COMBINED INTEROSSEOUS TIBIAL NERVE AND COMMON PERONEAL NERVE BLOCKS FOR FOOT SURGERY

Background Although several anterior approaches to sciatic nerve block have been described, they are used infrequently. The authors describe a new anterior approach that allows access to the sciatic nerve with the patient in the supine position. Method Sciatic nerve blocks were performed in 22 patients. A line was drawn between the inferior border of the anterosuperior iliac spine and the superior angle of the pubic symphysis tubercle. Next, a perpendicular line bisecting the initial line was drawn and extended 8 cm caudad. The needle was inserted perpendicularly to the skin, and the sciatic nerve was identified at a depth of 10.5 cm (9.5-13.5 cm; median and range) using a nerve stimulator and a 15-cm b-beveled insulated needle. After appropriate localization, either 30 ml mepivacaine, 1.5% (group 1 = knee arthroscopy; n = 16), or 15 ml mepivacaine, 1.5%, plus 15 ml ropivacaine, 0.75%, (group 2 = other procedures; n = 6) was injected. Results Appropriate landmarks were determined within 1.3 min (0.5-2.0 min). The sciatic nerve was identified in all patients within 2.5 min (1.2-5 min), starting from the beginning of the appropriate landmark determination to the stimulation of its common peroneal nerve component in 13 cases and its tibial nerve component in 9 cases. A complete sensory block in the distribution of both the common peroneal nerve component and the tibial nerve component was obtained within 15 min (5-30 min). A shorter onset was observed in patients who received mepivacaine alone compared with those who received a mixture of mepivacaine plus ropivacaine (10 min [5-25 min] vs. 20 min [10-30 min]; P < 0.05). Recovery time was 4.6 h (2.5-5.5 h) after mepivacaine administration. The addition of ropivacaine produced a block of a much longer duration 13.8 h (5.2-23.6 h); P < 0.05. No complications were observed. Conclusions This approach represents an easy and reliable anterior technique for performing sciatic nerve blocks.

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Foot Surgery in Vanuatu: Results of Combined Tibial, Common Peroneal and Saphenous Nerve Blocks in Fifty-six Adults

Anaesthesia and Intensive Care ◽

10.1177/0310057x8901700316 ◽

1989 ◽

Vol 17 (3) ◽

pp. 336-339 ◽

Cited By ~ 8

Author(s):

C. J. Sparks ◽

T. Higeleo

Keyword(s):

Peroneal Nerve ◽

Common Peroneal Nerve ◽

Saphenous Nerve ◽

Popliteal Fossa ◽

Constant Current ◽

Foot And Ankle ◽

Nerve Stimulator ◽

Foot Surgery ◽

Nerve Blocks ◽

Ankle Surgery

Combined tibial and common peroneal nerve anaesthesia was used for foot and ankle surgery in fifty-six adults. Where necessary, the saphenous nerve was also blocked. A calibrated constant current nerve stimulator was used to localise the nerves in the popliteal fossa. Using lignocaine 1%, an opioid premedication, but no other sedation or top-up injection, 60% of the blocks were successful. If a patient felt pain at incision or during surgery, the block was recorded as a failure.

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VARIANT RELATION OF THE SCIATIC NERVE TO THE PIRIFORMIS MUSCLE: A CADAVERIC STUDY FROM NORTH INDIA. Variaciones en la relación del nervio ciático con el músculo piriforme: Un estudio cadavérico en India del Norte

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v8.n1.14206 ◽

2016 ◽

Vol 8 (1) ◽

pp. 38-42

Author(s):

Virendra Budhiraja ◽

Rakhi Rastogi ◽

Sanjeev K Jain ◽

Nidhi Sharma ◽

Rohin Garg ◽

...

Keyword(s):

