Ultrasound-guided Saphenous Nerve Block Research Articles

Application of General Anesthesia Combined with Saphenous Nerve-Tibial Nerve Block in Total Knee Arthroplasty.

Background The study aimed to evaluate the safety and efficiency of the saphenous nerve plus selective tibial nerve block combined with general anesthesia in total knee replacement surgery (TKRS). Methods Sixty-four patients who underwent unilateral TKRS between October 2019 and June 2020 were selected as study subjects. All patients were divided into the control and observation groups using the random number table method, with 32 patients in each group. Conventional general anesthesia was performed preoperatively in both groups. The control group was given an ultrasound-guided saphenous nerve block before anesthesia induction, and the observation group was given a selective tibial nerve block on the basis of the control group. The dosage of general anesthetic drugs, recovery time from general anesthesia, hemodynamic index, inflammatory response, postoperative analgesic effect, and adverse reaction rate were compared between the two groups. Results Compared with the control group, the total amount of propofol and remifentanil used in the observation group was significantly less (P < 0.05). Compared with the control group, patients in the observation group experienced remarkably shorter time to recovery from respiration, time to extubation, and time in the PACU (P < 0.05). Compared with the control group, the observation group showed a significantly reduced SBP and MAP at T2, T3, and T4, respectively, and also showed a prominently lower HR at T3 and T4 (P < 0.05). Markedly lower CRP and IL-6 levels at 6 h and 24 h after surgery were found in the observation group compared to the control group (P < 0.05). Compared with the control group, patients receiving nerve block intervention got significantly lower VAS scores at 6 h, 24 h, and 48 h postoperatively (P < 0.05). However, there was no statistically significant difference in the incidence of adverse reactions between the two groups of patients (P > 0.05). Conclusion The application of the saphenous nerve plus selective tibial nerve block combined with general anesthesia in TKRS yields a promising analgesic effect, stable hemodynamics, low levels of postoperative inflammatory responses, and high safety.

Improvement in Pain and Quality of Life After Ultrasound-Guided Saphenous Nerve Block in Patients With Knee Osteoarthritis.

IntroductionOsteoarthritis (OA) of the knee is a common complaint in the elderly population and results in considerable disability in advanced stages. Though many pharmacological, electrotherapeutic, and interventional options are available for the effective treatment of knee OA in the early stages, these modalities fail to provide effective and long-term relief in some cases where peripheral nerve blocks may prove beneficial. Hence, this study was conducted to assess the efficacy of the saphenous nerve block in knee pain due to OA.ObjectiveTo evaluate improvement in pain and quality of life after ultrasound-guided saphenous nerve block in patients with knee OA.Material and methodsAn interventional prospective study in patients with knee OA, with medial compartment knee pain, was conducted from March 2016 to March 2017. All patients were evaluated prior to the procedure, and then at one week, one month, three months, and six months. The pain was evaluated using the visual analog scale (VAS) and functional improvement using the Knee injury and Osteoarthritis Outcome Score (KOOS).ResultsForty patients with unilateral knee OA underwent saphenous nerve block. Fifty percent of the patients reported pain relief within one week, whereas 58%, 33%, and 23% exhibited relief at subsequent follow-ups at one, three, and six months. A statistically significant difference (p < 0.0001) was observed in pain (VAS and KOOS pain) and functional scales (KOOS symptom, quality of life (QOL), and activities of daily living (ADL)) at follow-up evaluations.ConclusionUltrasound-guided saphenous nerve block results in a significant improvement in pain and QOL in patients with knee OA.

Ultrasound-Guided Saphenous Nerve Block in Rabbits (Oryctolagus cuniculus): A Cadaveric Study Comparing Two Injectate Volumes.

