Top Tweets for #PoplitealBlock
π§ π¦ππππ§ππ βπ‘ππ₯π©πβ: ππ¦ βππ‘π§π₯ππ‘ππ¨π₯ππβ π₯πππππ¬ ππ‘π§π₯ππ‘ππ¨π₯ππ?
#RegionalAnesthesia #SciaticNerve #SciaticNerveBlock #PoplitealBlock #PeripheralNerveBlock #NerveAnatomy #Sonoanatomy
#GrayZonesInRA #GrayAreasInRA
ππππ πππππ ππ ππ:
π¬ π. πππ₯π¦π§ π¨π‘πππ₯π¦π§ππ‘π π§ππ ππ‘ππ§π’π π¬
β«οΈ Calling SCN, a nerve, is itself is MISNOMER.
β«οΈ It is a composite neural complex containing TN + CPN within a paraneural envelope.
β«οΈ TN & CPN are distinct nerves.
β«οΈ Each has its own epineurium, fascicles, perineurium.
β«οΈ Therefore:
SCN paraneural boundary β TN/CPN epineurium.
π― π. π¦π¨ππ£ππ₯ππ‘ππ¨π₯ππ β π§π₯π¨π ππ‘π§π₯ππ‘ππ¨π₯ππ
β«οΈ Extraparaneural β outside the SCN paraneural envelope.
β«οΈ Subparaneural β inside that envelope.
β«οΈ Yet injectate may remain outside both TN & CPN epineuria.
ππ»ππΆπ±π² π¦ππ‘ π°πΌπΊπ½πΉπ²π
β πΆπ»ππΆπ±π² π§π‘/ππ£π‘.
β«οΈ Thus, spread may look βintraneuralβ relative to the composite SCN while remaining extraneural to its component nerves.
β«οΈ Nerve swelling on ultrasound β proof of intraepineurial TN/CPN injection.
β«οΈ Previous MRI/sonographic studies have already demonstrated this important terminologyβanatomy mismatch.
βIntraneuralβ means little unless we specify WHICH boundary has been crossed.
𧩠π. πͺπππ‘ ππ’ππ¦ ππ§ ππππ’π π π§π₯π¨ππ¬ ππ‘π§π₯ππ‘ππ¨π₯ππ?
β«οΈ Cross TN epineurium β intraneural to TN.
β«οΈ Cross CPN epineurium β intraneural to CPN.
β«οΈ Remain outside fascicles β intraneuralβextrafascicular.
β«οΈ βSubepineurialβ therefore belongs within this broad extrafascicular domain.
β«οΈ Cross perineurium β intrafascicular/endoneural.
Paraneural β Subparaneural β Subepineurial/Extrafascicular β Intrafascicular
ππ‘π§π₯ππ‘ππ¨π₯ππ β ππ‘π§π₯ππππ¦ππππ¨πππ₯.
π§ͺ π. π‘ππͺ πππππ©ππ₯ππ π¦π§π¨ππ¬ - πͺπππ§ ππ’ππ¦ ππ§ π₯πππππ¬ π£π₯π’π©π?
β«οΈ Paraneural/subparaneural spread was universal.
β«οΈ Deeper subepineurial and extrafascicular spread occurred variably.
β«οΈ No intrafascicular spread was demonstrated.
But important limitations remain:
β οΈ No histology β exact microscopic boundary crossing unconfirmed.
β οΈ Needle-tip position uncertain β deeper dye cannot automatically prove sequential inward migration.
β οΈ No pressure monitoring β mechanism of tissue separation remains unknown.
β οΈ Latex + cadaver β LA + living nerve.
β οΈ Very small sample β TNβCPN differences remain hypothesis-generating.
β οΈ βSubepineurialβ & βextrafascicular intraneuralβ may represent different depths of the same continuum, not completely separate compartments.
β οΈ Absence of fascicular dye β proof of clinical safety.