Sciatic Nerve ◽

Clinical Outcomes ◽

Peroneal Nerve ◽

Tibial Nerve ◽

Common Peroneal Nerve ◽

North India ◽

Piriformis Muscle ◽

The Common ◽

Long Course ◽

Relationship Of

El nervio ciático sale de la pelvis y entra en la región glútea debajo del músculo piriforme como un único tronco. Tiene dos componentes: el nervio peroneo común y el nervio tibial. La relación variable del nervio ciático con el músculo piriforme y su longitud hace que el nervio sea vulnerable a las lesiones. Estudiamos la relación variable del nervio ciático en sesenta extremidades inferiores de treinta cadáveres y encontramos el nervio ciático emergiendo indiviso por debajo del músculo piriforme en el 68,33% de los casos, pero en el 31,66% el nervio ciático estaba dividido arriba en la pelvis. En el 18,33% de los casos el componente peroneo común emergió arriba y en el 13,33% de los casos emergió a través del músculo piriforme. Pensamos que tener un conocimiento adecuado sobre la anatomía del nervio ciático es bueno para los resultados clínicos. Sciatic nerve leaves the pelvis and enters the gluteal region below the piriformis muscle as single trunk. It has two components common peroneal nerve and the tibial nerve. The variable relationship of sciatic nerve with the piriformis muscle and its long course makes the nerve vulnerable to injury. We studied sciatic nerve variable relation in sixty lower extremities of thirty cadavers and found the sciatic nerve emerging undivided below the piriformis muscle in 68.33% of cases but in 31.66% the sciatic nerve divided high in the pelvis. In 18.33% cases the common peroneal component emerged above and in 13.33% of cases it emerged through the piriformis muscle. We think proper knowledge of the anatomy of the sciatic nerve is good for clinical outcomes

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Nerve Blocks around the Knee in Children

Anaesthesia and Intensive Care ◽

10.1177/0310057x8401200103 ◽

1984 ◽

Vol 12 (1) ◽

pp. 14-17 ◽

Cited By ~ 20

Author(s):

P. M. Kempthorne ◽

T. C. K. Brown

Keyword(s):

Tibial Nerve ◽

Common Peroneal Nerve ◽

Saphenous Nerve ◽

Popliteal Fossa ◽

Nerve Stimulator ◽

Nerve Blocks ◽

Peripheral Nerve Stimulator ◽

Below The Knee ◽

The Common ◽

Equinus Deformity

Analgesia below the knee can be achieved by blocking the tibial nerve and the common peroneal nerve in the popliteal fossa, and the saphenous nerve adjacent to the knee. The anatomy and technique of nerve block in the popliteal fossa is described, the nerve being located prior to blockade using a peripheral nerve stimulator. The block as described has been used in children for postoperative analgesia, as a diagnostic block, and as an adjunct to the physiotherapy management of severe equinus deformity after brain injury.

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Controlled, clinical trial assessing saphenous, tibial and common peroneal nerve blocks for the control of perioperative pain following femoro-tibial joint surgery in the nonchondrodystrophoid dog

Veterinary Anaesthesia and Analgesia ◽

10.1111/j.1467-2995.2005.00235.x ◽

2006 ◽

Vol 33 (1) ◽

pp. 49-61 ◽

Cited By ~ 14

Author(s):

Lara M Rasmussen ◽

Alan J Lipowitz ◽

Lynelle F Graham

Keyword(s):

Clinical Trial ◽

Peroneal Nerve ◽

Common Peroneal Nerve ◽

Controlled Clinical Trial ◽

Nerve Blocks ◽

Joint Surgery ◽

Perioperative Pain

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Unilateral higher division of sciatic nerve and its clinical importance

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195573 ◽

2019 ◽

Vol 8 (1) ◽

pp. 355

Author(s):

Sonia Jandial

Keyword(s):

Sciatic Nerve ◽

Coming Out ◽

Peroneal Nerve ◽

Tibial Nerve ◽

Clinical Importance ◽

Common Peroneal Nerve ◽

Gluteal Region ◽

Piriformis Muscle ◽

Long Course ◽

The Right

The sciatic nerve has a long course right from the pelvis to the apex of the popliteal fossa. The point of division of the sciatic nerve into tibial and common peroneal nerves is very variable. The variation in the division of the sciatic nerve described in the present study should be helpful for anaesthetists and orthopaedic surgeons. While doing the dissection and teaching of the gluteal region in the Post Graduate Department of Anatomy, government medical college, Jammu, it was found that on the left side tibial nerve and common peroneal nerve were present instead of sciatic nerve. It meant that the main nerve that is the sciatic nerve had already been divided into its terminal branches in the pelvis region. Both tibial and common peroneal nerve were seen coming out of the pelvis below the piriformis muscle, while on the right side there were no variation. The sciatic nerve was seen coming out of the pelvis below the piriformis muscle as usual. Because of this high division of the sciatic nerve in the pelvis, there are many complications like failed sciatic nerve block during anaesthesia while performing surgery, but high division of the sciatic nerve may result in escape of either tibial nerve or common peroneal nerve. The gluteal region, back of the thigh and leg of the lower limb were dissected to study further course of tibial nerve and the common peroneal nerve. Photographs were also taken.

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The anatomic location and importance of the tibialis posterior fascicular bundle at the sciatic nerve bifurcation: report of 3 cases

Journal of Neurosurgery ◽

10.3171/2018.8.jns181190 ◽

2019 ◽

Vol 131 (6) ◽

pp. 1869-1875 ◽

Cited By ~ 1

Author(s):

Thomas J. Wilson ◽

Andres A. Maldonado ◽

Kimberly K. Amrami ◽

Katrina N. Glazebrook ◽

Michael R. Moynagh ◽

...