Simple SummaryGeneral anesthesia in rabbits is associated with significantly higher mortality than in dogs and cats. In addition, as prey animals, rabbits tend to mask signs of pain, making early detection particularly difficult. Loco-regional anesthesia represents a fundamental component of a multimodal approach to pain management and is an effective strategy to reduce the need for systemic anesthetic and analgesic drugs, thereby limiting their associated side effects. The saphenous nerve is the largest sensory branch of the femoral nerve and provides sensory supply to areas of the hind-limb. Saphenous nerve blockade allows for analgesia of the front and inner parts of the pelvic limb without affecting femoral nerve motor function, thus allowing optimal pain relief but permitting continued mobilization, which may be of particular importance in rabbits as it allows preservation of normal physiological prey behavior (e.g., hiding, kicking). This cadaveric study describes an ultrasound-guided saphenous nerve block technique in rabbits and compares the length of the nerves stained following injection of two different dye volumes. The results show that both volumes consistently stained the saphenous but not the femoral nerve. This technique has the potential to provide hind-limb analgesia while preserving femoral motor function in rabbits.Ultrasound-guided (US-guided) loco-regional anesthesia techniques allow direct visualization and blockade of sensory nerves. The saphenous nerve (SN), a terminal branch of the femoral nerve (FN), is strictly a sensory nerve for which electrical locator devices are ineffective for localization as no effector muscle contractions can be evoked. US-guided SN block in species other than rabbits produces hind-limb analgesia without affecting FN motor function. The aims of this study were to develop a US-guided SN block technique in rabbits and to compare the spread obtained using two different dye volumes. Twelve hind-limbs from six cadavers (1.6 ± 0.1 kg) were included; after randomization, the SN block was performed on the right or left hind-limb, injecting 0.05 mL kg−1 or 0.1 mL kg−1 of tissue dye in lidocaine (1:50 v:v). Subsequent dissections allowed nerve staining measurements. All SNs were identified, and 17.8 ± 4.6% and 31.0 ± 8.9% of the SN length were stained using low-volume and high-volume of the dye, respectively. Regardless of the volume used, the SN was consistently stained while the motor branch of the FN was not. This US-guided technique may provide hind-limb analgesia without affecting FN motor function in rabbits undergoing mid-distal hind-limb surgeries.

A Randomized, Double-blind, Comparative Study of the Analgesic Efficacy of Perineural Dexmedetomidine as Adjuvant to Ropivacaine versus Ropivacaine Alone in Ultrasound Guided Saphenous Nerve Block after Anterior Cruciate Ligament Reconstruction Surgery

Background: The saphenous nerve block has been effectively used for pain treatment after knee surgeries, however, a single-shot saphenous nerve block with a long-acting local anesthetic usually provides a relatively short duration of postoperative analgesia. Dexmedetomidine is a highly selective alpha-2 adrenoceptors agonist and its perineural injection as an additive to local anesthetics has been shown to improve postoperative analgesia. The aim of this prospective, randomized double-blind study was to evaluate the effects of adding dexmedetomidine to ropivacaine on the quality of postoperative analgesia with ultrasound-guided saphenous nerve block after anterior cruciate ligament reconstruction surgery of the knee. Methods: 40 ASA class I–II patients undergoing arthroscopic anterior cruciate ligament reconstruction surgery under general anesthesia were randomly divided into 2 groups of 20 patients each. At the end of surgery, ultrasound-guided saphenous nerve block was performed with either 10 ml ropivacaine 0.5% alone, or 1 µg/kg dexmedetomidine added to 10 ml of ropivacaine 0.5%. The total volume of injected solutions was increased to 12 ml by adding normal saline. The postoperative pain scores as well as fentanyl consumption through intravenous patient-controlled analgesia pump, hemodynamic parameters, sedation scores, and adverse effects were assessed every 1 hour to 6 hours and then every 2 hours to 24 hours. Results: There were significantly lower postoperative pain scores in the ropivacaine plus dexmedetomidine group compared to ropivacaine alone group at all postoperative measured time points. The total amount of fentanyl consumption and sedation scores after surgery was significantly higher in group ropivacaine alone than in group ropivacaine plus dexmedetomidine. Systolic blood pressure and heart rate within 24 hours after surgery were significantly lower in the dexmedetomidine+ ropivacaine group than in the ropivacaine alone group. However, no bradycardia and hypotension were detected in any of the patients. Conclusion: Perineural administration of 1 µg/kg of dexmedetomidine as an adjuvant to ropivacaine 0.5% for ultrasound guided saphenous nerve block significantly reduced pain scores and opioid requirements in the first 24 h after ACLR surgery compared to ropivacaine alone without any significant side effects.

