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Michael J Barrington - One of the best experts on this subject based on the ideXlab platform.
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determination of spread of injectate after ultrasound guided transversus abdominis plane block a cadaveric study
BJA: British Journal of Anaesthesia, 2009Co-Authors: T M N Tran, Jason J Ivanusic, P Hebbard, Michael J BarringtonAbstract:Abstract Background The transversus abdominis plane (TAP) block is a new regional anaesthesia technique that provides analgesia after abdominal surgery. It involves injection of local anaesthetic into the plane between the transversus abdominis and the internal oblique muscles. The TAP block can be performed using a landmark technique through the lumbar triangle or with ultrasound guidance. The goal of this anatomical study with dye injection into the TAP and subsequent cadaver dissections was to establish the likely spread of local anaesthesia in vivo and the segmental nerve involvement resulting from ultrasound-guided TAP block. Methods An ultrasound-guided injection of aniline dye into the TAP was performed for each hemi-abdominal wall of 10 unembalmed human cadavers and this was followed by dissection to determine the extent of dye spread and nerve involvement in the dye injection. Results After excluding one pilot specimen and one with advanced tissue decomposition, 16 hemi-abdominal walls were successfully injected and dissected. The lower Thoracic Nerves (T10–T12) and first lumbar nerve (L1) were found emerging from posterior to anterior between the costal margin and the iliac crest. Segmental Nerves T10, T11, T12, and L1 were involved in the dye in 50%, 100%, 100%, and 93% of cases, respectively. Conclusions This anatomical study shows that an ultrasound-guided TAP injection cephalad to the iliac crest is likely to involve the T10–L1 nerve roots, and implies that the technique may be limited to use in lower abdominal surgery.
David B. Auyong - One of the best experts on this subject based on the ideXlab platform.
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Systematic ultrasound identification of the dorsal scapular and long Thoracic Nerves during interscalene block.
Regional anesthesia and pain medicine, 2013Co-Authors: Neil A. Hanson, David B. AuyongAbstract:Background and Objectives The use of ultrasound for in-plane interscalene block shifts needle insertion to a more posterior approach through the middle scalene muscle, when compared with classic nerve stimulator techniques. Branches from the brachial plexus, including the dorsal scapular and long Thoracic Nerves, are often anatomically located within the middle scalene muscle. The aim of this study was to use ultrasound to identify and characterize the frequency and position of the dorsal scapular and long Thoracic Nerves located in the middle scalene muscle. Methods We recruited 50 subjects who presented for shoulder surgery. Before block placement, ultrasound was used to evaluate the area posterior to the brachial plexus for visible segments of the long Thoracic and dorsal scapular Nerves. If Nerves were identified, a stimulating Tuohy needle was advanced in close proximity. Current was then applied through the needle, and motor response confirmed the visualized nerve as being either the dorsal scapular nerve or long Thoracic nerve. Results Ninety percent of the subjects had a nerve visible under ultrasound assessment within or superficial to the middle scalene muscle. The Nerves were located at similar depth as the perceived C6 nerve root, at 1.1 ± 0.4 cm from skin and 0.7 ± 0.4 cm posterior from the brachial plexus. Stimulation revealed that the nerve identified on ultrasound was the dorsal scapular nerve (77%) or the long Thoracic nerve (23%). Conclusions This descriptive study revealed that the dorsal scapular and long Thoracic Nerves routinely could be identified with ultrasound.
Richard A. Yeasting - One of the best experts on this subject based on the ideXlab platform.
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Vulnerability of long Thoracic nerve: An anatomic study
Journal of Shoulder and Elbow Surgery, 1998Co-Authors: Nabil A. Ebraheim, Brian Porshinsky, Brace E. Heck, Richard A. YeastingAbstract:The anatomic course of 40 long Thoracic Nerves was studied in relation to anatomic landmarks and reference lines, that is, the axillary lines and first 2 ribs. After its supraclavicular course, the nerve passes beneath the clavicle within the axillary sheath and then emerges from the axillary sheath. As it passes inferiorly and posteriorly from the point of emergence to the posterior angle of the second rib (that is, the attachments of serratus anterior muscle), it makes a posterior angle of 30.7 degrees +/- 4.3 degrees on average, relative to the anterior axillary line. It then continues to descend inferiorly between the middle and posterior axillary lines. When the arm is raised, the axillary neurovascular bundle moves superiorly with the movements of the arm. The long Thoracic nerve is angulated and stretched at the point it passes out of the axillary sheath.
Heinrich Dircksen - One of the best experts on this subject based on the ideXlab platform.
