Dataset Information

Ultrasound-guided sciatic nerve block at the midthigh level in a porcine model: A descriptive study.

ABSTRACT:

Background and objective

There are a growing number of porcine models being used for orthopaedic experiments for human beings. Therefore, pain management of those research pigs using ultrasound (US)-guided nerve block can be usefully performed. The aim of this study is to determine optimal US approaches for accessing and localizing the sciatic nerve at the midthigh level, a relevant block site for hindlimb surgery in female Yorkshire pigs.

Methods

As a first step, we dissected the intubated, blood-washed out pigs (n = 3) and confirmed the anatomical position of the sciatic nerve at midthigh level. After dissection, we found the sciatic nerve, connected with nerve stimulator, and checked the dorsiflexion or plantar flexion of the hindlimb. We matched the sciatic nerve location with the US image. After the pigs were euthanized, the neural structures of the sciatic nerve were confirmed by histological examination with H&E staining. In second step, a main US-guided sciatic nerve block study was done in the intubated, live pigs (n = 8) based on the above study.

Results

In lateral position, the effective US-guided nerve block site was about 6 cm from the patella crease level; immediately proximal to the bifurcation of the sciatic nerve into the tibial nerve and common peroneal nerve. The distal femur was selected as the landmark. There were no vessels or other nerves surrounding the sciatic nerve. The needle-tip was positioned less than 1 cm lateral from the distal femur and about 2 cm deep to skin. 'Donut sign' in US images was confirmed in all 16 nerves.

Conclusions

Midthigh level sciatic nerve is located superficially, which enables nerve block to be easily performed using US. This is the first study to describe midthigh sciatic nerve block in the lateral position under US guidance in a porcine model from a clinical perspective.

SUBMITTER: Lee MG

PROVIDER: S-EPMC7397899 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Publications

Ultrasound-guided sciatic nerve block at the midthigh level in a porcine model: A descriptive study.

Lee Mi Geum MG Choi Sung Uk SU Lim Jae Kwan JK Lee Mee Ju MJ Hong Ji Su JS Baek Mi Ok MO Yoon Seung Zhoo SZ Park Hee Yeon HY Shin Hyeon Ju HJ

Veterinary medicine and science 20200412 3

<h4>Background and objective</h4>There are a growing number of porcine models being used for orthopaedic experiments for human beings. Therefore, pain management of those research pigs using ultrasound (US)-guided nerve block can be usefully performed. The aim of this study is to determine optimal US approaches for accessing and localizing the sciatic nerve at the midthigh level, a relevant block site for hindlimb surgery in female Yorkshire pigs.<h4>Methods</h4>As a first step, we dissected the ...[more]

PMID: 32281259

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Project description:BackgroundTo relieve prostate biopsy-related pain, various local anesthetic methods have been used. The best approach was periprostatic nerve block (PNB) in the past decade. Recently, pelvic plexus block (PPB) was employed to ultrasound-guided prostate biopsy. Compared with the PNB, the PPB may block a more extensive area. Therefore, PPB may be more effective in relieving prostate biopsy-related pain. However, several prospective randomized controlled trials (RCTs) comparing PPB and PNB drew conflicting conclusions, so we compared the difference of pain control between PPB and PNB for prostate biopsy.MethodsThe following databases were retrieved up to October 2020: PubMed, Chinese biomedicine literature database, the Cochrane Library, China National Knowledge Internet databases, Wan fang databases and Google Scholar. Only the RCTs were included. The main outcome measures were Visual Analog Scale (VAS) score and complications. The literature quality and extracted data were evaluated by two authors independently. The software Review Manager (version 5.3) was used to perform the data analysis that comparing the difference of VAS score and complications between PPB and PNB.ResultsAfter screening, six articles including 336 patients from PPB group and 337 patients from PNB group were performed meta-analysis in this study. The results showed that there were no significant difference of pain control in probe insertion and local anesthetic injection between PPB and PNB, while compared with PNB, patients with PPB experienced less pain during biopsy and 30 min after biopsy, respectively(MD = -0.57, 95% CI: -1.11 to -0.03, Z = 2.06, P = 0.04; MD = -0.21, 95% CI: -0.40 to -0.02, Z = 2.15, P = 0.03). In subgroup analysis, the pooled results showed that PPB was superior to PNB in 12-cores biopsy (pooled MD = -1.16, 95% CI: -1.61 to -0.71, P < 0.00001), and more than 40-ml prostate size, regardless of transrectal or transperineal prostate biopsy. The reported major complications were urinary retention, hematuria, infection and hemospermia. The pooled results showed that there were no obvious difference in complications between PPB group and PNB group.ConclusionsOverall, this meta-analysis suggests that PPB provides safe and effective pain control of ultrasound-guided prostate biopsy, and PPB is superior to PNB. In future, it also needs more high quality, large samples RCTs to verify.

