Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
J Clin Anesth. 2024 Feb;92:111315. doi: 10.1016/j.jclinane.2023.111315. Epub 2023 Nov 3.
A saphenous nerve block is an important tool for analgesia after foot and ankle surgery. The conventional midthigh approach to saphenous nerve block in the femoral triangle may impede ambulation by impairing quadriceps motor function.
Developing a selective saphenous nerve block targeting the nerve distal to its emergence from the adductor canal in the subsartorial compartment.
This study consists of A) a dissection study and B) Data from a clinical case series.
A) Medical University of Innsbruck, Austria (dissection of 15 cadaver sides) and. B) Aarhus University Hospital, Denmark (5 patients).
A) Five mL of methylene blue was injected into the subsartorial compartment distal to the intersection of the saphenous nerve and the tendon of the adductor magnus guided by ultrasound. B) Five patients undergoing major hindfoot and ankle surgery had a subsartorial compartment block with 10 mL of local anesthetic in addition to a popliteal sciatic nerve block.
A) The frequencies of staining the saphenous and medial vastus nerves. B) Assessment of postoperative pain by NRS score (0-10) and success rate of saphenous nerve block by presence of cutaneous anesthesia in the anteromedial lower leg, and motor impairment by ability to ambulate.
A) The saphenous nerve was stained in 15/15 cadaver sides. A terminal branch of the medial vastus nerve was stained in 2/15 cadaver sides. B) All patients were fully able to ambulate without support. No patients had any post-surgical pain from the anteromedial aspect of the ankle and foot (NRS score 0). The success rate of saphenous nerve block was 100%.
The saphenous nerve can be targeted in the subsartorial compartment distal to the intersection of the nerve and the tendon of the adductor magnus. The subsartorial compartment block provided efficient analgesia without quadriceps motor impairment.
隐神经阻滞是足部和踝关节手术后镇痛的重要工具。在股三角内进行传统的隐神经中大腿入路阻滞可能会通过损害股四头肌运动功能来妨碍活动。
开发一种针对隐神经在收肌腱管出口后的分支的选择性隐神经阻滞。
本研究包括 A）解剖研究和 B）临床病例系列数据。
A）奥地利因斯布鲁克医科大学（15 具尸体侧解剖）和 B）丹麦奥胡斯大学医院（5 例患者）。
A）在隐神经与收肌腱交叉点远端的收肌腱下间隙内，超声引导下注射 5 毫升亚甲蓝。B）5 例接受大足部和踝关节手术的患者在隐神经阻滞外加隐神经阻滞的基础上进行收肌腱下间隙阻滞，使用 10 毫升局部麻醉剂。
A）隐神经和股内侧肌神经染色的频率。B）通过 NRS 评分（0-10）评估术后疼痛和隐神经阻滞的成功率，通过前内侧小腿皮肤麻醉和活动能力评估股四头肌运动障碍的情况。
A）15 具尸体侧的隐神经均被染色。2 具尸体侧的股内侧肌神经终末支被染色。B）所有患者均无需支撑即可完全行走。没有患者出现踝关节和足部前内侧的任何术后疼痛（NRS 评分 0）。隐神经阻滞的成功率为 100%。
隐神经可以在隐神经与收肌腱交叉点远端的收肌腱下间隙内进行定位。收肌腱下间隙阻滞可提供有效的镇痛而不引起股四头肌运动障碍。
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