Comparison of Saphenous Nerve Block and Oral Oxycodone for Postoperative Pain Management in Total Knee Arthroplasty: A Randomized Clinical Trial

Background: Post-operative pain management following total knee replacement (TKA) is very crucial. There is a need to introduce some available, inexpensive, and effective methods for postoperative pain management. This randomized clinical trial was done for comparing the analgesic effect of an oral inexpensive drug (oxycodone) and saphenous nerve blocko study the better method for postoperative pain management after TKA surgery.Methods: This single-blind, randomized, controlled, single-center clinical trial was performed in Baghiatallah Hospital from June 2017 to June 2018. Eighty patients were included for TKA randomly divided into two groups. Group A received a single shot ultrasound-guided saphenous nerve block and group B had an oral intake of oxycodone started before and continued every 6 hours after surgery to control post-operative pain. The pain score by visual analog scale (VAS), nausea- vomiting and diclofenac consumption were assessed postoperatively at 2, 6, 12 and 24 hours post-spinal anesthesia administration. Data were analyzed by SPSS-21 and Chi2, Fishers' exact test, and Mann-Whitney were used for comparing data between the two groups. Result: The pain intensity according to the visual analog scale at 2, 6, 12, and 24 h post-operative was 1.25±1.37, 4.12±1.11, 5.25±0.89, and 4.57±095 in group A and 1.10±0.953.77±0.99, 4.05±0.78, and 2.95±0.78 in the group B respectively that was significantly lower in the group B at 12 and 24 hours (p <0.05). The mean diclofenac use was 87.01±68.02 mg in group B and 262.04±92.05 mg in the group A (p <0.001). Also, the incidence of nausea and vomiting was significantly higher in group B compared to the other group (p <0.001). Conclusion: Oral oxycodone can control post-operative pain better than saphenous nerve block in the management of postoperative relief and reducing total additional analgesic drugs consumption. But, adverse effects such as nausea and vomiting were lower in saphenous nerve block than oral oxycodone.

Retrospective comparison of three locoregional techniques for pelvic limb surgery in dogs

ObjectiveTo retrospectively compare the efficacy and duration of effect of three commonly used locoregional blocks in dogs undergoing pelvic limb orthopaedic surgery. Study designRetrospective clinical study. AnimalsA total of 236 dogs that underwent pelvic limb surgery and were administered a locoregional technique. MethodsA total of 236 hospital records were reviewed and 230 included in statistical analysis. Dogs were grouped as following: electrostimulation-guided pre-iliac femoral and sciatic nerve block (group PFS, n = 70); ultrasound-guided saphenous and sciatic nerve block (group SS, n = 76); or lumbosacral epidural (group EPI, n = 84). In group EPI, bupivacaine 0.5% or ropivacaine 0.75% was used with morphine. Dogs were pain scored (short form of the Glasgow Composite Measure Pain Scale) hourly following recovery from anaesthesia. Analysed data included: time to first postoperative dose of methadone, pain score at that time, intraoperative rescue analgesia, intraoperative hypotension and ability to walk and urinate overnight. Separate analyses were performed including all pelvic limb surgeries and including only elective stifle surgeries. Kruskal–Wallis and Mann–Whitney tests were performed. A p value < 0.05 was considered significant. The median (range) is reported. ResultsFor all pelvic limb surgeries, the time to first postoperative methadone was 530 (110–1337), 440 (140–1030) and 466 (135–1094) minutes in groups EPI, PFS and SS, respectively, and was not significantly different. Postoperatively, 10/84, 15/70 and 12/76 dogs in groups EPI, PFS and SS, respectively, did not require methadone (nonsignificant). Significantly fewer dogs in group EPI (18%) required intraoperative rescue analgesia compared with group SS (38%), but not compared with PFS (30%). Significantly more dogs in group EPI had hypotension intraoperatively (30%) and urinary retention postoperatively (62%). Conclusions and clinical relevanceIntraoperative analgesia may be superior with EPI than SS for some surgeries of the pelvic limb, but not for stifle surgeries. All three techniques provided similar requirement for postoperative analgesia, but EPI caused higher incidence of intraoperative hypotension and postopertive urinary retention.

