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1.
Medicine (Baltimore) ; 100(14): e25450, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832151

RESUMO

BACKGROUND: This meta-analysis aimed to compare the efficiency of fascia iliaca compartment block (FICB) and femoral nerve block (FNB) for pain management in knee and hip surgeries. METHODS: We searched four electronic databases (Pubmed, Embase, Cochrane library database, Web of Science) from inception to January 2019. Only randomized controlled trials (RCTs) were included. Two review authors independently extracted data for each included study. Primary outcomes were visual analogue scale at 12 hours, 24 hours, 48 hours, total morphine consumption, the length of hospital stay and the occurrence of nausea and vomiting. Standardized mean difference (SMD) or risk ratio (RR) and 95% confidence intervals (CIs) were calculated for continuous outcomes and discontinuous outcomes respectively. We used the Cochrane Risk of Bias tool to assess risk of bias. Stata 12.0 was used for meta-analysis. RESULTS: Finally, 7 RCTs involving 508 patients (FICB = 254, FNB = 254) were included in this meta-analysis. Compared with FNB group, FICB has no benefit for visual analogue scale at 12 hours (SMD = 0.02, 95% CI, -0.15 to 0.19; P = .820), 24 hours (SMD = -0.02, 95% CI, -0.22 to 0.18; P = .806), and 48 hours (SMD = -0.02, 95% CI, -0.22 to 0.19; P = .872). No significant differences were found regarding total morphine consumption (SMD = -0.07, 95% CI, -0.29 to 0.15; P = .533). What's more, there was no significant difference between the length of hospital stay and the occurrence of nausea and vomiting (P > .05). CONCLUSION: FICB has equivalent pain control and morphine-sparing efficacy when compared with FNB. More high-quality RCTs are needed to identify the optimal drugs and volume of local infiltration protocols.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Analgésicos Opioides/uso terapêutico , Fáscia/inervação , Nervo Femoral , Humanos , Morfina/uso terapêutico , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Resultado do Tratamento
2.
Wiad Lek ; 74(2): 207-212, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33813473

RESUMO

OBJECTIVE: The aim: Is to find out the features of innervation of the skin of the anterior femoral region and the fascia lata during the fetal period of human development. PATIENTS AND METHODS: Materials and methods: The study was carried out on 64 preparations of the lower extremities of human fetuses of 4-10 months using macromicroscopic preparation and morphometry. Macropreparations of the skin nerves of the lower extremities of different age fetuses with anatomical variants were subject to photo documentation. RESULTS: Results: The features of cutaneous nerve fetal topography of the anterior femoral region and the broad fascia of the femur were revealed, their connections were established, and their layering was determined. It was found that in human fetuses, not only the lateral cutaneous femoral nerve but in most cases the branches of other nerves of the lumbar plexus, except for the obturator nerve, are directed to the skin of the anterior-lateral femur surface. The innervation of the medial femur surface is provided by the following nerve complex: obturator, femoral, saphenous and genitofemoral nerves. CONCLUSION: Conclusions: Taking into account the fact that the terminal branches of adjacent cutaneous nerves of the femoral region intersect and overlap, innervation bypasses are formed, due to which, in case of possible damage to one of the nerves, its insufficiency is compensated to a certain extent. Anastomoses were found between the cutaneous nerves, in the form of loops of various shapes and sizes, namely: between the cutaneous-fascia branches of the femoral and ilioinguinal nerves and the femoral and obturator nerves.


Assuntos
Nervo Femoral , Plexo Lombossacral , Feto , Humanos , Pele , Coxa da Perna
3.
Bone Joint J ; 103-B(4): 659-664, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33789480

RESUMO

AIMS: Injury to the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) performed using the anterior approach, reported to occur in between 1.5% and 65% of cases. In this study, we performed a prospective study on the incidence of LFCN injury as well as its clinical outcomes based on the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). METHODS: The study included 42 consecutive hips in 42 patients (three male and 39 female) who underwent PAO from May 2016 to July 2018. We prospectively evaluated the incidence of LFCN injury at ten days, three months, six months, and one year postoperatively. We also evaluated the clinical scores, including the HHS, SF-36, and JHEQ scores, at one year postoperatively. RESULTS: LFCN injury was observed in 31 of 42 (74%) patients at ten days, of which 11 resolved completely by one year. Incidence decreased gradually, to 25 of 42 (60%) patients at three months, 24 of 42 patients (57%) at six months, and 20 of 42 (48%) patients at one year postoperatively. There was no significant difference in the HHS between patients with and without LFCN injury at one year postoperatively. Regarding the SF-36 and JHEQ, a significant difference in the mental score was recognized between patients with and without LFCN injury, but there were no significant differences in the other clinical scores. CONCLUSION: The incidence of LFCN injury was 74% at ten days after PAO, and subsequently decreased to 48% at one year. LFCN injury did not influence the hip function as assessed by the HHS, but had a negative impact on mental health at one year. Cite this article: Bone Joint J 2021;103-B(4):659-664.


