scholarly journals Anatomical Study of Saphenous Nerve and Great Saphenous Vein Using a Peripheral Vein Illumination Device and Ultrasonography

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0032
Author(s):  
Yuki Ota ◽  
Tomoyuki Nakasa ◽  
Yasunari Ikuta ◽  
Yusuke Tsuyuguchi ◽  
Munekazu Kanemitsu ◽  
...  
Keyword(s):  
Knee Joint ◽  
Nerve Block ◽  
Saphenous Vein ◽  
Near Infrared ◽  
Imaging System ◽  
External Rotation ◽  
Saphenous Nerve ◽  
Skin Marker ◽  
Significant Difference ◽  
The Mean

Category: Ankle, Basic Sciences/Biologics Introduction/Purpose: Usefulness of ultrasonographic guided saphenous nerve block is well known for perioperative pain management of foot and ankle surgery. However, in some cases it may be impossible to identify the saphenous nerve, especially women or obese patients, so successful rate of ultrasonographic guided saphenous nerve block was reported 70 to 80%. Previous reports demonstrated that the saphenous nerve is running adjacent to the greater saphenous vein, which suggests that the greater saphenous vein can be an indicator to identify the saphenous nerve. The purpose of this study was to examine anatomical relationship between the saphenous nerve and the greater saphenous vein which is depicted using the near-infrared (NIR) vascular imaging system, the Vein Viewer Flex®. Methods: Thirty legs as 15 healthy subjects (13 males, 2 females) were included in this study. Average age was 34.2 ± 3.2 years old. In a supine position, the knee joint was flexed 60 degrees with mild flexion, abduction, and external rotation of the hip joint, and the greater saphenous vein was depicted using the Vein Viewer Flex® on the skin of the lower extremity. The vein visualized as a green light was then marked using the skin marker. (Figure 1). After marking the greater saphenous vein, the greater saphenous vein and saphenous nerve were identified under ultrasonography at 5 cm distal from the medial knee joint space (Figure 2). The distance between the greater saphenous vein which was marked using the Vein Viewer Flex® and the saphenous nerve was measured in the ultrasonography images. The circumference of the leg (COL) was also measured. Results: The course of the greater saphenous vein could be depicted by the Vein Viewer Flex® in all cases, and it was confirmed by ultrasonography. It was confirmed that the saphenous nerve was located under the sartorius fascia and it was running posteromedially in parallel of the greater saphenous vein. The mean distance from the saphenous nerve and the greater saphenous vein was 7.9 ± 2.7 mm. There was no significant difference between left and right legs (right: 7.9±2.8 mm, left: 8.0±3.0 mm, P=0.95). The mean COL was 34.2 ± 1.9 mm, and there was a moderate positive correlation (r = 0.45). Conclusion: This study revealed that the saphenous nerve is running in parallel of the greater saphenous vein which can be depicted by the Vein Viewer Flex®. Ultrasonography after depicting greater saphenous vein enabled to confirm the saphenous nerve with certainly and noninvasive. These findings suggested that the combination of the Vein Viewer Flex® and ultrasonography enables the saphenous nerve block to be more reliable procedure even the saphenous nerve is hardly identified by the ultrasonography.

scholarly journals Similar early functional recovery after total knee replacement comparing single shot versus continuous saphenous nerve block: A randomised, double-blind trial

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902093203
Author(s):  
Ho Yee Joyce Lam ◽  
Yan Ho Bruce Tang ◽  
Hok Leung Wong ◽  
Isaac Bruce Yang
Keyword(s):  
Total Knee Replacement ◽  
Nerve Block ◽  
Knee Replacement ◽  
Femoral Nerve ◽  
Saphenous Nerve ◽  
Single Shot ◽  
Maximum Flexion ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Purpose: Total knee replacement (TKR) is associated with post-operative pain. Femoral nerve block can relieve the pain but also affects the post-operative mobility. Saphenous nerve block (SNB) can improve analgesia without interfering mobilisation. However, there is no consensus on the ideal mode of administration of SNB. We aim to compare the effects of single shot versus continuous SNB on patients undergoing TKR. Methods: Patients were randomised into two groups: single shot and continuous SNB groups. Post-operative rehabilitation and mobilisation were assessed by blinded physiotherapists, and preoperative and post-operative American knee scores were recorded by blinded specialised nurse. Post-operative analgesics usage was recorded by blinded pain nurses and anaesthetists. Results: Sixty-four patients were recruited; 6 patients withdrew with 29 patients in each group. There is no significant difference in early mobilisation and rehabilitation comparing both groups. The mean of the range gained on day 2 when compared to day 1 in single-shot SNB group was 17.41 ± 19.67° versus continuous SNB group was 23.45 ± 19.18° ( p = 0.149). The mean of the range gained on day 3 when compared to day 1 in single-shot group was 27.24 ± 22.66° versus continuous SNB group was 29.31 ± 21.57° ( p = 0.6). The mean of maximum flexion achieved by day 3 in single-shot SNB group was 92.41 ± 9.6° versus continuous SNB was 91.90 ± 7.95° ( p = 0.84). The day of reaching maximum flexion and the goal of 40 m showed no significant difference. Length of stay (LOS), difference in post-operative American Knee Society knee score at 3 months and analgesics usage showed no significant difference. Conclusion: There is no significant difference in comparing the effect on mobilisation, LOS, early clinical outcome, analgesics usage in the single-shot group and the continuous SNB group.

