Selective Nerve Block Research Articles

The Usefulness of Selective Nerve Block in Lumbar Spinal Stenosis in Cases with Inconsistent MRI Findings and Clinical Presentations

The Usefulness of Selective Nerve Block in Lumbar Spinal Stenosis in Cases with Inconsistent MRI Findings and Clinical Presentations

Therapeutic and diagnostic efficacy of root block procedure in lumbosacral radiculopathy: A study of 75 cases

Background: Back pain and leg pain are one of the most common symptoms in day to day orthopaedic clinical practice. Also, there is rise in incidence of discogenic back ache because of changed lifestyle, abnormal posture of sitting and lying, continuous sitting in vehicles, and inadequate physical activities. Selective nerve root blockings having the diagnostic and therapeutic use, which is popular and possess certain advantages in avoiding uncertain potential of surgical complications. Aim: To evaluate diagnostic and therapeutic efficacy of selective nerve root block procedure. To study relief in terms of pain alleviation, decrease in disability and straight leg raising (SLR) restriction. Materials and Method: It is a Prospective study of 75 patients of sciatic radiculopathy between the ages of 20 and 60 years are assessed under study that satisfied the inclusion criteria, received selective nerve blocks. Patients were assessed for pain relief and disability reduction.Results: Total of 75 patients were included in study with 55 males and 20 females with male to female ratio of approx 2:1. The VAS and ODI scores were evaluated in the patients received the nerve block. There was significant immediate improvement in the VAS score and reduction in ODI score at 1st week, 1 month and 6 month of follow-up period in patients. Conclusion: SNRB is a important and most effective less expensive and minimal invasive treatment modality to provide relief to patients with pain and long lasting therapeutic benefits. This allows the patients to resume the physical activity or work.

Selective Decrease in Allodynia With High-Frequency Neuromodulation via High-Electrode-Count Intrafascicular Peripheral Nerve Interface After Brachial Plexus Injury

Kilohertz high-frequency alternating current (KHFAC) electrical nerve stimulation produces a reversible nerve block in peripheral nerves in human patients with chronic pain pathologies. Although this stimulation methodology has been verified with nonselective extrafascicular electrodes, the effectiveness of producing a selective nerve block with more-selective intrafascicular electrodes has not been well documented. The objective of this study was to examine whether intrafascicular electrodes can block painful stimuli while preserving conduction of other neural activity within the implanted nerve. We analyzed the effects of various stimulation waveforms delivered through Utah Slanted Electrode Arrays (USEAs) implanted in the median nerve of a male human subject with a left brachial plexus injury. We compared KHFAC stimulation with a sham control. KHFAC stimulation through USEA electrodes produced a reduction in pain sensitivity in the palmar aspect of the left middle finger. KHFAC had limited effects on the patient's ability to feel tactile probing in the same area or move the digits of his left hand. Other tested stimulation parameters either increased or showed no reduction in pain. KHFAC stimulation in peripheral nerves through intrafascicular electrodes demonstrated a selective reduction in pain sensitivity while preserving other nerve functions. This treatment may benefit patient populations who have chronic pain originating from peripheral nerves, but who do not want to block whole-nerve function in order to preserve sensory and motor function reliant on the implanted nerve. Furthermore, KHFAC may benefit patients who respond negatively to other forms of peripheral nerve stimulation therapy.

Methylglyoxal causes pain and hyperalgesia in human through C-fiber activation.

The endogenous metabolite methylglyoxal (MG) accumulates in diabetic patients with neuropathic pain. Methylglyoxal could be a mediator of diabetes-induced neuropathic pain through TRPA1 activation and sensitization of the voltage-gated sodium channel subtype 1.8. In this study, we tested the algogenic and sensitizing effect of MG in healthy human subjects using intracutaneous microinjections. The involvement of C fibers was assessed through selective A-fiber nerve block, axon-reflex-erythema, and through single nerve fiber recordings in humans (microneurography). Involvement of the transduction channels TRPA1 and TRPV1 in MG-induced pain sensation was investigated with specific ion channel blockers. We showed for the first time in healthy humans that MG induces pain, axon-reflex-erythema, and long-lasting hyperalgesia through the activation of C nociceptors. Predominantly, the subclass of mechano-insensitive C fibers is activated by MG. A fibers contribute only negligibly to the burning pain sensation. Selective pharmacological blockade of TRPA1 or TRPV1 showed that TRPA1 is crucially involved in MG-induced chemical pain sensation and heat hyperalgesia. In conclusion, the actions of MG through TRPA1 activation on predominantly mechano-insensitive C fibers might be involved in spontaneously perceived pain in diabetic neuropathy and hyperalgesia as well as allodynia.

