Thigh Rotation and the Anterior Approach to the Sciatic Nerve

Moore, Colin; Sheppard, Declan; Wildsmith, J. A.W.

doi:10.1097/00115550-200401000-00008

Cited by 11 publications

(3 citation statements)

References 5 publications

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“…Maximum hip abduction in neonates is measured at 90°, whereas after two years normal maximum hip abduction is 45° (Magee et al, ). The position of the SN relative to bony pelvic landmarks varies with hip position (Goodard and Reid, ; Moore et al, ; Birke et al, ). We recognized that, in the 0–2 age group, the degree of hip abduction and rotation was highly variable.…”

Section: Discussionmentioning

confidence: 99%

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Revisiting the surface anatomy of the sciatic nerve in the gluteal region in children using computed tomography

2015

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No anatomy text specifically describes the course of the sciatic nerve (SN) in the gluteal region in children. Anatomical information is largely derived from cadaveric studies of adults, so accurate anatomical information about the location of the SN in children is required. The aim of this study is to assess the surface anatomy of the SN in children using computed tomography (CT). After excluding studies with pelvic pathology, 75 CT scans were analyzed. Three groups were selected for analysis (0-2, 4-6, and 8-10 years). The position of the SN was measured between the posterior superior iliac spine (PSIS) and the ischial tuberosity (IT) and between the IT and the greater trochanter (GT) using 3-dimensional images. In the 0-2 age group, the SN crossed the middle third of a line between the PSIS and the IT in 94% and the GT and the IT in 80% of cases. In the 4-6 age group, the SN crossed the middle third of a line between the PSIS and the IT in 96% and the GT and the IT in 87%. In the 8-10 age group, the SN crossed the middle third of a line between the PSIS and the IT in 100% and the GT and the IT in 71%. The findings indicate that the SN in children is most accurately located in the middle third along a line drawn from the PSIS to the IT and the GT to the IT. Our study is the first to provide anatomical CT data from living children to guide interventions in the gluteal region.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, we measured the degree of abduction in this age group and selected ≤45° as a maximum for inclusion. Hip rotation also alters the proximity of the GT to the SN (Moore et al, ). However, it was not possible to measure the degree of internal or external hip rotation accurately using limited range CT imaging.…”

Section: Discussionmentioning

confidence: 99%

Revisiting the surface anatomy of the sciatic nerve in the gluteal region in children using computed tomography

2015

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“…When the nerve is under the antero-posterior projection of the femur or the minor trochanter might hinder the access to this nerve. Moore et al 24 , using imaging exams, concluded that in 85% of the cases internal rotation of the lower limb makes access to the nerve easier by the anterior approach. Morin et al 4 did not get any stimuli in four patients, out of 30, after trying for 15 minutes.…”

Section: Discussionmentioning

confidence: 99%

Controle da dor pós-operatória da artroplastia total do joelho: é necessário associar o bloqueio do nervo isquiático ao bloqueio do nervo femoral?

Zugliani

Verçosa

Amaral

et al. 2007

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:A artroplastia total do joelho (ATJ) promove grande trauma tecidual, produzindo intensa dor no pós-operatório. A analgesia pós-operatória de boa qualidade é fundamental, devendo-se considerar que a mobilização articular precoce é um importante aspecto para obtenção de bons resultados. Há controvérsias na literatura sobre a eficácia do bloqueio isolado do nervo femoral. O objetivo deste estudo foi avaliar a analgesia pós-operatória com a associação do bloqueio dos nervos isquiático e femoral. MÉTODO:Foram estudados 17 pacientes submetidos à ATJ sob raquianestesia, divididos em dois grupos: A e B. No Grupo A (n = 9) foi realizado bloqueio do nervo femoral e no Grupo B (n = 8), bloqueio dos nervos femoral e isquiático. Os bloqueios foram realizados no pós-operatório imediato utilizando-se 20 mL de ropivacaína a 0,5% em cada um. A dor foi aferida nas primeiras 24 horas pela Escala Analógica Visual e escala verbal. Foi observado o tempo decorrido entre os bloqueios e a primeira queixa de dor (M1). RESULTADOS:A mediana do tempo de analgesia (M1) no Grupo A foi de 110 min. e no Grupo B de 1.285 min. (p = 0,0001). Não foram observadas complicações atribuíveis às técnicas utilizadas.CONCLUSÃO: O bloqueio do nervo isquiático, quando associado ao bloqueio do nervo femoral, nas condições deste estudo, melhorou de maneira significativa a qualidade da analgesia pós-operatória da ATJ.Unitermos: ANALGESIA: pós-operatória; CIRURGIA, Ortopédica: artroplastia total de joelho; TÉCNICAS ANESTÉSICAS, Regional: bloqueio do nervo femoral, bloqueio do nervo isquiático. Good postoperative analgesia is fundamental and one should consider that early mobilization of the joint is an important aspect to obtain good results. There is a controversy in the literature on the efficacy of isolated femoral nerve block. The objective of this study was to evaluate postoperative analgesia with the association of sciatic and femoral nerve block. SUMMARY METHODS:Seventeen patients undergoing TKA under spinal anesthesia were divided in two groups: A and B. In Group A (n = 9), femoral nerve block was performed, while in Group B (n = 8), femoral and sciatic nerve block were done. The blockades were done in the immediate postoperative period with 20 mL of 0.5% of ropivacaine. Pain was evaluated in the first 24 hours using the Visual Analog Scale and the verbal scale. The length of time between the nerve block and the first complaint of pain (M1) was also evaluated. RESULTS:The median of the duration of analgesia (M1) in Group A was 110 min, while in Group B it was 1285 min (p = 0.0001). There were no complications related to the technique used.CONCLUSIONS: Sciatic nerve block, when associated with femoral nerve block, under the conditions of the present study, improved significantly the quality of postoperative analgesia in TKA.

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