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      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

      research-article
      1 , 2 , , 3 , 1 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 1 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 35 , 37 , 1 , 38 , 32 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 6 , 49 , 55 , 56 , 57 , 15 , 57
      European Radiology
      Springer Berlin Heidelberg
      Interventional radiology, Ultrasonography, Nerves, Lidocaine, Corticosteroid

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          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 .

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          Most cited references55

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          The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018.

          This manuscript describes the use of ultrasound elastography, with the exception of liver applications, and represents an update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography.
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            The Delphi method: an efficient procedure to generate knowledge.

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              • Article: not found

              Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus

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                Author and article information

                Contributors
                io@lucasconfienza.it
                Journal
                Eur Radiol
                Eur Radiol
                European Radiology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0938-7994
                1432-1084
                28 September 2021
                28 September 2021
                2022
                : 32
                : 3
                : 1456-1464
                Affiliations
                [1 ]GRID grid.417776.4, IRCCS Istituto Ortopedico Galeazzi, ; Milan, Italy
                [2 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Dipartimento Di Scienze Biomediche Per La Salute, , Università Degli Studi Di Milano, ; Via Riccardo Galeazzi 4, 20161 Milan, Italy
                [3 ]Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, the Netherlands
                [4 ]GRID grid.10776.37, ISNI 0000 0004 1762 5517, Sezione Di Scienze Radiologiche, Dipartimento Di Biomedicina, , Neuroscienze E Diagnostica Avanzata, Università Degli Studi Di Palermo, ; Palermo, Italy
                [5 ]GRID grid.411171.3, ISNI 0000 0004 0425 3881, Hospital Universitario, ; 12 de Octubre, Madrid, Spain
                [6 ]St Luke’s Radiology Oxford Ltd, Oxford, UK
                [7 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, University of Oxford, ; Oxford, UK
                [8 ]GRID grid.414055.1, ISNI 0000 0000 9027 2851, Department of Radiology, , Auckland City Hospital, ; Auckland, New Zealand
                [9 ]Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
                [10 ]GRID grid.5395.a, ISNI 0000 0004 1757 3729, Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, , University of Pisa, ; Pisa, Italy
                [11 ]GRID grid.419038.7, ISNI 0000 0001 2154 6641, Diagnostic and Interventional Radiology, , IRCCS Istituto Ortopedico Rizzoli, ; Bologna, Italy
                [12 ]Analytic Imaging, Edinburgh, UK
                [13 ]Ospedale Evangelico Betania, Napoli, Italy
                [14 ]Clinica Di Radiologia EOC IIMSI, Lugano, Switzerland
                [15 ]GRID grid.419496.7, South West London Elective Orthopaedic Centre (SWLEOC), , Epsom & St Helier University Hospitals NHS Trust, ; London, UK
                [16 ]Studio MSK, Belluno, Italy
                [17 ]GRID grid.414651.3, ISNI 0000 0000 9920 5292, Hospital Universitario Donostia, ; San Sebastian, Spain
                [18 ]Dipartimento Di Diagnostica Per Immagini, Pineta Grande Hospital, Castel Volturno, Italy
                [19 ]MSK Radiology Services, Heraklion, Crete Greece
                [20 ]GRID grid.106023.6, ISNI 0000 0004 1770 977X, Hospital General Universitario de Valencia, ; Valencia, Spain
                [21 ]GRID grid.5216.0, ISNI 0000 0001 2155 0800, 2nd Department of Radiology, , University General Hospital “ATTIKON” Medical School, National and Kapodistrian University of Athens, ; Haidari/Athens, Greece
                [22 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Dipartimento Di Scienze Biomediche Per La Salute, , Università Degli Studi Di Milano, ; Milan, Italy
                [23 ]GRID grid.24029.3d, ISNI 0000 0004 0383 8386, Cambridge University Hospitals, ; Cambridge, UK
                [24 ]GRID grid.464636.5, ISNI 0000 0000 9898 1804, Mid Cheshire Hospitals NHS Foundation Trust, ; Cheshire, UK
                [25 ]Leeds Teaching Hospitals, Leeds, UK
