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Inderjeet S Julka - One of the best experts on this subject based on the ideXlab platform.
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efficacy of an ultrasound guided subsartorial approach to Saphenous Nerve block a case series
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2010Co-Authors: Phil B Tsai, Abhishek Karnwal, Clinton Kakazu, Vadim Tokhner, Inderjeet S JulkaAbstract:PURPOSE: The Saphenous Nerve, a branch of the femoral Nerve, is a pure sensory Nerve that supplies the anteromedial aspect of the lower leg from the knee to the foot. There is limited evidence of the effectiveness of ultrasound-guided techniques to block the Saphenous Nerve. We therefore undertook a retrospective case series to investigate the efficacy of an ultrasound-guided subsartorial approach to Saphenous Nerve block. METHODS: During a four-month period, all patients receiving a subsartorial Saphenous Nerve block for lower extremity surgery at our institution had their medical records reviewed. Patient demographics and data were recorded, including block characteristics, intraoperative anesthetic management, pre-block, post-block, and postoperative pain scores, as well as postoperative analgesic dosing. Preoperative block success was defined by minimal intraoperative analgesic administration and a pain score of 0 in the postanesthesia care unit not requiring analgesic supplementation. Postoperative block success was defined by reduction of pain score to 0 without need for additional analgesic dosing. RESULTS: Thirty-nine consecutive patients were identified as receiving an ultrasound-guided subsartorial Saphenous Nerve block. Overall, this ultrasound-guided technique was found to have a 77% success rate. CONCLUSION: This case series shows that an ultrasound-guided subsartorial approach to Saphenous Nerve blockade is a moderately effective means to anesthetize the anteromedial lower extremity. The success rate is based on stringent criteria with an endpoint of postoperative analgesia. A randomized prospective study would provide a more definitive answer regarding the efficacy of this technique for surgical anesthesia.
Stephan K W Schwarz - One of the best experts on this subject based on the ideXlab platform.
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effect of Nerve stimulation use on the success rate of ultrasound guided subsartorial Saphenous Nerve block a randomized controlled trial
Regional Anesthesia and Pain Medicine, 2017Co-Authors: Shaylyn H Montgomery, Colleen M Shamji, Grace S Yi, Cynthia H Yarnold, Stephen J Head, Scott C Bell, Stephan K W SchwarzAbstract:Background and Objectives Ultrasound-guided subsartorial Saphenous Nerve block is commonly used to provide complete surgical anesthesia of the foot and ankle in combination with a popliteal sciatic Nerve block. However, in part owing to its small caliber and absence of a prominent vascular landmark in the subsartorial plane distal to the adductor canal, the Saphenous Nerve is more difficult to reliably block than the sciatic Nerve in the popliteal fossa. Although the Saphenous Nerve is a sensory Nerve only, neurostimulation can be used to elicit a “tapping” sensation on the anteromedial aspect of the lower leg extending toward the medial malleolus. Our objective was to test the hypothesis that the addition of Nerve stimulation use to an ultrasound (US)-guided technique will increase the success rate of subsartorial Saphenous Nerve block. Methods With institutional human ethics board approval and participants9 written informed consent, we enrolled 80 patients undergoing foot and ankle surgery in a randomized, single-blinded, parallel-group clinical trial. Patients were randomly assigned to receive US-guided subsartorial Saphenous Nerve block either alone (US group) or with the use of additional Nerve stimulation (NS group; time limit, 5 minutes). For Saphenous Nerve blockade, all patients received 10 mL of 0.5% ropivacaine. The primary end point was complete absence of sensation to pinprick at 30 minutes at two different anatomic areas in the distribution of the Saphenous Nerve (2 cm proximal to the medial malleolus and 10 cm distal to the medial tibial condyle). Secondary end points included decreased sensation at 30 minutes and block failure (normal sensation) at 30 minutes. This trial was registered at ClinicalTrials.gov: NCT02382744. Results All 80 patients completed the trial (40 patients in each group). Twenty-two patients (55%) in the NS group versus 18 (45%) in the US group had complete absence of sensation to pinprick at 30 minutes at both anatomic areas of assessment (Fisher exact test, P = 0.25 [one sided]; 95% confidence interval of difference in proportions, −11.9% to 31.9%). The percentages of patients with any evidence of block (decreased or complete absence of sensation) at both areas at 30 minutes were 92.5% (NS) and 97.5% (US), respectively (P = 0.62 [two sided]); corresponding failure rates (normal sensation) were 7.5% (NS) and 2.5% (US). In the NS group, no response in the Saphenous Nerve distribution was elicited within 5 minutes of stimulation time limit in 20% of patients (n = 8). All of the patients in the NS group with normal sensation at 30 minutes (n = 3) were among this subcohort. Conclusions The addition of the use of Nerve stimulation did not improve the success rate of US-guided subsartorial Saphenous Nerve block. However, in the NS group, an inability to elicit a “tapping” sensation in the Saphenous Nerve distribution was associated with block failure.
