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P Hebbard - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound guided transversalis fascia plane block provides analgesia for anterior iliac crest bone graft harvesting
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2012
    Co-Authors: Ki Jinn Chin, P Hebbard, Vincent W S Chan, Meera Harris, Danielle Factor
    Abstract:

    To the Editor, The iliac crest is primarily innervated by the L1 nerve root via the iliohypogastric and ilioinguinal nerves. We describe our preliminary experience with a transversalis fascia plane (TFP) block, which targets these nerves in the plane between the transversus abdominis (TA) aponeurosis or Muscle and the deeper transversalis fascia. It can thus provide effective analgesia for anterior iliac crest bone graft (ICBG) harvesting. This technique is distinct from the transversus abdominis plane block, which does not reliably block the L1 dermatome, although its use has been described in ICBG harvesting. Following Ethics Board approval, we reviewed the records of 27 adult patients who underwent harvesting of an anterior ICBG as part of surgery on the distal forearm and wrist between November 1, 2009 and February 28, 2011 at the Toronto Western Hospital. All patients underwent general anesthesia preceded by a single-shot brachial plexus block with 30–40 mL of local anesthetic (1:1 mixture of 2% lidocaine and 0.5% bupivacaine, with epinephrine 2.5 lg mL). Twelve (44%) patients also underwent an ultrasound-guided TFP block. The ultrasound probe was placed in a transverse orientation above the iliac crest; and the external oblique, internal oblique (IO), and TA Muscles were identified and traced posteriorly until first the TA Muscle and then the IO Muscle tapered into their common aponeurosis, adjacent to the Quadratus Lumborum Muscle (Figure, A). The tip of a 22-gauge 80-mm block needle was positioned just deep to the TA Muscle and its aponeurosis at the point where the TA tapered off. Ropivacaine 0.5% (20 mL) with epinephrine 5 lg mL was injected into the plane between the TA and underlying transversalis fascia (Figure, B). Intraoperative and postoperative analgesia of the ICBG harvest site was provided by systemic opioids at the discretion of the operating theatre and postanesthesia care unit (PACU) staff. We extracted data on opioid consumption and pain scores during the immediate perioperative period, defined as the time at which the patient entered the operating room to the time the patient left the PACU. We converted all opioid doses into intravenous morphine equivalents and divided patients into two groups for comparison based on whether they had undergone a TFP block. The mean (standard deviation) perioperative opioid dose was substantially lower in the patients who underwent a TFP block [18.5 (9.6) mg of intravenous morphine equivalent] than in those who did not [32.6 (12.4) mg] (P = 0.006). These patients received less intravenous morphine during both the intraoperative period [10.2 (5.6) mg vs 17.4 (6.6) mg; P = 0.009] and the PACU period [8.3 (9.6) mg vs 15.1 (11.2) mg; P = 0.114]. It is of note that only one (8%) patient received intravenous ketorolac 30 mg in the TFP group compared with five (33%) patients in the other group. Patients who underwent a TFP block also had lower resting pain scores in the PACU. Pain scores (median [range]) were lower in the TFP group both at admission to the PACU (2 [0–6] vs 6 [5–7]; P = 0.015) as K. J. Chin, MBBS (&) V. Chan, MD M. Harris, MB BChir Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

  • transversalis fascia plane block a novel ultrasound guided abdominal wall nerve block
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2009
    Co-Authors: P Hebbard
    Abstract:

