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Sample records for obturator nerve block

  1. Ultrasound Guided Obturator Versus Sciatic Nerve Block in Addition to Continuous Femoral Nerve Block for Analgesia After Total Knee Arthroplasty

    OpenAIRE

    Keita Sato; Seijyu Sai; Naoto Shirai; Takehiko Adachi

    2011-01-01

    Both obturator and sciatic nerve block in combination with femoral nerve block (FNB) have been suggested to be useful in relieving pain after total knee arthroplasty (TKA), compared with FNB alone. We compared their efficacy in this retrospective study. For six consecutive months, patients undergoing unilateral TKA under general anesthesia with continuous FNB plus obturator nerve block (n = 8) or continuous FNB plus sciatic nerve block (n = 8) were investigated. Knee pain was assessed using v...

  2. Efficacy of ultrasound-guided obturator nerve block in transurethral surgery

    Directory of Open Access Journals (Sweden)

    Thallaj Ahmed

    2011-01-01

    Full Text Available Background: During transurethral resection surgery (TUR, accidental stimulation of the obturator nerve can cause violent adductor contraction, leading to serious intraoperative complications. General anesthesia with muscle relaxation is currently the preferred technique for TUR surgery. Spinal anesthesia combined with obturator nerve block has also been used for TUR surgery in geriatric population. Blind, anatomical methods for identifying the obturator nerve are often unsatisfactory. Therefore, we conducted this prospective study to validate the efficacy of ultrasound-guided obturator nerve block (USONB during TUR procedures. Methods: Eighteen male patients undergoing TURP surgery under spinal anesthesia were included in the study. Bilateral USONB with maximum 20 ml of 1% lidocaine per patient was performed. An independent observer was present to monitor any adduction movements during the operation and to record patient and surgeon satisfactions. Results: In all patients, obturator nerve was visualized from the first attempt, requiring an average of 4.3 min for blocking of each side. USONB was successful (97.2% in preventing an adductor spasm in all except one patient. Patient?s and surgeon?s satisfaction were appropriate. In all patients, adductor muscle strength recovered fully within 2 h following the surgical procedure. Conclusions: USONB is safe and effective during TUR surgery. It provides optimal intra-and postoperative conditions.

  3. A new ultrasound-guided pubic approach for proximal obturator nerve block: clinical study and cadaver evaluation.

    Science.gov (United States)

    Yoshida, T; Onishi, T; Furutani, K; Baba, H

    2016-03-01

    We evaluated an alternative technique for ultrasound-guided proximal level obturator nerve block that might facilitate needle visualisation using in-plane ultrasound guidance. Twenty patients undergoing transurethral bladder tumour resection requiring an obturator nerve block were enrolled into a prospective observational study. With the patient in the lithotomy position, the transducer was placed on the medial thigh along the extended line of the inguinal crease, and aimed cephalad to view a thick fascia between the pectineus and obturator externus muscles that contains the obturator nerve. A stimulating nerve block needle was inserted at the pubic region and advanced in-plane with the transducer in an anterior-to-posterior direction. Eight ml levobupivacaine 0.75% was injected within the fascia. The median (IQR [range]) duration for ultrasound identification of the target and injection were 8.5 (7-12 [5-24]) s and 62 (44.5-78.25 [39-383]) s, respectively. All blocks were successful. A cadaver evaluation demonstrated that the dye injected into the target fascia using our technique travelled retrogradely through the obturator canal, and surrounded the anterior and posterior branches of the obturator nerve both proximally and distally to the obturator canal. We believe that this is a promising new technique for ultrasound-guided proximal level obturator nerve block. PMID:26620274

  4. OBTURATOR NERVE BLOCK WITH SUB ARACHANOID BLOCK FOR A CASE OF COPD WITH COR PULMONALE UNDERGOING TURP AND TURBT

    OpenAIRE

    Basireddy Hariprasad; Kailash; Venkat

    2015-01-01

    Choosing safe and viable anesthetic technique is pivotal role for anesthesiologist. It depends Age, preexisting systemic diseases and Type of surgery. In this case report we have chosen obturator nerve block with sub arachnoid block for a case of COPD with cor pulmonale undergoing TURP and TURBT as an alternative to general anesthesia t...

  5. OBTURATOR NERVE BLOCK WITH SUB ARACHANOID BLOCK FOR A CASE OF COPD WITH COR PULMONALE UNDERGOING TURP AND TURBT

    Directory of Open Access Journals (Sweden)

    Basireddy Hariprasad

    2015-05-01

    Full Text Available Choosing safe and viable anesthetic technique is pivotal role for anesthesiologist. It depends Age, preexisting systemic diseases and Type of surgery. In this case report we have chosen obturator nerve block with sub arachnoid block for a case of COPD with cor pulmonale undergoing TURP and TURBT as an alternative to general anesthesia to avoid the perioperative Anesthetic complications of a patient with COPD and Cor pulmonale

  6. Neurolytic blockade of the obturator nerve in the treatment of idiopatic obturator neuralgia

    Directory of Open Access Journals (Sweden)

    ?ulafi? Slobodan

    2008-01-01

    Full Text Available Introduction. Idiopathic obturator neuralgia is a rare chronic pain condition. It consists of pain radiating from the obturator nerve territory to the inner thigh. However, the symptomatic obturator neuralgia is commonly caused by the obturator canal bowel hernia that causes painful compressive neuropathy in more than 85% of the cases. Case report. A 61-year-old female who underwent right femoral amputation due to the occlusion of the aortofemoral vascular graft, complained of the pain characterized by its localization in the inguinal region and anterointernal side of the right inner thigh. Computer tomography and MRI findings excluded obturator canal herniation or lumbar plexopathy. A diagnosis of the obturator neuralgia was confirmed by an analgesic block of the obturator nerve. Thereafter, the neurolitic blockade of the right obturator nerve was done. The complete pain relief was achieved. Pain relief was complete in three-month follow-up period. Conclusion. Neurolitic blockade is an efficacious method in treating chronic pain caused by the idiopathic obturator neuralgia.

  7. Ectopic pregnancy presenting with obturator nerve pain.

    OpenAIRE

    Ali, H S

    1998-01-01

    A 27 year old woman had a three day history of pain in the cutaneous distribution of the left obturator nerve before she developed the classical picture of ectopic pregnancy with lower abdominal pain and vaginal bleeding. A left tubal pregnancy was subsequently confirmed by laparoscopy. Referred pain along the obturator nerve has been reported in other pelvic conditions, but has not previously been reported as a manifestation of ectopic pregnancy. Ectopic pregnancy may present with a very wid...

  8. The role of succinylcholine in the prevention of the obturator nerve reflex during transurethral resection of bladder tumors

    International Nuclear Information System (INIS)

    Objective was to present our 8 year experience in the prevention of the obturator nerve reflex during transurethral resection of bladder tumors. This study was performed in Ataturk University Hospital between 1999 and 2007. We retrospectively reviewed the records of 89 patients with inferolateral bladder tumors, who underwent transurethral resection under epidural or general anesthesia and requested obturator nerve reflex inhibition. Epidural anesthesia was administered to 57 patients, while the remaining 32 patients underwent general anesthesia via mask; and succinylcholine was administered prior to resection. Of the 57 patients received epidural anesthesia, 18 were diagnosed as inferolateral bladder tumors during endoscopy and had to undergo general anesthesia. Obturator nerve block was attempted preoperatively in 39 patients. However, a nerve identification failure, hematoma and 4 obturator nerve reflex events, despite the block, were observed and these patients were subjected to general anesthesia with succinylcholine. Fifty-six patients (32 patients initially had general anesthesia and 24 converted from epidural to general anesthesia) were all given succinylcholine prior to resection. Due to its mechanisms of action, succinylcholine is completely effective and represents a simple alternative to obturator nerve block. No contraction was observed in any patient given succinylcholine. (author)

  9. Femoral and obturator nerves palsy caused by pelvic cement extrusion after hip arthroplasty.

    Directory of Open Access Journals (Sweden)

    Pawel Zwolak

    2011-05-01

    Full Text Available Cement extrusion into the pelvis with subsequent palsy of the obturator and femoral nerves is a rare entity after hip replacement surgery. Cemented fixation of the acetabular cup has been considered as a safe and reliable standard procedure with very good long term results. We present a case of fifty year old female patient after hip arthroplasty procedure which suffered an obturator and femoral nerve palsy caused by extrusion of bone cement into the pelvis. Postoperative X-rays and CT-scan of the pelvis demonstrated a huge mass consisted of bone cement in close proximity of femoral and obturator nerves. The surgery charts reported shallow and weak bony substance in postero-superior aspect of the acetabulum. This weak bony acetabular substance may have caused extrusion of bone cement during press-fitting of the polyethylene cup into the acetabulum, and the following damage of the both nerves produced by polymerization of bone cement. The bone cement fragment has been surgically removed 3 weeks after arthroplasty. The female patient underwent intensive postoperative physical therapy and electro stimulation which resulted in full recovery of the patient to daily routine and almost normal electromyography results.