Phil B Tsai - One of the best experts on this subject based on the ideXlab platform.
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efficacy of an ultrasound guided subsartorial approach to Saphenous Nerve block a case series
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2010Co-Authors: Phil B Tsai, Abhishek Karnwal, Clinton Kakazu, Vadim Tokhner, Inderjeet S JulkaAbstract:PURPOSE: The Saphenous Nerve, a branch of the femoral Nerve, is a pure sensory Nerve that supplies the anteromedial aspect of the lower leg from the knee to the foot. There is limited evidence of the effectiveness of ultrasound-guided techniques to block the Saphenous Nerve. We therefore undertook a retrospective case series to investigate the efficacy of an ultrasound-guided subsartorial approach to Saphenous Nerve block. METHODS: During a four-month period, all patients receiving a subsartorial Saphenous Nerve block for lower extremity surgery at our institution had their medical records reviewed. Patient demographics and data were recorded, including block characteristics, intraoperative anesthetic management, pre-block, post-block, and postoperative pain scores, as well as postoperative analgesic dosing. Preoperative block success was defined by minimal intraoperative analgesic administration and a pain score of 0 in the postanesthesia care unit not requiring analgesic supplementation. Postoperative block success was defined by reduction of pain score to 0 without need for additional analgesic dosing. RESULTS: Thirty-nine consecutive patients were identified as receiving an ultrasound-guided subsartorial Saphenous Nerve block. Overall, this ultrasound-guided technique was found to have a 77% success rate. CONCLUSION: This case series shows that an ultrasound-guided subsartorial approach to Saphenous Nerve blockade is a moderately effective means to anesthetize the anteromedial lower extremity. The success rate is based on stringent criteria with an endpoint of postoperative analgesia. A randomized prospective study would provide a more definitive answer regarding the efficacy of this technique for surgical anesthesia.
Georgia Kostopanagiotou - One of the best experts on this subject based on the ideXlab platform.