Randomized trial of ultrasound-guided superior cluneal nerve block

Background and objectivesThe superior cluneal nerves originate from the dorsal rami of primarily the upper lumbar spinal nerves. The nerves cross the iliac spine to innervate the skin and subcutaneous...

Low Back Pain in Adolescent Athletes: Comparison of Diagnoses Made by General Orthopedic Surgeons and Spine Surgeons

Nonspecific low back pain (NSLBP) is a term used to describe low back pain of unknown origin with no identifiable generators. Over a decade ago, it was reported to account for about 85% of all cases of low back pain, although there is some doubt about the frequency. The purpose of this study was to determine the frequency of NSLBP in adolescent athletes diagnosed by general orthopedic surgeons and by spine surgeons. A total of 69 adolescent athletes consulted our sports spine clinic to seek a second opinion for low back pain. Data on age, sex, type of sport played, the previous diagnosis made by general orthopedic surgeons, and the final diagnosis made by spine surgeons were collected retrospectively from medical records. The frequency of NSLBP diagnosed by general orthopedic surgeons was 18.9% and decreased to 1.4% after careful imaging and functional nerve block examination by spine surgeons. The final diagnoses made by spine surgeons for those patients previously diagnosed as having NSLBP by general orthopedic surgeons were as follows: early-stage lumbar spondylolysis, discogenic low back pain, facet joint arthritis, lumbar disc herniation, and lumbar apophyseal ring fracture. In adolescent athletes, the rate of NSLBP diagnosed by general orthopedic surgeons decreased markedly when the diagnosis was made by spine surgeons. A thorough medical interview, careful physical examination, appropriate diagnostic imaging, and selective nerve block examination can effectively identify the cause of low back pain.

Ultrasound-guided ankle block. History revisited.

Following forefoot surgery, compared to the traditional multimodal approach, regional anesthesia and analgesia provides high quality pain relief, decreases opioids consumption and leads to very high satisfaction scores. Traditional regional techniques relied either on wound infiltration, landmark technique ankle blocks or popliteal sciatic nerve block. Numerous anatomic variations of the different nerves might lead to failure following a blind technique. The current evolution towards ambulatory care will push surgical teams to favor techniques that simplify postoperative treatment and encourages immediate ambulation. The development of Ultrasound Guided Blocks has enabled us to perform very selective and precise nerve blocks. Ankle blocks provide excellent intraoperative anesthesia as well as long postoperative pain relief. Complications are rare using regional anesthesia for postoperative analgesia even after extensive foot surgery. Revival of ankle blocks is a perfect example of the high impact of new technological advances in improving ambulatory surgical care after foot surgery.

Temporomandibular joint arthrocentesis: a technique proposal. Case report

ABSTRACT BACKGROUND AND OBJECTIVES: Arthrocentesis is an effective treatment to reduce or eliminate pain, increase maximal interincisal distance, and to eliminate joint effusion in patients with disc displacement without reduction. This study aims to expose and to discuss a new technique proposal of temporomandibular joint arthrocentesis applied in the treatment of a single case of disc displacement without reduction. CASE REPORT: Female patient, 18-year-old patient sought treatment due to joint pain and mouth opening limitation. The maximal interincisal distance was 30.28mm. Magnetic resonance imaging confirmed the diagnosis of disc displacement without reduction with signs of joint effusion in the right temporomandibular joint. Temporomandibular joint arthrocentesis was performed under selective sensory nerve block of the auriculotemporal, the masseteric and posterior deep temporal nerves. Two needles were inserted in the upper compartment of the temporomandibular joint. In the second needle, a transparent catheter was connected into a vacuum pump. Clinically, after the arthrocentesis, the maximal interincisal distance increased to 46.25mm, and the patient referred no more pain. After six months, a magnetic resonance imaging was performed to observe the results, and there were no more signs of joint effusion. CONCLUSION: Temporomandibular joint arthrocentesis was an effective treatment for this patient with disc displacement without reduction. The aspect of this technique that is particularly relevant for clinical practice was the connection of a transparent catheter to a vacuum pump. In fact, it allowed the visualization of the solution fluidity, as well as guides the flow of the solution used for joint washing, optimizing the irrigation. However, new studies are necessary to compare different protocols of irrigation with and without the associated use of a vacuum pump.