Saphenous nerve block on medial compartment knee pain in patients with knee osteoarthritis

Knee osteoarthritis (KOA) is a common disease in middle-aged and elderly people. Pain is the chief complaint of symptomatic KOA and a leading cause of chronic disability, which is most often found in medial knees. The aim of this study is to evaluate the efficacy of pain relief and functional improvement in KOA patients treated with ultrasound-guided saphenous nerve block (SNB). This is a 3-month retrospective case-controlled comparative study. Two hundred patients with medial knee pain owing to KOA that was unresponsive to 3-month long conservative treatments. Ninety-two patients received SNB with 9 mL of 1% of lidocaine and 1 mL of 10 mg triamcinolone acetonide (SNB group), and 108 continued conservative treatments (control group). The main outcome measure was visual analog scale (VAS) of the average knee pain level for the past one week. Secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the timed up and go test, numbers of analgesic ingestion per day, and opioid consumption per day. During the 3-month follow-up, 86 patients in SNB group and 92 in control group were analyzed. There was no significant difference, with the exception of the duration of symptoms, between the 2 groups in age, sex, body mass index, and Kellgren–Lawrence grade. Repeated measures analysis of variance and post-hoc tests showed improvement of VAS (at month 1), WOMAC (at month 1), and opioid consumption per day (at month 1 and 2) in SNB group. No adverse events were reported. This study looked into the possibility of SNB as an alternative treatment for medial knee pain owing to KOA. Although a palliative treatment, SNB can be an option for patients with refractory KOA who cannot take or are not responsive to analgesics. However, to prove the efficacy of SNB, further studies on prospective randomized controlled trials would be needed.

Ultrasound-guided saphenous nerve block is an effective technique for perioperative analgesia in ambulatory arthroscopic surgery of the internal knee compartment

ObjectivesArthroscopic knee surgery is a minimally invasive technique with moderate pain during the first 24h. Our main objective was to evaluate the efficacy of ultrasound-guided saphenous nerve block as a method of pain control intraoperatively and postoperatively for this surgery. Materials and methodsThis is a prospective and observational study. All patients received general anesthesia with laryngeal mask in the saphenous group; nerve block was performed with 10ml ropivacaine 0.475%. Location of the surgery (external compartment group/internal compartment group), morphine consumption, VAS for pain at 5, 30, 60 and 120min and 24h after surgery, need for rescue medication, onset of nausea and vomiting, length of stay in PACU, delayed discharge and satisfaction were evaluated. ResultsThe study included 73 patients. Of these, 46 received saphenous nerve block and 27 did not receive it. Consumption of intraoperative, postoperative and total morphine was significantly lower in the saphenous group as well as VAS at 24h. In the subgroup of internal compartment surgery differences in VAS 24h, morphine consumed and length of stay in PACU were maintained. ConclusionsThe ultrasound-guided block of saphenous nerve, particularly in the internal compartment arthroscopic knee surgery, decreases analgesic requirements, obtaining more effective pain control in the first 24h postoperatively and without any known side effects.