                [26 ]Department of Radiology, Special Hospital for Orthopedic Surgery and Traumatology St. Erazmo, Ohrid, North Macedonia
                [27 ]GRID grid.7858.2, ISNI 0000 0001 0708 5391, Ss. Cyril and Methodius University in Skopje, ; Skopje, North Macedonia
                [28 ]GRID grid.417895.6, ISNI 0000 0001 0693 2181, Imperial College Healthcare NHS Trust, ; London, UK
                [29 ]GRID grid.5361.1, ISNI 0000 0000 8853 2677, Department of Radiology, , Medical University Innsbruck, ; Innsbruck, Austria
                [30 ]GRID grid.410556.3, ISNI 0000 0001 0440 1440, Oxford Musculoskeletal Radiology, , Oxford University Hospitals, ; Oxford, UK
                [31 ]Hospital Universitario Son Llatzer, Palma, Spain
                [32 ]GRID grid.414429.e, ISNI 0000 0001 0163 5700, Hospital da Luz, Musculoskeletal Imaging Unit, ; Lisbon, Portugal
                [33 ]AIRC, Advanced imaging research consortium, Lisbon, Portugal
                [34 ]GRID grid.15667.33, ISNI 0000 0004 1757 0843, Division of Interventional Radiology, , Istituto Europeo Di Oncologia, ; Milan, Italy
                [35 ]Oxford Musculoskeletal Radiology, Oxford, UK
                [36 ]GRID grid.439664.a, ISNI 0000 0004 0368 863X, Buckinghamshire Healthcare NHS Trust, ; Aylesbury, UK
                [37 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Department of Radiology, , Charité-Universitätsmedizin Berlin, ; Berlin, Germany
                [38 ]GRID grid.411646.0, ISNI 0000 0004 0646 7402, Department of Radiology, , Herlev og Gentofte Hospital, ; Herlev, Denmark
                [39 ]Hospital de Loulé, Loulé, Portugal
                [40 ]GRID grid.4495.c, ISNI 0000 0001 1090 049X, Department of Oral Surgery, , Wroclaw Medical University, ; Wroclaw, Poland
                [41 ]Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy
                [42 ]GRID grid.413176.6, ISNI 0000 0004 1768 9334, Hospital POVISA, ; Vigo, Spain
                [43 ]GRID grid.415131.3, ISNI 0000 0004 1767 2903, Post Graduate Institute of Medical Education & Research (PGIMER), ; Chandigarh, India
                [44 ]Indywidualna Praktyka Lekarska Magdalena Posadzy, Poznan, Poland
                [45 ]GRID grid.45083.3a, ISNI 0000 0004 0432 6841, Department of Radiology, , Lithuanian University of Health Sciences, ; Kaunas, Lithuania
                [46 ]GRID grid.29524.38, ISNI 0000 0004 0571 7705, Institute of Radiology, , University Medical Centre Ljubljana, ; Zaloska 7, 1000 Ljubljana, Slovenia
                [47 ]GRID grid.8954.0, ISNI 0000 0001 0721 6013, Faculty of Medicine, , University of Ljubljana, ; Ljubljana, Slovenia
                [48 ]GRID grid.5606.5, ISNI 0000 0001 2151 3065, Department of Health Sciences, , University of Genova, ; Genoa, Italy
                [49 ]GRID grid.410345.7, ISNI 0000 0004 1756 7871, IRCCS Ospedale Policlinico San Martino, ; Genova, Italy
                [50 ]GRID grid.420022.6, ISNI 0000 0001 0723 5126, Department of Radiology, , AUVA Trauma Center Vienna, ; Vienna, Austria
                [51 ]GRID grid.5841.8, ISNI 0000 0004 1937 0247, Radiology Dpt. MSK Unit. Hospital Clinic (CDIC), , University of Barcelona (UB), ; Barcelona, Spain
                [52 ]Clinical Center “Mother Theresa”, University Institute of Radiology, Skopje, North Macedonia
                [53 ]GRID grid.7858.2, ISNI 0000 0001 0708 5391, Faculty of Medicine, , Ss. Cyril and Methodius University in Skopje, ; Skopje, North Macedonia
                [54 ]Radiology Department, Hospital ICOT Ciudad de Telde, Las Palmas, Spain
                [55 ]GRID grid.10373.36, ISNI 0000000122055422, Department of Medicine and Health Sciences, , University of Molise, ; Campobasso, Italy
                [56 ]Varelli Institute, Naples, Italy
                [57 ]GRID grid.420545.2, ISNI 0000 0004 0489 3985, Guy’s and St Thomas’ Hospitals, ; London, UK
                Author information
                http://orcid.org/0000-0003-0759-8431
                Article
                8283
                10.1007/s00330-021-08283-0
                8831230
                34581843
                9f8b5677-e2b5-4d14-8dda-4e204f5f9ad5
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 27 March 2021
                : 1 August 2021
                : 17 August 2021
                Funding
                Funded by: Università degli Studi di Milano
                Categories
                Musculoskeletal
                Custom metadata
                © European Society of Radiology 2022

                Radiology & Imaging
                interventional radiology,ultrasonography,nerves,lidocaine,corticosteroid
                Radiology & Imaging
                interventional radiology, ultrasonography, nerves, lidocaine, corticosteroid

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