  10. Magnetic resonance neurography-guided nerve blocks for the diagnosis and treatment of chronic pelvic pain syndrome.

    Science.gov (United States)

    Fritz, Jan; Chhabra, Avneesh; Wang, Kenneth C; Carrino, John A

    2014-02-01

    Magnetic resonance (MR) neurography - guided nerve blocks and injections describe a techniques for selective percutaneous drug delivery, in which limited MR neurography and interventional MR imaging are used jointly to map and target specific pelvic nerves or muscles, navigate needles to the target, visualize the injected drug and detect spread to confounding structures. The procedures described, specifically include nerve blocks of the obturator nerve, lateral femoral cutaneous nerve, pudendal nerve, posterior femoral cutaneous nerve, sciatic nerve, ganglion impar, sacral spinal nerve, and injection into the piriformis muscle. PMID:24210321

  11. A randomised controlled trial of ultrasound-guided blockade of the saphenous nerve and the posterior branch of the obturator nerve for postoperative analgesia after day-case knee arthroscopy

    DEFF Research Database (Denmark)

    Westergaard, B; Jensen, K

    2014-01-01

    The purpose of this study was to investigate the effects of blockade of the saphenous nerve and the posterior branch of the obturator nerve in addition to a standard analgesic regimen for patients discharged the same day after knee arthroscopy. The primary outcome was knee pain on flexion during the first 24 postoperative hours, calculated as area under the curve. We allocated 60 patients to ultrasound-guided nerve blocks with either ropivacaine or saline, 30 to each. The median (IQR [range]) pain score on knee flexion in the ropivacaine group 2.0 (1.1-3.7 [0.1-7.1]) was not statistically different to that in the saline group (3.3 (1.7-4.6 [0.3-6.8]), p = 0.06). There were no differences in pain at rest, opioid consumption or function.

  12. Continuous axillary nerve block for chronic pain.

    OpenAIRE

    Fewtrell, M S; Sapsford, D J; Herrick, M J; Noble-Jamieson, G; Russell, R. I.

    1994-01-01

    Continuous axillary nerve block was used to relieve pain after a chemical burn to the arm in a child on mechanical ventilation after liver transplantation. The analgesia was sufficient to replace parenteral analgesia and allow extubation.

  13. Combined KHFAC + DC nerve block without onset or reduced nerve conductivity after block

    Science.gov (United States)

    Franke, Manfred; Vrabec, Tina; Wainright, Jesse; Bhadra, Niloy; Bhadra, Narendra; Kilgore, Kevin

    2014-10-01

    Objective. Kilohertz frequency alternating current (KHFAC) waveforms have been shown to provide peripheral nerve conductivity block in many acute and chronic animal models. KHFAC nerve block could be used to address multiple disorders caused by neural over-activity, including blocking pain and spasticity. However, one drawback of KHFAC block is a transient activation of nerve fibers during the initiation of the nerve block, called the onset response. The objective of this study is to evaluate the feasibility of using charge balanced direct current (CBDC) waveforms to temporarily block motor nerve conductivity distally to the KHFAC electrodes to mitigate the block onset-response. Approach. A total of eight animals were used in this study. A set of four animals were used to assess feasibility and reproducibility of a combined KHFAC + CBDC block. A following randomized study, conducted on a second set of four animals, compared the onset response resulting from KHFAC alone and combined KHFAC + CBDC waveforms. To quantify the onset, peak forces and the force-time integral were measured during KHFAC block initiation. Nerve conductivity was monitored throughout the study by comparing muscle twitch forces evoked by supra-maximal stimulation proximal and distal to the block electrodes. Each animal of the randomized study received at least 300 s (range: 318-1563 s) of cumulative dc to investigate the impact of combined KHFAC + CBDC on nerve viability. Main results. The peak onset force was reduced significantly from 20.73 N (range: 18.6-26.5 N) with KHFAC alone to 0.45 N (range: 0.2-0.7 N) with the combined CBDC and KHFAC block waveform (p nerve conductivity was observed after application of the combined KHFAC + CBDC block relative to KHFAC waveforms. Significance. The distal application of CBDC can significantly reduce or even completely prevent the KHFAC onset response without a change in nerve conductivity.

  14. Nerve injury caused by mandibular block analgesia

    DEFF Research Database (Denmark)

    Hillerup, S; Jensen, Rigmor H

    2006-01-01

    Fifty-four injection injuries in 52 patients were caused by mandibular block analgesia affecting the lingual nerve (n=42) and/or the inferior alveolar nerve (n=12). All patients were examined with a standardized test of neurosensory functions. The perception of the following stimuli was assessed: feather light touch, pinprick, sharp/dull discrimination, warm, cold, point location, brush stroke direction, 2-point discrimination and pain perception. Gustation was tested for recognition of sweet, s...

  15. Cost-effectiveness of ultrasound vs nerve stimulation guidance for continuous sciatic nerve block

    DEFF Research Database (Denmark)

    Ehlers, L; Jensen, J M; Bendtsen, T F

    2012-01-01

    This study assessed the cost-effectiveness of ultrasound (US) vs nerve stimulation (NS) guidance for continuous sciatic nerve block in Danish elective patients undergoing major foot and ankle surgery.......This study assessed the cost-effectiveness of ultrasound (US) vs nerve stimulation (NS) guidance for continuous sciatic nerve block in Danish elective patients undergoing major foot and ankle surgery....

  16. Anatomical basis for sciatic nerve block at the knee level

    OpenAIRE

    Fabiano Timbó Barbosa; Tatiana Rosa Bezerra Wanderley Barbosa; Rafael Martins da Cunha; Amanda Karine Barros Rodrigues; Fernando Wagner da Silva Ramos; Célio Fernando de Sousa-Rodrigues

    2015-01-01

    BACKGROUND AND OBJECTIVES: Recently, administration of sciatic nerve block has been revised due to the potential benefit for postoperative analgesia and patient satisfaction after the advent of ultrasound. The aim of this study was to describe the anatomical relations of the sciatic nerve in the popliteal fossa to determine the optimal distance the needle must be positioned in order to realize the sciatic nerve block anterior to its bifurcation into the tibial and common fibular nerve. METHOD...

  17. Direct current electrical conduction block of peripheral nerve.

    Science.gov (United States)

    Bhadra, Niloy; Kilgore, Kevin L

    2004-09-01

    Electrical currents can be used to produce a block of action potential conduction in whole nerves. This block has a rapid onset and reversal. The mechanism of electrical nerve conduction block has not been conclusively determined, and inconsistencies appear in the literature regarding whether the block is produced by membrane hyperpolarization, depolarization, or through some other means. We have used simulations in a nerve membrane model, coupled with in vivo experiments, to identify the mechanism and principles of electrical conduction block. A nerve simulation package (Neuron) was used to model direct current (dc) block in squid, frog, and mammalian neuron models. A frog sciatic nerve/gastrocnemius preparation was used to examine nerve conduction block in vivo. Both simulations and experiments confirm that depolarization block requires less current than hyperpolarization block. Dynamic simulations suggest that block can occur under both the real physical electrode as well as adjacent virtual electrode sites. A hypothesis is presented which formulates the likely types of dc block and the possible block current requirements. The results indicate that electrical currents generally produce a conduction block due to depolarization of the nerve membrane, resulting in an inactivation of the sodium channels. PMID:15473193

  18. Cost-effectiveness of ultrasound vs nerve stimulation guidance for continuous sciatic nerve block

    DEFF Research Database (Denmark)

    Ehlers, L; Jensen, J M

    2012-01-01

    This study assessed the cost-effectiveness of ultrasound (US) vs nerve stimulation (NS) guidance for continuous sciatic nerve block in Danish elective patients undergoing major foot and ankle surgery.

  19. Different clinical electrodes achieve similar electrical nerve conduction block

    Science.gov (United States)

    Boger, Adam; Bhadra, Narendra; Gustafson, Kenneth J.