Keyword(s):

Sciatic Nerve ◽

Peroneal Nerve ◽

Tibial Nerve ◽

Common Peroneal Nerve ◽

Foot Drop ◽

Preoperative Imaging ◽

Tibialis Posterior ◽

Severe Injuries ◽

Nerve Action ◽

Internal Neurolysis

The authors present the cases of 3 patients with severe injuries affecting the peroneal nerve combined with loss of tibialis posterior function (inversion) despite preservation of other tibial nerve function. Loss of tibialis posterior function is problematic, since transfer of the tibialis posterior tendon is arguably the best reconstructive option for foot drop, when available. Analysis of preoperative imaging studies correlated with operative findings and showed that the injuries, while predominantly to the common peroneal nerve, also affected the lateral portion of the tibial nerve/division near the sciatic nerve bifurcation. Sunderland’s fascicular topographic maps demonstrate the localization of the fascicular bundle subserving the tibialis posterior to the area that corresponds to the injury. This has clinical significance in predicting injury patterns and potentially for treatment of these injuries. The lateral fibers of the tibial division/nerve may be vulnerable with long stretch injuries. Due to the importance of tibialis posterior function, it may be important to perform internal neurolysis of the tibial division/nerve in order to facilitate nerve action potential testing of these fascicles, ultimately performing split nerve graft repair when nerve action potentials are absent in this important portion of the tibial nerve.

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Translocation of the soleus muscular branch of the tibial nerve to repair high common peroneal nerve injury

Acta Neurochirurgica ◽

10.1007/s00701-018-03797-x ◽

2019 ◽

Vol 161 (2) ◽

pp. 271-277 ◽

Cited By ~ 2

Author(s):

Huihao Chen ◽

Depeng Meng ◽

Gang Yin ◽

Chunlin Hou ◽

Haodong Lin

Keyword(s):

Nerve Injury ◽

Peroneal Nerve ◽

Tibial Nerve ◽

Common Peroneal Nerve ◽

Peroneal Nerve Injury ◽

Muscular Branch

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Persistent traumatic peroneal nerve palsy - surgical treatment by neuromusculotendinous gastrocnemius muscle transfer

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00228 ◽

2019 ◽

Vol 7 (6_suppl4) ◽

pp. 2325967119S0022

Author(s):

Matthias Hoppert ◽

Ulf Dornseifer

Keyword(s):

Surgical Technique ◽

Peroneal Nerve ◽

Nerve Palsy ◽

Gastrocnemius Muscle ◽

Tibial Nerve ◽

Common Peroneal Nerve ◽

Clinical Results ◽

Peroneal Nerve Palsy ◽

Muscle Transfer ◽

Common Peroneal Nerve Palsy

Aims and Objectives: Common peroneal nerve palsy is a relatively frequent complication in trauma of the knee and lower extremity. Persistent traumatic peroneal nerve palsy is usually treated by tendon transfer. A surgical concept for the treatment by neurotized lateral gastrocnemius muscle transfer is demonstrated with the aim of restoring active voluntary dorsiflexion. The indication, the surgical technique and the results obtained in two own cases with review of the literature are presented. Materials and Methods: Surgical technique: The lateral head of the gastrocnemius muscle is transferred to the tendons of the anterior tibial muscle group. The intact proximal end of the deep peroneal nerve is transpositioned to the tibial nerve of the gastrocnemius muscle by microsurgical technique. The transferred muscle is reinnervated by nerve coaptation between the undamaged proximal part of the deep peroneal nerve and the motor branch of the tibial nerve supplying the gastrocnemius muscle. The key steps of the surgical technique are described. Results: Short term results of the own cases appeared excellent. In both patients the transferred gastrocnemius muscle showed signs of reinnervation within 6 months after the operation. The patients achieved stable functional gait, voluntary movement of the transferred muscle and active range of motion of about 40 degrees. The early clinical results are compared with the clinical series in the literature since 1994. Conclusion: Early clinical results after the neuromusculotendinous gastrocnemius muscle transfer appear highly successful. They still need to be compared with conventional tendon transfer procedures. The described operative approach offers some advantages compared with other methods in the reconstruction of a drop foot secondary to traumatic common peroneal nerve palsy in a well-selected group of patients. In contrast to the commonly used treatment of tibialis posterior muscle transfer no reeducation of the transferred muscle is needed. We review the indications and limitations of this technique.

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