scholarly journals Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part VII, nerves of the lower limb

2021 ◽  
Author(s):  
Luca Maria Sconfienza ◽  
Miraude Adriaensen ◽  
Domenico Albano ◽  
Andrea Alcala-Galiano ◽  
Georgina Allen ◽  
...  
Keyword(s):  
Nerve Block ◽  
Lower Limb ◽  
Peripheral Nerves ◽  
Interventional Procedures ◽  
Symptom Relief ◽  
Regional Analgesia ◽  
Musculoskeletal Radiology ◽  
Image Guided ◽  
Clinical Indications ◽  
Femoral Cutaneous Nerve

Abstract Objectives To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton’s neuroma) and provide clinical indications. Methods We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton’s neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. Results Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. Conclusion Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. Key Points • Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. • US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. • US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area.

scholarly journals Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part V, knee

2021 ◽  
Author(s):  
Luca Maria Sconfienza ◽  
Miraude Adriaensen ◽  
Domenico Albano ◽  
Andrea Alcala-Galiano ◽  
Georgina Allen ◽  
...  
Keyword(s):  
European Society ◽  
Interventional Procedures ◽  
Patellar Tendinopathy ◽  
Level Of Evidence ◽  
Musculoskeletal Radiology ◽  
Imaging Guidance ◽  
Image Guided ◽  
System A ◽  
Clinical Indications

Abstract Objectives Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected. Methods We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications. Results A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus. Conclusions Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee. Key Points • A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR. • Strong consensus with 100% agreement was obtained for all statements. • Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments.

scholarly journals Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part IV, hip

2021 ◽  
Author(s):  
Luca Maria Sconfienza ◽  
Miraude Adriaensen ◽  
Andrea Alcala-Galiano ◽  
Georgina Allen ◽  
Maria Pilar Aparisi Gómez ◽  
...  
Keyword(s):  
European Society ◽  
Interventional Procedures ◽  
Soft Tissues ◽  
Added Value ◽  
Research Committee ◽  
Level Of Evidence ◽  
Musculoskeletal Radiology ◽  
Image Guided ◽  
Clinical Indications ◽  
Treatment Procedures

Abstract Objectives Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications. Methods In this article, we report the results of a Delphi-based consensus of 53 experts who reviewed the published literature for evidence on image-guided interventional procedures offered in the joint and soft tissues around the hip in order of their clinical indications. Results Ten statements concerning image-guided treatment procedures around the hip have been collected by the panel of ESSR experts. Conclusions This work highlighted that there is still low evidence in the existing literature on some of these interventional procedures. Further large prospective randomized trials are essential to better confirm the benefits and objectively clarify the role of imaging to guide musculoskeletal interventional procedures around the hip. Key Points • Expert consensus produced a list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the hip. • The highest level of evidence was only reached for one statement. • Strong consensus was obtained for all statements.

scholarly journals Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part VI, foot and ankle

2021 ◽  
Author(s):  
Luca Maria Sconfienza ◽  
Miraude Adriaensen ◽  
Domenico Albano ◽  
Andrea Alcala-Galiano ◽  
Georgina Allen ◽  
...  
Keyword(s):  
European Society ◽  
Plantar Fasciitis ◽  
Interventional Procedures ◽  
Evidence Based ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Musculoskeletal Radiology ◽  
Image Guided ◽  
Clinical Indications ◽  
Morton's Neuroma

Abstract Objectives Clarity regarding accuracy and effectiveness for interventional procedures around the foot and ankle is lacking. Consequently, a board of 53 members of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the published literature to evaluate the evidence on image-guided musculoskeletal interventional procedures around this anatomical region. Methods We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around foot and ankle in order to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper that was shared with all panel members for final approval. Results A list of 16 evidence-based statements on clinical indications for image-guided musculoskeletal interventional procedures in the foot and ankle were drafted after a literature review. The highest level of evidence was reported for four statements, all receiving 100% agreement. Conclusion According to this consensus, image-guided interventions should not be considered a first-level approach for treating Achilles tendinopathy, while ultrasonography guidance is strongly recommended to improve the efficacy of interventional procedures for plantar fasciitis and Morton’s neuroma, particularly using platelet-rich plasma and corticosteroids, respectively. Key Points • The expert panel of the ESSR listed 16 evidence-based statements on clinical indications of image-guided musculoskeletal interventional procedures in the foot and ankle. • Strong consensus was obtained for all statements. • The highest level of evidence was reached by four statements concerning the effectiveness of US-guided injections of corticosteroid for Morton’s neuroma and PRP for plantar fasciitis.