    2013-10-01

    Objective. We aim to evaluate the suitability of four electrodes previously used in clinical experiments for peripheral nerve electrical block applications. Approach. We evaluated peripheral nerve electrical block using three such clinical nerve cuff electrodes (the Huntington helix, the Case self-sizing Spiral and the flat interface nerve electrode) and one clinical intramuscular electrode (the Memberg electrode) in five cats. Amplitude thresholds for the block using 12 or 25 kHz voltage-controlled stimulation, onset response, and stimulation thresholds before and after block testing were determined. Main results. Complete nerve block was achieved reliably and the onset response to blocking stimulation was similar for all electrodes. Amplitude thresholds for the block were lowest for the Case Spiral electrode (4 ± 1 Vpp) and lower for the nerve cuff electrodes (7 ± 3 Vpp) than for the intramuscular electrode (26 ± 10 Vpp). A minor elevation in stimulation threshold and reduction in stimulus-evoked urethral pressure was observed during testing, but the effect was temporary and did not vary between electrodes. Significance. Multiple clinical electrodes appear suitable for neuroprostheses using peripheral nerve electrical block. The freedom to choose electrodes based on secondary criteria such as ease of implantation or cost should ease translation of electrical nerve block to clinical practice.

  20. Nerve Block Technique Might Help Ease Chronic Back Pain

    Science.gov (United States)

    ... html Nerve Block Technique Might Help Ease Chronic Back Pain Small study found half of patients still getting ... that uses radio waves to treat chronic low back pain provided long-lasting relief to a small group ...

  1. Sciatic nerve block performed with nerve stimulation technique in an amputee a case study

    DEFF Research Database (Denmark)

    Heiring, C.; Kristensen, Billy

    2008-01-01

    We present a case of a sciatic nerve block performed with the nerve stimulation technique. This technique is normally not used in amputees because detection of a motor response to an electrical stimulation is impossible. In our patient the stimulation provoked a phantom sensation of movement in the...

  2. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty

    DEFF Research Database (Denmark)

    Jaeger, Pia; Zaric, Dusanka; Fomsgaard, Jonna Storm; Hilsted, Karen Lisa; Bjerregaard, Jens; Gyrn, Jens; Mathiesen, Ole; Larsen, Tommy; Dahl, J?rgen Berg

    2013-01-01

    Femoral nerve block (FNB), a commonly used postoperative pain treatment after total knee arthroplasty (TKA), reduces quadriceps muscle strength essential for mobilization. In contrast, adductor canal block (ACB) is predominately a sensory nerve block. We hypothesized that ACB preserves quadriceps...... muscle strength as compared with FNB (primary end point) in patients after TKA. Secondary end points were effects on morphine consumption, pain, adductor muscle strength, morphine-related complications, and mobilization ability....

  3. Bupivacaine and ropivacaine: comparative effects on nerve conduction block.

    Science.gov (United States)

    Bariskaner, H; Ayaz, M; Guney, F B; Dalkilic, N; Guney, O

    2007-06-01

    Unlike other drugs which act in the region of the synapse, local anesthetics are agents that reversibly block the generation and conduction of nerve impulses along a nerve fiber. This study aims to investigate the comparative inhibitions of bupivacaine and ropivacaine on the frog sciatic nerve. Isolated nerves were transferred to the nerve chamber which includes Ringer's solution. The nerves were stimulated by standard square wave pulse protocols and the responses were recorded with conventional systems. Bupivacaine (n = 8) and ropivacaine (n = 8) were administered in the nerve chamber bath with cumulative concentrations (10(-9) to 10(-3) M) and the effects were monitored for variable time periods (5, 10 and 15 min). Both bupivacaine and ropivacaine significantly depressed the compound action potential (CAP) parameters in a dose-dependent (p or =10(-5) M) and exposure time (15 min) were increased. Percent inhibitions in maximum derivatives and latency-period measurements have shown that ropivacaine is not only fast but also much more powerful in conduction block for longer and higher doses. Bupivacaine, on the other hand, is effective in the group of fibers with relatively slower conduction velocity for all the measured doses and time periods. In conclusion, ropivacaine has a sensory specific side of action, when compared with the bupivacaine. PMID:17805435

  4. Ultrasound-Guided Musculocutaneous Nerve Block in Postherpetic Neuralgia.

    Science.gov (United States)

    Kuo, Ying-Chen; Hsieh, Lin-Fen; Chiou, Hong-Jen

    2016-01-01

    Postherpetic neuralgia is a common and challenging complication of herpes zoster infection, particularly in older people. In recent decades, first-line treatments, including oral or topical medication, have become well established. However, few studies have reported the efficacy of interventional procedures for the treatment of postherpetic neuralgia. Here, the authors present a case of intractable postherpetic neuralgia treated with musculocutaneous peripheral nerve block under ultrasound guidance. Symptoms remained controlled at 1 mo follow-up. Ultrasound can be readily applied to improve the accuracy and efficiency of peripheral nerve block as it is currently widely used to evaluate the musculoskeletal system in clinical settings. PMID:26390394

  5. Delayed appearance of hypaesthesia and paralysis after femoral nerve block

    Directory of Open Access Journals (Sweden)

    Stefan Landgraeber

    2012-03-01

    Full Text Available We report on a female patient who underwent an arthroscopy of the right knee and was given a continuous femoral nerve block catheter. The postoperative course was initially unremarkable, but when postoperative mobilisation was commenced, 18 hours after removal of the catheter, the patient noticed paralysis and hypaesthesia. Examination confirmed the diagnosis of femoral nerve dysfunction. Colour duplex sonography of the femoral artery and computed tomography of the lumbar spine and pelvis yielded no pathological findings. Overnight the neurological deficits decreased without therapy and were finally no longer detectable. We speculate that during the administration of the local anaesthetic a depot formed, localised in the medial femoral intermuscular septa, which was leaked after first mobilisation. To our knowledge no similar case has been published up to now. We conclude that patients who are treated with a nerve block should be informed and physician should be aware that delayed neurological deficits are possible.

  6. Magellan: Technical Description of a New System for Robot-Assisted Nerve Blocks

    OpenAIRE

    Joshua Morse; Mohamad Wehbe; Riccardo Taddei; Shantale Cyr; Hemmerling, Thomas M.

    2013-01-01

    Nerve blocks are common procedures used to remove sensation from a specific region of the body via injection of local anesthetic. Ultrasound-guided nerve blocks are common-place in anesthesia, but require specialized training and advanced bi-manual dexterity. This paper describes a system designed to robotically assist in ultrasound-guided nerve blocks. Robot-assisted nerve blocks could allow for more precise needle placement, and therefore a higher efficacy of blocks. This system is the firs...

  7. Occipital Nerve Blocks for Pediatric Posttraumatic Headache: A Case Series.

    Science.gov (United States)

    Seeger, Trevor A; Orr, Serena; Bodell, Lisa; Lockyer, Lisette; Rajapakse, Thilinie; Barlow, Karen M

    2015-08-01

    Posttraumatic headache is one of the most common and disabling symptoms after traumatic brain injury. However, evidence for treating posttraumatic headache is sparse, especially in the pediatric literature. This retrospective chart review evaluated the use of occipital nerve blocks in adolescents treated for posttraumatic headache following mild traumatic brain injury, presenting to the Complex Concussion and Traumatic Brain Injury clinic. Fifteen patients (mean age 15.47; range: 13-17) received occipital nerve block for posttraumatic headache. Follow-up was obtained in 14 patients at 5.57 (standard deviation = 3.52) months postinjury. The headache burden was high, with all except one having headaches 15 or more days per month (median 30, range 10-30). Sixty-four percent reported long-term response to the occipital nerve blocks, with associated improved quality of life and decreased postconcussion symptom scores (P < .05). One patient reported transient allopecia. Occipital nerve blocks are well tolerated and can be helpful in posttraumatic headache. PMID:25406154

  8. Bony spurs projecting in the obturator foramen.

    Science.gov (United States)

    Singh, R

    2012-05-01

    The obturator foramen is large oval aperture in males or irregularly triangular aperture in females in the hipbone, situated anteroinferior to the acetabulum between the pubis and ischium. The dry bone under study is a male left sided hipbone. It contains the obturator groove through which the obturator nerve and vessels pass. During analysis of hipbones in the osteology laboratory of CSM Medical University Lucknow, UP, India, a hipbone was found in which bony spurs or exostoses were projecting from the margins into the obturator foramen. These bony projections in the obturator foramen constitute a new anatomical variant in the hipbone, as they have not been reported before. These bony spurs may impinge on the obturator nerve and vessels causing neurovascular complications and also trauma to the soft tissues during biomechanical movements. In addition, these bony spurs may cause spasms of the obturator internus and externus muscles, causing groin pain. These bony projections may also lead to misinterpretation of radiographs. Thus, knowledge of these bony spurs is of paramount importance to anatomists, surgeons, sport physicians, and radiologists. PMID:22648594

  9. Simulation of spinal nerve blocks for training anesthesiology residents

    Science.gov (United States)

    Blezek, Daniel J.; Robb, Richard A.; Camp, Jon J.; Nauss, Lee A.; Martin, David P.

