Novel Demonstration of the Anterior Femoral Cutaneous Nerves using Ultrasound

Pivec, Christopher; Bodner, Gerd; Mayer, Johannes A.; Brugger, Peter C.; Paraszti, István; Moser, Veith; Traxler, Hannes; Riegler, Georg

doi:10.1055/s-0043-121628

Cited by 19 publications

(29 citation statements)

References 21 publications

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“…The dissections in this study showed that the IFCN branches can be identified where they pierce the FL using ultrasound with a 100% success rate of correct identification. The observed pattern with the IFCN dividing into two main branches corresponds to the findings by Pivec et al , who targeted the IFCN at the point of origin from the FN, at the midportion of the thigh and at the most distally visible point 14. In this study, the level of injection was at the level where the IFCN branches pierce the FL, approximately 10 cm below the intersection of the inguinal crease and the FA (9.6 cm (SD 1.4)).…”

Section: Discussionsupporting

confidence: 86%

“…The IFCN branches pierce the fascia lata (FL) and become subcutaneous in the proximal part of the FT (figure 1). 13–17 See online supplementary appendix 1 for a detailed review of the nomenclature and anatomy of the AFCN.…”

Section: Introductionmentioning

confidence: 99%

“…A proximal FTB will not anesthetize the IFCN (figure 1). Instead, the IFCN branches can be ultrasonographically identified and targeted in the subcutis on the anterior thigh as previously described 14 18 19. However, no study has presented a technique for targeting the IFCN branches where they pierce the FL anterior to the SAM before they ramify in multiple branches.…”

Section: Introductionmentioning

confidence: 99%

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Anesthesia of the anterior femoral cutaneous nerves for total knee arthroplasty incision: randomized volunteer trial

Bjørn

Nielsen

Moriggl

et al. 2019

Reg Anesth Pain Med

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Background and objectives For pain relief after total knee arthroplasty (TKA), an injection at the midthigh level may produce analgesia inferior to that of a femoral nerve block as the anterior femoral cutaneous nerves (intermediate femoral cutaneous nerve (IFCN) and medial femoral cutaneous nerve (MFCN)) are not anesthetized. The IFCN can be selectively anesthetized in the subcutaneous tissue above the sartorius muscle and the MFCN by an injection in the proximal part of the femoral triangle (FT). The primary aim was to investigate the area of cutaneous anesthesia in relation to the surgical incision for TKA and anteromedial knee area after intermediate femoral cutaneous nerve blockade (IFCNB) in combination with an injection in the proximal or distal part of the FT (proximal vs distal femoral triangle block (FTB)). Methods The study was carried out as two separate investigations: first, dissection of nine cadaver sides to verify a technique for IFCNB; second, a volunteer study with 40 healthy volunteers. The surgical midline incision for TKA was drawn bilaterally. All volunteers received an active distal FTB combined with a placebo proximal FTB on one side and vice versa on the other side. All volunteers were randomized to an active IFCNB on one side and placebo IFCNB on the contralateral side. Results Identification of IFCN was successful in all cadaver sides. Fifteen out of 20 volunteers had complete anesthesia of the incision line after IFCNB combined with proximal FTB, which was significantly higher compared with proximal FTB alone and with distal FTB+IFCNB. A gap at the anteromedial knee area was present in 2/20 volunteers with proximal FTB compared with 17/20 with distal FTB when all volunteers had active IFCNB. Conclusion Ultrasound-guided blockade of the IFCN and MFCN anesthetize the surgical midline incision and the anteromedial area of the knee relevant for TKA. In contrast, an injection at the midthigh level produces insufficient cutaneous anesthesia not covering the areas of interest. Trial registration number EudraCT: 2018-004986-15.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anesthesia of the anterior femoral cutaneous nerves for total knee arthroplasty incision: randomized volunteer trial

Bjørn

Nielsen

Moriggl

et al. 2019

Reg Anesth Pain Med

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“…The medial branch descends obliquely along the sartorius muscle, pierces the fascia lata at the distal third of the thigh, and provides cutaneous sensation to the medial aspect of the thigh. Both branches may have an anastomosis with the lateral femoral cutaneous nerve, the infrapatellar branch of the saphenous nerve, and the obturator nerve to form the subsartorial plexus ( Figure 8 A) [ 28 ].…”

Section: The Anterior Femoral Cutaneous Nerve (Afcn)mentioning

confidence: 99%

Ultrasound Imaging for the Cutaneous Nerves of the Extremities and Relevant Entrapment Syndromes: From Anatomy to Clinical Implications

Chang

Mezian

Naňka

et al. 2018

JCM

114

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Cutaneous nerve entrapment plays an important role in neuropathic pain syndrome. Due to the advancement of ultrasound technology, the cutaneous nerves can be visualized by high-resolution ultrasound. As the cutaneous nerves course superficially in the subcutaneous layer, they are vulnerable to entrapment or collateral damage in traumatic insults. Scanning of the cutaneous nerves is challenging due to fewer anatomic landmarks for referencing. Therefore, the aim of the present article is to summarize the anatomy of the limb cutaneous nerves, to elaborate the scanning techniques, and also to discuss the clinical implications of pertinent entrapment syndromes of the medial brachial cutaneous nerve, intercostobrachial cutaneous nerve, medial antebrachial cutaneous nerve, lateral antebrachial cutaneous nerve, posterior antebrachial cutaneous nerve, superficial branch of the radial nerve, dorsal cutaneous branch of the ulnar nerve, palmar cutaneous branch of the median nerve, anterior femoral cutaneous nerve, posterior femoral cutaneous nerve, lateral femoral cutaneous nerve, sural nerve, and saphenous nerve.

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“…Die Sonografie ist die Methode der Wahl für die Bildgebung des peripheren Nervensystems [1]. Klinisch ist die Darstellung insbesondere der kleinen peripheren Nerven für folgende Anwendungen relevant: (i) ihre Lokalisierung, um Schäden während chirurgischer oder anderer invasiver Eingriffe zu vermeiden [2][3][4], (ii) die Zielführung applizierbarer Therapeutika oder chirurgischer Eingriffe an diesen Nerven [5][6][7][8][9], und (iii) zur Bestimmung ihres Kalibers für die Beurteilung von kompressiven, entzündlichen oder degenerativen Neuropathien [12][13][14][15][16][17][18].…”

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How small can small nerves be for diagnostic ultrasonography?

Walter

2019

Ultraschall in Med

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Novel Demonstration of the Anterior Femoral Cutaneous Nerves using Ultrasound

Abstract: This study confirms that the IFCN and the MFCN can be reliably visualized with HRUS throughout the course of these nerves, both in anatomical specimens and in patients.

Cited by 19 publications

References 21 publications

Anesthesia of the anterior femoral cutaneous nerves for total knee arthroplasty incision: randomized volunteer trial

Anesthesia of the anterior femoral cutaneous nerves for total knee arthroplasty incision: randomized volunteer trial

Ultrasound Imaging for the Cutaneous Nerves of the Extremities and Relevant Entrapment Syndromes: From Anatomy to Clinical Implications

How small can small nerves be for diagnostic ultrasonography?

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