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anatomy and clinical implications of the ultrasound guided subsartorial Saphenous Nerve block
Regional Anesthesia and Pain Medicine, 2011Co-Authors: Theodosios Saranteas, George Anagnostis, Tilemachos Paraskeuopoulos, Dimitrios Koulalis, Zinon T Kokkalis, Mariza Nakou, Sofia Anagnostopoulou, Georgia KostopanagiotouAbstract:Background: We evaluated the anatomic basis and the clinical results of an ultrasound-guided Saphenous Nerve block close to the level of the Nerve9s exit from the inferior foramina of the adductor canal. Methods: The anatomic study was conducted in 11 knees of formalin-preserved cadavers in which the Saphenous Nerve was dissected from near its exit from the inferior foramina of the adductor canal. The clinical study was conducted in 23 volunteers. Using a linear probe, the femoral vessels and the sartorius muscle were depicted in short-axis view at the level where the Saphenous Nerve exits the inferior foramina of the adductor canal. Ten milliliters of 1.5% lidocaine was injected into the compartment structured by the sartorius muscle and the femoral artery. Results: The Saphenous Nerve was found to exit the adductor canal from its inferior foramina in 9 (81.8%) of 11 and at a more proximal level in 2 (18.2%) of 11 of the anatomic specimens. In a single specimen (9%), the Saphenous Nerve was formed by the anastomosis of 2 branches. In all the dissections, the Saphenous Nerve, after exiting the adductor canal, passed between the sartorius muscle and the femoral artery. Of the 23 volunteers, 22 responded with a complete sensory block, whereas a single volunteer demonstrated no sensory blockade. None of the volunteers experienced a motor block of the hip flexors and knee extensors. Conclusions: Ultrasound-guided injection directly caudally from the inferior foramina of the adductor canal, between the sartorius muscle and the femoral artery, seems to be an effective approach for Saphenous Nerve block.
Theodosios Saranteas - One of the best experts on this subject based on the ideXlab platform.
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Ultrasound-guided Saphenous Nerve Block for Saphenous Neuralgia after Knee Surgery: Two Case Reports and Review of Literature.
Indian Journal of Orthopaedics, 2019Co-Authors: Chrysanthi Batistaki, Theodosios Saranteas, George D. Chloros, Olga D. SavvidouAbstract:: Saphenous neuralgia is characterized by persistent neuropathic pain at the distribution of the Saphenous Nerve. Injury to the Saphenous Nerve, and specifically to its infrapatellar branch of the Saphenous Nerve has been implicated as a cause of medial knee pain after orthopedic knee surgery or trauma. We present two cases of Saphenous neuralgia, one after total knee arthroplasty and the other after anterior cruciate ligament reconstruction, that were adequately treated with ultrasound-guided Saphenous Nerve blocks distal to the adductor canal. Early recognition and treatment of Saphenous neuralgia is essential to prevent persistent disabling pain, which significantly affects patients' quality of life.
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anatomy and clinical implications of the ultrasound guided subsartorial Saphenous Nerve block
Regional Anesthesia and Pain Medicine, 2011Co-Authors: Theodosios Saranteas, George Anagnostis, Tilemachos Paraskeuopoulos, Dimitrios Koulalis, Zinon T Kokkalis, Mariza Nakou, Sofia Anagnostopoulou, Georgia KostopanagiotouAbstract:Background: We evaluated the anatomic basis and the clinical results of an ultrasound-guided Saphenous Nerve block close to the level of the Nerve9s exit from the inferior foramina of the adductor canal. Methods: The anatomic study was conducted in 11 knees of formalin-preserved cadavers in which the Saphenous Nerve was dissected from near its exit from the inferior foramina of the adductor canal. The clinical study was conducted in 23 volunteers. Using a linear probe, the femoral vessels and the sartorius muscle were depicted in short-axis view at the level where the Saphenous Nerve exits the inferior foramina of the adductor canal. Ten milliliters of 1.5% lidocaine was injected into the compartment structured by the sartorius muscle and the femoral artery. Results: The Saphenous Nerve was found to exit the adductor canal from its inferior foramina in 9 (81.8%) of 11 and at a more proximal level in 2 (18.2%) of 11 of the anatomic specimens. In a single specimen (9%), the Saphenous Nerve was formed by the anastomosis of 2 branches. In all the dissections, the Saphenous Nerve, after exiting the adductor canal, passed between the sartorius muscle and the femoral artery. Of the 23 volunteers, 22 responded with a complete sensory block, whereas a single volunteer demonstrated no sensory blockade. None of the volunteers experienced a motor block of the hip flexors and knee extensors. Conclusions: Ultrasound-guided injection directly caudally from the inferior foramina of the adductor canal, between the sartorius muscle and the femoral artery, seems to be an effective approach for Saphenous Nerve block.