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Putative neurohemal areas in the peripheral nervous system of an insect, Gryllus bimaculatus, revealed by immunocytochemistry
Cell and Tissue Research, 1995Co-Authors: Johannes Helle, Heinrich Dircksen, Manfred Eckert, Dick R. Nässel, Ulrike Spörhase-eichmann, Friedrich-wilhelm SchürmannAbstract:The morphology and position of putative neurohemal areas in the peripheral nervous system (ventral nerve cord and retrocerebral complex) of the cricket Gryllus bimaculatus are described. By using antisera to the amines dopamine, histamine, octopamine, and serotonin, and the neuropeptides crustacean cardioactive peptide, FMRFamide, leucokinin 1, and proctolin, an extensive system of varicose fibers has been detected throughout the Nerves of all neuromeres, except for nerve 2 of the proThoracic ganglion. Immunoreactive varicose fibers occur mainly in a superficial position at the neurilemma, indicating neurosecretory storage and release of neuroactive compounds. The varicose fibers are projections from central or peripheral neurons that may extend over more than one segment. The peripheral fiber varicosities show segment-specific arrangements for each of the substances investigated. Immunoreactivity to histamine and octopamine is mainly found in the Nerves of abdominal segments, whereas serotonin immunoreactivity is concentrated in subesophageal and terminal ganglion Nerves. Immunoreactivity to FMRFamide and crustacean cardioactive peptide is widespread throughout all segments. Structures immunoreactive to leucokinin 1 are present in abdominal Nerves, and proctolin immunostaining is found in the terminal ganglion and Thoracic Nerves. Codistribution of peripheral varicose fiber plexuses is regularly seen for amines and peptides, whereas the colocalization of substances in neurons has not been detected for any of the neuroactive compounds investigated. The varicose fiber system is regarded as complementary to the classical neurohemal organs.
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Crustacean cardioactive peptide in the nervous system of the locust, Locusta migratoria : an immunocytochemical study on the ventral nerve cord and peripheral innervation
Cell and Tissue Research, 1991Co-Authors: Heinrich Dircksen, Arno H.j. Müller, Rainer KellerAbstract:Crustacean cardioactive peptide-immunoreactive neurons occur in the entire central nervous system of Locusta migratoria. The present paper focuses on mapping studies in the ventral nerve cord and on peripheral projection sites. Two types of contralaterally projecting neurons occur in all neuromers from the subesophageal to the seventh abdominal ganglia. One type forms terminals at the surface of the Thoracic Nerves 6 and 1, the distal perisympathetic organs, the lateral heart Nerves, and on ventral and dorsal diaphragm muscles. Two large neurons in the anterior part and several neurons of a different type in the posterior part of the terminal ganglion project into the last tergal Nerves. In the abdominal neuromers 1–7, two types of ipsilaterally projecting neurons occur, one of which gives rise to neurosecretory terminals in the distal perisympathetic organs, in peripheral areas of the transverse, stigmata and lateral heart Nerves. Four subesophageal neurons have putative terminals in the neurilemma of the nervus corporis allati II, and in the corpora allata and cardiaca. In addition, several immunoreactive putative interneurons and other neurons were mapped in the ventral nerve cord. A new in situ whole-mount technique was essential for elucidation of the peripheral pathways and targets of the identified neurons, which suggest a role of the peptide in the control of heartbeat, abdominal ventilatory and visceral muscle activity.
T M N Tran - One of the best experts on this subject based on the ideXlab platform.
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determination of spread of injectate after ultrasound guided transversus abdominis plane block a cadaveric study
BJA: British Journal of Anaesthesia, 2009Co-Authors: T M N Tran, Jason J Ivanusic, P Hebbard, Michael J BarringtonAbstract:Abstract Background The transversus abdominis plane (TAP) block is a new regional anaesthesia technique that provides analgesia after abdominal surgery. It involves injection of local anaesthetic into the plane between the transversus abdominis and the internal oblique muscles. The TAP block can be performed using a landmark technique through the lumbar triangle or with ultrasound guidance. The goal of this anatomical study with dye injection into the TAP and subsequent cadaver dissections was to establish the likely spread of local anaesthesia in vivo and the segmental nerve involvement resulting from ultrasound-guided TAP block. Methods An ultrasound-guided injection of aniline dye into the TAP was performed for each hemi-abdominal wall of 10 unembalmed human cadavers and this was followed by dissection to determine the extent of dye spread and nerve involvement in the dye injection. Results After excluding one pilot specimen and one with advanced tissue decomposition, 16 hemi-abdominal walls were successfully injected and dissected. The lower Thoracic Nerves (T10–T12) and first lumbar nerve (L1) were found emerging from posterior to anterior between the costal margin and the iliac crest. Segmental Nerves T10, T11, T12, and L1 were involved in the dye in 50%, 100%, 100%, and 93% of cases, respectively. Conclusions This anatomical study shows that an ultrasound-guided TAP injection cephalad to the iliac crest is likely to involve the T10–L1 nerve roots, and implies that the technique may be limited to use in lower abdominal surgery.