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.  

scholarly journals Templating of Syndesmotic Ankle Lesions by Use of 3D Analysis in Weightbearing and Classical CT

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0017 ◽  
Author(s):  
Arne Burssens ◽  
Alexej Barg ◽  
Laurens De Cock ◽  
Jan Victor ◽  
Kristian Buedts
Keyword(s):  
Sequential Analysis ◽  
External Rotation ◽  
Lateral Displacement ◽  
Computer Calculation ◽  
Control Group ◽  
3D Analysis ◽  
Distal Fibula ◽  
Fracture Group ◽  
Significant Difference ◽  
The Mean

Category: Ankle Introduction/Purpose: Syndesmotic lesions of the ankle have shown to be challenging injuries towards diagnosis and surgical treatment. This could be mainly attributed to the limitations of 2D imaging, which make it difficult to accurately determine the extent of the lesion and to verify if peroperatively an anatomical reduction is achieved of the distal tibiofibular congruence. The aim of this study is therefore to develop a reproducible method to quantify the displacement in a syndesmotic ankle lesion in all six degrees of freedom based on 3D imaging. Methods: Eighteen patients were retrospectively included having a unilateral syndesmotic lesion. N=12 sustained a high ankle sprain and a bilateral weightbearing conebeam CT was obtained because of positive clinical syndesmotic tests. N=6 presented with a fracture associated syndesmotic lesion and were imaged by a bilateral non-weightbearing CT. The non-affected ankle was used as a template after being mirrored and matched on the contralateral ankle containing a syndesmotic lesion (Fig 1A-B). The distal fibula was marked by computer calculation of the most outer point of the anterior tubercle, posterior tubercle and apex malleolis lateralis. The change of these points towards the unaffected fibular position was used to quantify the syndesmotic lesion (Fig 1C). A control group of seven patients (N=7) was used to analyse if these changes differed from the normal variation in tibio-fibular congruency (Fig 1D). Results: The main findings consisted of a statistical significant difference in the mean mediolateral diastasis of both the sprained group (M = 1.60 mm, SD=1.02) and the fracture group (M = 1.69 mm, SD=0.62) compared to the control group (P<.001). The mean external rotation was statistically different when comparing the sprained group (M = 4.68°, SD=2.74) and the fracture group (M = 6.97°, SD=3.02) towards the control group (P<.05). The mean antero-posterior translation was only significantly different when comparing the fracture group (M = -4.73 mm, SD=4.53) towards the sprained group (M = -0.91 mm, SD=1.26) and the control group (M = -0.26 mm, SD=1.53) (P<.05). Conclusion: This study demonstrates an effective method to quantify a unilateral syndesmotic lesion of the ankle. The pathological measurements differed from the normal distal tibio-fibular configuration in the syndesmotic complex. This sequential analysis is of use for an accurate diagnosis and a pre-operative planning to know in advance which correction needs to be achieved to have the fibula at proper length correctly rotated, and reduced into the syndesmosis with no anterior, posterior or lateral displacement.

