Bibliographical record: KURKOVÁ, Simona. Sonographic evaluation of sciatic nerve in individuals with radicular symptoms S1, Charles University, 2nd Faculty of Medicine, Department of Rehabilitation and Sports Medicine, 2019, p. 99, Thesis Supervisor: Mgr. Stanislav Machač Ph.D. Abstract The thesis deals with radicular symptomatics S1 and sonographic imaging and evaluation of sciatic nerve in individuals with unilateral radicular manifestation. The theoretical part describes anatomy and biomechanics of nerve structures, radicular syndrome and its clinical image, diagnostics and treatment. The theory also includes the less known extraspinal causes manifesting themselves as radicular syndrome, the effects of which may be equally important in differential diagnosis. It describes classical and new possibilities of nerve imaging with emphasis on sonography and approach of new procedures such as MRI tractography. In the practical part, the aim of the thesis is to evaluate morphological changes of sciatic nerve in patients with unilateral symptomatic S1 by sonographic imaging of the nerve during its course, from the subgluteal groove to the popliteal groove. It also examines the relationship between the pathophysiology and symptomatology of these patients, comparing whether changes in nerve size correlate with...

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Background Dislocation of catheters within the tissue is a challenge in continuous regional anesthesia. A novel self-coiling catheter design is available and has demonstrated a lower dislocation rate in a cadaver model. The dislocation rate and effect on postoperative pain of these catheters in vivo has yet to be determined and were the subjects of this investigation. Methods After ethics committee approval 140 patients undergoing elective distal lower limb surgery were enrolled in this prospective randomized controlled trial. Preoperatively, patients were randomly assigned and received either the conventional (n = 70) or self-coiling catheter (n = 70) for ultrasound-guided popliteal sciatic nerve block in short axis view and by the in-plane approach from lateral to medial. The primary outcome was pain intensity after surgery and on the following three postoperative days. Secondary outcomes investigated were dislocation rate in situ determined by sonography, catheter movement visible from outside, opioid consumption as well as leakage at the puncture site. Results All catheters were successfully inserted. The study population of self-coiling catheters had significantly lower mean numeric rating scale values than the reference cohort on the first (p = 0.01) and second postoperative days (p < 0.01). Sonographic evaluation demonstrated, 42 standard catheters (60%) and 10 self-coiling catheters (14.3%) were dislocated in situ within the first three postoperative days. The externally visible movement of the catheters at insertion site did not differ significantly between groups through the third postoperative day. The opioid consumption was significantly lower in the self-coiling catheter group on the day of surgery and on the second and third postoperative days (p = 0.04, p = 0.03 and p = 0.04, respectively). Conclusion The self-coiling catheter offers a better postoperative pain control and a lower dislocation rate within the tissue when blocking the popliteal sciatic nerve compared to a conventional catheter. Further trials in large patient cohorts are warranted to investigate the potential beneficial effects of self-coiling catheters for other localisations and other application techniques.

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<p>  </p> <p>Understanding the mechanical properties of peripheral nerves is essential for chronically implanted device design. The work in this thesis aimed to understand the relationship between local deformation responses to global strain changes in peripheral nerves. A custom-built mechanical testing rig and sample holder enabled an improved cyclical uniaxial tensile testing environment on rabbit sciatic nerves (N=5). A speckle was placed on the surface of the nerve and recorded with a microscope camera to track local deformations. The development of a semi-automated digital image processing algorithm systematically measured local speckle dimension and nerve diameter changes. Combined with the measured force response, local and global strain values constructed a stress-strain relationship and corresponding elastic modulus. Preliminary exploration of models such as Fung and 2-Term Mooney-Rivlin confirmed the hyperelastic nature of the nerve. The results of strain analysis show that, on average, local strain levels were approximately five times smaller than globally measured strains; however, the relationship was dependent on global strain magnitude. Elastic modulus values corresponding to ~9% global strains were 2.070 ± 1.020 MPa globally and 10.15 ± 4 MPa locally. Elastic modulus values corresponding to ~6% global strains were 0.173 ± 0.091 MPa globally and 1.030 ± 0.532 MPa locally.   </p>