    1998-06-01

    Deep nerve regional anesthesiology procedures, such as the celiac plexus block, are challenging to learn. The current training process primarily involves studying anatomy and practicing needle insertion is cadavers. Unfortunately, the training often continues on the first few patients subjected to the care of the new resident. To augment the training, we have developed a virtual reality surgical simulation designed to provide an immersive environment in which an understanding of the complex 3D relationships among the anatomic structures involved can be obtained and the mechanics of the celiac block procedure practiced under realistic conditions. Study of the relevant anatomy is provided by interactive 3D visualization of patient specific data nd the practice simulated using a head mounted display, a 6 degree of freedom tracker, and a haptic feedback device simulating the needle insertion. By training in a controlled environment, the resident may practice procedures repeatedly without the risks associated with actual patient procedures, and may become more adept and confident in the ability to perform nerve blocks. The resident may select a variety of different nerve block procedures to practice, and may place the virtual patient in any desired position and orientation. The preliminary anatomic models used in the simulation have been computed from the Visible Human Male; however, patient specific models may be generated from patient image data, allowing the physician to evaluate, plan, and practice difficult blocks and/or understand variations in anatomy before attempting the procedure on any specific patient.

  10. Rare cause of paraparesis: bilateral obturator neuropathy after hysterosalpingectomy.

    Science.gov (United States)

    López-Blanco, Roberto; Mejía-Jiménez, Inmaculada; de Fuenmayor-Fernández de la Hoz, Carlos Pablo; Ruiz-Morales, Juan

    2015-01-01

    Bilateral obturator nerve injury during pelvic surgery is an infrequent cause of lower limb paraparesis. We report the case of a 45-year-old woman with a large uterine leiomyoma who underwent simple total hysterectomy and bilateral salpingectomy. At 24?h after the surgery, the patient noticed loss of muscle strength when adducting both legs. She had no problem with other movements and no sensory or sphincter abnormalities. Neurological examination confirmed that there was loss of strength only in the adductor muscles, with preserved sensory function and reflexes, suggesting bilateral obturator nerve involvement. Pelvic MRI showed a small postsurgical haematoma in the Douglas recess, but far from the obturator nerves. 2?weeks later, electromyography showed positive sharp waves and low motor unit recruitment in the adductor magnus muscles, confirming acute, bilateral obturator nerve neuropathy. The few cases of bilateral obturator neuropathy that have been reported were mostly related to abdominopelvic interventions. PMID:26689250

  11. Evidence of peripheral nerve blocks for cancer-related pain

    DEFF Research Database (Denmark)

    Klepstad, P; Kurita, G P; Mercadante, S; Sjøgren, P

    2015-01-01

    The European Association for Palliative Care has initiated a comprehensive program to achieve an over-all review of the evidence of multiple cancer pain management strategies in order to extend the current guideline for treatment of cancer pain. The present systematic review analyzed the existing...... evidence of analgesic efficacy for peripheral nerve blocks in adult patients with cancer. A search strategy was elaborated with words related to cancer, pain, peripheral nerve and block. The search was performed in PubMed, EMBASE, and Cochrane for the period until February 2014. The number of abstracts...... good pain relief and no side effects. The use of peripheral blocks is based upon anecdotal evidence. However, this review only demonstrates the lack of studies, which does not equal a lack of effectiveness....

  12. Comparative analysis between direct Conventional Mandibular nerve block and Vazirani-Akinosi closed mouth Mandibular nerve block technique

    Science.gov (United States)

    Mishra, Sobhan; Tripathy, Ramanupam; Sabhlok, Samrat; Panda, Pankaj Kumar; Patnaik, Satyabrata

    2012-11-01

    Introduction: Over the years different techniques have been developed for achieving mandibular nerve anaesthesia. The main aim of our study was to carry out comparison and clinical efficacy of mandibular nerve anaesthesia by Direct Conventional technique with that of Vazirani-Akinosi mandibular nerve block technique.Materials and Methods: 50 adult patients requiring surgical extraction of premolars, mandibular first, second and third molars were selected randomly to receive Direct Conventional technique and Vazirani- Akinosi technique for nerve block alternatively.Results: No statistically significant differences were observed regarding complete lip anaesthesia at 5 minutes and 10 minutes, nerves anaesthetized with single injection, effectiveness of anaesthesia, supplementary injections and complications in both the techniques. However, onset of lip anaesthesia was found to be faster in Vazirani-Akinosi technique, patients experienced less pain during the Vazirani-Akinosi technique as compared to the Direct Conventional technique. Post injection complication complications were less in the VaziraniAkinosi Technique.Conclusions: Except for faster onset of lip anaesthesia, less pain during injection and fewer post injection complications in Vazirani-Akinosi technique all other parameters were of same efficacy as Direct Conventional technique. This has strong clinical applications as in cases with limited mouth opening, apprehensive patients Vazirani-Akinosi technique is the indicated technique of choice.

  13. Modeling Electric Fields of Peripheral Nerve Block Needles.

    Science.gov (United States)

    Davis, James Ch.; Anderson, Norman E.; Meisel, Mark W.; Ramirez, Jason G.; Kayser Enneking, F.

    2006-03-01

    Peripheral nerve blocks present an alternative to general anesthesia in certain surgical procedures and a means of acute pain relief through continuous blockades. They have been shown to decrease the incidence of postoperative nausea and vomiting, reduce oral narcotic side effects, and improve sleep quality. Injecting needles, which carry small stimulating currents, are often used to aid in locating the target nerve bundle. With this technique, muscle responses indicate needle proximity to the corresponding nerve bundle. Failure rates in first injection attempts prompted our study of electric field distributions. Finite difference methods were used to solve for the electric fields generated by two widely used needles. Geometric differences in the needles effect variations in their electric field and current distributions. Further investigations may suggest needle modifications that result in a reduction of initial probing failures.

  14. CT-guided suprascapular nerve blocks: a pilot study

    International Nuclear Information System (INIS)

    The objective of this study was to describe the suprascapular nerve block using CT guidance and to evaluate the short- and medium-term efficacy in a range of shoulder pathologies. CT-guided infiltration around the suprascapular nerve was performed with bupivacaine and Celestone Chronodose on 40 consecutive patients presenting with chronic shoulder pathologies unresponsive to conventional treatment. Patients were interviewed using the Shoulder Pain and Disability Index (SPADI) before the procedure, 30 min after the procedure and at 3 days, 3 weeks and 6 weeks afterwards. Within 30 min of the block overall pain scores decreased from a mean (±SEM) pain score of 7.0 (±0.4) to 3.5 (±0.5) (n=39, P<0.001). At 3 days after the procedure, the mean overall improvement of the pain and disability scores were 20.4% (±4.9, P<0.001) and 16.8% (±4.8, P=0.004) respectively. Sustained pain relief and reduced disability were achieved in 10 of 35 (29%) patients at 3 weeks and longer. Patients suffering from soft tissue pathologies were the most likely patients to benefit from the injection. No serious side effects were noted. In some patients with chronic soft tissue pathologies who do not respond to conventional treatment, a CT-guided suprascapular nerve block can provide safe short- and medium-term relief from pain and disability. (orig.)

