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" Sciatic Nerve Block"
Do u know SCN is not actually a Nerve?
#sciaticnerve#sciaticnerveblock#SCNB
My 10 points:
1. SCN is also called Ischiadic N. (related to ischium) or Pregnant N. (enclosing two components like a fetus with a pulsating heart (a branch of inferior Gluteal A). Optic N is another pregnant nerve enclosing Central A. of Retina inside.
2. SCN is the longest (40-45 cm), largest, and thickest (1.5-2 cm) nerve of the human body.
3. SCN is not the Nerve. Like other body nerves, it does not have its own connective tissues (epineurium, perineurium, endoneurium). It is just a compact paraneural sheath (or mesoneurium) enclosing two nerves (TN & CPN) with separate connective tissues. This sheath is also known as Vloka’s sheath.
4. Both the components (TN & CPN) are separated (since beginning) by a “Co-Cu (Comptom-Cruveilhier) Septum.” The presence of this barrier can affect the spread of the drug between the TN & CPN.
5. The paraneural sheath merges with the fat layer of the popliteal fossa, separating both components. Therefore, SCN never divides; it always bifurcates.
6. Blood Supply: SCN have a rich blood supply in the proximal part (gluteal) compared to the distal part (thigh).
Gluteal region: inferior gluteal A. & Cruciate anastomosis (between medial & lateral circumflex FA + IGA+ Profunda femoris A.).
Thigh: Perforating branches of profunda femoris A. & and occasionally from popliteal A.
7. SCN gives muscular branches to the hamstrings in the proximal-most part. Therefore, Hamstring contractions on stimulation can be accepted during Parasacral & Transgluteal SCNB.
For all other approaches, Foot responses should be looked for (Inversion > plantar Flexion).
8. For all lateral approaches of SCNB, persistent undesired responses (dorsiflexion>Eversion) due to stimulation of CPN (posterolateral) can be compensated by increasing LA volume to involve TN (anteromedial).
9. Complimentary involvement of PCNT is possible only with Parasacral, Transgluteal, and Subgluteal SCNB.
The ultrasound-guided transgluteal SCN is incorrectly named in some literature; it is actually Subgluteal SCNB.
10. Infragluteal SCN is the most superficial part of SCN, covered by only Skin & subcutaneous tissues (not any muscles). The Sleeping foot on prolonged sitting is primarily due to compression of this part of SCN. The effect of the infragluteal SCNB up to the popliteal SCNB is the same.
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If you know any of the interesting points about SCNB, Plz Share.
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