Evaluation of the iPACK block injectate spread: a cadaveric study

2019 ◽  
Vol 44 (7) ◽  
pp. 689-694 ◽  
Author(s):  
John Tran ◽  
Laura Giron Arango ◽  
Philip Peng ◽  
Sanjay Kumar Sinha ◽  
Anne Agur ◽  
...  
Keyword(s):  
Cadaveric Study ◽  
Injection Technique ◽  
Blue Dye ◽  
Ultrasound Guided ◽  
Posterior Aspect ◽  
Anterior Branch ◽  
Injection Techniques ◽  
Posterior Division ◽  
Analgesic Technique ◽  
Posterior Knee

Background and objectivesUltrasound-guided infiltration of the interspace between the popliteal artery and capsule of the knee (iPACK) block, a new regional analgesic technique, is believed to relieve posterior knee pain, after total knee arthroplasty, by targeting the articular branches innervating posterior aspect of the joint. The extent of injectate spread and the number of articular branches affected is currently unknown. This cadaveric study aimed to compare the area of dye spread and frequency of articular branches staining following a proximal versus distal injection technique.MethodsAn ultrasound-guided iPACK injection (10 mL of methylene blue dye solution) was performed in 14 lightly embalmed specimens: 7 injected using a proximal injection technique (1 fingerbreadth above base of patella) and 7 using a distal injection technique (at the superior border of the femoral condyles). Following injection, dissection, digitization, and 3D modeling were performed to map the area of dye spread and determine the frequency of nerve staining.ResultsBoth injection techniques achieved a similar mean area of injectate spread. Of the four articular branches supplying the posterior knee joint capsule, the genicular branch of posterior division of obturator nerve was stained in all specimens. The proximal injection resulted in staining of superior medial genicular nerve, due to dye spread through the adductor hiatus, whereas superior lateral genicular nerve and anterior branch of common fibular nerve were consistently stained following distal injection. Other articular branches were stained with variable frequency.ConclusionsBoth proximal and distal iPACK injection techniques provided a similar area of dye spread in the popliteal region and extensive staining of the articular branches supplying the posterior capsule. The proximal injection technique promoted greater anteromedial dye spread, while the distal injection had more anterolateral spread. Further clinical study is required to confirm our cadaveric findings. 

Thoracic-paravertebral blocks: comparative anatomical study with different injection techniques and volumes

2019 ◽  
pp. rapm-2019-100896 ◽  
Author(s):  
Ronald Seidel ◽  
Andreas Wree ◽  
Marko Schulze
Keyword(s):  
Epidural Space ◽  
Anatomical Study ◽  
Sympathetic Trunk ◽  
Injection Technique ◽  
Initial Contact ◽  
Ultrasound Guided ◽  
Paravertebral Space ◽  
Injection Volume ◽  
Injection Techniques ◽  
Intercostal Nerves

Background and objectivesWe hypothesized that different injection techniques and volumes in thoracic-paravertebral blocks (TPVB) lead to different patterns of dye spread. In particular, we investigated whether an alternating injection technique leads to complete staining of all adjacent intercostal nerves.MethodsThis comparative anatomical investigation was performed using 10 or 20 mL of dye (Alcian Blue) in 10 unfixed donor cadavers (54 injections) that were designated for education or research purposes.ResultsIn landmark-guided TPVB, the thoracic-paravertebral space (TPVS) was either not stained at all (spread of dye in the paraspinal muscles, n=3) or the dye was predominantly found in the epidural space (n=3). In ultrasound-guided TPVB, the TPVS was correctly identified in all cases (n=48). The sympathetic trunk was stained in 84.6% of injections (multi-injection technique: 100%), independent of injection technique and volume. The epidural space was stained more frequently (p≤0.001) if both the puncture site (sagittal transducer position) and guidance of the needle were more medial (77.8%). Finally, a higher injection volume (20 vs 10 mL) resulted in a higher number of stained intercostal nerves (p=0.04).ConclusionFor ultrasound-guided techniques, a higher injection volume resulted in a larger number of stained intercostal nerves. Staining of the sympathetic trunk was independent of the injection technique. Epidural spread was observed significantly less frequently if the injection was lateral (transducer transversal) or with a strictly cranial injection direction (transducer sagittal). Landmark-guided injections reliably achieved the TPVS (and the epidural space) only after a needle advance of 2.5 cm after initial contact with the transverse process.

Comparison of Jet Injection and Needle-Syringe Injection Techniques in Production of Edema

1972 ◽  
Vol 51 (2) ◽  
pp. 573-576 ◽  
Author(s):  
Norman K. Ikehara ◽  
David H. Mc Kibben ◽  
Jack L. Pechersky ◽  
Robert Rapp
Keyword(s):  
Local Anesthetic ◽  
Injection Technique ◽  
Jet Injection ◽  
Edema Fluid ◽  
Injection Techniques ◽  
Anesthetic Solution ◽  
Syringe Injection ◽  
Local Anesthetic Solution

A biopsy desiccation method was used to demonstrate the production of edema fluid after administration of a local anesthetic solution by jet and needle-syringe injection techniques. The jet injection technique produced less edema fluid than the needle-syringe injection technique.