  15. CT-guided suprascapular nerve blocks: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Schneider-Kolsky, M.E.; Pike, J.; Connell, D.A. [Department of Medical Imaging, Victoria House Private Hospital, 316 Malvern Road, Prahran 3181, Melbourne, Victoria (Australia)

    2004-05-01

    The objective of this study was to describe the suprascapular nerve block using CT guidance and to evaluate the short- and medium-term efficacy in a range of shoulder pathologies. CT-guided infiltration around the suprascapular nerve was performed with bupivacaine and Celestone Chronodose on 40 consecutive patients presenting with chronic shoulder pathologies unresponsive to conventional treatment. Patients were interviewed using the Shoulder Pain and Disability Index (SPADI) before the procedure, 30 min after the procedure and at 3 days, 3 weeks and 6 weeks afterwards. Within 30 min of the block overall pain scores decreased from a mean ({+-}SEM) pain score of 7.0 ({+-}0.4) to 3.5 ({+-}0.5) (n=39, P<0.001). At 3 days after the procedure, the mean overall improvement of the pain and disability scores were 20.4% ({+-}4.9, P<0.001) and 16.8% ({+-}4.8, P=0.004) respectively. Sustained pain relief and reduced disability were achieved in 10 of 35 (29%) patients at 3 weeks and longer. Patients suffering from soft tissue pathologies were the most likely patients to benefit from the injection. No serious side effects were noted. In some patients with chronic soft tissue pathologies who do not respond to conventional treatment, a CT-guided suprascapular nerve block can provide safe short- and medium-term relief from pain and disability. (orig.)

  16. Variant obturator vessels

    Directory of Open Access Journals (Sweden)

    Nayak SB

    2009-10-01

    Full Text Available The obturator artery is a branch of anterior division of the internal iliac artery. However, in about 20% of cases it is replaced by the pubic branch of inferior epigastric artery, which is then known as abnormal obturator artery. The knowledge of abnormal obturator artery is of importance to the surgeons reducing the femoral hernia as it runs across the lacunar ligament. We saw an anomalous obturator artery arising from the external iliac artery. The obturator vein is usually a tributary of internal iliac vein. In the current case, the vein terminated in the external iliac vein. The knowledge of this variation is important anatomically, radiologically and surgically.

  17. Sciatic nerve blocks for diagnosis of piriformis syndrome

    International Nuclear Information System (INIS)

    We used sciatic nerve block (SNB) to make the differential diagnosis of piriformis syndrome in 188 consecutive patients with sciatica in whom it was impossible to make the diagnosis based on the lumbar MRI findings. We rated the effectiveness of SNB as excellent (60%), good (25%) and poor (15%). After performing SNBs, lumbar radicular blocks, and surgeries based on the initial diagnosis, the final diagnoses were piriformis syndrome (56%), piriformis syndrome complicated with lumbar degenerative disease (4%), lumbar degenerative disease (23%), others or unknown (16%). The prevalence of piriformis syndrome in the excellent effectiveness group was 81%. SNB was effective in all patients with piriformis syndrome and in 66% of the lumbar degeneration patients. The diagnostic value of SNB is of limited value for differentiating piriformis syndrome from lumbar degenerative disease. (author)

  18. Anesthetic technique for inferior alveolar nerve block: a new approach

    Scientific Electronic Library Online (English)

    Dafna Geller, Palti; Cristiane Machado de, Almeida; Antonio de Castro, Rodrigues; Jesus Carlos, Andreo; José Eduardo Oliveira, Lima.

    2011-02-01

    Full Text Available BACKGROUND: Effective pain control in Dentistry may be achieved by local anesthetic techniques. The success of the anesthetic technique in mandibular structures depends on the proximity of the needle tip to the mandibular foramen at the moment of anesthetic injection into the pterygomandibular regio [...] n. Two techniques are available to reach the inferior alveolar nerve where it enters the mandibular canal, namely indirect and direct; these techniques differ in the number of movements required. Data demonstrate that the indirect technique is considered ineffective in 15% of cases and the direct technique in 13-29% of cases. OBJECTIVE: The aim of this study was to describe an alternative technique for inferior alveolar nerve block using several anatomical points for reference, simplifying the procedure and enabling greater success and a more rapid learning curve. MATERIAL AND METHODS: A total of 193 mandibles (146 with permanent dentition and 47 with primary dentition) from dry skulls were used to establish a relationship between the teeth and the mandibular foramen. By using two wires, the first passing through the mesiobuccal groove and middle point of the mesial slope of the distolingual cusp of the primary second molar or permanent first molar (right side), and the second following the oclusal plane (left side), a line can be achieved whose projection coincides with the left mandibular foramen. RESULTS: The obtained data showed correlation in 82.88% of cases using the permanent first molar, and in 93.62% of cases using the primary second molar. CONCLUSION: This method is potentially effective for inferior alveolar nerve block, especially in Pediatric Dentistry.

  19. Anesthetic technique for inferior alveolar nerve block: a new approach

    Directory of Open Access Journals (Sweden)

    Dafna Geller Palti

    2011-02-01

    Full Text Available BACKGROUND: Effective pain control in Dentistry may be achieved by local anesthetic techniques. The success of the anesthetic technique in mandibular structures depends on the proximity of the needle tip to the mandibular foramen at the moment of anesthetic injection into the pterygomandibular region. Two techniques are available to reach the inferior alveolar nerve where it enters the mandibular canal, namely indirect and direct; these techniques differ in the number of movements required. Data demonstrate that the indirect technique is considered ineffective in 15% of cases and the direct technique in 13-29% of cases. OBJECTIVE: The aim of this study was to describe an alternative technique for inferior alveolar nerve block using several anatomical points for reference, simplifying the procedure and enabling greater success and a more rapid learning curve. MATERIAL AND METHODS: A total of 193 mandibles (146 with permanent dentition and 47 with primary dentition from dry skulls were used to establish a relationship between the teeth and the mandibular foramen. By using two wires, the first passing through the mesiobuccal groove and middle point of the mesial slope of the distolingual cusp of the primary second molar or permanent first molar (right side, and the second following the oclusal plane (left side, a line can be achieved whose projection coincides with the left mandibular foramen. RESULTS: The obtained data showed correlation in 82.88% of cases using the permanent first molar, and in 93.62% of cases using the primary second molar. CONCLUSION: This method is potentially effective for inferior alveolar nerve block, especially in Pediatric Dentistry.

  20. Development of a Mobile Ultrasound-Guided Peripheral Nerve Block and Catheter Service

    Science.gov (United States)

    Jeng, Christina L.; Torrillo, Toni M.; Anderson, Michael R.; Morrison, R. Sean; Todd, Knox H.; Rosenblatt, Meg A.

    2015-01-01

    Ultrasound guidance is associated with improved efficiency and success of peripheral nerve blockade and a decreased incidence of vascular puncture, making these interventions safer. Patients with peripheral nerve blocks report decreased pain and increased satisfaction scores. We present the development of a mobile ultrasound-guided block service that allows for the safe and efficient placement of nerve blocks and perineural catheters at the nontraditional location of the patient’s bedside and in the emergency department. PMID:21795490

  1. The technique comparison of brachial plexus blocks by ultrasound guided with blocks by nerve stimulator guided

    Science.gov (United States)

    Liu, Guo-Ying; Chen, Zhen-Qiang; Jia, Hai-Yan; Dai, Zhi-Gang; Zhang, Xue-Jun

    2015-01-01

    Objective: Brachial plexus perineural blocks provide specific analgesia for upper limb surgery. We present our experience with ultrasound-guided supraclavicular brachial plexus perineural blocks for distal upper limb surgery. Although single-injection ultrasound-guided supraclavicular blocks have been reported, little is known about the advantages using this approach compared with nerve stimulator guided. Methods: There were 60 patients who underwent upper limb surgery for orthopedic trauma and received a supraclavicular brachial plexus anesthesia. 30 patients (U-group) were injected by an ultrasound-guided technique with the needle tip remaining under direct vision. 30 patients (NS-group) were inserted by nerve stimulator guided. Recorded the onset time, puncture times, pains cases with tourniquet in each group. Compared the difference between two groups. Results: In U-group, all cases had successful perineural injection. Most of them, effect of anesthesia was fast onset and needed insert only once. No pains were reported under using tourniquet. There were no vessel punctures or other direct procedure-related complications. In NS-group, most injections were successful, but slow onset and needed multiply insert needle. 5 patients said pains under using tourniquet when surgery started and had to add opioid by vein. One patients’ lung were puncture and result in pneumothorax. One patient’s was intravascular injection. Conclusions: Supraclavicular brachial plexus perineural insertion using ultrasound guidance is feasible and almost have no complications, deserves further study with a randomized controlled trial comparing this relatively new technique with only using nerve stimulator. PMID:26629206

  2. Augmented reality guidance system for peripheral nerve blocks

    Science.gov (United States)

    Wedlake, Chris; Moore, John; Rachinsky, Maxim; Bainbridge, Daniel; Wiles, Andrew D.; Peters, Terry M.

