Abstract
Regional anesthesia relies on a sound understanding of anatomy and the
utility of ultrasound in identifying relevant structures. We assessed
the ability to identify the point at which the superficial peroneal
nerve (SPN) emerges through the deep fascia by ultrasound on 26
volunteers (mean age 27.85 years ± 13.186; equal male: female). This
point was identified, characterized in relation to surrounding bony
landmarks (lateral malleolus and head of the fibula), and compared to
data from 16 formalin‐fixed human cadavers (mean age 82.88 years ±
6.964; equal male: female). The SPN was identified bilaterally in all
subjects. On ultrasound it was found to pierce the deep fascia of the
leg at a point 0.31 (±0.066) of the way along a straight line from the
lateral malleolus to the head of the fibula (LM‐HF line). This occurred
on or anterior to the line in all cases. Dissection of cadavers found
this point to be 0.30 (±0.062) along the LM‐HF line, with no
statistically significant difference between the two groups (U = 764.000; exact two‐tailed P
= 0.534). It was always on or anterior to the LM‐HF line, anterior by
0.74 cm (±0.624) on ultrasound and by 1.51 cm (±0.509) during
dissection. This point was significantly further anterior to the LM‐HF
line in cadavers (U = 257.700, exact two‐tailed P <
0.001). Dissection revealed the nerve to divide prior to emergence in
46.88% (n = 15) limbs, which was not identified on ultrasound (although
not specifically assessed). Such information can guide clinicians when
patient factors (e.g., obesity and peripheral edema) make
ultrasound‐guided nerve localization more technically challenging.
Original language | English |
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Pages (from-to) | 390-395 |
Number of pages | 6 |
Journal | Clinical Anatomy |
Volume | 32 |
Issue number | 3 |
Early online date | 7 Jan 2019 |
DOIs | |
Publication status | Published - Apr 2019 |
Keywords
- Block
- Nerve anatomy
- Regional anesthesia
- Superficial peroneal nerve
- Ultrasound