El bloqueo ecoguiado del nervio safeno resulta efectivo para la analgesia perioperatoria en los procedimientos ambulatorios artroscópicos realizados en el compartimento interno de la rodilla

ObjectivesArthroscopic knee surgery is a minimally invasive technique with moderate pain during the first 24h. Our main objective was to evaluate the efficacy of ultrasound guided saphenous nerve block as a method of pain control intraoperatively and postoperatively for this surgery. Material and methodsA prospective and observational study. All patients received general anesthesia with laryngeal mask in the saphenous group, nerve block was performed with 10ml ropivacaine 0.475%. Location of the surgery (external compartment group/internal compartment group), morphine consumption, VAS for pain at 5, 30, 60 and 120min and 24h after surgery, need for rescue medication, onset of nausea and vomiting, length of stay in PACU, delayed discharge and satisfaction were evaluated. ResultsThe study included 73 patients. Of these, 46 received saphenous nerve block and 27 didn’t receive it. Consumption of intraoperative, postoperative and total morphine was significantly lower in the saphenous group as well as VAS at 24h. In the subgroup of internal compartment surgery differences in VAS 24h, morphine consume and lenght of stay in PACU were mantained. ConclusionsThe ultrasound-guided block of saphenous nerve, particularly in the internal compartment arthroscopic knee surgery, decreases analgesic requirements, obtaining more effective pain control in the first 24h postoperatively and without any known side effects.

Efficacy and safety of ultrasound-guided saphenous nerve block in patients with chronic knee pain

IntroductionKnee osteoarthritis is a common cause for consultation around the world. Many patients with mild symptoms respond to conservative treatment, while others require interventional therapy including peripheral nerve blocks. ObjectiveTo establish the clinical efficacy and safety of interventional management with ultrasound-guided saphenous nerve block in patients with chronic keen pain. Materials and methodsDescriptive, retrospective trial in chronic keen pain patients who underwent ultrasound-guided interventional therapy at the pain clinic in the country, between September 2011 and June 2012, to determine the clinical efficacy and safety of the procedure. Data were obtained from all patients prior to the procedure, and then at two days, one month and three months later. The pain intensity was measured using the visual analog scale. Results25 saphenous nerve blocks were performed. 68% of the patients experienced pain relief within two days. 56% and 40% exhibited relief one and three months after the procedure, respectively, with a statistically significant difference (p<0.0001) between the baseline visual analog scale and the follow-up evaluation. Patients with a history of fibromyalgia, neuropathic characteristics and previous knee surgery exhibited variable analgesic responses to the procedure. ConclusionsInterventionist chronic knee pain management with ultrasound-guided saphenous nerve block was an effective and safe approach for these patients.

Eficacia y seguridad del bloqueo del nervio safeno guiado por ultrasonido en pacientes con dolor crónico de rodilla

IntroductionKnee osteoarthritis is a common cause for consultation around the world. Many patients with mild symptoms respond to conservative treatment, while others require interventional therapy including peripheral nerve blocks. ObjectiveTo establish the clinical efficacy and safety of interventional management with ultrasound-guided saphenous nerve block in patients with chronic keen pain. Materials and methodsDescriptive, retrospective trial in chronic keen pain patients who underwent ultrasound-guided interventional therapy at the pain clinic in the country, between September 2011 and June 2012, to determine the clinical efficacy and safety of the procedure. Data were obtained from all patients prior to the procedure, and then at two days, one month and three months later. The pain intensity was measured using the visual analog scale. Results25 saphenous nerve blocks were performed. 68% of the patients experienced pain relief within two days. 56% and 40% exhibited relief one and three months after the procedure, respectively, with a statistically significant difference (p < 0.0001) between the baseline visual analog scale and the follow-up evaluation. Patients with a history of fibromyalgia, neuropathic characteristics and previous knee surgery exhibited variable analgesic responses to the procedure. ConclusionsInterventionist chronic knee pain management with ultrasound-guided saphenous nerve block was an effective and safe approach for these patients.

