Identifying the emergence of the superficial peroneal nerve through deep fascia on ultrasound and by dissection: implications for regional anaesthesia in foot and ankle surgery

Bowness, J., Turnbull, K., Taylor, A., Halcrow, J., Chisholm, F., Grant, C. and Varsou, O. (2019) Identifying the emergence of the superficial peroneal nerve through deep fascia on ultrasound and by dissection: implications for regional anaesthesia in foot and ankle surgery. Clinical Anatomy, 32(3), pp. 390-395. (doi:10.1002/ca.23323) (PMID:30536834)

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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 2‐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 2‐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, peripheral edema) make ultrasound‐guided nerve localization more technically challenging.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Varsou, Dr Ourania
Authors: Bowness, J., Turnbull, K., Taylor, A., Halcrow, J., Chisholm, F., Grant, C., and Varsou, O.
College/School:College of Medical Veterinary and Life Sciences > School of Life Sciences
Journal Name:Clinical Anatomy
Publisher:Wiley
ISSN:0897-3806
ISSN (Online):1098-2353
Published Online:10 December 2018
Copyright Holders:Copyright © 2018 Wiley Periodicals, Inc.
First Published:First published in Clinical Anatomy 32(3): 390-395
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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