    2010-02-01

    Peripheral nerve block treatments are ubiquitous in hospitals and pain clinics worldwide. State of the art techniques use ultrasound (US) guidance and/or electrical stimulation to verify needle tip location. However, problems such as needle-US beam alignment, poor echogenicity of block needles and US beam thickness can make it difficult for the anesthetist to know the exact needle tip location. Inaccurate therapy delivery raises obvious safety and efficacy issues. We have developed and evaluated a needle guidance system that makes use of a magnetic tracking system (MTS) to provide an augmented reality (AR) guidance platform to accurately localize the needle tip as well as its projected trajectory. Five anesthetists and five novices performed simulated nerve block deliveries in a polyvinyl alcohol phantom to compare needle guidance under US alone to US placed in our AR environment. Our phantom study demonstrated a decrease in targeting attempts, decrease in contacting of critical structures, and an increase in accuracy of 0.68 mm compared to 1.34mm RMS in US guidance alone. Currently, the MTS uses 18 and 21 gauge hypodermic needles with a 5 degree of freedom sensor located at the needle tip. These needles can only be sterilized using an ethylene oxide process. In the interest of providing clinicians with a simple and efficient guidance system, we also evaluated attaching the sensor at the needle hub as a simple clip-on device. To do this, we simultaneously performed a needle bending study to assess the reliability of a hub-based sensor.

  3. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty : a randomized, double-blind study

    DEFF Research Database (Denmark)

    Jaeger, Pia; Zaric, Dusanka

    2013-01-01

    Femoral nerve block (FNB), a commonly used postoperative pain treatment after total knee arthroplasty (TKA), reduces quadriceps muscle strength essential for mobilization. In contrast, adductor canal block (ACB) is predominately a sensory nerve block. We hypothesized that ACB preserves quadriceps muscle strength as compared with FNB (primary end point) in patients after TKA. Secondary end points were effects on morphine consumption, pain, adductor muscle strength, morphine-related complications, and mobilization ability.

  4. Clinical observation on thoracic paravertebral nerve block with ozone treatment in patients with postherpetic neuralgia

    Directory of Open Access Journals (Sweden)

    GUO Xiang-fei

    2013-10-01

    Full Text Available Objective To analyze the clinical efficacy of thoracic paravertebral nerve block with ozone in the treatment of postherpetic neuralgia. Methods Eighty-five patients suffered postherpetic neuralgia were divided into 4 groups: Group A (oral drugs + intramuscular injection of vitamin B12 + local nerve block of lesion area, Group B (oral drugs + intramuscular injection of compound trivitamin B + local nerve block of lesion area, Group C (oral drugs + intramuscular injection of compound trivitamin B + thoracic paravertebral nerve block + local nerve block of lesion area, Group D (oral drugs + intramuscular injection of compound trivitamin B + thoracic paravertebral nerve block with ozone + local nerve block of lesion area. Treatment outcomes were evaluated by Visual Analogue Scale (VAS, Quality of Sleep (QS, Self-Rating Depression Scale (SDS and C-reactive protein (CRP before treatment and 4 weeks after treatment. Results After treatment, VAS, QS and SDS scores of 4 groups were lower than that before treatment, and the differences were statistically significant (P 0.05, for all, while a significant change in CRP was observed in patients of group D between before and after treatment (P < 0.05. The improvement of VAS, QS and SDS scores of group D was significantly better than other 3 groups (P < 0.05, for all. Conclusion Thoracic paravertebral nerve block combined with ozone is a quick and effective method for postherpetic neuralgia patients.

  5. [Management of pain after thoracotomy: experience of intercostal nerve block with alcohol during operation].

    Science.gov (United States)

    Sasai, T; Sakakibara, S; Kaji, M; Nitta, T; Masaki, Y; Yajima, T; Gomibuchi, M; Tanaka, S; Shouji, T

    1991-02-01

    Post-thoracotomy wound pain in 11 patients who underwent thoracic operation was controlled by intercostal nerve block with alcohol and thoracic epidural anesthesia. The intercostal nerve block was performed just before the closure of the thoracotomy wound. Epidural anesthesia was employed from the 1st to 5th post operative day. This method alleviated post-thoracotomy pain and obviated postoperative pulmonary complication in all patients in early post operative periods. In late post operative periods after discharge, intercostal nerve block could maintain excellent analgesia in 9 of 11 patients, only 2 patients required analgesic drugs or re-block of the intercostal nerve. Thus, intercostal nerve block with alcohol is an effective and simple option to control recalcitrant post-thoracotomy wound pain in thoracic surgery. PMID:2008052

  6. Electrical nerve stimulation as an aid to the placement of a brachial plexus block : clinical communication

    Directory of Open Access Journals (Sweden)

    K.E. Joubert

    2002-07-01

    Full Text Available Most local anaesthetic blocks are placed blindly, based on a sound knowledge of anatomy. Very often the relationship between the site of deposition of local anaesthetic and the nerve to be blocked is unknown. Large motor neurons may be stimulated with the aid of an electrical current. By observing for muscle twitches, through electrical stimulation of the nerve, a needle can be positioned extremely close to the nerve. The accuracy of local anaesthetic blocks can be improved by this technique. By using the lowest possible current a needle could be positioned within 2-5mm of a nerve. The correct duration of stimulation ensures that stimulation of sensory nerves does not occur. The use of electrical nerve stimulation in veterinary medicine is a novel technique that requires further evaluation.

  7. A Study to Evaluate the Effectiveness of Phenol Blocks to Peripheral Nerves in Reducing Spasticity in Patients with Paraplegia and Brain Injury

    Directory of Open Access Journals (Sweden)

    Kumar ER

    2008-04-01

    Full Text Available Primary objective: To evaluate effectiveness of phenol blocks of peripheral nerves in reducing spasticitybrain injured and spinal cord injured patients.Secondary objectives: To measure the change in the range of motion after phenol blocks to peripheralnerves, to identify the electrophysiological changes and to study the cost effectiveness and side effects ofphenol blocks.Study design: Descriptive studySetting: Tertiary referral centre, India.Methods: This study was conducted from March 2000 to January 2002 among 20 patients with spasticity.Spasticity was measured by modified Ashworth scale and range of motion was measured with a standardgoniometer on 1st, 7th, 14th and 21st days of the study. Nerve conduction studies, gait analysis, and functionalindependence measure was measured on 1st and 21st day of the study. Nerve blocks were done on 7th and14th day of the study with 0.5% bupivacaine and 6% phenol in water respectively.Results: 20 patients were included in the study, out of which 85% had spinal cord injury and 15% patientshad brain injury sequelae. Spasticity measured by modified Ashworth scale, showed a statistically significantreduction with neurolysis. Following obturator neurolysis abduction of hip joint improved significantly andwith posterior tibial neurolysis there was significant improvement in dorsiflexion and plantar flexion rangeof the ankle joint. Functional improvement measured with the FIM score also showed statistically significantimprovement after neurolysis. H reflex amplitude was significantly reduced following neurolysis. Therewas a statistically significant reduction in the consumption of systemic medications for spasticity followingthe injection.Conclusion: Range of motion in neighboring joints improved significantly after blockade of spasticity usingPhenol neurolysis. There was statistically significant reduction in the amplitude of the H reflex. Therewere no major adverse effects following neurolysis with phenol and it was found to be significantly costeffective when compared to systemic antispastic medications.

  8. Inhibitory effects of forskolin and papaverine on nerve conduction partially blocked by tetrodotoxin in the frog sciatic nerve.

    OpenAIRE

    Ribeiro, J.A; Sebastião, A. M.

    1985-01-01

    The effects of forskolin, sodium fluoride and papaverine on compound action potentials were investigated in de-sheathed sciatic nerve preparations of the frog. Forskolin decreased in a concentration-dependent manner the amplitude of compound action potentials when nerve conduction was partially blocked by tetrodotoxin (TTX). In the presence of TTX a 50% decrease in the action potential amplitude recorded was obtained with about 2.5 microM forskolin. Sodium fluoride did not modify the amplitud...

