Effects of the Intraneural and Subparaneural Ultrasound-Guided Popliteal Sciatic Nerve Block

Cappelleri, Gianluca; Cedrati, Valeria; Fedele, L; Gemma, Marco; Camici, Laura; Loiero, Mario; Gallazzi, M.; Cornaggia, Gabriele

doi:10.1097/aap.0000000000000413

Cited by 32 publications

(13 citation statements)

References 26 publications

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“…Limitations of this study were the short observational period considered after the injections as neurologic dysfunctions may occur weeks after the block, as well as the inability to perform electrophysiological studies in our laboratory. Nevertheless, in a previous work, the duration of the electrophysiological impairment after intraneural administration of local anesthetic in the ScN in humans was similar to that obtained after carrying out a conventional extraneural block (36).…”

Section: Discussionsupporting

confidence: 66%

Short-Term Effects of Deliberate Subparaneural or Subepineural Injections With Saline Solution or Bupivacaine 0.75% in the Sciatic Nerve of Rabbits

et al. 2020

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Background: Ultrasound (US)-guided techniques for peripheral nerve blockade have revealed that intraneural injections are relatively frequent and not necessarily associated with neurological deficits. Objectives: To evaluate the short-term effects of deliberate injections performed under direct vision in two different sites of the sciatic nerve (ScN). Material and Methods: Seventy-two New Zealand white rabbits randomly assigned to one of four experimental groups (n = 18) were employed. All procedures were conducted at a proximal femoral level where the ScN incorporates the common peroneal nerve and the tibial nerve (TN). Fixed volumes of 0.5 ml of saline solution (ES group) or bupivacaine 0.75% (EB group) were administered extrafascicularly inside the paraneurium of the ScN or intrafascicularly (IS and IB groups) under the epineurium of the TN. Cross-sectional area (CSA) and relative echogenicity (RE) of the entire ScN were determined by US before injections, after injections, and at 3 and 7 days. ScN samples were obtained for structural and ultrastructural histopathological studies. Proprioceptive, sensorial, and motor function were clinically evaluated on a daily basis. Results: The CSA of the ScN increased significantly immediately after injections when compared with pre-injection values in all groups (p < 0.05). The RE of the ScN decreased in relation to pre-injection values in all groups (p < 0.05). The CSA and RE of the ScN returned to normal values 7 days after injections in almost all groups. Injected nerves showed histological signs of mild perineural inflammation. Histopathological scores were not significantly different between groups (p > 0.05). The architecture of the ScN was preserved in all rabbits at 3 days and in 31/32 rabbits at 7 days. A focal area of damaged nerve fibers with degeneration of the axons and myelin sheath affecting the TN was observed in one rabbit of the IB group. Nerve function was not clinically impaired in any case. Laredo et al. Intraneural Injections in Rabbits Conclusion: Despite the lack of severe nerve disruption observed in most rabbits, the evidence of a focal area of damaged nerve fibers in one rabbit injected intrafascicularly with bupivacaine confirms that intrafascicular injections should be avoided as they may increase the risk of nerve damage.

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Section: Discussionsupporting

confidence: 66%

Short-Term Effects of Deliberate Subparaneural or Subepineural Injections With Saline Solution or Bupivacaine 0.75% in the Sciatic Nerve of Rabbits

et al. 2020

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“…The tibial nerve can be easily identified just lateral and superficial to the popliteal artery, then tracing proximally along its course should be followed to find the bifurcation point of the sciatic nerve where the tibial nerve merge with the peroneal nerve. The PB is performed just proximal to the bifurcation point [ 14 , 15 ]. Moreover, it is possible to achieve anesthesia of both nail folds with a single injection if bilateral nail folds are involved.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Popliteal Nerve Block with Short-Acting Lidocaine in the Surgical Treatment of Ingrown Toenails

