Patient Variability in Sciatic Nerve Branch Point Distance Using Ultrasound Guided Localization

Background and Objectives: Improved ultrasound and needle technology make popliteal sciatic nerve blockade a popular anesthetic technique and imaging to localize the branch point of the common peroneal and posterior tibial components is important because successful blockade techniques vary with respect to injection of the common trunk proximally or separate injections distally. Nerve stimulation, ultrasound, cadaveric and magnetic resonance studies demonstrate variability in distance and discordance between imaging and anatomic examination of the branch point. The popliteal crease and imprecise, inaccessible landmarks render measurement of the branch point variable and inaccurate. The purpose of this study was to use the tibial tuberosity, a fixed bony reference, to measure the distance of the branch point. Method: During popliteal sciatic nerve blockade in the supine position the branch point was identified by ultrasound and the block needle was inserted. The vertical distance from the tibial tuberosity prominence and needle insertion point was measured. Results: In 92 patients the branch point is a mean distance of 12.91 cm proximal to the tibial tuberosity and more proximal in male (13.74 cm) than female patients (12.08 cm). Body height is related to the branch point distance and is more proximal in taller patients. Separation into two nerve branches during local anesthetic injection supports notions of more proximal neural anatomic division. Limitations: Imaging of the sciatic nerve division may not equal its true anatomic separation. Conclusion: Refinements in identification and resolution of the anatomic division of the nerve branch point will determine if more accurate localization is of any clinical significance for successful nerve blockade.

Ethos and Ideology of Knowledge Organization: Toward Precepts for and Engaged Knowledge Organization Drawing on The Arts and Crafts Movement, Critical Theory, and Žižek

Ethos is the spirit that motivates ideas and practices. When we talk casually about the ethos of a town, state, or country we are describing the fundamental or at least underlying rationale for action, as we see it. Ideology is a way of looking at things.It is the set of ideas that constitute one’s goals, expectations, and actions. In this brief essay I want to create a space where we might talk about the ethos and ideology in knowledge organization from a particular point of view; combining ideas and inspiration from the Arts and Crafts movement of the early Twentieth Century, critical theory in extant knowledge organization work, the work of Slavoj Žižek, and the work of Thich Nhat Hahn on Engaged Buddhism.I will expand more below, but we can say here and now that there are many open questions about ethos and ideology in and of knowledge organization, both its practice and products. Many of them in classification, positioned as they are around identity politics of race, gender, and other marginalized groups, ask the classificationist to be mindful of the choice of terms and relationships between terms. From this work we understand that race and gender requires special consideration, which manifests as a particular concern for the form of representation inside extant schemes. Even with these advances in our understanding there are still other categories about which we must make decisions and take action. For example, there are ethical decisions about fiduciary resource allocation, political decisions about standards adoption, and even broader zeitgeist considerations like the question of Fordist conceptions (Day, 2001; Tennis 2006) of the mechanics of description and representation present in much of today’s practice.Just as taking action in a particular way is an ethical concern, so too is avoiding a lack of action. Scholars in Knowledge Organization have also looked at the absence of what we might call right action in the context of cataloguing and classification. This leads to some problems above, and hints at larger ethical concerns of watching a subtle semantic violence go on without intervention (Bowker and Star, 2001; Bade 2006).The problem is not to act or not act, but how to act or not act in an ethical way, or at least with ethical considerations. The action advocated by an ethical consideration for knowledge organization is an engaged one, and it is here where we can take a nod from contemporary ethical theory advanced by Engaged Buddhism. In this context we can see the manifestation of fourteen precepts that guide ethical action, and warn against lack of action.