CT-guided nerve root blocks for sciatica

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CT guided nerve root blocks for sciatica

PICO terms

Population / Problem: sciatica Intervention: CT guide nerve root blocks Comparison: none specified Outcome: none specified

Comment

Only two relevant papers found after a search of the Cochrane Library, Medline and EMBASE.

Top papers identified

Title: A new lateral approach to the parasacral sciatic nerve block: an anatomical study.
Citation: Surgical and radiologic anatomy : SRA, Mar 2011, vol. 33, no. 2, p. 91-95, 1279-8517 (March 2011)
Author(s): Le Corroller, Thomas, Wittenberg, Rodolphe, Pauly, Vanessa, Pirro, Nicolas, Champsaur, Pierre, Choquet, Olivier
Abstract: Sciatic nerve block is a commonly used technique for providing anesthesia and analgesia to the lower extremity. At the parasacral level, the nerve block is classically performed via a posterior approach in lateral decubitus position causing patient’s discomfort. Therefore, we aimed to conduct an anatomical study describing a new lateral approach to the parasacral sciatic nerve in supine position. The skin entry point was located on the vertical line through the greater trochanter (GT) at the midpoint between the anterior superior iliac spine (ASIS) level and the GT. The angle to the skin was 10° dorsally oriented. According to these palpable anatomical landmarks, the parasacral lateral approach was simulated bilaterally in four cadavers in supine position. Anatomical dissection allowed assessment of the needle tip position with regard to the sciatic nerve. Then, to refine the anatomical description of this new lateral approach, 40 pelvic computer tomography (CT) examinations were retrospectively selected and post-processed to bilaterally simulate the needle route to the sciatic nerve. The skin-nerve distance, the optimal angle to the skin, and the sciatic nerve anteroposterior diameter at parasacral and ischial tuberosity levels, respectively were recorded by two independent readers. Cadaver dissection showed that the needle tip was placed in the vicinity of the sciatic nerve in 8/8 cases. Then, CT-simulated lateral approach demonstrated a mean skin-nerve distance of 128 mm (81-173), and a 12° dorsally oriented (5-22) optimal angle to the skin. The sciatic nerve anteroposterior diameter was 10 mm (7-15) at the parasacral level, and 7 mm (5-10) more caudally at the ischial tuberosity level. No significant intra- or inter-observer variability was observed. This study describes a new lateral approach to the parasacral sciatic nerve block in supine position. These anatomical results should be confirmed by further clinical studies.
Full Text:
Available from ProQuest in Surgical and Radiologic Anatomy; SRA
Available from EBSCOhost in Surgical & Radiologic Anatomy

Title: Computed tomography scanning of the sciatic nerve posterior to the femur: Practical implications for the lateral midfemoral block.
Citation: Regional anesthesia and pain medicine, Sep 2003, vol. 28, no. 5, p. 445-449, 1098-7339 (2003 Sep-Oct)
Author(s): Floch, Hervé, Naux, Edouard, Pham Dang, Charles, Dupas, Benoit, Pinaud, Michel
Abstract: Using computed tomography (CT) scans of the thighs, this study addresses sciatic nerve anatomy at the injection site for the lateral midfemoral sciatic nerve block. It addresses the recommendation of neutral leg rotation to facilitate block placement. This prospective and descriptive study involves 21 patients scheduled for CT scan imaging of the lower limbs. Transverse CT scans were analyzed at 20, 25, and 30 cm distal to the upper border of the greater trochanter (GT) of the femur with the knee externally rotated by 30 degrees. The angle alpha formed by the broad axis of the sciatic nerve and the coronal plane, skin-to-nerve distance, great vessel-to-nerve distance, division of the sciatic nerve, and widths of the perineural space were assessed. Values are expressed as mean +/- SD. At 20, 25, and 30 cm distal to the GT, the alpha angle was 50 degrees +/- 14 degrees, 55 degrees +/- 13 degrees, and 56 degrees +/- 26 degrees, respectively. This angle increased to nearly 90 degrees when the knee was rotated to a neutral position. The skin-to-nerve distance was 5.9 +/- 1.1 cm, 5.4 +/- 0.9 cm, and 5.7 +/- 1.1 cm. The section width of the perineural space was 1.8 +/- 0.9 cm(2), 3.9 +/- 2 cm(2), and 5.6 +/- 2.4 cm(2). The sciatic nerve was divided in 27% of subjects at 20 cm and in 90% at 30 cm distal. The characteristics of sciatic nerve anatomy described in this study support observations and clinical recommendations regarding lateral midfemoral sciatic nerve block.
Full Text:
Available from ProQuest in Regional Anesthesia and Pain Medicine

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