized 2.1 +/- 2.0 cm distal and 2.1 +/- 1.2 cm lateral to the PT. The Nerves (common, anterior, and posterior) averaged 2.7 +/- 1.2 mm, 1.4 +/- 0.6 mm, and 1.7 +/- 0.6 mm in anterior-posterior dimension and 9.0 +/- 4.3 mm, 9.6 +/- 3.9 mm, and 10.9 +/- 4.1 mm in medial-lateral dimension and were 25.9 +/- 7.6 mm, 15.5 +/- 3.9 mm, and 29.3 +/- 7.9 mm below the skin surface. The common Obturator Nerve and its anterior and posterior divisions are all relatively flat Nerves with average anterior-posterior/medial-lateral dimension ratios of 0.32, 0.18, and 0.18, respectively. In the clinical series, Nerve identification was confirmed with Nerve stimulation (n = 6 block procedures, mean threshold stimulating current for evoked adductor contraction = 0.70 +/- 0.14 mA). The Obturator Nerve and its divisions are the flattest peripheral Nerves yet described with ultrasound imaging. Knowledge of the Obturator Nerve's ultrasound appearance facilitates localization of this Nerve for regional block and may increase success of such procedures.
James N Campbell - One of the best experts on this subject based on the ideXlab platform.
-
Obturator Nerve transfer as an option for femoral Nerve repair: case report.
Neurosurgery, 2010Co-Authors: Ashley A Campbell, Frederic Eckhauser, Allan J Belzberg, James N CampbellAbstract:Nerve transfers have proved to be an important addition to the armamentarium in the repair of brachial plexus lesions, but have been used sparingly for lower extremity Nerve repair. Here, we present what is believed to be the first description of a successful transfer of the Obturator Nerve to the femoral Nerve. A 45-year-old woman presented with a complete femoral Nerve lesion after removal of a large (15-cm) schwannoma of the retroperitoneum involving the lumbar plexus. The Obturator Nerve was transferred to the distal stump of the femoral Nerve in the retroperitoneal space at the inguinal ligament three months post-injury. At 2 years post-repair, the patient demonstrated 4 out of 5 return (Medical Research Council grade) of quadriceps function and was able to walk nearly normally. In cases in which there are extensive gaps in the femoral Nerve, transfer of the Obturator Nerve provides an option to traditional Nerve graft repair.
-
Obturator Nerve transfer as an option for femoral Nerve repair: case report.
Neurosurgery, 2010Co-Authors: Ashley A Campbell, Frederic Eckhauser, Allan J Belzberg, James N CampbellAbstract:Objective Nerve transfers have proved to be an important addition to the armamentarium in the repair of brachial plexus lesions, but have been used sparingly for lower extremity Nerve repair. Here, we present what is believed to be the first description of a successful transfer of the Obturator Nerve to the femoral Nerve. Clinical presentation A 45-year-old woman presented with a complete femoral Nerve lesion after removal of a large (15-cm) schwannoma of the retroperitoneum involving the lumbar plexus. Intervention The Obturator Nerve was transferred to the distal stump of the femoral Nerve in the retroperitoneal space at the inguinal ligament three months post-injury. At 2 years post-repair, the patient demonstrated 4 out of 5 return (Medical Research Council grade) of quadriceps function and was able to walk nearly normally. Conclusion In cases in which there are extensive gaps in the femoral Nerve, transfer of the Obturator Nerve provides an option to traditional Nerve graft repair.
Getulio Rodrigues De Oliveira Filho - One of the best experts on this subject based on the ideXlab platform.
-
ultrasound guided Obturator Nerve block a preliminary report of a case series
Regional Anesthesia and Pain Medicine, 2007Co-Authors: Pablo Escovedo Helayel, Diogo Bruggemann Da Conceicao, Patricia Pavei, Julian Alexander Knaesel, Getulio Rodrigues De Oliveira FilhoAbstract:Background and Objectives Obturator-Nerve block improves analgesia for knee surgery. Traditional techniques rely on surface landmarks, which can be variable and result in excessive performance times and multiple needle passes. The objective of this study was to evaluate a novel ultrasound-guided technique for localizing the Obturator Nerve. Methods A total of 22 patients undergoing anterior cruciate ligament repair had ultrasound-guided Obturator-Nerve blocks. Needles were directed under real-time ultrasound guidance. Endpoint for injection consisted of identifying contact of the tip of an insulated needle to Nerve confirmed by adductor muscles’ contraction. Local anesthetic was injected, and block was evaluated within 30 minutes. After that, ultrasound-guided sciatic-femoral blocks were placed for surgical purposes. Data collected included: time required for Nerve identification, minimum stimulating current, number of attempts for correct identification, preblock and postblock adductor muscles’ strength, sensory-Nerve block, and quality of surgical anesthesia. Results In 91% of cases, the Obturator Nerve was correctly identified on first attempt within 30 ± 23 seconds, as a hyperechoic flat or lip-shaped structure with internal hypoechoic dots. Minimal intensity of current to Nerve stimulation was 0.30 ± 0.08 mA. All patients exhibited decreases in adductor strength. Sensory territories were variable, with no cutaneous distribution in 32% of the patients. Small-dose opioid supplementation was required in 14% of the patients, but none required general anesthesia to complete surgery. Conclusions These preliminary data suggest that ultrasound-guided Obturator-Nerve identification and block are technically easy and highly successful.