The ultrasound-guided selective nerve block in the upper arm: an approach of retaining the motor function in elbow

BackgroundProximal brachial plexus blocks can lead to an extended period of motor paralysis and delay the return of motor function. This could influence patient satisfaction, and extend hospitalizations. The aim of the study is to compare a selective distal nerve block of the arm to a proximal axillary block, both ultrasound-guided, in terms of their motor block intensity of the elbow. Our hypothesis is that a selective nerve block of the arm would result in a different motor block of the elbow, compared to the axillary block.MethodsA sample size of 24 patients who were undergoing elective surgery (ASA I-III) of the wrist, hand or forearm was randomly divided into two groups: Arm Group (n = 12) and Axillary Group (n = 12). The Arm Group received ultrasound-guided block of the median, ulnar, and medial antebrachial cutaneous nerves at the level of upper-median 1/3 of the arm, and a block of the radial and musculocutaneous nerves at the level of low-median 1/3 of the arm, while the Axillary Group received ultrasound-guided axillary brachial plexus blocks. Both blocks used in combination with general anesthesia.ResultsOur results demonstrated that the incidence of motor block at the elbow in the Arm Group was lower than in the Axillary Group. Compared with the Axillary Group, the duration of motor block at the elbow and the onset time of sensory block in the Arm Group were shortened. The patient satisfaction was increased in the Arm Group. There were no differences in the duration of the sensory block, the effect on postoperative analgesia, or in the duration of the motor block at the shoulder between both groups.ConclusionOur study showed that ultrasound-guided selective nerve block in the upper arm allowed improved retention of motor function at the elbow compared to axillary block. Secondarily, the ultrasound-guided selective nerve block seemed to provide similar analgesia after surgery of the hand or forearm with an enhanced patient satisfaction.Trial registrationChinese Clinical Trial Registry, ChiCTR-IOR-16008769. Registered 3 July 2016.

Spread of injectate around hip articular sensory branches of the femoral nerve in cadavers

Anatomical knowledge dictates that regional anaesthesia after total hip arthroplasty requires blockade of the hip articular branches of the femoral and obturator nerves. A direct femoral nerve block increases the risk of fall and impedes mobilisation. We propose a selective nerve block of the hip articular branches of the femoral nerve by an ultrasound-guided injection in the plane between the iliopsoas muscle and the iliofemoral ligament (the iliopsoas plane). The aim of this study was to assess whether dye injected in the iliopsoas plane spreads to all hip articular branches of the femoral nerve. Fifteen cadaver sides were injected with 5mL dye in the iliopsoas plane guided by ultrasound. Dissection was performed to verify the spread of injectate around the hip articular branches of the femoral nerve. In 10 dissections (67% [95% confidence interval: 38-88%]), the injectate was contained in the iliopsoas plane staining all hip articular branches of the femoral nerve without spread to motor branches. In four dissections (27% [8-55%]), the injection was unintentionally made within the iliopectineal bursa resulting in secondary spread. In one dissection (7% [0.2-32%]) adhesions partially obstructed the spread of dye. An injection of 5mL in the iliopsoas plane spreads around all hip articular branches of the femoral nerve in 10 of 15 cadaver sides. If these findings translate to living humans, injection of local anaesthetic into the iliopsoas plane could generate a selective sensory nerve block of the articular branches of the femoral nerve without motor blockade.

Evaluation of Pain Reproduction and other Predictive Factors of Selective Lumbar Nerve Block Efficacy for the Diagnosis and Palliative Treatment of Chronic Low Back Pain: A Retrospective Cohort Study (P2.095)

Evaluation of Pain Reproduction and other Predictive Factors of Selective Lumbar Nerve Block Efficacy for the Diagnosis and Palliative Treatment of Chronic Low Back Pain: A Retrospective Cohort Study (P2.095)

A Novel Technique of Ultrasound-Guided Selective Mandibular Nerve Block With a Lateral Pterygoid Plate Approach: A Cadaveric Study.