Project description:BackgroundSurgeons commonly perform ultrasound-guided Transversus Abdominis Plane blocks to manage acute pain following abdominal surgeries. There is no consensus on whether surgeons should undergo basic hands-on training to perform TAP blocks or if video-based learning is sufficient. We theorized that simulation-based learning is superior to video-based learning. In the present study, we present the analysis of technical skills of UGSA-TAP block performance on a live porcine model by general surgery trainees after undergoing video or simulation-based learning.MethodsWe performed a prospective, double-blinded, randomized study. Ten surgery residents and two surgery critical-care fellows (n = 12) without prior experience in performing the TAP block were recruited. The participants were randomized either into a video-based or simulation-based training group. After that, all participants performed a TAP block on a live anesthetized pig, which was recorded and scored by three blinded anesthesiologists. All participants completed a post-performance survey to assess their confidence in gaining competency in the UGSA-TAP block. Statistical analyses were performed to assess the differences between the two groups. P < 0.05 was considered statistically significant.ResultsAll simulation-based learning participants successfully performed a survey scan, identified the three muscular layers of the abdominal wall, and identified the transversus abdominis plane compared to 50 %, 50 %, and 33 % video-based learning group participants for the respective parameters (p < 0.05). While some performance metrics showed no statistically significant differences between the groups, substantial effect sizes (Cohen's ℎ up to 1.07) highlighted notable differences in participants' performance. Both groups exhibited confidence in core competencies, with varied rates of satisfactory skill execution. Performance assessed using a global rating scale revealed a higher passing rate for the simulation group (83 % vs. 33 %). Participant feedback via the Likert scale reflected confidence post-training. Inter-rater reliability (0.83-1) confirmed the robustness of study evaluations.ConclusionThe UGSA-TAP block curriculum should be introduced into the surgical residency programs with an emphasis on simulation-based learning to enhance the procedural skills of the trainees before transitioning to surgical patients.

Project description:BACKGROUND AND OBJECTIVES:Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducing needle followed by the delivery of electric current. This modality has been reported to treat chronic pain as well as postoperative pain the day following knee surgery. However, it remains unknown if this analgesic technique may be used in ambulatory subjects following foot procedures beginning within the recovery room immediately following surgery, and with only short series of patients reported to date, the only available data are derived from strictly observational studies. The purposes of this proof-of-concept study were to demonstrate the feasibility of using percutaneous sciatic nerve PNS to treat postoperative pain following ambulatory foot surgery in the immediate postoperative period and provide the first available data from a randomized controlled study design to provide evidence of analgesic effect. METHODS:Preoperatively, an electrical lead (SPRINT; SPR Therapeutics, Inc, Cleveland, Ohio) was percutaneously inserted posterior to the sciatic nerve between the subgluteal region and bifurcation with ultrasound guidance. Following hallux valgus osteotomy, subjects received 5 minutes of either stimulation or sham in a randomized, double-masked fashion followed by a 5-minute crossover period and then continuous stimulation until lead removal on postoperative days 14 to 28. RESULTS:During the initial 5-minute treatment period, subjects randomized to stimulation (n = 4) experienced a downward trajectory in their pain over the 5 minutes of treatment, whereas those receiving sham (n = 3) reported no such change until their subsequent 5-minute stimulation crossover. During the subsequent 30 minutes of stimulation, pain scores decreased to 52% of baseline (n = 7). Three subjects (43%) used a continuous popliteal nerve block for rescue analgesia during postoperative days 0 to 3. Overall, resting and dynamic pain scores averaged less than 1 on the numeric rating scale, and opioid use averaged less than 1 tablet daily with active stimulation. One lead dislodged, 2 fractured during use, and 1 fractured during intentional withdrawal. CONCLUSIONS:This proof-of-concept study demonstrates that percutaneous sciatic nerve PNS is feasible for ambulatory foot surgery and suggests that this modality provides analgesia and decreases opioid requirements following hallux valgus procedures. However, lead dislodgement and fracture are concerns. CLINICAL TRIAL REGISTRATION:This study was registered at Clinicaltrials.gov, identifier NCT02898103.