Most importantly:
The study demonstrates DISTRIBUTION, not necessarily TRAJECTORY.
π π. πͺππ¬ π’ππ βππ‘π§π₯ππ‘ππ¨π₯ππ π¦ππ‘β π¦π§π¨ππππ¦ π‘πππ π₯πππ‘π§ππ₯π£π₯ππ§ππ§ππ’π‘
β«οΈ Much of the reassuring βintraneuralβ literature comes from the popliteal SCN.
β«οΈ Prior clinical, MRI, sonographic & cadaveric studies have shown that:
apparent SCN intraneural spread may actually be subparaneural or extrafascicular.
β«οΈ Their findings therefore cannot be automatically extrapolated to ordinary single-epineurial peripheral nerves.
The βsafe intraneural SCNβ narrative may partly be an ANATOMICAL NOMENCLATURE problem.
π‘ πππ¬ π§πππππͺππ¬π¦
β«οΈ Popliteal SCN β simple single-epineurial nerve.
β«οΈ Think TN + CPN within a specialised paraneural complex.
β«οΈ Extraparaneural β subparaneural.
β«οΈ Subparaneural β intraepineurial TN/CPN.
β«οΈ SCN spread may appear βintraneuralβ while remaining extraneural to TN & CPN.
β«οΈ Subepineurial = intraneuralβextrafascicular to the individual nerve.
β«οΈ Intraneural β intrafascicular.
π― ππππ’π₯π ππππππ‘π ππ‘ ππ‘ππππ§ππ’π‘ βππ‘π§π₯ππ‘ππ¨π₯ππβ, ππ¦π:
Which boundary was crossed : PARANEURIUM, EPINEURIUM or PERINEURIUM?
Anatomy should define the terminology, not ultrasound appearance alone.
@docmorne @docroland @glauncel @amit_pawa @LSORA_UK @diegoslsampaio @RegionalAnaesUK @GEHealthcare @KiJinnChin @IcostacheIoana @alanpartridge We also do #poplitealblock on supine position, just asking pt to slightly internally rotate the leg. Enough room for probe and no need to change position for performing further blocks or GA
Last Seen Hashtags on Sotwe
candid
Seen from United Kingdom
gay
Seen from Vietnam
lesbian
Seen from France
teeNager
Seen from Malaysia
ΰΈͺΰΈ²ΰΈ£ΰΈΰΈ²ΰΈ‘ΰΈΰΈ±ΰΈΰΉΰΈ’ΰΉΰΈ
Seen from Thailand
drunksex
Seen from Mexico
nakedexposed
Seen from Germany
ΰΈΰΉΰΈ²ΰΈΰΈ‘ΰΈ·ΰΈΰΈ§ΰΈ±ΰΈ’ΰΈΰΈ³ΰΈΰΈ²ΰΈ
Seen from Thailand
ome sange.
Seen from Thailand
poshwife
Seen from United Kingdom
Trends for you
Most Popular Users
Elon Musk 
@elonmusk
241.7M followers
Barack Obama
@barackobama
119M followers
Cristiano Ronaldo
@cristiano
114.4M followers
Donald J. Trump
@realdonaldtrump
111.9M followers
Narendra Modi
@narendramodi
107.2M followers
Rihanna
@rihanna
98.7M followers
NASA
@nasa
92.4M followers
Justin Bieber
@justinbieber
91.8M followers
KATY PERRY
@katyperry
90M followers
Taylor Swift
@taylorswift13
83.9M followers
Lady Gaga
@ladygaga
75.4M followers
Virat Kohli
@imvkohli
73.3M followers
Kim Kardashian
@kimkardashian
70.9M followers
YouTube
@youtube
68.8M followers
Neymar Jr
@neymarjr
66.3M followers
Bill Gates
@billgates
65.1M followers
Selena Gomez
@selenagomez
63M followers
The Ellen Show
@theellenshow
62.3M followers
CNN
@cnn
61.8M followers
X
@x
60.7M followers