We aimed to describe a novel technique of ultrasound-guided selective mandibular nerve block with a lateral pterygoid plate (LPP) approach and to assess its feasibility and accuracy in a soft cadaver model. Ten soft cadavers were studied. A curved array ultrasound transducer was applied over 1 side of the face of the cadaver, in an open-mouth position. The transducer was placed transversely below the zygomatic arch and tilted in the caudal-to-cranial direction to identify the boundary of the LPP. The needle was inserted in-plane, in an anterior-to-posterior direction, into the posterior border of the uppermost part of the LPP, and 3 mL of methylene blue was injected. Mandibular nerve block was successfully performed in all 10 cadavers using an LPP approach under ultrasound guidance. The mandibular nerve and its branches were seen to be stained with methylene blue in all cadaveric specimens. No accidental injection into the facial nerve or maxillary artery was observed. This cadaveric study suggests that this novel technique, using an LPP approach under ultrasound guidance, is helpful for selective mandibular nerve block, with high accuracy and feasibility. Further studies are required to establish its safety and efficacy for clinical application. This study was registered at the Thai Clinical Trials Registry (ClinicalTrials.in.th), identifier TCTR20160601004.

Selective Spinal Nerve Block in Ilioinguinal, Iliohypogastric and Genitofemoral Neuralgia.

To seek the efficacy of selective spinal nerve blocks in the treatment of groin pain that are irresponsive to peripheral nerve blocks. This retrospective study comprised 17 patients with ilioinguinal, iliohypogastric, and genitofemoral neuralgias treated between 2017 and 2018. All patients received diagnostic peripheral nerve blocks and/or TAP blocks with blind or ultrasound-guided techniques. Four patients had ineffectual peripheral nerve blocks, after which they underwent T12 and L1 selective spinal nerve blocks. All four patients had satisfactory results. If distal peripheral nerve blocks are ineffective, an upper level nerve lesion, a lesion in the lumbar plexus or an L1 radiculopathy should be considered in ilioinguinal, iliohypogastric, and genitofemoral neuralgias. Upper level nerve blocks should be performed before deciding on surgery.

Effects of continuous femoral nerve block with selective tibial nerve block after total knee arthroplasty

Effects of continuous femoral nerve block with selective tibial nerve block after total knee arthroplasty

Complications in Transurethral Resection of the Bladder Tumor: Using Nerve Stimulator with or Without Ultrasonography for Obturator Nerve Block: A Comparative Study

BackgroundThe use of ultrasonographic guide is a suggested way to ease the obturator nerve block procedure. Accordingly, in this study, the procedures by selective obturator nerve block with and without use of ultrasonographic guide were compared.MethodsThis interventional study was performed as an open-label randomized clinical trial among 50 consecutive subjects under surgery for intramural tumors of urinary bladder in a training hospital in 2016. The subjects were randomly assigned to be operated under spinal anesthesia accompanied with selective obturator nerve block (10 mL of 1.5% lidocaine adding 1:200000 epinephrine) with or without ultrasonographic guide. The outcomes were compared across the groups.ResultsThere was no statistically significant difference between the onset time in group without guide (6.3 ± 2.2 minutes) and that in the guided group (5.9 ± 2.1 minutes). The time required for the nerve block (4.4 ± 1.3 minutes versus 1.7 ± 0.8 minutes) was significantly shorter (P = 0.001). There were less complications in the group with use of ultrasonographic guide showing significant difference (P = 0.01). The success rate in block was significantly higher in the group with ultrasonographic guide (100% versus 92%, P > 0.05).ConclusionsFinally, according to the obtained results, it may be concluded that ultrasonography guidance would improve efficacy of obturator nerve block compared with conventional techniques.

