Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part VII, nerves of the lower limb
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Published:2021-09-28
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ISSN:0938-7994
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Container-title:European Radiology
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language:en
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Short-container-title:Eur Radiol
Author:
Sconfienza Luca MariaORCID, Adriaensen Miraude, Albano Domenico, Alcala-Galiano Andrea, Allen Georgina, Aparisi Gómez Maria Pilar, Aringhieri Giacomo, Bazzocchi Alberto, Beggs Ian, Chianca Vito, Corazza Angelo, Dalili Danoob, De Dea Miriam, del Cura Jose Luis, Di Pietto Francesco, Drakonaki Elena, Facal de Castro Fernando, Filippiadis Dimitrios, Gitto Salvatore, Grainger Andrew J., Greenwood Simon, Gupta Harun, Ivanoski Slavcho, Khanna Monica, Klauser Andrea, Mansour Ramy, Martin Silvia, Mascarenhas Vasco, Mauri Giovanni, McCarthy Catherine, McKean David, McNally Eugene, Melaki Kalliopi, Messina Carmelo, Miron Mombiela Rebeca, Moutinho Ricardo, Olchowy Cyprian, Orlandi Davide, Prada González Raquel, Prakash Mahesh, Posadzy Magdalena, Rutkauskas Saulius, Snoj Žiga, Tagliafico Alberto Stefano, Talaska Alexander, Tomas Xavier, Vasilevska Nikodinovska Violeta, Vucetic Jelena, Wilson David, Zaottini Federico, Zappia Marcello, Isaac Amanda
Abstract
Abstract
Objectives
To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton’s neuroma) and provide clinical indications.
Methods
We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton’s neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper.
Results
Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia.
Conclusion
Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures.
Key Points
• Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications.
• US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role.
• US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area.
Funder
Università degli Studi di Milano
Publisher
Springer Science and Business Media LLC
Subject
Radiology Nuclear Medicine and imaging,General Medicine
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