Accuracy of Ultrasound-Guided and Palpation-Guided Knee Injections By an Experienced and Less-Experienced Injector Using a Superolateral Approach: A Cadaveric Study

PM&R ◽  
2011 ◽  
Vol 3 (6) ◽  
pp. 507-515 ◽  
Author(s):  
Heather M. Curtiss ◽  
Jonathan T. Finnoff ◽  
Evan Peck ◽  
John Hollman ◽  
Jeff Muir ◽  
...  
Keyword(s):  
Cadaveric Study ◽  
Ultrasound Guided

Comparison of two ultrasound-guided injection techniques targeting the sacroiliac joint region in equine cadavers

2016 ◽  
Vol 29 (05) ◽  
pp. 386-393 ◽  
Author(s):  
Chiara Bergamino ◽  
Ruth Sanders ◽  
Ursula Fogarty ◽  
Antonella Puggioni ◽  
Clodagh Kearney ◽  
...  
Keyword(s):  
Sacroiliac Joint ◽  
Ultra Sound ◽  
Needle Guidance ◽  
Sacroiliac Joints ◽  
Ultrasound Guided ◽  
Joint Region ◽  
Median Distance ◽  
Iodinated Contrast ◽  
Before And After ◽  
Injection Techniques

Summary Objectives: To compare the accuracy and distribution of injectate for cranial (CR) and caudomedial (CM) ultrasound-guided injections of equine sacroiliac joints. Methods: Both sacroiliac joints from 10 lumbo sacropelvic specimens were injected using cranial parasagittal (CR; curved 18 gauge, 25 cm spinal needles) and caudomedial (CM; straight 18 gauge, 15 cm spinal needles) ultrasound-guided approaches. Injectate consisted of 4 ml iodinated contrast and 2 ml methylene blue. Computed tomo-graphical (CT) scans were performed before and after injections. Time for needle guidance and repositioning attempts were recorded. The CT sequences were analysed for accuracy and distribution of contrast. Results: Intra-articular contrast was detected in sacroiliac joints following 15/40 injections. The CR and CM approaches deposited injectate ≤ 2 cm from sacroiliac joint margins following 17/20 and 20/20 injections, respectively. Median distance of closest contrast to the sacroiliac joint was 0.4 cm (interquartile range [IQR]: 1.5 cm) for CR approaches and 0.6 cm (IQR: 0.95 cm) for CM approaches. Cranial injections resulted in injectate contacting lumbosacral intertrans-verse joints 15/20 times. Caudomedial injections were perivascular 16/20 times. Limitations: Safety and efficacy could not be established. Clinical relevance: Cranial and CM ultra-sound-guided injections targeting sacroiliac joints were very accurate for periarticular injection, but accuracy was poor for intra- articular injection. Injectate was frequently found in contact with interosseous sacroiliac ligaments, as well as neurovascular and synovial structures in close vicinity of sacroiliac joints.

Anatomy and Ultrasound-Guided Injection of the Medial Branch of the Dorsal Ramus of the Cervical Spinal Nerves in the Horse: A Cadaveric Study

2020 ◽  
Vol 33 (06) ◽  
pp. 377-386
Author(s):  
Giorgio Corraretti ◽  
Jean-Michel Vandeweerd ◽  
Fanny Hontoir ◽  
Katrien Vanderperren ◽  
Katrien Palmers
Keyword(s):  
Spinal Nerve ◽  
Blue Dye ◽  
Anatomical Landmarks ◽  
Medial Branch ◽  
Intervertebral Foramen ◽  
Ultrasound Guided ◽  
Clinical Value ◽  
Spinal Nerves ◽  
Articular Process ◽  
Cervical Spinal Nerve

Abstract Objective The aim of this study was to describe the anatomy of the nerves supplying the cervical articular process joint and to identify relevant anatomical landmarks that could aid in the ultrasound-guided location and injection of these nerves for diagnostic and therapeutic purposes. Study Design Twelve cadaveric equine necks were used. Five necks were dissected to study the anatomy of the medial branch of the dorsal ramus of the cervical spinal nerves 3 to 7. Relevant anatomical findings detected during dissections were combined with ultrasonographic images obtained in one other neck. Six additional necks were used to assess the accuracy of ultrasound-guided injections of the medial branch with blue dye. Results Each examined cervical articular process joint, except for C2 to C3, presented a dual nerve supply. The articular process joints were found to be in close anatomical relationship with the medial branch of the dorsal ramus of the cervical spinal nerve exiting from the intervertebral foramen at the same level, and with the medial branch of the dorsal ramus of the cervical spinal nerve exiting from the intervertebral foramen one level cranial to the articular process joint of interest. A total of 55 nerves were injected under ultrasonographic guidance, 51 of which were successfully stained. Conclusion The current study provided new detailed information regarding the innervation of the cervical articular process joint. The medial branches of the dorsal rami of the cervical spinal nerves were injected with an accuracy that would be of clinical value. Our study offers the foundations to develop new diagnostic and therapeutic techniques for pain management in cervical articular process joint arthropathy in horses.