Project description:AudienceThis small-group workshop is designed for emergency medicine residents. This workshop can also be offered to medical students or faculty interested in reviewing and practicing ultrasound-guided regional nerve blocks.IntroductionUltrasound-guided regional nerve block (UGRNB) is a method used to administer local anesthesia to otherwise unreachable locations on the body and may be used in the management of various painful conditions seen in the emergency department. The ultrasound curriculum of our residency program is longitudinal. All residents spend time with the ultrasound director throughout their training, engage in daily bedside ultrasound, and have regular skills training on the various clinical applications of ultrasound. Additionally, all residents have a required ultrasound rotation dedicated to performing bedside ultrasound in the Emergency Department. Although others have outlined approaches to teaching emergency medicine residents the techniques needed to perform UGRNBs, the value of taking a one-day, high-efficiency teaching strategy with a narrow focus on practical application has yet to be appreciated.Educational objectivesThe objective of this workshop is to provide emergency medicine residents the confidence and skill sets needed to effectively perform five commonly used UGRNBs for conditions encountered in the emergency department. Through this one-day, accelerated workshop, residents will be given an opportunity to sharpen their UGRNB technique prior to applying them in the clinical environment. By the end of this workshop, learners will be able to: 1) recognize the clinical situations in which UGRNBs can be utilized and understand the associated risks, 2) list the commonly used local anesthetic medications and their proper dosing in respect to regional nerve blocks, 3) demonstrate proper ultrasound probe positioning and identify relevant anatomical landmarks for each nerve block on both standardized patients and cadavers, 4) describe the common steps involved to perform each nerve block, 5) perform the five UGRNB techniques outlined in this workshop.Educational methodsSmall group activity combining didactic learning, case-based learning, and procedural simulation. The didactic component may be delivered in an asynchronous learning or "flipped classroom" format.Research methodsIn-person interviews of the learners were obtained following the debriefing session during which they were asked about their enjoyment and satisfaction with the workshop. In addition, learners were asked about the value of the activities for their clinical practices and to provide formative feedback regarding the design of the workshop.ResultsOverall, participants reported high levels of enjoyment, and many verbalized their satisfaction with the expeditious and pragmatic nature of the workshop. Some participants commented that they were looking forward to future workshops of similar design. Participants also stated that they felt more confident performing nerve blocks and looked forward to applying these skills in the clinical setting.DiscussionA focused small-group workshop directed towards developing the confidence and skill set necessary to perform UGRNBs can be successfully offered to emergency medicine residents in a single-day workshop.TopicsUltrasound, nerve block, local anesthesia, injection, pain, resident, workshop.

Project description:BackgroundWorldwide, one of the most common surgical procedures in the pediatric population is circumcision. There is no consent on the best anesthesiologic approach. This study aimed to investigate ultrasound-guided dorsal penile nerve block (DPNB) plus sedation in spontaneous breathing as a time-saving, safe, effective, and opioid-sparing technique.AimsThe primary outcome was the assessment of the time from the end of surgery and the discharge to the post-anesthesia care unit. Secondary outcomes were to evaluate the cumulative dosages of opioids, differences in pain levels between the two groups, and complications at the awakening, 4 h and 72 h after surgery, respectively.MethodsThis was a prospective study with a retrospective control group, approved by the Friuli-Venezia Giulia Ethics Committee. Children in the intervention group received an ultrasound-guided DPNB under sedation and spontaneous breathing. With the probe positioned transversally at the base of the penis using an in-plane approach with a modified technique, local anesthetic was injected under the deep fascia of the penis.ResultsWe recruited 70 children who underwent circumcision at the University Hospital of Udine, Italy, from 1 January 2016 to 1 October 2021: 35 children in the ultrasound-guided DPNB group and 35 children in the control group. Children who received ultrasound-guided DPNB had a statistically significant lower time to discharge from the operating room, did not require mechanical ventilation, maintained spontaneous breathing at all times, received fewer opioids, had lower mean intraoperative arterial pressures, and lower pain levels immediately after surgery.ConclusionUltrasound-guided DPNB associated with sedation and spontaneous breathing is a time-saving, opioid-sparing, safe, and effective strategy for the management of intraoperative and postoperative pain in children undergoing circumcision.Clinical trial registration: ClinicalTrial.gov (NCT04475458, 17 July 2020).

Dataset Information

Ultrasound-guided sciatic nerve block at the midthigh level in a porcine model: A descriptive study.

Background and objective

Methods

Results

Conclusions

Publications

Ultrasound-guided sciatic nerve block at the midthigh level in a porcine model: A descriptive study.

Similar Datasets

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