Harvesting Split-thickness Skin Grafts with Lateral Femoral Cutaneous Nerve Block

2004 ◽  
Vol 66 (6) ◽  
pp. 612-614
Author(s):  
Yukiko TERAMOTO ◽  
Makoto ICHIMIYA ◽  
Yuko TAKITA ◽  
Yoshiaki YOSHIKAWA ◽  
Masahiko MUTO
Keyword(s):  
Nerve Block ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Skin Grafts ◽  
Thickness Skin ◽  
Femoral Cutaneous Nerve

Present Status of Musculoskeletal Radiology in Europe: International Survey by the European Society of Musculoskeletal Radiology

2020 ◽  
Vol 24 (03) ◽  
pp. 323-330
Author(s):  
Timea Hebar ◽  
Žiga Snoj ◽  
Luca Maria Sconfienza ◽  
Filip Maria H.M. Vanhoenacker ◽  
Maryam Shahabpour ◽  
...  
Keyword(s):  
European Society ◽  
Interventional Procedures ◽  
National Level ◽  
International Survey ◽  
Online Questionnaire ◽  
Musculoskeletal Radiology ◽  
Radiological Society ◽  
The Status ◽  
Structure Relationship ◽  
Academic Radiology

No official data exist on the status of musculoskeletal (MSK) radiology in Europe. The Committee for National Societies conducted an international survey to understand the status of training, subspecialization, and local practice among the European Society of Musculoskeletal Radiology (ESSR) partner societies. This article reports the results of that survey. An online questionnaire was distributed to all 26 European national associations that act as official partner societies of the ESSR. The 24 questions were subdivided into six sections: society structure, relationship with the national radiological society, subspecialization, present radiology practice, MSK interventional procedures, and MSK ultrasound. The findings of our study show a lack of standardized training and/or accreditation methods in the field of MSK radiology at a national level. The European diploma in musculoskeletal radiology is directed to partly overcome this problem; however, this certification is still underrecognized. Using certification methods, a more homogeneous European landscape could be created in the future with a view to subspecialist training. MSK ultrasound and MSK interventional procedures should be performed by a health professional with a solid knowledge of the relevant imaging modalities and sufficient training in MSK radiology. Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology. Key Points

Femorosciatic nerve block for lower limb orthopedic surgeries

2010 ◽  
Vol 1 (1) ◽  
pp. 37-40
Author(s):  
Manpreet Singh ◽  
Arvind Kumar Arya ◽  
Rajesh Singh Rautela ◽  
Rajesh Bhardwaj
Keyword(s):  
Nerve Block ◽  
Lower Limb

scholarly journals Efficacy of intrathecal midazolam on enhancing analgesic effect of fentanyl in patients undergoing lower limb surgery

2018 ◽  
Vol 5 (10) ◽  
pp. 2726-2732
Author(s):  
Masoum Khoshfetrat ◽  
Sima Davarpanah ◽  
Aliakbar Keykha
Keyword(s):  
Nerve Block ◽  
Lower Limb ◽  
Analgesic Effect ◽  
Synergistic Effects ◽  
Sensory Nerve ◽  
Study Groups ◽  
The Third ◽  
Significant Difference ◽  
Lower Limb Surgery ◽  
The Mean

Background: Co-administration of drugs with synergistic effects is considered as one of the methods to increase the effectiveness of intrathecal anesthesia and to reduce the need for injectable analgesics. The purpose of this study was to investigate the efficacy of intrathecal midazolam on enhancing the analgesic effect of fentanyl in patients undergoing lower limb surgery. Materials: The present double-blinded clinical trial was conducted on 90 candidate patients undergoing lower limb orthopedic surgery in 2017 at Khatam-Al-Anbiya Hospital in the city of Zahedan, Iran. To this end, the patients were selected via convenience sampling method and then randomly divided into three groups. Afterwards, 3 cc of 0.5% hyperbaric Marcaine was injected intrathecally in the first group, 3 cc of Marcaine + 25 ug of fentanyl was administered to the second group, and 3 cc of Marcaine + 25 ug of fentanyl + 1 mg of midazolam was administered to the third group (the final volume of all three syringes was brought up to 3.7 cc with normal saline). The duration of sensory nerve block and those of motor block and analgesia, as well as changes in vital signs, were then measured in these groups. Moreover, the data were analyzed using SPSS Statistics (Version 22.0) through Chi-square test and one-way analysis of variance (ANOVA). Results: The mean age and gender distribution of the patients in the three study groups did not differ significantly. The mean duration of sensory nerve block was equal to 98.6+/-11.1 min in the first group, 142.2+/-12.4 min in the second group, and 174.3+/-10.9 min in the third group; all showed a statistically significant difference (P=0.0001, P=0.001, P=0.000).The mean duration of analgesia was also reported to be 204.43+/-0.3 min in the first group, 323.62+/-7.4 min in the second group, and 526.22+/-0.9 min in the third group, indicating a statistically significant difference between the three study groups (P=0.0001, P=0.000, P=000). Conclusion: The results of this study demonstrated that adding midazolam to intrathecal fentanyl could significantly increase the duration of sensory nerve block and that of post-operative analgesia.  

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