Onur BALABAN, Merve YAMAN, Tayfun AYDIN, Ahmet MUSMUL

Siyatik sinir hareketinin ayak bileği dorsifleksiyon ve plantar fleksiyonuyla ultrason eşliğinde görüntülenmesi: Siyatik sinirin yerinin belirlenmesinde yeni bir yöntem

Amaç: Sinirlerin in vivo hareketlerini gerçek zamanlı ultrason kullanarak gözlemlemek mümkündür. Siyatik siniri etrafındaki dokudan ayırt etmek ve tanımlamak için bir kılavuz olarak hareketlerini göstermeyi amaçladık. Gereç ve Yöntem: Bu araştırma prospektif çapraz karşılaştırmalı çalışma olarak planlandı. Bu çalışmaya, 25 gönüllü dahil ettik. Siyatik sinirin hareketleri ultrasonografi kullanılarak popliteal ve orta uyluk seviyelerinde enine kesitlerde görüntülendi. Ciltsinir mesafesi ölçülerek sinirin ön-arka hareketi değerlendirildi. Mesafeler, maksimum ayak bileği dorsiflksiyonu, maksimum plantar flksiyon ve nötr pozisyonda ölçüldü ve birbirleriyle karşılaştırıldı. Ayrıca, siyatik sinirin dinamik (gerçek zamanlı) rotasyon/lateral hareketleri subjektif bir gözlemci puanı verilerek değerlendirildi. Bulgular: Siyatik sinirin hareketi popliteal bölgede aktif ve pasif ayak bileği dorsiflksiyonunda, sırasıyla 0,32 cm ve 0,23 cm olarak ölçüldü ve anlamlı bulundu (p=0,003). Siyatik sinirin hareketi orta uylukta, aktif ve pasif ayak bileği plantar flksiyonu ile sırasıyla 0,11 cm ve 0,01 cm olarak ölçüldü (p

Ultrasound detection of sciatic nerve movements with ankle dorsiflexion/plantar flexion: Prospective comparative study of a novel method to locate the sciatic nerve

Objectives: It is possible to observe the in-vivo movements of nerves using real-time ultrasound. In this study, we aimed tovisualize the movements of the sciatic nerve as a guide to identify the sciatic nerve to distinguish from surrounding tissue.Methods: This trial was a prospective, cross-over comparative study. We included 25 healthy volunteers in this study. Themovements of the sciatic nerve were visualized in the transverse view at popliteal and midthigh levels using ultrasonography. Anterior-posterior movements were assessed by measuring skin-to-nerve distance. The distances were measured duringmaximum ankle dorsiflxion, maximum plantar flxion and neutral position and compared with each other. We also evaluatedthe quality of dynamic (real-time) rotation/lateral movements of the sciatic nerve by assigning a subjective observer score.Results: The movement of sciatic nerve was signifiant at popliteal region with active and passive ankle dorsiflxion whichwas 0.32 cm and 0.23 cm respectively (p=0.003). The movement of sciatic nerve was signifiant at midthigh region with activeand passive ankle plantar flxion which was 0.11 cm and 0.01 cm respectively (p

PDF

___

1. Chan VW, Nova H, Abbas S, McCartney CJ, Perlas A, Xu DQ. Ultrasound examination and localization of the sciatic nerve: a volunteer study. Anesthesiology 2006;104(2):309– 14.
2. Barrington MJ, Lai SL, Briggs CA, Ivanusic JJ, Gledhill SR. Ultrasound-guided midthigh sciatic nerve blocka clinical and anatomical study. Reg Anesth Pain Med 2008;33(4):369–76.
3. Choquet O, Capdevila X. Case report: Three-dimensional high-resolution ultrasound-guided nerve blocks: a new panoramic vision of local anesthetic spread and perineural catheter tip location. Anesth Analg 2013;116(5):1176–81.
4. Elsharkawy H, Kashy BK, Babazade R, Gray AT. Ultrasound Detection of Arteria Comitans: A Novel Technique to Locate the Sciatic Nerve. Reg Anesth Pain Med 2018;43(1):57–61.
5. Ehlers L, Jensen JM, Bendtsen TF. Cost-effctiveness of ultrasound vs nerve stimulation guidance for continuous sciatic nerve block. Br J Anaesth 2012;109(5):804–8.
6. Ellis RF, Hing WA. Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficy. J Man Manip Ther 2008;16(1):8–22.
7. Coppieters MW, Andersen LS, Johansen R, Giskegjerde PK, Høivik M, Vestre S, et al. Excursion of the Sciatic Nerve During Nerve Mobilization Exercises: An In Vivo Cross-sectional Study Using Dynamic Ultrasound Imaging. J Orthop Sports Phys Ther 2015;45(10):731–7.
8. Ellis RF, Hing WA, McNair PJ. Comparison of longitudinal sciatic nerve movement with diffrent mobilization exercises: an in vivo study utilizing ultrasound imaging. J Orthop Sports Phys Ther 2012;42(8):667–75.
9. Ellis R, Hing W, Dilley A, McNair P. Reliability of measuring sciatic and tibial nerve movement with diagnostic ultrasound during a neural mobilisation technique. Ultrasound Med Biol 2008;34(8):1209–16.
10. Balaban O, Aydın T, Inal S. Movement of sciatic nerve with dorsiflxion and plantar flxion of foot: A new identifiation method by ultrasound. J Clin Anesth 2018 Feb;44:66– 7.
11. Ben-Ari AY, Joshi R, Uskova A, Chelly JE. Ultrasound localization of the sacral plexus using a parasacral approach. Anesth Analg 2009;108(6):1977–80.
12. Karmakar MK, Kwok WH, Ho AM, Tsang K, Chui PT, Gin T. Ultrasound-guided sciatic nerve block: description of a new approach at the subgluteal space. Br J Anaesth 2007;98(3):390–5.
13. Taha AM. A simple and successful sonographic technique to identify the sciatic nerve in the parasacral area. Can J Anaesth 2012;59(3):263–7.
14. Gürkan Y, Sarisoy HT, Cağlayan C, Solak M, Toker K. “Figure of four” position improves the visibility of the sciatic nerve in the popliteal fossa. Agri 2009;21(4):149–54.
15. Yamamoto H, Sakura S, Wada M, Shido A. A prospective, randomized comparison between single- and multipleinjection techniques for ultrasound-guided subgluteal sciatic nerve block. Anesth Analg 2014;119(6):1442–8.
16. Gürkan Y, Ohtaroğlu ÇN. Can we use ‘’coin sign’’ image to predict block success after performance of sciatic nerve block? Agri 2012;24(3):142–3.
17. Bang SU, Kim DJ, Bae JH, Chung K, Kim Y. Minimum effective local anesthetic volume for surgical anesthesia by subparaneural, ultrasound-guided popliteal sciatic nerve block: A prospective dose-fiding study. Medicine (Baltimore) 2016;95(34):e4652.
18. Cappelleri G, Ambrosoli AL, Gemma M, Cedrati VLE, Bizzarri F, Danelli GF. Intraneural Ultrasound-guided Sciatic Nerve Block: Minimum Effctive Volume and Electrophysiologic Effcts. Anesthesiology 2018;129(2):241–8.