Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve: accuracy of a selective new technique confirmed by anatomical dissection

Background. Ilioinguinal and iliohypogastric nerve blocks may be used in the diagnosis of chronic groin pain or for analgesia for hernia repair. This study describes a new ultrasound-guided approach to these nerves and determines its accuracy using anatomical dissection control. Methods. After having tested the new method in a pilot cadaver, 10 additional embalmed cadavers were used to perform 37 ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve. After injection of 0.1 ml of dye the cadavers were dissected to evaluate needle position and colouring of the nerves. Results. Thirty-three of the thirty-seven needle tips were located at the exact target point, in or directly at the ilioinguinal or iliohypogastric nerve. In all these cases the targeted nerve was coloured entirely. In two of the remaining four cases parts of the nerves were coloured. This corresponds to a simulated block success rate of 95%. In contrast to the standard ‘blind' techniques of inguinal nerve blocks we visualized and targeted the nerves 5 cm cranial and posterior to the anterior superior iliac spine. The median diameters of the nerves measured by ultrasound were: ilioinguinal 3.0×1.6 mm, and iliohypogastric 2.9×1.6 mm. The median distance of the ilioinguinal nerve to the iliac bone was 6.0 mm and the distance between the two nerves was 10.4 mm. Conclusions. The anatomical dissections confirmed that our new ultrasound-guided approach to the ilioinguinal and iliohypogastric nerve is accurate. Ultrasound could become an attractive alternative to the ‘blind' standard techniques of ilioinguinal and iliohypogastric nerve block in pain medicine and anaesthetic practic

Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection

Background Local anaesthetic blocks of the greater occipital nerve (GON) are frequently performed in different types of headache, but no selective approaches exist. Our cadaver study compares the sonographic visibility of the nerve and the accuracy and specificity of ultrasound-guided injections at two different sites. Methods After sonographic measurements in 10 embalmed cadavers, 20 ultrasound-guided injections of the GON were performed with 0.1 ml of dye at the classical site (superior nuchal line) followed by 20 at a newly described site more proximal (C2, superficial to the obliquus capitis inferior muscle). The spread of dye and coloration of nerve were evaluated by dissection. Results The median sonographic diameter of the GON was 4.2×1.4 mm at the classical and 4.0×1.8 mm at the new site. The nerves were found at a median depth of 8 and 17.5 mm, respectively. In 16 of 20 in the classical approach and 20 of 20 in the new approach, the nerve was successfully coloured with the dye. This corresponds to a block success rate of 80% (95% confidence interval: 58-93%) vs 100% (95% confidence interval: 86-100%), which is statistically significant (McNemar's test, P=0.002). Conclusions Our findings confirm that the GON can be visualized using ultrasound both at the level of the superior nuchal line and C2. This newly described approach superficial to the obliquus capitis inferior muscle has a higher success rate and should allow a more precise blockade of the nerv

Measuring attention: An evaluation of the Search and Cancellation of Ascending Numbers (SCAN) and the short form of the Test of Attentional and Interpersonal Style (TAIS)

This study found a relationship between the Search and Cancellation of Ascending Numbers (SCAN), Digit Span, and Visual Search and Attention Test (VSAT). Data suggest the measures represent a common construct interpreted to be attention. An auditory distracter condition of the SCAN did not distract participants, while the measure exhibited ample alternate forms reliability. The study also found that the Test of Attentional and Interpersonal Style (TAIS) short form poorly predicted performance on the Digit Span, VSAT, and SCAN. Although the TAIS exhibited good internal consistency, the items likely measure the subjective perception of attention. Furthermore, discriminant and convergent validity of the TAIS were found to be poor

Virtual piano instruction for the college learner

This article investigates the affordability and feasibility of conducting virtual piano lessons for the college level learner. It proposes an approach that works well and requires equipment costing approximately $300 per student. We outline the pros and cons of conducting virtual piano lessons online. The main benefit is overcoming geographical distances, whereas limitations include challenges such as the instructor being able to check issues such as fingerings or dynamics. Latency is not a major problem as long as only one person is playing at any given time, as found in past work. The process of teaching and learning online requires the student to be strongly motivated, and it is helpful for instructor and student to have worked together before in non-virtual environments

The Effects of Assessment Context on State Anxiety and a Neuropsychological Model of Attention

This study investigated the effects of assessment context on state anxiety and attention according to the Mirsky (1996) model of attention. Context varied in the physical testing environment, demeanor of the assessor, and explanation of the purpose of testing. A relaxed condition (RC) and structured medical condition (SMC) distinction was made prior to data collection and the two contexts were designed to reflect contrasting practices of neuropsychologists. Elements of attention evaluated included Encoding (Digit Span), Focusing/Executing (Visual Search and Attention Test), Shifting (Wisconsin Card Sorting Test: Computerized Version 2), Sustaining, and Stabilizing (Continuous Performance Test-Identical Pairs). Eighty healthy adult females participated in the study. The findings suggest that the SMC caused higher levels of anxiety and lower valence than the RC, which in turn caused poorer sustained attention and superior shifting attention for this condition. Such interpretations are consistent with several theories on the effects of anxiety on attention. It should be noted, however, that differences observed in attention were limited to select measures. Factor analysis also indicates that the encode, shift, and sustain elements of attention were largely consistent with the factor solution proposed by Mirsky, while findings on the focus/execute and stabilize elements bring into question the construct validity of these aspects of the model. Findings from the study are considered relevant to those interested in attention theory and particularly researchers and clinicians involved in the administration of neuropsychological testing