    To the Editor, The lateral cutaneous branches (LCB) of the thoracoabdominal nerves (T6 to L1) arise proximal to the angle of the rib, run a short distance with the main nerve, and emerge obliquely through the overlying Muscles in the midaxillary line. They pass superficially to supply the skin of the lateral thorax, the abdomen, the iliac crest, and the upper thigh as far as the greater trochanter of the femur. As previously described, it is rare to produce block of the LCB of the subcostal (T12) and iliohypogastric (L1) nerves when performing ultrasound-guided posterior transversus abdominis plane (TAP) block. The subcostal and iliohypogastric nerves normally send out their LCB preceding entry or very proximal in the TAP. The LCB leave the TAP in a more posterior position than the local anesthetic of the ultrasound-guided posterior TAP block, which appears on imaging as being restricted from spreading posterior to the extent of the Muscle belly. The subcostal and iliohypogastric nerves pass deep over the anterior surface of the Quadratus Lumborum Muscle, which extends from the 12th rib to the iliac crest. The subcostal nerve then continues a short distance deep to the aponeurotic posterior extension of the transversus abdominis Muscle before passing through the aponeurosis into the TAP. The iliohypogastric nerve continues deep to the transversus Muscle aponeurosis and belly to penetrate the transversus in a more anterior and highly variable position. Local anesthetic injected between the transversus abdominis Muscle and its deep investing transversalis fascia will spread over the inner surface of the Quadratus Lumborum Muscle and block the proximal portions of the T12 and L1 nerves. This will produce block of both the anterior and the lateral branches of these nerves. This transversalis fascia block (TFP) targets these nerves anatomically between the lumbar plexus block and the TAP block. With the patient in a supine position, the needle is advanced from the anterior using an in-plane technique. A linear or curvilinear ultrasound probe is orientated transversely over the lateral abdomen between the iliac crest and the costal margin. The external oblique, internal oblique, and transversus abdominis Muscles are imaged, and the more posterior transversus aponeurosis is distinguished. The reflection of the peritoneum curving away from the Muscles from anterior to posterior is identified, and the perinephric fat, which lies behind the peritoneum and deep to the transversalis fascia, identified. The perinephric fat is generally more prominent closer to the iliac crest. The Quadratus Lumborum is identified medial to the aponeurosis of the transversus abdominis. It may be confused with the partly overlying erector spinae Muscle, which is more superficial and often more prominent on ultrasound (Fig. 1). To minimize the risk of peritoneal penetration or liver trauma, the block area should be sufficiently posterior so that the perinephric fat, rather than the peritoneum and liver, underlies the transversalis fascia. To enhance needle visibility, the needle insertion point is selected such that a 100–150 mm needle is introduced relatively perpendicular to the ultrasound beam, and the probe is slid anteriorly to image the needle throughout its course. The end point is more visible if the needle is passed through the posterior ‘‘tail’’ of the transversus Muscle, as the transversus aponeurosis is thinner and less distinct as a separate layer. P. D. Hebbard, FANZCA (&) Anaesthesia and Pain Management Unit, University of Melbourne, Melbourne, VIC, Australia e-mail: p.hebbard@bigpond.com

Felsenberg Dieter - One of the best experts on this subject based on the ideXlab platform.

  • Changes in intervertebral disc morphology persist 5 mo after 21-day bed rest
    'American Physiological Society', 2011
    Co-Authors: Belavy, Daniel Ludovic, Bansmann Martin, Böhme Gisela, Frings-meuthen Petra, Heer Martina, Rittweger Jörn, Zange Jochen, Felsenberg Dieter
    Abstract:

    As part of the nutrition- countermeasures (NUC) study in Cologne, Germany in 2010, seven healthy male subjects underwent 21 days of head-down tilt bed rest and returned 153 days later to undergo a second bout of 21-day bed rest. As part of this model, we aimed to examine the recovery of the lumbar intervertebral discs and Muscle cross-sectional area (CSA) after bed rest using magnetic resonance imaging and conduct a pilot study on the effects of bed rest in lumbar Muscle activation, as measured by signal intensity changes in T2-weighted images after a standardized isometric spinal extension loading task. The changes in intervertebral disc volume, anterior and posterior disc height, and intervertebral length seen after bed rest did not return to prebed-rest values 153 days later. While recovery of Muscle CSA occurred after bed rest, increases (P 0.016) in multifidus, psoas, and Quadratus Lumborum Muscle CSA were seen 153 days after bed rest. A trend was seen for greater activation of the erector spinae and multifidus Muscles in the standardized loading task after bed rest. Greater reductions of multifidus and psoas CSA Muscle and greater increases in multifidus signal intensity with loading were associated with incidence of low back pain in the first 28 days after bed rest (P 0.044). The current study contributes to our understanding of the recovery of the lumbar spine after 21-day bed rest, and the main finding was that a decrease in spinal extensor Muscle CSA recovers within 5 mo after bed rest but that changes in the intervertebral discs persist