  9. Ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty: a multicenter randomized controlled study

    Directory of Open Access Journals (Sweden)

    Fen Wang

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Postoperative analgesia is crucial for early functional excise after total knee arthroplasty. To investigate the clinical efficacy of ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty. METHODS: 46 patients with ASA grade I-III who underwent total knee arthroplasty received postoperative analgesia from October 2012 to January 2013. In 22 patients, ultrasound and nerve stimulator guided continuous femoral nerve block were performed for analgesia (CFNB group; in 24 patients, epidural analgesia was done (PCEA group. The analgesic effects, side effects, articular recovery and complications were compared between two groups. RESULTS: At 6 h and 12 h after surgery, the knee pain score (VAS score during functional tests after active exercise and after passive excise in CFNB were significantly reduced when compared with PCEA group. The amount of parecoxib used in CFNB patients was significantly reduced when compared with PCEA group. At 48 h after surgery, the muscle strength grade in CFNB group was significantly higher, and the time to ambulatory activity was shorter than those in PCEA group. The incidence of nausea and vomiting in CFNB patients was significantly reduced when compared with PCEA group. CONCLUSION: Ultrasound and nerve stimulator guided continuous femoral nerve block provide better analgesia at 6 h and 12 h, demonstrated by RVAS and PVAS. The amount of parecoxib also reduces, the incidence of nausea and vomiting decreased, the influence on muscle strength is compromised and patients can perform ambulatory activity under this condition.

  10. VARIABILITY OF ORIGIN OF OBTURATOR ARTERY AND ITS CLINICAL SIGNIFICANCE

    Directory of Open Access Journals (Sweden)

    Sakthivel

    2015-12-01

    Full Text Available Background: Obturator artery is a branch of anterior division of internal iliac artery. It normally runs anteroinferiorly on the lateral wall of pelvis to the upper part of the obturator foramen and leaves the pelvis by passing through the obturator canal. On its course, the artery is accompanied by the obturator nerve and vein. It supplies the muscles of the medial compartment of the thigh. A severe and potentially lethal complication in pelvic injuries is arterial bleeding commonly involving the branches of the internal iliac artery, namely the lateral sacral, iliolumbar, obturator, vesical and inferior gluteal arteries. A sound knowledge of retro-pubic pelvic vascular anatomy is pivotal for successful performance of endoscopic procedures such as total extra-peritoneal inguinal hernioplasty or laparoscopic herniorraphy. The context and purpose of the study: This study is an attempt to analyse the origin, course, distribution of obturator artery in pelvis and their clinical implication. Result: out of 60 formalin fixed pelvic halves 36.6% of the specimens, (26.67% in males and 10% in females the origin of obturator artery was found to be normal from anterior division of internal iliac artery. About 63.63% from various other sources. Conclusion: This knowledge of variation in the origin of obturator artery is important while doing pelvic and groin surgeries requiring appropriate ligation. Such aberrant origins may be a significant source for persistent bleeding in the setting of acute trauma. Knowledge regarding the variations of obturator artery is useful during surgeries of fracture and direct or indirect inguinal, femoral and obturator hernias.

  11. Suprascapular nerve block in chronic shoulder pain: are the radiologists better?

    OpenAIRE

    Shanahan, E; Smith, M.; Wetherall, M; Lott, C; Slavotinek, J; Fitzgerald, O.; Ahern, M.

    2004-01-01

    Background: Suprascapular nerve block is a safe and effective treatment for chronic shoulder pain in arthritis, which can be performed either by direct imaging (CT guided) or in the clinic using anatomical landmarks to determine needle placement.

  12. Thigh abscess as a complication of continuous popliteal sciatic nerve block.

    Science.gov (United States)

    Compère, V; Cornet, C; Fourdrinier, V; Maitre, A M; Mazirt, N; Biga, N; Dureuil, B

    2005-08-01

    We present a case report of severe localized infection after continuous popliteal sciatic nerve block. The report highlights the importance of meticulous asepsis and possibly limiting the duration of catheter use. PMID:15923265

  13. Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain

    OpenAIRE

    Shanahan, E; Ahern, M.; Smith, M.; Wetherall, M; Bresnihan, B.; Fitzgerald, O.

    2003-01-01

    Background: Shoulder pain from inflammatory arthritis and/or degenerative disease is a common cause of morbidity in the community. It is difficult to treat and there are limited data on the efficacy of most interventions. Suprascapular nerve block has shown promise in limited trials in reducing shoulder pain. There have been no large randomised placebo controlled trials examining the efficacy of suprascapular nerve block for shoulder pain in arthritis and/or degenerative disease using pain an...

  14. Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique

    OpenAIRE

    Alok Kumar1 ,; Sharma, D. K.; E Sibi; Barun Datta; Biraj Gogoi

    2014-01-01

    Background: The established methods of nerve location were based on either proper motor response on nerve stimulation (NS) or ultrasound guidance. In this prospective, randomised, observer-blinded study, we compared ultrasound guidance with NS for axillary brachial plexus block using 0.5% bupivacaine with the multiple injection techniques. Methods : A total of 120 patients receiving axillary brachial plexus block with 0.5% bupivacaine, using a multiple injection technique, were randomly alloc...

  15. Glossopharyngeal Nerve Block versus Lidocaine Spray to Improve Tolerance in Upper Gastrointestinal Endoscopy

    OpenAIRE

    Ortega Ramírez, Moisés; Linares Segovia, Benigno; García Cuevas, Marco Antonio; Sánchez Romero, Jorge Luis; Botello Buenrostro, Illich; Amador Licona, Norma; Guízar Mendoza, Juan Manuel; Guerrero Romero, Jesús Francisco; Vázquez Zárate, Víctor Manuel

    2013-01-01

    Aim of the Study. To compare the effect of glossopharyngeal nerve block with topical anesthesia on the tolerance of patients to upper gastrointestinal endoscopy. Methods. We performed a clinical trial in one hundred patients undergoing upper gastrointestinal endoscopy. Subjects were randomly assigned to one of the following two groups: (1) treatment with bilateral glossopharyngeal nerve block (GFNB) and intravenous midazolam or (2) treatment with topical anesthetic (TASS) and intravenous mida...

  16. The spread of injectate during saphenous nerve block at the adductor canal

    DEFF Research Database (Denmark)

    Andersen, H L; Andersen, S L; Tranum-Jensen, J

    2015-01-01

    BACKGROUND: The spread of injectate during a saphenous nerve block at the adductor canal has not been clearly described. METHODS: We examined the spread of 15?ml dyed injectate during ultrasound-guided saphenous nerve blocks at the adductor canal in 15 unembalmed cadavers' lower limbs followed by comparative dissections of the same limbs. RESULTS: The spread of the injectates was determined by the fascial limits and the muscles surrounding the adductor canal. The anteromedial limit of the adduct...

  17. Ultrasound-Guided Pudendal Nerve Block at the Entrance of the Pudendal (Alcock) Canal

    DEFF Research Database (Denmark)

    Bendtsen, Thomas Fichtner; Parras, Teresa; Moriggl, Bernhard; Chan, Vincent; Lundby, Lilli; Buntzen, Steen; Dalgaard, Karoline; Brandsborg, Birgitte; Børglum, Jens

    2016-01-01

    BACKGROUND AND OBJECTIVES: Ultrasound-guided techniques for pudendal nerve block have been described at the level of the ischial spine and transperineally. Theoretically, however, blockade of the pudendal nerve inside Alcock canal with a small local anesthetic volume would minimize the risk of...... sacral plexus blockade and would anesthetize all 3 branches of the pudendal nerve before they ramify in the ischioanal fossa. This technical report describes a new ultrasound-guided technique to block the pudendal nerve. The technique indicates an easy and effective roadmap to target the pudendal nerve...... inside the Alcock canal by following the margin of the hip bone sonographically along the greater sciatic notch, the ischial spine, and the lesser sciatic notch. METHODS: The technique was applied bilaterally in 3 patients with chronic perineal pain. The technique described was also used to locate the...

  18. Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle

    OpenAIRE

    Shanthanna, Harsha

    2014-01-01

    We report the anaesthetic management of two cases involving surgeries on the clavicle, performed under superficial cervical plexus block and selective C5 nerve root block under ultrasound (US) guidance, along with general anaesthesia. Regional analgesia for clavicular surgeries is challenging. Our patients also had significant comorbidities necessitating individualised approach. The first patient had a history of emphysema, obesity, and was allergic to morphine and hydromorphone. The second p...

