Comparison of the median and intermediate approaches to the ultrasound-guided sacral erector spinae plane block: a cadaveric and radiologic study / 대한마취과학회지

Background@#Erector spinae plane block (ESPB) is a well-established method for managing postoperative and chronic pain. ESPB applications for the sacral area procedures are called sacral ESPBs (SESPBs). This cadaveric study aimed to determine the distribution of local anesthesia using the median and intermediate approaches to the SESPB. @*Methods@# Four cadavers were categorized into the median and intermediate approach groups. Ultrasound-guided SESPBs were performed using a mixture of radiopaque agents and dye. Following confirmation of the solution distribution through computed tomography (CT), the cadavers were dissected to observe the solution distribution. @*Results@# CT images of the median group demonstrated subcutaneous pooling of the radiopaque solution between the S1 and S5 horizontal planes. Radiopaque solution also passed from the sacral foramina to the anterior sacrum via the spinal nerves between S2 and S5. In the intermediate group, the solution distribution was observed along the bilateral erector spinae muscle between the L2 and S3 horizontal planes; no anterior transition was detected. Dissection in the median group revealed blue solution distribution in subcutaneous tissue between horizontal planes S1 and S5, but no distribution in superficial fascia or muscle. In the intermediate group, red solution was detected in the erector spinae muscle between the L2 and S3 intervertebral levels. @*Conclusions@# Radiologic and anatomic findings revealed the presence of radiopaque dye in the superficial and erector spinae compartments in both the median and intermediate groups. However, anterior transition of the radiopaque dye was detected only in the median group.

Nutcracker syndrome with different clinical presentations in a young male population

The nutcracker syndrome [NCS] depends on mesoaortic compression of the left renal vein. It has different clinical entities. This study aimed to examine different clinical aspects of NCS. This was a retrospective and descriptively designed study. The patients with abdominal pain, flank pain, or scrotal pain admitted to the Urology and General Surgery outpatient clinic between January 2014 and May 2016 were reviewed. All data were examined descriptively. Urologic and general surgical examinations were performed individually by a urologist and a general surgeon. The abdominal ultrasonography and computed tomography findings, blood pressure, white blood cell count, bilirubin tests, and urine tests were recorded. Patients with inconsistent diagnostic data or missing outcomes were excluded. Five patients were diagnosed with NCS on scanning 134 patients. The mean age was 24 years [20-33 years]. The first patient had left lower quadrant pain. The second patient also had left lower quadrant pain with microscopic hematuria and a mild increase in the total bilirubin level [1.84 mg/dL]. The third patient presented left testicular pain and hypertension [160/100 mm Hg]. Consequently, left side varicocele was found on physical examination and Doppler ultrasound. The fourth patient had leukocytosis [11,900], a mild increase in total bilirubin level [1.73 mg/dL], and left and right lower quadrant pain. The radiological and laboratory entities must be taken into consideration with clinical findings for correct diagnosis because NCS may have different symptoms