Hadzic’s Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia

Edelman, Anthony L.

doi:10.1001/jama.308.3.297-a

Cited by 4 publications

(7 citation statements)

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“…Of note, large interpatient variability in block duration is commonly observed in neural blockade and results from multiple factors, such as variability in amount and quality of connective tissues of nerves, and variability in sensitivity to local anesthetics. 13 In conclusion, under the conditions of our study using ultrasound-guided injections for median and ulnar nerve blocks, lidocaine 2% and bupivacaine 0.5% anesthetics have similar onset time. This suggests that for these blocks, local anesthetic may be chosen for desired duration, rather than for speed of onset of the block.…”

Section: Limitationsmentioning

confidence: 56%

Effect of Lidocaine 2% Versus Bupivacaine 0.5% and 1 Versus 2 Dual Separate Injections on Onset and Duration of Ultrasound-Guided Wrist Blocks: A Blinded 2 × 2 Factorial Randomized Clinical Trial

Boxstael

Vandepitte

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Local anesthetics are often selected or mixed to accomplish faster onset of anesthesia. However, with ultrasound guidance, local anesthetics are delivered with greater precision, which may shorten the onset time with all classes of local anesthetics. In this study, we compared onset time and duration of ultrasound-guided wrist blocks with a fast onset versus a longer lasting local anesthetic administered via single or dual (spatially separate) injections at the level of the midforearm. METHODS: In this randomized clinical trial, 36 subjects scheduled for carpal tunnel release were randomly assigned to receive ultrasound-guided median and ulnar nerve blocks with lidocaine 2% or bupivacaine 0.5% via single or dual injections (n = 9 in each group). Subjects fulfilled the study requirements. The main outcome variables were onset and duration of sensory blockade, which were tested separately in 2 (drug) × 2 (injection) analysis of variances (ANOVAs) with interaction terms. RESULTS: Sensory block onset time did not differ significantly between subjects given lidocaine 2% (9.2 ± 3.4 minutes) or bupivacaine 0.5% (9.5 ± 3.1 minutes) (P = .76; mean difference, −0.3 ± 1.1 minutes [95% confidence interval {CI}, −2.5 to 1.9]) or between the single-(9.6 ± 2.8 minutes) and dual-(9.1 ± 3.6 minutes) injection groups (P = .69; mean difference, −0.4 ± 1.1 minutes [95% CI, −1.8 to 2.6]). Sensory duration was longer for subjects in the bupivacaine 0.5% group (27.3 ± 11.6 hours) than for subjects in the lidocaine 2% group (8.4 ± 4.1 hours) (P < .001; 95% CI, 12.7-25.1). However, sensory duration in the single-(15.7 ± 12.5 hours) and dual-(19.4 ± 13.1 hours) injection groups did not differ significantly (P = .28; mean difference, −3.7 ± 4.3 hours [95% CI, −12.6 to 5.1]). CONCLUSIONS: No significant effect was found for onset time between lidocaine 2% and bupivacaine 0.5% used in ultrasound-guided wrist blocks. Dual injections did not shorten onset time. Since mean nerve block duration was longer with bupivacaine 0.5%, our results suggest that the selection of local anesthetic for the median and ulnar nerves at the level of the midforearm should be based on the desired duration of the block and not on its speed of onset. (Anesth Analg 2022;134:1318-25) KEY POINTS• Question: Is there a difference in onset time and duration of sensory block between lidocaine 2% and bupivacaine 0.5% and between single and dual spatially separate injections, in median and ulnar nerve blocks? • Findings: There was no clinically significant difference in onset or duration of sensory block between lidocaine 2% and bupivacaine 0.5% or between single and dual injections. • Meaning: Selection of local anesthetic for the median and ulnar nerves at the level of the midforearm can be based on the desired duration of the ultrasound-guided wrist block and not on its speed of onset.

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Section: Limitationsmentioning

confidence: 56%

Effect of Lidocaine 2% Versus Bupivacaine 0.5% and 1 Versus 2 Dual Separate Injections on Onset and Duration of Ultrasound-Guided Wrist Blocks: A Blinded 2 × 2 Factorial Randomized Clinical Trial

Boxstael

Vandepitte

et al. 2022

Anesthesia &Amp; Analgesia

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“…2,9,10,14 Despite its critical role, PFCN blockade is less frequently discussed in literature compared to other neural structures like the lumbar plexus or its branches, and the sciatic nerve. [3][4][5][6] In our PFCN block technique, we target the Gluteal Deep Investing Fascia (GDIF) compartment, a potential space between the epimysium of the gluteus maximus and the DIF of the gluteus maximus above the conjoint tendon at the ischial tuberosity. The inferior gluteal artery, which accompanies the PFCN, serves as a key ultrasound landmark and must be avoided during this approach.…”