Saphenous Neuropathy Secondary to Extraneural Ganglion Cyst 15 Years After Reconstruction of the Anterior Cruciate Ligament

This case report describes a 43-year-old woman with a previous anterior cruciate ligament reconstruction and medial meniscectomy who presented with right knee dysesthesias radiating into her medial ankle with associated allodynia. An extensive work-up was pursued, without a definitive diagnosis found or improvement in the patient's symptoms. Eventually, she was referred to Pain Medicine for an ultrasound-guided saphenous nerve (SN) block, where a scan before the injection revealed a large cyst anteromedial to the sartorius in the expected location of the SN. Magnetic resonance imaging and surgical pathology confirmed a juxta-articular ganglion cyst compressing the main SN, just above the take-off of the infrapatellar branch. The cyst was successfully resected, with improvement noted in the patient's neuropathic symptoms postoperatively. Saphenous neuropathy is a rare condition, and to our knowledge this case is the first reported of saphenous neuropathy caused by a knee joint capsule-derived ganglion cyst.

Prospective randomized comparison between ultrasound-guided saphenous nerve block within and distal to the adductor canal with low volume of local anesthetic.

Background and Aims:The anatomic site and the volume of local anesthetic needed for an ultrasound-guided saphenous nerve block differ in the literature. The purpose of this study was to examine the effect of two different ultrasound-guided low volume injections of local anesthetic on saphenous and vastus medialis nerves.Materials and Methods:Recruited patients (N = 48) scheduled for orthopedic surgery were randomized in two groups; Group distal adductor canal (DAC): Ultrasound-guided injection (5 ml of local anesthetic) distal to the inferior foramina of the adductor canal. Group adductor canal (AC): Ultrasound-guided injection (5 ml local anesthetic) within the adductor canal. Following the injection of local anesthetic, block progression was monitored in 5 min intervals for 15 min in the sartorial branches of the saphenous nerve and vastus medialis nerve.Results:Twenty two patients in each group completed the study. Complete block of the saphenous nerve was observed in 55% and 59% in Group AC and DAC, respectively (P = 0.88). The proportion of patients with vastus medialis weakness at 15 min in Group AC, 36%, was significantly higher than in Group DAC (0/22), (P = 0.021).Conclusions:Low volume of local anesthetic injected within the adductor canal or distally its inferior foramina leads to moderate success rate of the saphenous nerve block, while only the injection within the adductor canal may result in vastus medialis nerve motor block.

Anatomy and Clinical Implications of the Ultrasound-Guided Subsartorial Saphenous Nerve Block

We evaluated the anatomic basis and the clinical results of an ultrasound-guided saphenous nerve block close to the level of the nerve's exit from the inferior foramina of the adductor canal. The anatomic study was conducted in 11 knees of formalin-preserved cadavers in which the saphenous nerve was dissected from near its exit from the inferior foramina of the adductor canal. The clinical study was conducted in 23 volunteers. Using a linear probe, the femoral vessels and the sartorius muscle were depicted in short-axis view at the level where the saphenous nerve exits the inferior foramina of the adductor canal. Ten milliliters of 1.5% lidocaine was injected into the compartment structured by the sartorius muscle and the femoral artery. The saphenous nerve was found to exit the adductor canal from its inferior foramina in 9 (81.8%) of 11 and at a more proximal level in 2 (18.2%) of 11 of the anatomic specimens. In a single specimen (9%), the saphenous nerve was formed by the anastomosis of 2 branches. In all the dissections, the saphenous nerve, after exiting the adductor canal, passed between the sartorius muscle and the femoral artery. Of the 23 volunteers, 22 responded with a complete sensory block, whereas a single volunteer demonstrated no sensory blockade. None of the volunteers experienced a motor block of the hip flexors and knee extensors. Ultrasound-guided injection directly caudally from the inferior foramina of the adductor canal, between the sartorius muscle and the femoral artery, seems to be an effective approach for saphenous nerve block.

Preliminary Experience With a New Approach to Performing an Ultrasound-Guided Saphenous Nerve Block in the Mid to Proximal Femur

Preliminary Experience With a New Approach to Performing an Ultrasound-Guided Saphenous Nerve Block in the Mid to Proximal Femur

Ultrasound-Guided Saphenous Nerve Block

Ultrasound-Guided Saphenous Nerve Block