![]() ![]() “ Ultrasound-guided blockade of the lateral femoral cutaneous nerve: technical description and review of 10 cases“. Note: This injection can also be performed with ultrasound guidance as well, which has as an advance, no radiation and the ability to perform in even small rooms. Withdraw the needle and apply band-aid.įor the image shown above, 3-ml of contrast was then injected, which demonstrated an impressive neurogram (the contrast spread is in the distribution of the lateral femoral cutaneous nerve).īecause the anatomical location of the lateral femoral cutaneous nerve is variable, and many patients are obese, use of a nerve stimulator is important to localize the nerve.After negative aspiration, inject the full contents of the injectate syringe (injectate should flow easily).Aspirate to make sure you’re not in any vessel.With the Stimuplex needle, penetrates the skin and advanced until the needle reads a sensory response of about 0.5MA (which means you’re close to the LFCN).Fluoroscopy: P-A (posterior to anterior) fluoroscopic view is used to visualize the anatomy just medial to the ipsilateral ASIS (anterior superior iliac spine).Clean the skin thoroughly with chloroprep.Mark the injection site with the pen tip in order to leave an impression in the skin (2-cm medial and 2-cm inferior to the ASIS).Always start with informed consent from the patient, and then a time-out to verify correct patient and injection site.For skin numbing: 25-gauge 1.5″ needle with 1-ml syringe filled with 1% lidocaine.10-cm Stimuplex needle (peripheral nerve stimulator needle).Should NOT use 64447, which is for injection of the femoral nerve, not the lateral femoral cutaneous nerve.ICD-10 code: G57.1 “meralgia paresthetica” (lateral cutaneous nerve of thigh syndrome)ĬPT code: 64450“Injection, anesthetic agent other peripheral nerve or branch”.ICD-9 code: 355.1 “meralgia paresthetica”.Meralgia paresthetica (lateral femoral cutaneous nerve of thigh syndrome).( click for more anatomical and diagnostic information)įluoroscopic procedure technique with Stimuplex guidance: Pathology of this nerve, with resultant paresthesias in its distribution, is called Meralgia Paresthetica. BMI 45 - Opioid consumption of greater or equal to 30mg morphine equivalents per day - Age 80 years old - ASA IV or greater - Inability to use a PCA - Inability to access the intrathecal space - Infection at the site of injection (either for spinal or PNB) - INR greater than or equal to 1.4Ĭontact information is only displayed when the study is recruiting subjects.Ĭontrol arm to receive Adductor Canal Block without additional interventions Intervention: ropivacaine 0.5% 15cc injected under ultrasound guidanceĮxperimental arm to receive Adductor Canal Block plus SPANK Block (Sensory Posterior Articular Nerves of the Knee) without additional interventions Intervention: ropivacaine 0.5% 15cc injected under ultrasound guidance into the adductor canal plus 20cc ropivacaine 0.The lateral femoral cutaneous nerve (LFCN) is a purely sensory nerve that supplies the skin over the anterolateral thigh. Inclusion Criteria: - Patients between the ages of 40 and 80 years old undergoing total knee arthroplasty amenable to peripheral nerve block for perioperative analgesia. The drug itself is not being studied and the same concentration will be used in all participants.Įchogenic needle used for ultrasound guided nerve blockade. Injection of local anesthetic into the inner thigh under ultrasound guidance to provide sensory blockade to the anterior aspect of the kneeĪmide local anesthetic, this concentration is commonly used to achieve surgical level anesthesia. Injection of local anesthetic into the tissues on the posterior aspect of the knee to provide sensory blockade of the articular nerves of the knee. SPANK Block (Sensory Posterior Articular Nerves of the Knee) The study will aid in answering the question of whether SPANK block is an effective adjunct in preventing pain and decreasing opioid requirement after TKA. Secondary outcomes include pain scores recorded at 4, 8, 12, 16, 20, and 24 hours post-operatively, cumulative pain score, incidence of post-operative nausea and vomiting, and extent of motor blockade. The primary outcome is pain control, which will be measured throughout the post-operative course using morphine equivalents of opioid analgesics used during the first 24 hours after surgery. This is a prospective, randomized control trial to compare SPANK block combined with adductor canal block to adductor canal block alone in treatment of post-operative pain after total knee arthroplasty. San Antonio Uniformed Services Health Education Consortium Single Dose Adductor Canal Block With SPANK (Sensory Posterior Articular Nerves of the Knee) Block Compared to Single Dose Adductor Canal Block and Pain Control After Total Knee Arthroplasty ![]()
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