Results of Arthroscopic Synovectomy for Treatment of Synovial Lipomatosis (Lipoma Arborescens) of the Knee

2017 ◽  
Vol 31 (06) ◽  
pp. 536-540 ◽  
Author(s):  
Melih Malkoc ◽  
Özgur Korkmaz
Keyword(s):  
Knee Joint ◽  
Inflammatory Cells ◽  
Knee Joints ◽  
Lipoma Arborescens ◽  
Arthroscopic Synovectomy ◽  
Tumor Pathology ◽  
Significant Difference ◽  
The Mean ◽  
Synovial Lipomatosis

AbstractSynovial lipomatosis (SL; lipoma arborescens) is a tumor-like condition with villous proliferation of the synovium. The exact etiology of SL is still unknown. The knee is the most commonly involved part. The goal of this retrospective study was to report the results of arthroscopic synovectomy in patients with SL in their knee joints as well as to emphasize the importance of considering this pathology when treating patients with recurrent knee joint effusions. In total, 21 patients (8 females and 13 males) were evaluated retrospectively from May 2009 to July 2014. The mean follow-up period was 29.13 (range, 12–61) months. The mean duration of compliance was 22.76 (range, 7–61) months. All patients were evaluated by Knee Society score pre- and postoperatively. The mean preoperative and last follow-up Knee Society scores were 67.82 and 88.23 points, respectively. There was a significant difference between the preoperative and postoperative Knee Society scores (p = 0.0001). Histopathological examinations showed that the subsynovial layer exhibited diffuse replacement by mature fat cells that had formed villous projections. In addition, infiltration of mononuclear inflammatory cells was observed at different stages. SL is a nondestructive and benign tumor pathology of the knee joint without a clearly identified etiology. The main difficulty in diagnosis is lack of clinical practice.

Templating of Syndesmotic Ankle Lesions by Use of 3D Analysis in Weightbearing and Nonweightbearing CT

2018 ◽  
Vol 39 (12) ◽  
pp. 1487-1496 ◽  
Author(s):  
Arne Burssens ◽  
Hannes Vermue ◽  
Alexej Barg ◽  
Nicola Krähenbühl ◽  
Jan Victor ◽  
...  
Keyword(s):  
External Rotation ◽  
Imaging Techniques ◽  
Ankle Injuries ◽  
Control Group ◽  
3D Analysis ◽  
Anatomical Landmarks ◽  
Distal Fibula ◽  
Fracture Group ◽  
Significant Difference ◽  
The Mean

Background: Diagnosis and operative treatment of syndesmotic ankle injuries remain challenging due to the limitations of 2-dimensional imaging. The aim of this study was therefore to develop a reproducible method to quantify the displacement of a syndesmotic lesion based on 3-dimensional computed imaging techniques. Methods: Eighteen patients with a unilateral syndesmotic lesion were included. Bilateral imaging was performed with weightbearing cone-beam computed tomography (CT) in case of a high ankle sprain (n = 12) and by nonweightbearing CT in case of a fracture-associated syndesmotic lesion (n = 6). The healthy ankle was used as a template after being mirrored and superimposed on the contralateral ankle. The following anatomical landmarks of the distal fibula were computed: the most lateral aspect of the lateral malleolus and the anterior and posterior tubercle. The change in position of these landmarks relative to the stationary, healthy fibula was used to quantify the syndesmotic lesion. A control group of 7 studies was used. Results: The main clinical relevant findings demonstrated a statistically significant difference between the mean mediolateral diastasis of both the sprained (mean [SD], 1.6 [1.0] mm) and the fracture group (mean [SD], 1.7 [0.6] mm) compared to the control group ( P < .001). The mean external rotation was statistically different when comparing the sprained (mean [SD], 4.7 [2.7] degrees) and the fracture group (mean [SD], 7.0 [7.1] degrees) to the control group ( P < .05). Conclusion: This study evaluated an effective method for quantifying a unilateral syndesmotic lesion of the ankle. Applications in clinical practice could improve diagnostic accuracy and potentially aid in preoperative planning by determining which correction needs to be achieved to have the fibula correctly reduced in the syndesmosis. Level of Evidence: Level III, retrospective comparative study.

scholarly journals A PROSPECTIVE RANDOMISED COMPARITIVE DOUBLE BLIND STUDY TO DETERMINE THE DURATION OF ANALGESIA OF BUPRENORPHINE AND DEXAMETHASONE AS ADJUNCTS TO BUPIVACAINE IN SCIATICO-POPLITEAL AND SAPHENOUS NERVE BLOCK FOR BELOW KNEE SURGERIES.