Assuntos
Acetábulo/cirurgia , Nervo Femoral/lesões , Osteotomia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários
4.
A A Pract ; 15(4): e01434, 2021 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-33783374

Assuntos
Nervo Femoral , Humanos
6.
Medicine (Baltimore) ; 100(3): e23978, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545983

RESUMO

BACKGROUND AND PURPOSE: Medial compartment femoro-tibial osteoarthritis (OA) is a common disease and opening-wedge high tibial osteotomy (OWHTO) is the common surgical procedure carried out for these patients. While most researchers are focusing on the surgical techniques during operation, the aim of this study is to evaluate the pain control effect of femoral nerve block (FNB) for OWHTO patients. METHODS: In this prospective, single-center, randomized controlled trial (RCT) study, 41 patients were operated on by OWHTO for OA during 2017 to 2018. Twenty of them (group A) accepted epidural anesthesia with FNB and 21 patients (group B) only had their single epidural anesthesia. All blocks were successful and all the 41 patients recruited were included in the analysis and there was no loss to follow-up or withdrawal. Systematic records of visual analog scores (VAS), quadriceps strength, mean number of times of patient-controlled intravenous analgesia (PCIA), using of additional opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), and complications were done after hospitalization. The Student t test and Chi-Squared test was used and all P values ≤.05 were considered statistically significant. RESULTS: VAS scores at rest (3.48 ±â€Š1.0 vs 4.68 ±â€Š1.1) and on movemment (4.51 ±â€Š0.6 vs 4.97 ±â€Š0.8) decreased more in group A than group B with significance at follow-up of 12 hours. The quadriceps strength, consumption of additional opioids or NSAID injections and mean number of times that the patients pushed the PCIA button didnot differ significantly within each group. CONCLUSION: This RCT study shows that FNB in patients undergoing OWHTO for unicompartmental osteoarthritis of the knee could result in significant reduction in VAS scores at 12 hours postoperatively.Research registry, Researchregistry4792. Registered April 7, 2019 - Retrospectively registered, http://www.researchregistry.com.


Assuntos
Nervo Femoral/efeitos dos fármacos , Bloqueio Nervoso/normas , Manejo da Dor/normas , Tíbia/cirurgia , Feminino , Nervo Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Bloqueio Nervoso/estatística & dados numéricos , Osteotomia/efeitos adversos , Osteotomia/métodos , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Estudos Prospectivos , Tíbia/efeitos dos fármacos
7.
Medicine (Baltimore) ; 100(3): e23895, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545958

RESUMO

BACKGROUND: Several previous trials have attempted to compare the efficacy of femoral nerve block (FNB) and local infiltrative analgesia (LIA) for patients received anterior cruciate ligament (ACL) reconstruction, but reached inconsistent conclusions. The primary purpose of this present research was to compare the FNB and LIA in the reconstruction of ACL. METHODS: This investigation was conducted and then reported on the basis of Strengthening the Reporting of Observational studies in the Epidemiology checklist. From our registry database, we retrospectively determined 688 patients who received the primary reconstruction of ACL from 2016 to 2019 at our academic institutions. This current retrospective cohort study was approved through the institutional review committee at our hospital. Inclusion criteria contained the primary or autograft bone-patellar tendine-bone reconstruction of ACL in the patients over 16 years of age. Patients in the LIA group underwent intraoperative infiltration at the harvested site after tendon harvest, with use of 2 mg/mL of ropivacaine 20 mL and 5 mg/mL of epinephrine, respectively. After the reconstruction of ACL, 5 Lg/mL of epinephrine, and 20 mL of ropivacaine (2 mg/mL) were injected at the site of surgical trauma. The patient in FNB group was given 40 mL of ropivacaine (2 mg/mL), and the ropivacaine was injected into femoral nerve sheath at femoral triangle level. The primary outcome was the consumption of morphine 24 h after the operation. And the secondary results involved the complications, functional results, and the scores of pain. RESULTS: It is assumed that the efficacy of LIA in the early postoperative pain is no less than that of FNB. For our study, the major limitation is the lack of randomization. Nevertheless, these data were prospectively harvested, with high response rate of patient. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6277).


