The Experts below are selected from a list of 42 Experts worldwide ranked by ideXlab platform
Shane R Tubbs - One of the best experts on this subject based on the ideXlab platform.
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the Subcostal Nerve during lateral approaches to the lumbar spine an anatomical study with relevance for injury avoidance and postoperative complications such as abdominal wall hernia
World Neurosurgery, 2017Co-Authors: Fernando Alonso, Rachel A Graham, Tarush Rustagi, Doniel Drazin, Marios Loukas, Rod J Oskouian, Jens R Chapman, Shane R TubbsAbstract:Background Lateral approaches to the spine are increasing in popularity. However, details of the innervation pattern of the abdominal oblique muscles with the initial dissection have not been well studied. Methods Ten adult fresh-frozen cadavers (20 sides) were placed in the lateral position. On each side, the region in which transpsoas approaches are performed, between the iliac crest and the 12th rib, was dissected. The Nerves, their course, and their muscular supply were studied. Results The Subcostal Nerve is the predominant Nerve supply for the anterolateral abdominal muscle innervation. It is larger and has a wider field of distribution and more branches (8 on average) compared with the L1 (4 on average) and 11th intercostal Nerves (2 on average 2). The proximal 6–10 cm of each Nerve has few if any branches. The Subcostal Nerve is often (75%) located up to 5 cm inferior to the 12th rib in its initial course. The area of least concentration (“safe zone”) is located at an approximate midpoint between the lower edge of the 12th rib and the superior-most aspect of the iliac crest. A previously undescribed branch of the Subcostal Nerve was found traveling posterior to the quadratus lumborum and joining the remaining Subcostal Nerve in an anastomosis at or near the lateral position. Conclusions Knowledge of the innervation and Nerve dominance patterns might help decrease postoperative complications such as sensory deficits or abdominal wall hernias. The Subcostal Nerve is the dominant Nerve in both size and innervation of the oblique muscles in the lateral position, transpsoas approach.
Fernando Alonso - One of the best experts on this subject based on the ideXlab platform.
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the Subcostal Nerve during lateral approaches to the lumbar spine an anatomical study with relevance for injury avoidance and postoperative complications such as abdominal wall hernia
World Neurosurgery, 2017Co-Authors: Fernando Alonso, Rachel A Graham, Tarush Rustagi, Doniel Drazin, Marios Loukas, Rod J Oskouian, Jens R Chapman, Shane R TubbsAbstract:Background Lateral approaches to the spine are increasing in popularity. However, details of the innervation pattern of the abdominal oblique muscles with the initial dissection have not been well studied. Methods Ten adult fresh-frozen cadavers (20 sides) were placed in the lateral position. On each side, the region in which transpsoas approaches are performed, between the iliac crest and the 12th rib, was dissected. The Nerves, their course, and their muscular supply were studied. Results The Subcostal Nerve is the predominant Nerve supply for the anterolateral abdominal muscle innervation. It is larger and has a wider field of distribution and more branches (8 on average) compared with the L1 (4 on average) and 11th intercostal Nerves (2 on average 2). The proximal 6–10 cm of each Nerve has few if any branches. The Subcostal Nerve is often (75%) located up to 5 cm inferior to the 12th rib in its initial course. The area of least concentration (“safe zone”) is located at an approximate midpoint between the lower edge of the 12th rib and the superior-most aspect of the iliac crest. A previously undescribed branch of the Subcostal Nerve was found traveling posterior to the quadratus lumborum and joining the remaining Subcostal Nerve in an anastomosis at or near the lateral position. Conclusions Knowledge of the innervation and Nerve dominance patterns might help decrease postoperative complications such as sensory deficits or abdominal wall hernias. The Subcostal Nerve is the dominant Nerve in both size and innervation of the oblique muscles in the lateral position, transpsoas approach.
Mark A. Mahan - One of the best experts on this subject based on the ideXlab platform.
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Subcostal Nerve injury after laparoscopic lipoma surgery: an unusual culprit for an unusual complication.