  • Changes in intervertebral disc morphology persist 5 mo after 21-day bed rest
    'American Physiological Society', 2011
    Co-Authors: Belavý, Daniel L., Böhme Gisela, Frings-meuthen Petra, Heer Martina, Rittweger Jörn, Zange Jochen, Bansmann P. Martin, Felsenberg Dieter
    Abstract:

    As part of the nutrition-countermeasures (NUC) study in Cologne, Germany in 2010, seven healthy male subjects underwent 21 days of head-down tilt bed rest and returned 153 days later to undergo a second bout of 21-day bed rest. As part of this model, we aimed to examine the recovery of the lumbar intervertebral discs and Muscle cross-sectional area (CSA) after bed rest using magnetic resonance imaging and conduct a pilot study on the effects of bed rest in lumbar Muscle activation, as measured by signal intensity changes in T(2)-weighted images after a standardized isometric spinal extension loading task. The changes in intervertebral disc volume, anterior and posterior disc height, and intervertebral length seen after bed rest did not return to prebed-rest values 153 days later. While recovery of Muscle CSA occurred after bed rest, increases (P ≤ 0.016) in multifidus, psoas, and Quadratus Lumborum Muscle CSA were seen 153 days after bed rest. A trend was seen for greater activation of the erector spinae and multifidus Muscles in the standardized loading task after bed rest. Greater reductions of multifidus and psoas CSA Muscle and greater increases in multifidus signal intensity with loading were associated with incidence of low back pain in the first 28 days after bed rest (P ≤ 0.044). The current study contributes to our understanding of the recovery of the lumbar spine after 21-day bed rest, and the main finding was that a decrease in spinal extensor Muscle CSA recovers within 5 mo after bed rest but that changes in the intervertebral discs persist

Danielle Factor - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound guided transversalis fascia plane block provides analgesia for anterior iliac crest bone graft harvesting
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2012
    Co-Authors: Ki Jinn Chin, P Hebbard, Vincent W S Chan, Meera Harris, Danielle Factor
    Abstract:

    To the Editor, The iliac crest is primarily innervated by the L1 nerve root via the iliohypogastric and ilioinguinal nerves. We describe our preliminary experience with a transversalis fascia plane (TFP) block, which targets these nerves in the plane between the transversus abdominis (TA) aponeurosis or Muscle and the deeper transversalis fascia. It can thus provide effective analgesia for anterior iliac crest bone graft (ICBG) harvesting. This technique is distinct from the transversus abdominis plane block, which does not reliably block the L1 dermatome, although its use has been described in ICBG harvesting. Following Ethics Board approval, we reviewed the records of 27 adult patients who underwent harvesting of an anterior ICBG as part of surgery on the distal forearm and wrist between November 1, 2009 and February 28, 2011 at the Toronto Western Hospital. All patients underwent general anesthesia preceded by a single-shot brachial plexus block with 30–40 mL of local anesthetic (1:1 mixture of 2% lidocaine and 0.5% bupivacaine, with epinephrine 2.5 lg mL). Twelve (44%) patients also underwent an ultrasound-guided TFP block. The ultrasound probe was placed in a transverse orientation above the iliac crest; and the external oblique, internal oblique (IO), and TA Muscles were identified and traced posteriorly until first the TA Muscle and then the IO Muscle tapered into their common aponeurosis, adjacent to the Quadratus Lumborum Muscle (Figure, A). The tip of a 22-gauge 80-mm block needle was positioned just deep to the TA Muscle and its aponeurosis at the point where the TA tapered off. Ropivacaine 0.5% (20 mL) with epinephrine 5 lg mL was injected into the plane between the TA and underlying transversalis fascia (Figure, B). Intraoperative and postoperative analgesia of the ICBG harvest site was provided by systemic opioids at the discretion of the operating theatre and postanesthesia care unit (PACU) staff. We extracted data on opioid consumption and pain scores during the immediate perioperative period, defined as the time at which the patient entered the operating room to the time the patient left the PACU. We converted all opioid doses into intravenous morphine equivalents and divided patients into two groups for comparison based on whether they had undergone a TFP block. The mean (standard deviation) perioperative opioid dose was substantially lower in the patients who underwent a TFP block [18.5 (9.6) mg of intravenous morphine equivalent] than in those who did not [32.6 (12.4) mg] (P = 0.006). These patients received less intravenous morphine during both the intraoperative period [10.2 (5.6) mg vs 17.4 (6.6) mg; P = 0.009] and the PACU period [8.3 (9.6) mg vs 15.1 (11.2) mg; P = 0.114]. It is of note that only one (8%) patient received intravenous ketorolac 30 mg in the TFP group compared with five (33%) patients in the other group. Patients who underwent a TFP block also had lower resting pain scores in the PACU. Pain scores (median [range]) were lower in the TFP group both at admission to the PACU (2 [0–6] vs 6 [5–7]; P = 0.015) as K. J. Chin, MBBS (&) V. Chan, MD M. Harris, MB BChir Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