Assuntos
Analgésicos/uso terapêutico , Reconstrução do Ligamento Cruzado Anterior , Bloqueio Nervoso , Dor Pós-Operatória/prevenção & controle , Analgésicos/administração & dosagem , Nervo Femoral , Humanos , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento
8.
BMC Surg ; 21(1): 30, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413245

RESUMO

BACKGROUND: A hibernoma, also known as a brown fat tumor, is a rare benign soft tissue tumor, which originates from brown adipose tissue remaining in the fetus after the gestational period. It is often detected in adult men, presenting as a painless slow-growing mass. Hibernomas of the thigh have been reported; however, motor and sensory disorders caused by the tumors compressing the femoral nerve have not been reported. We report a case of a histopathologically proven hibernoma that induced femoral mononeuropathy. CASE PRESENTATION: A 26-year-old man was admitted to the hospital due to a mass, approximately 11.0 × 9.0 × 4.0 cm in size, that had developed 5 years ago in the anterolateral aspect of the proximal thigh. Furthermore, he had a history of hypoesthesia 1 month prior to his admission. He had signs and symptoms of both a motor and sensory disorder, involving the anterior aspect of the right thigh and the medial aspect of the calf, along the distribution of the femoral nerve. During surgery, the femoral nerve was found to be compressed by the giant tumor. The resultant symptoms probably caused the patient to seek medical care. Marginal resection of the mass was performed by careful dissection, and the branches of the femoral nerve were spared. Histopathology examination showed findings suggestive of a hibernoma. At the 4-month follow-up, no femoral nerve compression was evident, and local tumor recurrence or metastasis was not found. CONCLUSIONS: Asymptomatic hibernomas do not require treatment; however, in cases of hibernomas with apparent symptoms, complete marginal surgical excision at an early stage is a treatment option because it is associated with a low risk of postoperative tumor recurrence.


Assuntos
Nervo Femoral/cirurgia , Neuropatia Femoral/diagnóstico por imagem , Neuropatia Femoral/cirurgia , Lipoma/complicações , Lipoma/patologia , Adulto , Neuropatia Femoral/etiologia , Neuropatia Femoral/patologia , Humanos , Lipoma/diagnóstico , Lipoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia , Coxa da Perna , Resultado do Tratamento , Ultrassonografia Doppler em Cores
9.
Sci Rep ; 10(1): 21859, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33318589

RESUMO

Supra inguinal fascia iliaca compartment block (FICB) is increasingly used in elderly patients with hip fractures. However, the minimum effective volume of local anesthetics required for ultrasound-guided supra-inguinal FICB has not been determined. With ethical committee approval and written informed consent from patients, we studied 21 consecutive patients of ASA physical status I-III undergoing surgery for hip fracture who met the inclusion criteria. Blocks were performed before going to the operation room. We determined the injection volumes of 0.25% ropivacaine for consecutive patients from the preceding patient's outcome. The initial volume was 30 ml. The testing interval was set at 10 ml, and the lowest volume was 5 ml. An effective block was defined as loss of sensation of pinprick in the territory of the femoral nerve and lateral cutaneous nerve of the thigh 30 min after the injection. The aim of this study was to determine the 50% effective volume (EV50) and the 95% effective volume (EV95) of 0.25% ropivacaine for ultrasound-guided supra-inguinal FICB using Logistic regression analysis. EV50 and EV95 of 0.25% ropivacaine for ultrasound-guided supra-inguinal FICB calculated with logistic regression analysis were 15.01 ml (95% confidence interval, 6.53-22.99 ml) and 26.99 ml (95% confidence interval, 20.54-84.09 ml), respectively. EV50 and EV95 of 0.25% ropivacaine for ultrasound-guided supra-inguinal FICB were 15.01 ml and 26.99 ml, respectively.Clinical trial number: UMIN000027277 (URL https://www.umin.ac.jp/ctr/index-j.htm ).