Journal of neurosurgery, 2018Co-Authors: Hussam Abou-al-shaar, Mark A. MahanAbstract:Endoscopic surgery has revolutionized the field of minimally invasive surgery. Nerve injury after laparoscopic surgery is presumably rare, with only scarce reports in the literature; however, the use of these techniques for new purposes presents the opportunity for novel complications. The authors report a case of Subcostal Nerve injury after an anterior laparoscopic approach to a posterior abdominal wall lipoma.A 62-year-old woman presented with a left abdominal flank bulge (pseudohernia) that developed after laparoscopic posterior flank wall lipoma resection. Imaging demonstrated frank ballooning of the oblique muscles; denervation atrophy and thinning of the external oblique, internal oblique, and transverse abdominis muscles; and thinning of the rectus abdominis muscle. The patient underwent Subcostal Nerve repair and removal of a foreign plastic material from the laparoscopic procedure. At 8 months, she has regained substantial improvement in abdominal wall strength.Although endoscopic procedures have resulted in significant reduction in morbidity, "minimally invasive" approaches should not be confused with "low risk" when approaching novel pathology. The Subcostal Nerve is at risk of injury in posterior abdominal wall surgery, whether laparoscopic or not. With the pseudohernia and abdominal bulge after this surgery, the cosmetic appeal of laparoscopic incisions was definitively undone. Selecting an approach based on the anatomy of adjacent structures may lead to a better functional result.
Maarten V Rademakers - One of the best experts on this subject based on the ideXlab platform.
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no effect of double Nerve block of the lateral cutaneous Nerve and Subcostal Nerves in total hip arthroplasty
Acta Orthopaedica, 2018Co-Authors: Johannes L Bron, Jeanette Verhart, Inger N Sierevelt, Dirk De Vries, Hylke J Kingma, Maarten V RademakersAbstract:Background and purpose - The use of local infiltration anesthesia (LIA) has become one of the cornerstones of rapid recovery protocols in total knee arthroplasty patients during the past decade. In total hip arthroplasty (THR), however, the study results are more variable and LIA has therefore not yet been generally accepted. There is no consensus on which structure should be infiltrated and the cutaneous Nerves are generally neglected. Hence, we hypothesized a pain-reducing effect of specifically blocking these Nerves. Patients and methods - We performed a single-center randomized placebo-controlled trial in 162 subjects to evaluate the infiltration of the lateral cutaneous femoral and Subcostal Nerve with ropivacaine in patients undergoing total hip arthroplasty via a straight lateral approach. The primary endpoint was pain at rest after 24 hours. Patients were followed up to 6 weeks postoperatively. Results - After correction for multiple testing, no statistically significant differences in pain scores were found between the ropivacaine compared with the placebo group after surgery. In addition, no differences were observed in the use of escape pain medication, complications, and the length of hospital stay. Interpretation - We found no clinically meaningful differences in pain scores between placebo and ropivacaine patients in the postoperative period after THA performed via a straight lateral approach under spinal anesthesia and a multimodal pain regimen. Moreover, our primary endpoint, pain reduction after 24 hours, was not met. Further research should focus on the composition and volume of the LIA suspension, the optimal localization of the infiltration, and should be evaluated for every surgical approach separately.
Thomas Fichtner Bendtsen - One of the best experts on this subject based on the ideXlab platform.
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cutaneous anaesthesia of hip surgery incisions with iliohypogastric and Subcostal Nerve blockade a randomised trial
Acta Anaesthesiologica Scandinavica, 2019Co-Authors: Thomas D Nielsen, Bernhard Moriggl, Jeppe Barckman, Jan Mick Jensen, Jens A Kolsenpetersen, Kjeld Soballe, Jens Borglum, Thomas Fichtner BendtsenAbstract:BACKGROUND Cutaneous Nerve blockade may improve analgesia after hip surgery. Anaesthesia after the lateral femoral cutaneous (LFC) Nerve block is too distal for complete coverage of most hip surgery incisions, which requires additional anaesthesia of the adjacent, proximal area. The transversalis fascia plane (TFP) block potentially anaesthetises the iliohypogastric and Subcostal Nerves. The primary aim of the present study was to investigate, if the TFP block provides cutaneous anaesthesia adjacent to the LFC Nerve block. METHODS Active vs placebo TFP blocks were compared in a paired randomised controlled trial (RCT) in 20 volunteers, who all had bilateral LFC Nerve blocks. The day preceding the RCT, the area anaesthetised by a novel selective ultrasound guided Subcostal Nerve block was identified bilaterally in order to assess the contribution of the Subcostal Nerve to the area anaesthesia by the TFP block. RESULTS Anaesthesia of the lateral hip region after TFP block was 80%. The cutaneous anaesthesia after active TFP block was in continuity with the LFC Nerve block in 65%. Combined TFP and LFC Nerve blockade significantly increased the coverage of hip surgery incisions compared to LFC Nerve block alone. The success rate of blocking the Subcostal Nerve was 50% with the TFP block. CONCLUSION The TFP block anaesthetises the skin proximal to the LFC Nerve block by anaesthetising the iliohypogastric and Subcostal Nerves. TFP block as a supplement to LFC Nerve block improves the coverage of the proximal surgical incisions used for hip surgery.
