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

Luca Maria Sconfienza, Miraude Adriaensen, Domenico Albano, Andrea Alcala-Galiano, Georgina Allen, Maria Pilar Aparisi Gómez, Giacomo Aringhieri, Alberto Bazzocchi, Ian Beggs, Vito Chianca, Angelo Corazza, Danoob Dalili, Miriam De Dea, Jose Luis Del Cura, Francesco Di Pietto, Elena Drakonaki, Fernando Facal de Castro, Dimitrios Filippiadis, Salvatore Gitto, Andrew J GraingerSimon Greenwood, Harun Gupta, Slavcho Ivanoski, Monica Khanna, Andrea Klauser, Ramy Mansour, Silvia Martin, Vasco Mascarenhas, Giovanni Mauri, Catherine McCarthy, David McKean, Eugene McNally, Kalliopi Melaki, Carmelo Messina, Rebeca Miron Mombiela, Ricardo Moutinho, Cyprian Olchowy, Davide Orlandi, Raquel Prada González, Mahesh Prakash, Magdalena Posadzy, Saulius Rutkauskas, Žiga Snoj, Alberto Stefano Tagliafico, Alexander Talaska, Xavier Tomas, Violeta Vasilevska Nikodinovska, Jelena Vucetic, David Wilson, Federico Zaottini, Marcello Zappia, Amanda Isaac

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)1456-1464
Number of pages9
JournalEuropean Radiology
Volume32
Issue number3
DOIs
Publication statusPublished - Mar 2022

Keywords

  • Corticosteroid
  • Interventional radiology
  • Lidocaine
  • Nerves
  • Ultrasonography

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