Kim

Day

Aspang

2021

IJERPH

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Background: Digital nerve block (DB) is a commonly utilized anesthetic procedure in ingrown toenail surgery. However, severe procedure-related pain has been reported. Although the popliteal sciatic nerve block (PB) is widely accepted in foot and ankle surgery, its use in ingrown toenail surgery has not been reported. Therefore, this study aimed to investigate the safety and effectiveness of PB in the surgical treatment of ingrown toenails. Methods: One-hundred-ten patients surgically treated for an ingrown toenail were enrolled. Sixty-six patients underwent DB, and 44 underwent PB. PB was performed under ultrasound-guidance via a 22-gauge needle with 15 mL of 1% lidocaine in the popliteal region. The visual analogue scale was used to assess pain at two-time points: pain with skin penetration and pain with the solution injection. Time to sensory block, duration of sensory block, need for additional injections, and adverse events were recorded. Results: PB group demonstrated significantly lower procedure-related pain than the DB group. Time to sensory block was significantly longer in the PB group (20.8 ± 4.6 versus 6.5 ± 1.6 minutes). The sensory block duration was significantly longer in the PB group (187.9 ± 22.0 versus 106.5 ± 19.1 minutes). Additional injections were required in 16 (24.2%) DB cases, while no additional injections were required in PB cases. Four adverse events occurred in the DB group and two in the PB group. Conclusion: PB was a less painful anesthetic procedure associated with a longer sensory block duration and fewer repeat injections compared with DB. The result of this study implicates that PB can be an alternative anesthetic option in the surgical treatment of ingrown toenails.

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“…We believe that the paresthesias experienced by his patients could result from his use of nerve stimulation to locate the nerve, whereas we only used sonography for this purpose. Furthermore, according to the results of Cappelleri and colleagues [18] paresthesias seems to be a poor marker for intrafascicular injections in SN blocks in any case. This study did also not detect any difference in postoperative electrophysiological signs of subclinical axonal damage regardless of whether the injection was subparaneural or intrafascicular [18].…”

Section: Discussionmentioning

confidence: 99%

“…We determined the cross-sectional area of the SN by planimetry of the sonographic image. All other studies [2,3,8,17,18] have relied on an approximation using the equation for the area of an ellipse, a shape that does not accurately match the neural cross-section. There was a nearly 50% increase in the cross-sectional area of the SN in the sonographic images.…”

Section: Discussionmentioning

confidence: 99%

Subparaneural injection in popliteal sciatic nerve blocks evaluated by MRI

et al. 2019

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AbstractIntraneural injection of a local anesthetic can damage the nerve, yet it occurs frequently during distal sciatic block with no neurological sequelae. This has led to a controversy about the optimal needle tip placement that results from the particular anatomy of the sciatic nerve with its paraneural sheath.The study population included patients undergoing lower extremity surgery under popliteal sciatic nerve block. Ultrasound-guidance was used to position the needle tip subparaneurally and to monitor the injection of the local anesthetic. Sonography and magnetic resonance imaging were used to assess the extent of the subparaneural injection.Twenty-two patients participated. The median sciatic cross-sectional area increased from 57.8 mm2 pre-block to 110.8 mm2 immediately post-block. An intraneural injection according to the current definition was seen in 21 patients. Two patients had sonographic evidence of an intrafascicular injection, which was confirmed by MRI in one patient (the other patient refused further examinations). No patient reported any neurological symptoms.A subparaneural injection in the popliteal segment of the distal sciatic nerve is actually rarely intraneural, i.e. intrafascicular. This may explain the discrepancy between the conventional sonographic evidence of an intraneural injection and the lack of neurological sequelae.

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Effects of the Intraneural and Subparaneural Ultrasound-Guided Popliteal Sciatic Nerve Block

Cited by 32 publications

References 26 publications

Short-Term Effects of Deliberate Subparaneural or Subepineural Injections With Saline Solution or Bupivacaine 0.75% in the Sciatic Nerve of Rabbits

Short-Term Effects of Deliberate Subparaneural or Subepineural Injections With Saline Solution or Bupivacaine 0.75% in the Sciatic Nerve of Rabbits

Ultrasound-Guided Popliteal Nerve Block with Short-Acting Lidocaine in the Surgical Treatment of Ingrown Toenails

Subparaneural injection in popliteal sciatic nerve blocks evaluated by MRI

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