2020 ◽  
pp. 1-3
Author(s):  
Renjith I ◽  
Renu Devaprasath ◽  
Geo Navin Jude ◽  
T. S. Ambujam
Keyword(s):  
Side Effects ◽  
Nerve Block ◽  
Normal Saline ◽  
Motor Block ◽  
Sensory Block ◽  
Saphenous Nerve ◽  
Double Blind Study ◽  
Double Blind ◽  
The Mean ◽  
Mean Time

BACKGROUND: Adjuvants to local anaesthetics improve the block properties and reduce opioid consumption. This study compared combination of local anaesthetic bupivacaine with buprenorphine and dexamethasone in ultrasound guided sciatico-popliteal and saphenous nerve block for below knee surgeries. STUDY DESIGN:A prospective, double-blind, randomized, comparative study. MATERIAL AND METHODS: 82 patients posted for elective or emergency below knee surgeries were randomly divided into 2 groups. Group X received 25ml block solution made up of 2mg/kg of 0.5% bupivacaine with 2mcg/kg buprenorphine and normal saline and group Y received 25ml block solution made of 2mg/kg of 0.5% bupivacaine with 0.1mg/kg dexamethasone and normal saline. Onset of sensory block, onset of motor block, duration of analgesia, hemodynamic parameters, and side effects were noted in each group. RESULTS: The mean time of onset of sensory block was earlier in group X (6.730±1.871 min) as compared to group Y (11.340±3.038min). The mean time of onset of motor block was also rapid in group X (9.000±2.121 min) than in group Y (13.020±2.286min). The mean total duration of analgesia was longer in group Y (1098.000±169.216) as compared to group X (794.070±145.084). There was no signicant difference in the mean duration of motor block between the groups. Both the groups were hemodynamically stable, and no signicant side effects were noted. CONCLUSIONS: Onset of sensory and motor blockade was faster in the buprenorphine group, however duration of analgesia was much longer in the dexamethasone group without any signicant side effects.

scholarly journals No Difference between Percutaneous and Arthroscopic Techniques in Identifying the Calcaneal Insertion during Ankle Lateral Ligament Reconstruction: A Cadaveric Study

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Hong-Yun Li ◽  
Sheng-Kun Li ◽  
Ri Zhou ◽  
Shi-Yi Chen ◽  
Ying-Hui Hua
Keyword(s):  
Ankle Instability ◽  
Kirschner Wire ◽  
Lateral Ligament ◽  
Percutaneous Technique ◽  
Reconstruction Technique ◽  
Calcaneofibular Ligament ◽  
Lateral Ligaments ◽  
Skin Marker ◽  
Significant Difference ◽  
The Mean

Background. Both percutaneous and arthroscopic techniques have been introduced in anatomic ankle lateral ligaments reconstruction. The purpose of this study was to compare these two techniques in identifying the calcaneal insertion of the calcaneofibular ligament (CFL). Methods. Fifteen fresh-frozen human ankle cadaver specimens were used in this study. Each specimen was tested in three stages. For stage 1, each specimen was evaluated under arthroscopy. After debridement was performed, the insertion of the CFL on the calcaneus was identified, and a 1.5mm Kirschner wire was drilled at the center of the insertion. For stage 2, a percutaneous technique was used to identify the center of the insertion of the CFL. A second 1.5 mm Kirschner wire was drilled through the skin marker. For stage 3, the ankle was dissected, the footprint of the CFL was identified under direct vision, and the distances between the center of the CFL insertion on the calcaneus and the two Kirschner wires were measured, respectively. Results. In the arthroscopic technique group, the mean distance from the Kirschner wire to the center of the CFL insertion in the calcaneus was 3.4 ± 1.3 mm. In the percutaneous technique group, the mean distance from the Kirschner wire to the center of the CFL insertion was 3.2 ± 1.4 mm. No significant difference was found between the two groups. Conclusion. No difference in identifying the calcaneal insertion of the CFL was found between the percutaneous and the arthroscopic ankle lateral ligaments reconstruction technique. Both techniques can be used during anatomic ligaments reconstruction in treatment of chronic ankle instability.

scholarly journals Near-Infrared Transmittance Spectral Imaging for Nondestructive Measurement of Internal Disorder in Korean Ginseng

Sensors ◽  
2020 ◽  
Vol 20 (1) ◽  
pp. 273 ◽  
Author(s):  
Lalit Mohan Kandpal ◽  
Jayoung Lee ◽  
Hyungjin Bae ◽  
Moon S. Kim ◽  
Insuck Baek ◽  
...  
Keyword(s):  
Near Infrared ◽  
Imaging System ◽  
Quality Measurement ◽  
Spectral Imaging ◽  
Cost Effective ◽  
Ginseng Root ◽  
Internal Quality ◽  
Infrared Transmittance ◽  
Significant Difference ◽  
Novel Strategy