Stuart Crozier - One of the best experts on this subject based on the ideXlab platform.

Böhme Gisela - One of the best experts on this subject based on the ideXlab platform.

  • Changes in intervertebral disc morphology persist 5 mo after 21-day bed rest
    'American Physiological Society', 2011
    Co-Authors: Belavy, Daniel Ludovic, Bansmann Martin, Böhme Gisela, Frings-meuthen Petra, Heer Martina, Rittweger Jörn, Zange Jochen, Felsenberg Dieter
    Abstract:

    As part of the nutrition- countermeasures (NUC) study in Cologne, Germany in 2010, seven healthy male subjects underwent 21 days of head-down tilt bed rest and returned 153 days later to undergo a second bout of 21-day bed rest. As part of this model, we aimed to examine the recovery of the lumbar intervertebral discs and Muscle cross-sectional area (CSA) after bed rest using magnetic resonance imaging and conduct a pilot study on the effects of bed rest in lumbar Muscle activation, as measured by signal intensity changes in T2-weighted images after a standardized isometric spinal extension loading task. The changes in intervertebral disc volume, anterior and posterior disc height, and intervertebral length seen after bed rest did not return to prebed-rest values 153 days later. While recovery of Muscle CSA occurred after bed rest, increases (P 0.016) in multifidus, psoas, and Quadratus Lumborum Muscle CSA were seen 153 days after bed rest. A trend was seen for greater activation of the erector spinae and multifidus Muscles in the standardized loading task after bed rest. Greater reductions of multifidus and psoas CSA Muscle and greater increases in multifidus signal intensity with loading were associated with incidence of low back pain in the first 28 days after bed rest (P 0.044). The current study contributes to our understanding of the recovery of the lumbar spine after 21-day bed rest, and the main finding was that a decrease in spinal extensor Muscle CSA recovers within 5 mo after bed rest but that changes in the intervertebral discs persist

  • Changes in intervertebral disc morphology persist 5 mo after 21-day bed rest
    'American Physiological Society', 2011
    Co-Authors: Belavý, Daniel L., Böhme Gisela, Frings-meuthen Petra, Heer Martina, Rittweger Jörn, Zange Jochen, Bansmann P. Martin, Felsenberg Dieter
    Abstract:

    As part of the nutrition-countermeasures (NUC) study in Cologne, Germany in 2010, seven healthy male subjects underwent 21 days of head-down tilt bed rest and returned 153 days later to undergo a second bout of 21-day bed rest. As part of this model, we aimed to examine the recovery of the lumbar intervertebral discs and Muscle cross-sectional area (CSA) after bed rest using magnetic resonance imaging and conduct a pilot study on the effects of bed rest in lumbar Muscle activation, as measured by signal intensity changes in T(2)-weighted images after a standardized isometric spinal extension loading task. The changes in intervertebral disc volume, anterior and posterior disc height, and intervertebral length seen after bed rest did not return to prebed-rest values 153 days later. While recovery of Muscle CSA occurred after bed rest, increases (P ≤ 0.016) in multifidus, psoas, and Quadratus Lumborum Muscle CSA were seen 153 days after bed rest. A trend was seen for greater activation of the erector spinae and multifidus Muscles in the standardized loading task after bed rest. Greater reductions of multifidus and psoas CSA Muscle and greater increases in multifidus signal intensity with loading were associated with incidence of low back pain in the first 28 days after bed rest (P ≤ 0.044). The current study contributes to our understanding of the recovery of the lumbar spine after 21-day bed rest, and the main finding was that a decrease in spinal extensor Muscle CSA recovers within 5 mo after bed rest but that changes in the intervertebral discs persist