Assuntos
Anestésicos Locais , Fraturas do Quadril , Bloqueio Nervoso , Ropivacaina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Fáscia/diagnóstico por imagem , Feminino , Nervo Femoral/diagnóstico por imagem , Nervo Femoral/cirurgia , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia de Intervenção
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 6074-6077, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019356

RESUMO

The femoral nerve blockage is a procedure that aims to provide anesthesia to the hip, anterior thigh, and stifle. This procedure presents several challenges when performed in veterinary patients with diverse anatomy and physiology. Successful use of this technique will improve a dog's recovery time after surgery in comparison to the commonly used epidural block. A mixed reality application to guide practitioners in the femoral nerve block procedure was developed in Unity and Visual Studio. A 3D model for use within the application was created from pictures of a cadaver leg using photogrammetry software. The Microsoft HoloLens headset provides the mixed reality hardware platform. This paper presents the workflow used in developing the mixed reality application and custom 3D model, as well as initial results with respect to the utility of the application in guiding an anesthesiologist in the procedure of the femoral nerve block.


Assuntos
Anestesia Epidural , Bloqueio Nervoso , Animais , Realidade Aumentada , Cães , Nervo Femoral , Humanos , Injeções
11.
Medicine (Baltimore) ; 99(43): e22667, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120758

RESUMO

BACKGROUND: Total knee arthroplasty is accompanied by moderate to severe postoperative pain. Postoperative pain hampers the functional recovery and lowers patient satisfaction with the surgery. Recently, the adductor canal block (ACB) has been widely used in total knee arthroplasty. However, there is no definite answer as to the location of a continuous block within the ACBs. METHOD: Randomized controlled trials about relevant studies were searched in PubMed (1996 to Oct 2019), Embase (1996 to Oct 2019), and Cochrane Library (CENTRAL, Oct 2019). RESULTS: Five studies involving 348 patients met the inclusion criteria. Pooled data indicated that the proximal ACB was as effective as the distal ACB in terms of total opioid consumption (P = .54), average visual analog scale (VAS) score (P = .35), worst VAS score (P = .19), block success rate (P = .86), and time of catheter insertion (P = .54). CONCLUSIONS: Compared with the distal ACB, the proximal ACB showed similar analgesic efficacy for total opioid consumption, average VAS score, worst VAS score, block success rate, and time of catheter insertion. However, because of the limited number of involved studies, more high-quality studies are needed to further identify the optimal location of the ACB.


Assuntos
Artroplastia do Joelho/métodos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Analgésicos Opioides/administração & dosagem , Feminino , Nervo Femoral , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
Medicine (Baltimore) ; 99(43): e22762, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120783

RESUMO

BACKGROUND: Adductor canal block (ACB) has emerged as an attractive alternative for femoral nerve blocks (FNB) as the peripheral nerve block of choice for total knee arthroplasty (TKA), preserving quadriceps motor function while providing analgesia comparable to FNB. However, its optimal application for TKA remains controversial. The objective of this meta-analysis was to compare continuous-injection ACB (CACB) vs single-injection ACB (SACB) for postoperative pain control in patients undergoing TKA. METHODS: This study attempts to identify the available and relevant randomized controlled trials (RCTs) regarding the analgesic effects of CACB compared to SACB in patients undergoing TKA according to electronic databases, including PubMed, Medline, Web of Science, EMbase, and the Cochrane Library, up to September 2019. Primary outcomes in this regard included the use of a visual analogue scale (VAS) pain score with rest or activity, while secondary outcomes were cumulative opioid consumption, length of hospital stay (LOS), complications of vomiting and nausea, and rescue analgesia. The corresponding data were analyzed using RevMan v5.3. ETHICAL REVIEW: Because all of the data used in this systematic review and meta-analysis has been published, the ethical approval was not necessary RESULTS:: This research included 9 studies comprised of 739 patients. The analyzed outcomes demonstrated that patients who received CACB had a better at rest-VAS scores at 4 hours (P = .007), 8 hors (P < .0001), 12 hours (P < .0001), 24 hours (P = .02), mobilization-VAS score at 48 hours (P < .0001), and rescue analgesia (P = .03) than those who underwent SACB. Nevertheless, no significant differences were present between the 2 strategies in terms of pain VAS scores 48 hours at rest (P = .23) and 24 hours at mobilization (P = .10), complications of vomiting and nausea (P = .42), and length of hospital stay (P = .09). CONCLUSION: This meta-analysis indicated that CACB is superior to SACB in regard to analgesic effect following TKA. However, due to the variation of the included studies, no firm conclusions can be drawn. Further investigations into RCT are required for verification.