Singultus - Diagnostic Workup and Therapy

A hiccup is a reflex movement with diffusely distributed afferents and efferents in the thorax; its functional relevance is controversial. In its physiological form, it is mostly a minor complaint that stops spontaneously and rarely leads to medical consultation. However, prolonged agonizing hiccups represent serious deterioration of quality of life. Chronic hiccups by definition last for more than 48 h, with gastroesophageal reflux being the frequent underlying disease. Various other causes affect multiple organ systems, some with serious underlying diseases. A hiccup may be the only symptom at the first manifestation of some neurological disorders. In neuroimaging a lesion of the medulla oblongata is often seen. A NMO and an ischemic stroke with Wallenberg syndrome are 2 frequently underlying neurological diseases, but other inflammatory and vascular diseases and tumors of the central nervous system may be present. No optimal evidencebased recommendations for diagnosis and management of chronic hiccups are available. The search for the underlying disease often requires an interdisciplinary approach by internists, neurologists, and otolaryngologists. Symptomatic treatment may be necessary even before diagnosis. Persistent hiccups, a common problem in oncological palliative care, are often challenging. Proton pump inhibitor or prokinetics are used for treating underlying gastroesophageal reflux and baclofen with or without gabapentin in other cases. Anticonvulsants, antipsychotics, antidepressants, and calcium channel blockers represent other alternative treatment possibilities. In therapy-refractory cases, invasive procedures such as the selective phrenic nerve block are available. More studies are needed to help deal with the diagnostic and therapeutic challenge that hiccups present for neurologists.

Comparative study between selective nerve blocks and the intravenous opioids in mastoid surgery

ObjectiveThis double-blind randomized trial was conducted to compare the efficacy of selective nerve blocks over intravenous use of morphine during mastoid surgery. Materials and methodsA total of 50 patients between the ages 25 to 45years were divided into two groups as per the anaesthetic techniques used; nerve block group (N) and intravenous morphine group (M). After induction of general anaesthesia and before surgical incision: Group N patients (nerve block group) were given Great Auricular Nerve (GAN) and Auriculo-Temporal Nerve (ATN) block with 0.25% bupivacaine. Group M patients (morphine group) received 0.1mg/kg morphine. In the post anaesthesia care unit (PACU), Visual Analogue Scale (VAS) was used to assess post operative pain, Ramsay Sedation Scale (RSS) for sedation and post operative nausea and vomiting (PONV) impact scale score. ResultsVAS scores and requirement of rescue analgesics in the PACU was significantly less in the N Group for first 3h. The group N patients had a less frequent incidence of vomiting requiring intervention and were ready to be discharged from hospital after 3h of surgery. ConclusionCombination of GAN and ATN block with general anaesthesia is an uncomplicated, effective and well tolerated method for the safe conduct of mastoid surgery.

Selective Low-Volume Nerve Block for the Open Surgical Fixation of a Midshaft Clavicle Fracture in a Conscious High-Risk Patient

We report a case of successful intraoperative management using only low-volume regional anesthesia for the open surgical fixation of a traumatic clavicle fracture in a conscious 69-year-old man with severe chronic obstructive pulmonary disease. To avoid general anesthesia, we provided low-volume C5 and C6 nerve root blocks along with a superficial cervical plexus block using only 9 mL of anesthetic solution to avoid the often encountered complications of higher volume injections. Throughout the procedure, the patient remained comfortable and cooperative with stable hemodynamics and respiration. The postoperative course was uncomplicated.

A Selective Anterior Obturator Nerve Block for Total Hip Arthroplasty

A Selective Anterior Obturator Nerve Block for Total Hip Arthroplasty

The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty.

Background. A recently described selective tibial nerve block at the popliteal crease presents a viable alternative to sciatic nerve block for patients undergoing total knee arthroplasty. In this two-part investigation, we describe the effects of a tibial nerve block at the popliteal crease. Methods. In embalmed cadavers, after the ultrasound-guided dye injection the dissection revealed proximal spread of dye within the paraneural sheath. Consequentially, in the clinical study twenty patients scheduled for total knee arthroplasty received the ultrasound-guided selective tibial nerve block at the popliteal crease, which also resulted in proximal spread of local anesthetic. A sensorimotor exam was performed to monitor the effect on the peroneal nerve. Results. In the cadaver study, dye was observed to spread proximal in the paraneural sheath to reach the sciatic nerve. In the clinical observational study, local anesthetic was observed to spread a mean of 4.7 + 1.9 (SD) cm proximal to popliteal crease. A negative correlation was found between the excess spread of local anesthetic and bifurcation distance. Conclusions. There is significant proximal spread of local anesthetic following tibial nerve block at the popliteal crease with possibility of the undesirable motor blocks of the peroneal nerve.