Development of an ultrasound-guided transgluteal injection of the pudendal nerve in cats: a cadaveric study

Background and objectivesThe intercostobrachial nerve (ICBN) has significant anatomical variation. Localization of the ICBN requires an operator’s skill. This cadaveric study aims to describe two simple ultrasound-guided plane blocks of the ICBN when it emerges at the chest wall (proximal approach) and passes through the axillary fossa (distal approach).MethodsThe anatomical relation of the ICBN and adjacent structures was investigated in six fresh cadavers. Thereafter, we described two potential techniques of the ICBN block. The proximal approach was an injection medial to the medial border of the serratus anterior muscle at the inferior border of the second rib. The distal approach was an injection on the surface of the latissimus dorsi muscle at 3–4 cm caudal to the axillary artery. The ultrasound-guided proximal and distal ICBN blocks were performed in seven hemithoraxes and axillary fossae. We recorded dye staining on the ICBN, its branches and clinically correlated structures.ResultsAll ICBNs originated from the second intercostal nerve and 34.6% received a contribution from the first or third intercostal nerve. All ICBNs gave off axillary branches in the axillary fossa and ran towards the posteromedial aspect of the arm. Following the proximal ICBN block, dye stained on 90% of all ICBN’s origins. After the distal ICBN block, all terminal branches and 43% of the axillary branches of the ICBN were stained.ConclusionsThe proximal and distal ICBN blocks, using easily recognized sonoanatomical landmarks, provided consistent dye spread to the ICBN. We encourage further validation of these two techniques in clinical studies.

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Assessment of feasibility of neuronal reinnervation of pudendal nerve by femoral nerve’s motor branch to vastus lateralis: an ultrasound-guided study

European Journal of Plastic Surgery ◽

10.1007/s00238-020-01675-3 ◽

2020 ◽

Vol 43 (6) ◽

pp. 779-784

Author(s):

Pawan Agarwal ◽

Geetesh Ratre ◽

Sanjoy Pandey ◽

D. Sharma

Keyword(s):

Pudendal Nerve ◽

Vastus Lateralis ◽

Ultrasound Guided ◽

Motor Branch

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Accuracy of Ultrasound-Guided Pudendal Nerve Block in the Ischial Spine and Alcock’s Canal Levels: A Cadaveric Study

Pain Medicine ◽

10.1093/pm/pnaa136 ◽

2020 ◽

Vol 21 (11) ◽

pp. 2692-2698

Author(s):

Béatrice Soucy ◽

Dien Hung Luong ◽

Johan Michaud ◽

Mathieu Boudier-Revéret ◽

Stéphane Sobczak

Keyword(s):

Pudendal Nerve ◽

Ischial Spine ◽

Ultrasound Guided ◽

Us Guidance ◽

Significant Difference ◽

Alcock’S Canal ◽

The Difference ◽

One Year ◽

Musculoskeletal Us ◽

Different Levels

Abstract Background Blockade of the pudendal nerve (PN) using ultrasound (US) guidance has been described at the levels of the ischial spine and Alcock’s canal. However, no study has been conducted to compare anatomical accuracy between different approaches in targeting the PN. Objective To investigate the accuracy of US-guided injection of the PN at the ischial spine and Alcock’s canal levels. This study also compared the accuracy of the infiltrations by three sonographers with different levels of experience. Subjects Eight Thiel-embalmed cadavers (16 hemipelvises). Methods Three physiatrists trained in musculoskeletal US imaging with 12 years, five years, and one year of experience performed the injections. Each injected a 0.1-mL bolus of colored dye in both hemipelvises of each cadaver at the ischial spine and Alcock’s canal levels under US guidance. Each cadaver received three injections per hemipelvis. The accuracy of the injection was determined following hemipelvis dissection by an anatomist. Results The injections were accurate 33 times out of the total 42 attempts, resulting in 78% accuracy. Sixteen out of 21 injections at the ischial spine level were on target (76% accuracy), while the approach at Alcock’s canal level yielded 17 successful injections (81% accuracy). The difference between the approaches was not statistically significant. There was also no significant difference in accuracy between the operators. Conclusions US-guided injection of the PN can be performed accurately at both the ischial spine and Alcock’s canal levels. The difference between the approaches was not statistically significant.

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