Assuntos
Analgesia/métodos , Artroplastia do Joelho , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Nervo Femoral , Humanos , Injeções , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(37): e21956, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925729

RESUMO

BACKGROUND: Several studies reported short-term analgesic efficacy of obturator nerve block (ONB), as in comparison with the femoral nerve block (FNB) in the treatment of postoperative pain after the total knee replacement (TKR). The optimal method remains under debate. The purpose of our current work is to compare the safety and efficacy of FNB and ONB for postoperative analgesia after TKR. METHODS: This prospective, randomized, and controlled study was performed from January 2018 to December 2019. It was authorized via the Institutional Review Committee in NO.971 Hospital of the People's Liberation Army Navy (2019-PLAN-132).Two hundred patients were divided randomly into 2 groups, the control group (n = 100) and study group (n = 100). The experimental group received FNB and control groups received ONB. Primary outcome included pain at different time point (Visual Analogue Scale score of anterior knee pain at rest and in motion). The Visual Analogue Scale scores were marked by patients themselves on a paper with a graduated line starting at 0 (no pain) and ending at 10 (the most painful). Opioid consumption was converted to equivalents of oral morphine uniformly for statistical analysis. Secondary outcomes included the knee range of motion, the hospital stay length as well as the postoperative complications such as pulmonary embolism and deep vein thrombosis. RESULTS: Table 1 will show the clinical outcomes between the 2 groups. CONCLUSION: This trial would provide an evidence for the use of different types of peripheral nerve blocks in TKR.


Assuntos
Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Administração Oral , Analgésicos Opioides/administração & dosagem , Nervo Femoral , Humanos , Pessoa de Meia-Idade , Morfina/administração & dosagem , Debilidade Muscular/etiologia , Bloqueio Nervoso/efeitos adversos , Nervo Obturador , Manejo da Dor/métodos , Medição da Dor , Complicações Pós-Operatórias , Estudos Prospectivos , Músculo Quadríceps
15.
Medicine (Baltimore) ; 99(28): e20776, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664070

RESUMO

BACKGROUND: Femoral nerve block (FNB) is considered the preferred analgesia after anterior cruciate ligament reconstruction (ACLR), but leads to weakness in the quadriceps muscles. Adductor canal block (ACB) is a new sensory block technique that effectively relieves postoperative pain while preserving quadriceps strength. The purpose of our study was to compare the efficacy of FNB vs ACB for pain control after ACLR. METHODS: This prospective, randomized, double-blind, controlled, superiority clinical trial was approved by the institutional review board in our university hospital. We enrolled 120 patients set to undergo ACLR in this randomized therapeutic trial. Sixty patients received FNB and the other 60 received ACB for postoperative pain control. All ACB and FNB were performed using ultrasound-guided single-shot procedures. The primary outcomes included maximum voluntary isovolumetric contraction and postoperative pain score. Secondary outcomes included total opioid consumption, length of hospital stay, complication, and satisfaction score. RESULTS: This clinical trial might provide some insights to estimate and compare the safety and efficacy of ACB vs FNB following ACLR. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5569).


Assuntos
Analgesia/métodos , Reconstrução do Ligamento Cruzado Anterior , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Anestesia Geral , Nervo Femoral , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica
16.
Pain Physician ; 23(4): E363-E368, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709182

RESUMO

BACKGROUND: Ultrasound-guided perineural injections at the lateral femoral cutaneous nerve (LFCN) may confirm the correct diagnosis and provide symptom relief in meralgia paresthetica. Although correct visualization of the nerve is generally described as feasible, failure rates of the procedure may be as high as 30%. OBJECTIVES: This study investigated the spread of injected fluids in ultrasound-guided perineural injections at the LFCN. The aim of the study was to evaluate whether the inguinal ligament impedes the distribution of injected fluids along the course of the LFCN. STUDY DESIGN: We used a descriptive research design. SETTING: Research was conducted at an anatomical research facility. METHODS: In fresh, nonembalmed cadavers, 2 mL of ink were injected with ultrasound-guidance at the LFCN below the inguinal ligament. The course of the nerve was then dissected to show the extent of nerve staining. RESULTS: Spread of the injected ink proximal to the inguinal ligament was found in 67.65% of specimens, while the ink did not pass the inguinal ligament in 32.35%. Concerning proximal spread, specimen body mass index was not of any relevance. LIMITATIONS: This cadaver study is only a simulation of the real clinical setting and does not allow any insight into the efficacy of the injection in living patients. CONCLUSIONS: The inguinal ligament is a barrier in the distribution of injected fluids in about one-third of specimens. This might be a major cause of failure in ultrasound-guided injections. The results from our study are in line with previously published failure rates and our findings might provide the anatomic basis to advance injection techniques. KEY WORDS: Cadaver study; injection; lateral femoral cutaneous nerve; LFCN; meralgia paresthetica; nerve entrapment; sonography; ultrasound.