The grading of ginseng (Panax ginseng) including the evaluation of internal quality attributes is essential in the ginseng industry for quality control. Assessment for inner whitening, a major internal disorder, must be conducted when identifying high quality ginseng. Conventional methods for detecting inner whitening in ginseng root samples use manual inspection, which is time-consuming and inaccurate. This study develops an internal quality measurement technique using near-infrared transmittance spectral imaging to evaluate inner whitening in ginseng samples. Principle component analysis (PCA) was used on ginseng hypercube data to evaluate the developed technique. The transmittance spectra and spectral images of ginseng samples exhibiting inner whitening showed weak intensity characteristics compared to normal ginseng in the region of 900–1050 nm and 1150–1400 nm respectively, owing to the presence of whitish internal tissues that have higher optical density. On the basis of the multivariate analysis method, even a simple waveband ratio image has the great potential to quickly detect inner whitening in ginseng samples, since these ratio images show a significant difference between whitened and non-whitened regions. Therefore, it is possible to develop an efficient and rapid spectral imaging system for the real-time detection of inner whitening in ginseng using minimal spectral wavebands. This novel strategy for the rapid, cost-effective, non-destructive detection of ginseng’s inner quality can be a key component for the automation of ginseng grading.

scholarly journals Ideal Anatomic Location for Saphenous Nerve Block for Foot and Ankle Surgeries: A Prospective Randomized Clinical Evaluation

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0003
Author(s):  
Karl Henrikson ◽  
Sanjib Adhikary ◽  
Gregory Pace ◽  
Wai Liu ◽  
Paul Juliano ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Score ◽  
Nerve Block ◽  
Knee Extension ◽  
Saphenous Nerve ◽  
Foot And Ankle ◽  
Nerve Blocks ◽  
Knee Extension Strength ◽  
Significant Difference ◽  
Isometric Knee Extension

Category: Regional anesthesia for foot and ankle surgery Introduction/Purpose: Regional anesthesia has resulted in significant improvements in patient outcomes including reduced postoperative pain, opioid consumption, opioid-related adverse effects, and decreased postoperative length of stay. Saphenous nerve blocks provide distal analgesia while minimizing the reduction in quadriceps strength seen with more proximal femoral nerve blocks. Saphenous nerve blocks may be performed at the mid-thigh with the subsartorial technique or just proximal to the knee with the transsartorial technique. The present study compares these two techniques in terms of analgesia effectiveness and quadriceps motor preservation. Methods: This study was approved by our institutional IRB committee. A power analysis was conducted prior to the study. Patients, aged 18 to 65, were prospectively identified from a list of elective foot and ankle surgeries performed by one of the study investigators. Preoperatively, bilateral isometric knee extension strength was measured, and subjects completed a PROMIS global health survey. The surgeon was blinded to the randomization of patients to proximal or distal blocks. Bilateral isometric knee extension strength was reassessed following the block as well as sensation, post-operative visual analogue pain score (VAS), and subjective satisfaction. Due to non-normality of the sample, the Wilcoxon rank-sum test was employed to analyze continuous variables such as strength measures. For categorical variables such as gender, pain score, and patient satisfaction, the Pearson chi- square test was used. Results: Twenty-four patients (24 lower extremities) were enrolled in the study and 12 randomized to each group. The two groups were not significantly different in age, gender, or pre-operative PROMIS Mental and Physical Summary Scores. The nerve block procedure was successfully performed in a single attempt in all cases. The VAS was not significantly different at 2 in the distal group and 3 in the proximal group. In each group 11 patients were totally satisfied with the block and 1 was moderately satisfied. The knee extension strength decreased in both the operative and non-operative lower extremity following administration of the nerve block. When normalized to the effect in the non-operative extremity, there was no significant difference in strength decrease between the two groups (p=0.89). Conclusion: This randomized, single-blinded trial compared proximal subsartorial saphenous nerve block with distal transsartorial saphenous nerve block outside of the adductor canal. There was no significant difference in the efficacy of the two techniques was observed in terms of VAS pain score or patient satisfaction and no difference in post-operative weakness. This is the first randomized trial on saphenous nerve blocks to normalize strength to the non-operative lower extremity, reducing the confounding effect of peri-operative narcotic and sedative medications. This study offers evidence for equivalence of the subsartorial and transsartorial saphenous nerve block techniques.

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