Meralgia Paresthetica
Started by nopain1234
Lennard. Old school.
Nysora. New school.
www.nysora.com
Nysora. New school.
Ultrasound-Guided Lateral Femoral Cutaneous Nerve Block - NYSORA
The lateral femoral cutaneous nerve (LFCN) divides into several branches innervating the lateral and anterior aspects of the thigh.Indications are postoperative analgesia for hip surgery, meralgia paresthetica, and muscle biopsy of the proximal lateral thigh.
www.nysora.com
I love NYSORA but if you're trying to find the compression, you'll want to start your scan higher at the ASIS and slide down as it's most at risk at the inguinal ligament level was the old teaching.
www.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
It's an easy PNS case if you're into that.
Sonographic features of the lateral femoral cutaneous nerve in meralgia paresthetica - PMC
The diagnosis of meralgia paresthetica (MP) is usually based on clinical symptoms and physical examination. Therefore, the present study aimed to investigate the lateral femoral cutaneous nerve (LFCN) sonographic features in MP patients. A total of ...
www.ncbi.nlm.nih.gov
Ultrasound-Guided Diagnosis and Treatment of Meralgia Paresthetica - PubMed
Meralgia paresthetica refers to the entrapment of the lateral femoral cutaneous nerve at the level of the inguinal ligament. The lateral femoral cutaneous nerve - a purely sensory nerve - arises from the L2 and L3 spinal nerve roots, travels downward lateral to the psoas muscle, and then crosses...
pubmed.ncbi.nlm.nih.gov
It's an easy PNS case if you're into that.
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it's easier to find at the fat filled tunnel between TFL and sartorious and track it up than start high and trace down.
spoke to a lady today who I did this block/hydrodissection on 2 months ago, after experiencing the issue for 6 months (she gained a bunch of weight but wore the same clothes...) about 10 ml injected once i found the nerve and tracked it up under the inguinal ligament.
she hasn't experienced the pain since the block.
wanted to bring this threat back up...i see some other doscs from other practice doing thse fluoro guided, not sure why you would choose that over US unless just how you were trainied. Couldnt find this technique online, anybody have any insigts on papers, if ths is common to do it with fluoro. I have never seen it done other then US and palpation guuided
Do you have an input on how you do this with PNS? I have a lady with MP I've been doin blocks on looking for a more durable solution.I love NYSORA but if you're trying to find the compression, you'll want to start your scan higher at the ASIS and slide down as it's most at risk at the inguinal ligament level was the old teaching.
Sonographic features of the lateral femoral cutaneous nerve in meralgia paresthetica - PMC
The diagnosis of meralgia paresthetica (MP) is usually based on clinical symptoms and physical examination. Therefore, the present study aimed to investigate the lateral femoral cutaneous nerve (LFCN) sonographic features in MP patients. A total of ...
Ultrasound-Guided Diagnosis and Treatment of Meralgia Paresthetica - PubMed
Meralgia paresthetica refers to the entrapment of the lateral femoral cutaneous nerve at the level of the inguinal ligament. The lateral femoral cutaneous nerve - a purely sensory nerve - arises from the L2 and L3 spinal nerve roots, travels downward lateral to the psoas muscle, and then crosses...
It's an easy PNS case if you're into that.
SPRINT
Step one is making sure it's the nerve. Step two is deciding if you really want to use electricity instead of sending to a surgeon for a neurectomy/neurolysis/neuroplasty. Step 3 is then deciding on SCS/DRG or PNS with a durable or temporary stimulator. I assume we're sure, aren't doing surgery referral, and are onto PNS.
In general for the LFCN, I like to start distal and somewhat lateral in the thigh depending on their body habitus and clothing preferences. I then target the LFCN below their inguinal crease and aim above the sartorius. In reality it's ultrasound assisted as I'm just aiming for the ASIS and using the ultrasound to stay in the SQ fat. I like to stay out of the muscle with the PNS systems to avoid muscle pulling/shearing the lead, although the SPR system doesn't care as much as the others do. Just have them take it easy with bending the thigh on that side for the first few days. All of the 3 durable implants can be applied to the anterior or lateral thigh pretty readily.
I don't mind coming laterally to medially with the durable systems for the trial or implant if you want to cover across the sartorius, but with ultrasound and an awake patient, you shouldn't need to. Lead migration with the perc systems is still in or out, so running parallel to the nerve should be simpler for most reps to work with and less problematic from a migration perspective.
Doing the lateral to medial approach with SPR is foolish as you want at least 3 - 4 cm of the lead in the body to give the spiral bound lead something to hold onto.
In general for the LFCN, I like to start distal and somewhat lateral in the thigh depending on their body habitus and clothing preferences. I then target the LFCN below their inguinal crease and aim above the sartorius. In reality it's ultrasound assisted as I'm just aiming for the ASIS and using the ultrasound to stay in the SQ fat. I like to stay out of the muscle with the PNS systems to avoid muscle pulling/shearing the lead, although the SPR system doesn't care as much as the others do. Just have them take it easy with bending the thigh on that side for the first few days. All of the 3 durable implants can be applied to the anterior or lateral thigh pretty readily.
I don't mind coming laterally to medially with the durable systems for the trial or implant if you want to cover across the sartorius, but with ultrasound and an awake patient, you shouldn't need to. Lead migration with the perc systems is still in or out, so running parallel to the nerve should be simpler for most reps to work with and less problematic from a migration perspective.
Doing the lateral to medial approach with SPR is foolish as you want at least 3 - 4 cm of the lead in the body to give the spiral bound lead something to hold onto.
fluoro is just a field block. standard of care 25 years ago
Was it ever SOC? Palpation probably just as good if BMI < 25.
Field block unless finding it on US.
Few are as good as Oreos.
US guided field block with no images saved is what happens by me.
When you say happens by you you mean that’s what you do or that’s what guys down the street from you do?
I just go by landmarks.
I know a lot of folks "using US"