Section: Discussionmentioning

confidence: 99%

“…The sciatic nerve is located beneath the gluteus maximus muscle, above the quadratus femoris muscle, and is situated between two key bony landmarks: the ischium and the trochanter (Figure 2A and D). 6 A curvilinear ultrasound probe is utilized for adult patients, while a linear probe may be employed for pediatric patients and slender adults. Both the sciatic and posterior femoral cutaneous (PFCN) nerves are accessed via the same entry point.…”

Section: Description Of the Block Techniquementioning

confidence: 99%

“…1,2 Despite its importance in innervating a substantial area, the block of this nerve is rarely, if ever, addressed in regional anesthesia literature. [3][4][5][6] For above-knee surgery requiring regional anesthesia, performing a PFCN block alongside the sciatic (SN) nerve block is essential. 7,8 Additionally, incomplete blocks in below-knee surgery may be due to the PFCN's innervation extending beyond the popliteal fossa, highlighting the importance of including a PFCN block.…”

Section: Introductionmentioning

confidence: 99%

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THE GLUTEUS DEEP INVESTING FASCIA COMPARTMENT BLOCK: A Novel Technique for Posterior Femoral Cutaneous Nerve Block

Shabani,

Beye,

Traore

et al. 2024

LRA

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Purpose The posterior femoral cutaneous nerve (PFCN) block is used in regional anesthesia for lower extremity surgery. This study introduces a new ultrasound-guided technique called the “Gluteus-Deep Investing Fascia compartment Block (GDIF block)“ for blocking the PFCN. This approach involves injecting local anesthetic into the potential space between the gluteus maximus muscle and the deep investing fascia, named the ‘Gluteus Deep Investing Fascia Compartment’. The study discusses the anatomical and sonographic features crucial for identifying this compartment and explores the potential benefits of this approach for achieving effective PFCN block. Additionally, it examines the clinical application of the GDIF block for PFCN block as part of the Complete Lower Extremity Fascia Tri-compartment Block technique, named ”CLEFT Block.” This technique combines the suprainguinal fascia iliaca block with GDIF compartment block for PFCN and a sciatic nerve block as exclusive anesthesia technique. Patients and Methods Nine patients with weapon-related lower limb injuries underwent surgery at district hospitals supported by the International Committee of the Red Cross. Between October and December 2023, seventeen above-knee procedures were performed for the nine patients using the GDIF block as part of a CLEFT block technique. Anesthesia was performed with a CLEFT block technique using a volume ratio of 1:1 of 1% lidocaine and 0.5% levobupivacaine. Results The GDIF block technique for PFCN blockade was performed successfully in all patients without complications, achieving complete PFCN blockade. The CLEFT block technique proved effective as the sole anesthetic technique for seventeen above-knee procedures. All surgeries were completed successfully without additional pain medication or conversion to general anesthesia. Conclusion The GDIF block appears to be a promising technique for anesthetic management, alone or as part of the CLEFT block. Further research with a larger patient population is necessary to validate these findings.

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“…However, the infection can easily spread across nerve fascicles when the perineurium is not intact. The tough perineurium also acts as a semipermeable barrier to LA [33,34].…”

Section: Perineuriummentioning

confidence: 99%

“Knowing It Before Blocking It,” the ABCD of the Peripheral Nerves: Part A (Nerve Anatomy and Physiology)

Sonawane,

Dixit,

Jayaraj

et al. 2023

Cureus

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Regional anesthesia (RA) is an interplay between the local anesthetic (LA) solution and the neural structures, resulting in nerve conduction blockade. For that, it is necessary to understand which hurdles the LA has to overcome and which components of the nerves are involved. Background knowledge of the neural and non-neural components of the nerve helps locate the safest area for LA deposition. In addition, knowledge of nerve physiology and the conduction process helps to understand the patterns of block onset, involved fibers, and block regression. Neural connective tissue protects the nerve on the one hand and influences the overall effect of the blockade and the occurrence of nerve injuries on the other. The arrangement of the nerve fibers explains the science behind the differential blockage after LA deposition. This article describes the important aspects of nerve anatomy (nerve formation and composition) and nerve physiology (impulse generation and propagation). It also provides insight into the physiological processes involved when a damaged neural structure leads to potential clinical symptoms. It will help readers sharpen their skills and knowledge to execute safe RA without damaging any vital structures in the nerve.

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Hadzic’s Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia

Cited by 4 publications

References 0 publications

Effect of Lidocaine 2% Versus Bupivacaine 0.5% and 1 Versus 2 Dual Separate Injections on Onset and Duration of Ultrasound-Guided Wrist Blocks: A Blinded 2 × 2 Factorial Randomized Clinical Trial

Effect of Lidocaine 2% Versus Bupivacaine 0.5% and 1 Versus 2 Dual Separate Injections on Onset and Duration of Ultrasound-Guided Wrist Blocks: A Blinded 2 × 2 Factorial Randomized Clinical Trial

THE GLUTEUS DEEP INVESTING FASCIA COMPARTMENT BLOCK: A Novel Technique for Posterior Femoral Cutaneous Nerve Block

“Knowing It Before Blocking It,” the ABCD of the Peripheral Nerves: Part A (Nerve Anatomy and Physiology)

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