The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty
Background. A recently described selective tibial nerve block at the popliteal crease presents a viable alternative to sciatic nerve block for patients undergoing total knee arthroplasty. In this two-part investigation, we describe the effects of a tibial nerve block at the popliteal crease. Methods...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Pain Research and Management |
| Online Access: | http://dx.doi.org/10.1155/2017/7250181 |
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| author | Eric R. Silverman Amaresh Vydyanathan Karina Gritsenko Naum Shaparin Nair Singh Sherry A. Downie Boleslav Kosharskyy |
| author_facet | Eric R. Silverman Amaresh Vydyanathan Karina Gritsenko Naum Shaparin Nair Singh Sherry A. Downie Boleslav Kosharskyy |
| author_sort | Eric R. Silverman |
| collection | DOAJ |
| description | Background. A recently described selective tibial nerve block at the popliteal crease presents a viable alternative to sciatic nerve block for patients undergoing total knee arthroplasty. In this two-part investigation, we describe the effects of a tibial nerve block at the popliteal crease. Methods. In embalmed cadavers, after the ultrasound-guided dye injection the dissection revealed proximal spread of dye within the paraneural sheath. Consequentially, in the clinical study twenty patients scheduled for total knee arthroplasty received the ultrasound-guided selective tibial nerve block at the popliteal crease, which also resulted in proximal spread of local anesthetic. A sensorimotor exam was performed to monitor the effect on the peroneal nerve. Results. In the cadaver study, dye was observed to spread proximal in the paraneural sheath to reach the sciatic nerve. In the clinical observational study, local anesthetic was observed to spread a mean of 4.7+1.9 (SD) cm proximal to popliteal crease. A negative correlation was found between the excess spread of local anesthetic and bifurcation distance. Conclusions. There is significant proximal spread of local anesthetic following tibial nerve block at the popliteal crease with possibility of the undesirable motor blocks of the peroneal nerve. |
| format | Article |
| id | doaj-art-7733358fc6514ebabc9dcd5671344e3c |
| institution | Kabale University |
| issn | 1203-6765 1918-1523 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pain Research and Management |
| spelling | doaj-art-7733358fc6514ebabc9dcd5671344e3c2025-02-03T06:07:18ZengWileyPain Research and Management1203-67651918-15232017-01-01201710.1155/2017/72501817250181The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee ArthroplastyEric R. Silverman0Amaresh Vydyanathan1Karina Gritsenko2Naum Shaparin3Nair Singh4Sherry A. Downie5Boleslav Kosharskyy6Department of Anesthesiology, Albany Medical Center, Albany, NY, USADepartment of Anesthesiology, Montefiore Medical Center, Bronx, NY, USADepartment of Anesthesiology, Montefiore Medical Center, Bronx, NY, USADepartment of Anesthesiology, Montefiore Medical Center, Bronx, NY, USADepartment of Anesthesiology, Montefiore Medical Center, Bronx, NY, USAAlbert Einstein Medical College, Bronx, NY, USADepartment of Anesthesiology, Montefiore Medical Center, Bronx, NY, USABackground. A recently described selective tibial nerve block at the popliteal crease presents a viable alternative to sciatic nerve block for patients undergoing total knee arthroplasty. In this two-part investigation, we describe the effects of a tibial nerve block at the popliteal crease. Methods. In embalmed cadavers, after the ultrasound-guided dye injection the dissection revealed proximal spread of dye within the paraneural sheath. Consequentially, in the clinical study twenty patients scheduled for total knee arthroplasty received the ultrasound-guided selective tibial nerve block at the popliteal crease, which also resulted in proximal spread of local anesthetic. A sensorimotor exam was performed to monitor the effect on the peroneal nerve. Results. In the cadaver study, dye was observed to spread proximal in the paraneural sheath to reach the sciatic nerve. In the clinical observational study, local anesthetic was observed to spread a mean of 4.7+1.9 (SD) cm proximal to popliteal crease. A negative correlation was found between the excess spread of local anesthetic and bifurcation distance. Conclusions. There is significant proximal spread of local anesthetic following tibial nerve block at the popliteal crease with possibility of the undesirable motor blocks of the peroneal nerve.http://dx.doi.org/10.1155/2017/7250181 |
| spellingShingle | Eric R. Silverman Amaresh Vydyanathan Karina Gritsenko Naum Shaparin Nair Singh Sherry A. Downie Boleslav Kosharskyy The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty Pain Research and Management |
| title | The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty |
| title_full | The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty |
| title_fullStr | The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty |
| title_full_unstemmed | The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty |
| title_short | The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty |
| title_sort | anatomic relationship of the tibial nerve to the common peroneal nerve in the popliteal fossa implications for selective tibial nerve block in total knee arthroplasty |
| url | http://dx.doi.org/10.1155/2017/7250181 |
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