Ultrasound-Guided Treatment of Meralgia Paresthetica (Lateral Femoral Cutaneous Neuropathy)

Tagliafico, Alberto; Serafini, Giovanni; Lacelli, Francesca; Perrone, N.; Valsania, Valtero; Martinoli, Carlo

doi:10.7863/jum.2011.30.10.1341

Cited by 115 publications

(77 citation statements)

References 17 publications

(41 reference statements)

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“…In agreement with previous studies, we found that LCFN blockage for 4 weeks significantly improved both pain (VAS) and neuropathic pain (DN4) (32,35). None of the patients experienced any complications during LFNC application.…”

Section: Discussionsupporting

confidence: 92%

“…Due to these anatomic variations, blind blockage may result in rates of perineural injections into incorrect locations as high as 60% (5). USG guidance makes possible the separation of the LFCN from other tissues, increasing the delivery of injection (32) and reducing the amounts of local anesthetic and steroids when compared with blind blocks (33). In our study, each patient was administered 5 cc, including 20 mg-1cc triamcinolone and 4cc prilocaine; in contrast, at least 30 cc were required for blind blockage (34).…”

Section: Discussionmentioning

confidence: 99%

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Comparative Efficacy of Pregabalin and Ultrasonography-guided Lateral Femoral Cutaneous Nerve Blockage for Meralgia Paresthetica

Okur¹,

Vural²,

Doğan³

et al. 2017

International Journal of Therapies and Rehabilitation Research

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Comparative Efficacy of Pregabalin and Ultrasonography-guided Lateral Femoral Cutaneous Nerve Blockage for Meralgia Paresthetica

Okur¹,

Vural²,

Doğan³

et al. 2017

International Journal of Therapies and Rehabilitation Research

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“…These results were confirmed in a volunteer study where a nerve stimulator was used [3]. In a series of 20 patients with meralgia paresthetica, all had resolution of their symptoms within 2 weeks of injection; however, four patients required repeat injections at 1 week [73] • • Other US-guidance has also been described for injections of the ganglion of impar [75], pudendal nerves [76] and abdominal cutaneous nerves [77]. These studies demonstrated feasibility of the methods rather than superiority of the technique.…”

Section: • Lateral Femoral Cutaneous Nervesupporting

confidence: 66%

“…Chronic pain associated with LFCN is common in obese and pregnant patients whose abdominal tissue folds over the inguinal canal and awkwardly compresses the small nerve as it passes under and through the inguinal canal [73]. Symptoms include numbness, paresthesia and aching pain in the distribution.…”

Section: • Lateral Femoral Cutaneous Nervementioning

confidence: 99%

Ultrasound-guided interventional procedures for chronic pain management

et al. 2015

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Ultrasonography has multiple advantages over traditional radiologic imaging modalities when used for interventional procedures. It allows improved visualization of the anatomy while avoiding ionizing radiation and risks associated with contrast use. It has proved superiority at accuracy of delivery and procedural effectiveness over blind procedures when used in association with interventional pain procedures. Although limited in its ability to see through bony structures, ultrasound has utility in visualizing soft tissues and vascular structures in anatomic regions of interest resulting in increased use for posterior neuraxial, periaxial, peripheral nerve and joint-related structures. Current evidence for use in these settings is presented here. In some cases, optimal utility may be improved by combining ultrasonography with other imaging modalities. KEYWORDS• chronic pain management Advantages of ultrasound imagingInterventional pain procedures were traditionally performed under fluoroscopic (FS), computed tomography (CT) or MRI guidance. The use of ultrasound (US) to perform injections for chronic pain has significantly increased in the past decade [1,2]. This increase is attributed to its multiple advantages over other imaging modalities including ease of performance, absence of ionizing radiation, better visualization of soft tissue (i.e., muscle, ligament) and blood vessels, real time visualization of needle advancement and, at times, the ability to observe the spread of injectate [3]. US Practice points• Use of ultrasound in medicine has grown with smaller size equipment, increased portability and decreased cost.• Ultrasound has multiple advantages over radiographic imaging when used for interventional pain procedures.• Sonography is useful for medial branch blocks and intra-articular facet blocks in the cervical and lumbar spine but there is little evidence to support its use in the thoracic spine.• Ultrasonography is limited in utility for many types of axial injections because of bony and acoustic shadowing artifact but it does show some promise with transforaminal epidurals or selective nerve root blocks.• Ultrasound guidance is effective in preventing soft tissue and vascular injury in stellate ganglion blocks compared with blind techniques. Soft tissue and vascular anomalies can be identified that fluoroscopic technique will miss.• Ultrasound improves accuracy and efficacy in ilioinguinal, iliohypogastric and genitofemoral blocks for inguinal and testicular pain.• Lateral femoral cutaneous nerve injections are more accurate under ultrasound guidance, especially given the anatomic variation the nerve exhibits in cadaver dissections.• Injections into the knee, shoulder and hip joints are more successful when performed using ultrasound.For reprint orders, please contact: reprints@futuremedicine.com

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“…Not surprisingly, in the recent years, the role of US in peripheral nerve evaluation has been widened [15,16] . In the past, nerve US was mainly used to assess nervecross sectional area [1722] , but now more advanced measurements and considerations are desirable and can boost the role of peripheral nerve US.…”

Section: Introductionmentioning

confidence: 99%

Peripheral nerve imaging: Not only cross-sectional area

Tagliafico

2016

WJR

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suggest to use ultrasound (US) for nerve evaluation due to the fact that, in sever anatomical area, magnetic resonance imaging is not able to give additional in formations. US could be considered the firstchoice approach for the assessment of peripheral nerves. The relative drawback of peripheral nerve US is the long learning curve and the deep anatomic competence to evaluate even small nerves. In the recent years, the role of US in peripheral nerve evaluation has been widened. In the past, nerve US was mainly used to assess nerve cross sectional area, but now more advanced mea surements and considerations are desirable and can boost the role of peripheral nerve US. Nerve echotexture evaluation was defined in 2010: The ratio between the hypoechoic and hyperechoic areas of peripheral nerves on US was called "nerve density". For evaluation of patients who have peripheral neuropathies, the role of peripheral nerve is US wider than simple crosssectional area evaluation. Quantitative measurements describing the internal fascicular echotexture of peripheral nerves introduce the concept of considering US as a possible quantitative imaging biomarker technique. The potential of nerve US has started to be uncovered. It seems clear that only crosssectional area measurement is no more sufficient for a comprehensive US evaluation of peripheral nerves. AbstractPeripheral nerve imaging is recognized as a complement to clinical and neurophysiological assessment in the evaluation of peripheral nerves with the ability to impact patient management, even for small and difficult nerves.

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Ultrasound-Guided Treatment of Meralgia Paresthetica (Lateral Femoral Cutaneous Neuropathy)

Abstract: Treatment of meralgia paresthetica with ultrasound-guided perineural injections resulted in substantial symptom relief in most patients 2 months after injection. Randomized placebo-controlled trials of this treatment should be considered in the future.

Cited by 115 publications

References 17 publications

Comparative Efficacy of Pregabalin and Ultrasonography-guided Lateral Femoral Cutaneous Nerve Blockage for Meralgia Paresthetica

Comparative Efficacy of Pregabalin and Ultrasonography-guided Lateral Femoral Cutaneous Nerve Blockage for Meralgia Paresthetica

Ultrasound-guided interventional procedures for chronic pain management

Peripheral nerve imaging: Not only cross-sectional area

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