Assuntos
Nervo Femoral/diagnóstico por imagem , Tinta , Ligamentos/diagnóstico por imagem , Síndromes de Compressão Nervosa/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Nervo Femoral/patologia , Neuropatia Femoral/diagnóstico por imagem , Neuropatia Femoral/patologia , Humanos , Injeções , Ligamentos/patologia , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/patologia , Coxa da Perna/diagnóstico por imagem , Coxa da Perna/inervação
17.
BMC Surg ; 20(1): 123, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32517752

RESUMO

BACKGROUND: Giant inguinal hernia(GIH), a rare disease, has brought great challenges to surgeons. GIH is defined as an inguinal hernia that extends below the midpoint of the inner thigh in standing position. However, a giant recurrent inguinal hernia resulting from previous operations that destroy the anatomical structure of the inguinal region is extremely rare. Nerve injury, a complication following inguinal hernia repair, is mostly found in ilioinguinal nerve and iliohypogastric nerve, which often presents as numbness and acute or chronic pain, while postoperative muscular dysfunction results from femoral nerve injury is rare. CASE PRESENTATION: A 77-years-old woman presented with a complaint of a reducible mass in the left inguinal of duration 1 year. The patient had three previous inguinal hernia repairs. Physical examination and auxiliary examination indicated a giant inguinal hernia with femoral nerve injury. After preoperative evaluation and preparation, a transabdominal partial extraperitoneal(TAPE) repair have performed. Finally, the patient recovered and was discharged. CONCLUSIONS: In conclusion, we reported a rare case of a giant recurrent inguinal hernia with femoral nerve injury and made a successful treatment for the patient via transabdominal partial extraperitoneal(TAPE) repair.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Traumatismos dos Nervos Periféricos/cirurgia , Idoso , Feminino , Nervo Femoral/cirurgia , Virilha/cirurgia , Humanos
18.
Zhongguo Gu Shang ; 33(4): 363-7, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32351092

RESUMO

OBJECTIVE: To evaluate the effect of femoral and sciatic nerve block in total knee replacement of elderly patients under general anesthesia. METHODS: From July 2017 to July 2019, 60 patients with unilateral total knee replacement were selected, including 35 males and 25 females; aged 66 to 74(70.2±10.3) years;BMI 18 to 25 (21.3 ± 3.5) kg /m2;course 2 to 3 (1.2±0.3) days. The patients were divided into general anesthesia group (G group) 30 cases and general anesthesia plus nerve block group(GNB group) 30 cases. In GNB group, the femoral nerve sciatic nerve block was guided by ultrasound before anesthesia induction, 20 to 25 ml was injected into the femoral nerve puncture point with 0.5% ropivacaine, 15 to 20 ml was injected into the sciaticnerve puncture point, and the total volume was no more than 40 ml. Postoperative intravenous analgesia (PCIA) was performed in two groups. The dosage of propofol and remifentanil was recorded. Forty-eight hours after operation, the incidence of postoperative nausea and vomiting (PONV) and postoperative farsightedness were recorded. When VAS>3, tramadol 2 mg / kg was injected intravenously, and the additional times of tramadol were recorded. Forty-eight hours after operation, patients' satisfaction score was used to record the length of stay. RESULTS: Compared with group G, the dosage of propofol and remifentanil decreased, the incidence of PONV and the number of additional tramadol decreased, and the patients' satisfaction increased (P<0.05). There was no significant difference in the length of stay between two groups (P>0.05). The ROM and HSS scores of two groups after treatment were higher than those before treatment (P<0.05), and the VAS scores were lower than those before treatment (P<0.05). There was no significantdifference in ROM, VAS scores and HSS scores between two groups before treatment (P>0.05). The ROM and HSS scores of the GNB group after treatment were higher than those of the G group (P<0.05), and the VAS scores were lower than those of the G group (P<0.05). CONCLUSION: The application of femoral sciatic nerve block in total knee replacement under general anesthesia in elderly patients has good postoperative analgesic effect, and can reduce the dosage of general anesthesia, reduce PONV, and increase patient satisfaction.


Assuntos
Artroplastia do Joelho , Bloqueio Nervoso , Idoso , Anestesia Geral , Feminino , Nervo Femoral , Humanos , Masculino , Dor Pós-Operatória , Nervo Isquiático
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