scholarly journals Ultrasound-guided posterior antebrachial cutaneous nerve block utilising the ‘fat-filled flat tunnel’: Description of technique and cutaneous sensory block area

2019 ◽  
Vol 47 (6) ◽  
pp. 532-540
Author(s):  
Philip J Corke
Keyword(s):  
Nerve Block ◽  
Sensory Block ◽  
Individual Variability ◽  
Cutaneous Nerve ◽  
Sensory Loss ◽  
Ultrasound Guided ◽  
Upper Arm ◽  
Posterior Aspect ◽  
Lateral Epicondyle ◽  
Block Area

The aim of the study was to investigate an ultrasound-guided posterior antebrachial cutaneous nerve block based on visualising the nerve within the fat-filled flat tunnel and describe the area of cutaneous sensory loss. A total of 12 healthy volunteers were included in the study. The posterior antebrachial cutaneous nerve was identified within the fat-filled flat tunnel in the upper arm using high-frequency ultrasound. The nerve was blocked using an in-plane needle guidance technique with 1 ml 2% lidocaine. Sensory loss to pinprick was evaluated 15 minutes after performing the block and the cutaneous sensory block area mapped. Ultrasound visualisation of the posterior antebrachial cutaneous nerve in the fat-filled flat tunnel was possible in all volunteers. The median distance of the posterior antebrachial cutaneous nerve to the lateral epicondyle of the elbow was 67.5 (range 54–105) mm. Loss of sharpness sensation to pinprick extended from the posterior aspect of the distal upper arm and posterior forearm to the wrist. The median cutaneous sensory block area was 103 (range 61–341) cm2. Two volunteers had a sensory block over the anterior forearm of 29 and 10 cm2 respectively. This amounted to 11% and 4.5% of the total cutaneous sensory block area. One volunteer had a sensory block over the dorsum of the hand of 39 cm2 (15% of the total cutaneous sensory block area). The results of this study indicate that the fat-filled flat tunnel can be a useful sono-anatomical landmark in identifying the posterior antebrachial cutaneous nerve and may serve as a target for injection. Although sensory block is predominantly confined to the posterior distal arm and forearm, inter-individual variability in the area and distribution was observed. Sensory block in the anterior forearm and dorsum of the hand can occur. The study was prospectively registered at the Australian New Zealand Clinical Trials Registry, identifier ACTRN12618000891224.

Cadaveric study identifying clinical sonoanatomy for proximal and distal approaches of ultrasound-guided intercostobrachial nerve block

2020 ◽  
Vol 45 (11) ◽  
pp. 853-859
Author(s):  
Artid Samerchua ◽  
Prangmalee Leurcharusmee ◽  
Krit Panjasawatwong ◽  
Kittitorn Pansuan ◽  
Pasuk Mahakkanukrauh
Keyword(s):  
Axillary Artery ◽  
Anatomical Variation ◽  
Intercostal Nerve ◽  
Cadaveric Study ◽  
Ultrasound Guided ◽  
Serratus Anterior ◽  
Adjacent Structures ◽  
Intercostobrachial Nerve ◽  
Inferior Border ◽  
Axillary Branches

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.

Evaluation of the proximal adductor canal block injectate spread: a cadaveric study

2019 ◽  
Vol 45 (2) ◽  
pp. 124-130 ◽  
Author(s):  
John Tran ◽  
Vincent W S Chan ◽  
Philip W H Peng ◽  
Anne M R Agur
Keyword(s):  
Clinical Investigation ◽  
Anatomical Study ◽  
Obturator Nerve ◽  
Cadaveric Study ◽  
Injection Technique ◽  
Vastus Medialis ◽  
Adductor Canal Block ◽  
Adductor Canal ◽  
Total Knee ◽  
Anterior Division

Background and objectives Quadriceps sparing adductor canal block has emerged as a viable intervention to manage pain after total knee arthroplasty. Recent studies have defined ultrasound (US) landmarks to localize the proximal and distal adductor canal. US-guided proximal adductor canal injection has not been investigated using these sonographic landmarks. The objectives of this cadaveric study were to evaluate dye injectate spread and quantify the capture rates of nerves supplying articular branches to the knee joint capsule using a proximal adductor canal injection technique. Methods A US-guided proximal adductor canal injection with 10 mL of dye was performed in seven lightly embalmed specimens. Following injection, specimens were dissected to document dye spread and frequency of nerve staining. Results Following proximal adductor canal injection, dye spread consistently stained the deep surface of sartorius, vastoadductor membrane, aponeurosis of the vastus medialis obliquus, and adductor canal. The saphenous nerve, posteromedial branch of nerve to vastus medialis, superior medial genicular nerve and genicular branch of obturator nerve were captured in all specimens at the proximal adductor canal. There was minimal to no dye spread to the distal femoral triangle, anterior division of the obturator nerve and anterior branches of nerve to vastus medialis. Conclusions This anatomical study provides some insights into the mechanism of analgesia to the knee following a proximal adductor canal injection and its motor sparing properties. Further clinical investigation is required to confirm cadaveric findings.

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