  19. Effects of intraneural and perineural injection and concentration of Ropivacaine on nerve injury during peripheral nerve block in Wistar rats

    Directory of Open Access Journals (Sweden)

    Ilvana Hasanbegovic

    2013-12-01

    Full Text Available Introduction: Injury during peripheral nerve blocks is relatively uncommon, but potentially devastating complication. Recent studies emphasized that location of needle insertion in relationship to the fascicles may be the predominant factor that determines the risk for neurologic complications. However, it is wellestablished that concentration of local anesthetic is also associated with the risk for injury. In this study, we examined the effect of location of injection and concentration of Ropivacaine on risk for neurologic complications. Our hypothesis is that location of the injection is more prognostic for occurrence of nerve injury than the concentration of Ropivacaine.Methods: In experimental design of the study fi fty Wistar rats were used and sciatic nerves were randomized to receive: Ropivacaine or 0.9% NaCl, either intraneurally or perineurally. Pressure data during application was acquired by using a manometer and was analyzed using software package BioBench. Neurologic examination was performed thought the following seven days, there after the rats were sacrificed while sciatic nerves were extracted for histological examination.Results: Independently of tested solution intraneural injections in most of cases resulted with high injection pressure, followed by obvious neurologic defi cit and microscopic destruction of peripheral nerves. Also, low injection pressure, applied either in perineural or intraneural extrafascicular area, resulted with transitory neurologic defi cit and without destruction of the nerve normal histological structure.Conclusions: The main mechanism which leads to neurologic injury combined with peripheral nerve blockade is intrafascicular injection. Higher concentrations of Ropivacaine during intrafascicular applications magnify nerve injury.

  20. Unintentional side error for continuous sciatic nerve block at the popliteal fossa.

    Science.gov (United States)

    Al-Nasser, B

    2011-01-01

    Among all fields of healthcare about 45% of medical errors occur in the operating theatre. Wrong site procedures remain one of the most preventable medical errors. Unintentional wrong-sided peripheral nerve block is relatively a rare event in anesthesia care. However, the incidence is unknown but each time wrong-sided block occurs it represents a mistake and a potential for harm. The surgical safety checklist was established in 2008 by the world Health organization (WHO) as a part of the "Safe surgery save Lives" initiative. We report in this article a case of wrong sided continuous popliteal sciatic nerve block and discuss the role of the WHO's checklist in preventing wrong side peripheral nerve block and surgery. PMID:22379761

  1. Effectiveness of nasopalatine nerve block for anesthesia of maxillary central incisors after failure of the anterior superior alveolar nerve block technique

    Scientific Electronic Library Online (English)

    Tufi Neder, Meyer; Leonardo Lima, Lemos; Carolina Neder Matuck do, Nascimento; William Ricardo Ribeiro de, Lellis.

    Full Text Available O objetivo deste estudo foi avaliar a eficácia do bloqueio do nervo nasopalatino após falha na anestesia dos incisivos centrais superiores pelo bloqueio no nervo alveolar superior anterior (NASA). Secundariamente, investigou-se a possível inervação do incisivo central superior por ramos do nervo nas [...] opalatino (NNP). Foram avaliados 27 voluntários saudáveis, adultos jovens (idade: 17-26 anos; sexo: 9 homens e 18 mulheres). Todos eram estudantes de Odontologia da Faculdade do Vale do Rio Verde de Três Corações. Os voluntários tiveram os nervos alveolares anteriores superiores anestesiados e em seguida foram submetidos a um teste de sensibilidade térmica nos incisivos centrais superiores. Aqueles pacientes que ainda apresentavam sensibilidade após o bloqueio do NASA receberam bloqueio do NNP e então o teste térmico foi repetido. Todos os pacientes foram anestesiados por um único operador. Três pacientes ainda apresentaram sensibilidade após ambos os bloqueios bilaterais (NASA e NNP) e foram excluídos das análises de percentagem. Dos 24 pacientes restantes, 16 tiveram seus incisivos centrais superiores anestesiados pelo bloqueio do NASA e 8 permaneceram com sensibilidade após este procedimento. Estes 8 pacientes submeteram-se ao bloqueio do NNP, o que resultou em sucesso na anestesia dos incisivos centrais superiores. Neste estudo, 33,3% dos pacientes tinham a inervação de um ou de ambos os incisivos centrais superiores derivada do nervo nasopalatino, enquanto a maioria dos pacientes (66,7%) tinha tais dentes inervados pelo nervo alveolar superior anterior. O bloqueio do NNP foi eficaz para anestesiar os incisivos centrais superiores, nos casos em que falhou o bloqueio do NASA. Abstract in english The purpose of this study was to assess the effectiveness of nasopalatine nerve block for anesthesia of maxillary central incisors after failure of the anterior superior alveolar nerve (ASAN) block technique. Secondarily, the possible innervation of the maxillary central incisors by the nasopalatine [...] nerve was also investigated. Twenty-seven healthy, young adult volunteers (age: 17-26 years; gender: 9 males and 18 females) were enrolled in this study. All participants were undergraduate dental students of the University of Vale do Rio Verde de Três Corações. The volunteers had the anterior superior alveolar nerves anesthetized and a thermal sensitivity test (cold) was performed on the maxillary central incisors. The volunteers that responded positively to cold stimulus received a nasopalatine nerve block and the thermal sensitivity test was repeated. All participants were anesthetized by a single operator. Three patients presented sensitivity after both types of bilateral blocks and were excluded from the percentage calculations. In the remaining 24 patients, 16 had their maxillary central incisors anesthetized by the anterior superior alveolar block and 8 remained with sensitivity after the ASAN block. All these 8 patients had their maxillary central incisors successfully anesthetized by the nasopalatine block. In this study, 33.3% of the subjects had the innervation of one or both maxillary central incisors derived from the nasopalatine nerve, whilst most subjects (66.7%) had such teeth innervated by the anterior superior alveolar nerve. The nasopalatine nerve block was effective in anesthetizing the maxillary central incisors when the anterior superior alveolar nerve block failed.

  2. High Frequency Stimulation Selectively Blocks Different Types of Fibers in Frog Sciatic Nerve

    OpenAIRE

    Joseph, Laveeta; Butera, Robert J.

    2011-01-01

    Conduction block using high frequency alternating current (HFAC) stimulation has been shown to reversibly block conduction through various nerves. However, unlike simulations and experiments on myelinated fibers, prior experimental work in our lab on the sea-slug, Aplysia, found a nonmonotonic relationship between frequency and blocking thresholds in the unmyelinated fibers. To resolve this discrepancy, we investigated the effect of HFAC waveforms on the compound action potential of the sciat...

  3. Vagal Nerve Stimulation Blocks Peritoneal Macrophage Inflammatory Responsiveness after Severe Burn Injury

    OpenAIRE

    Lopez, Nicole E; Krzyzaniak, Michael; Costantini, Todd W.; De Maio, Antonio; Baird, Andrew; Eliceiri, Brian P; Coimbra, Raul

    2012-01-01

    Large surface area burn injuries lead to activation of the innate immune system, which can be blocked by parasympathetic inputs mediated by the vagus nerve. We hypothesized that vagal nerve stimulation (VNS) would alter the inflammatory response of peritoneal macrophages after severe burn injury. Male BALB/c mice underwent right cervical VNS prior to 30% total body surface area steam burn and were compared to animals subjected to burn alone. Peritoneal macrophages were harvested at several ti...

  4. Stellate ganglion block can relieve symptoms and pain and prevent facial nerve damage

    OpenAIRE

    Gogia, Anoop Raj; Chandra, Kumar Naren

    2015-01-01

    Ramsay hunt syndrome[1] is a varicella zoster virus infection of the geniculate ganglion of the facial nerve. It is typically associated with a red rash and blister (inflamed vesicles or tiny water filled sacks in the skin) in or around the ear and eardrum and sometimes on the roof of the mouth or tongue. Corticosteroid, oral acyclovir, and anticonvulsant are used for treatment of this. In addition to this sympathetic neural blockade via stellate ganglion block is used to prevent facial nerve...

  5. A comparison of epidural anesthesia and lumbar plexus-sciatic nerve blocks for knee surgery

    OpenAIRE

    Eyup Horasanli; Mehmet Gamli; Yasar Pala; Mustafa Erol; Fazilet Sahin; Bayazit Dikmen

    2010-01-01

    OBJECTIVES: The efficacy of combined lumbar plexus-sciatic nerve blocks was compared to epidural anesthesia in patients undergoing total knee surgery. PATIENTS AND METHODS: The study included 80 American Society of Anesthesiologists (ASA) Physical Status I-III patients (age range 18 to 65) undergoing knee surgery. The patients were randomly divided into one of two groups. Epidural anesthesia was performed in the epidural anesthesia (EA) group (n=40), and the lumbar plexus and sciatic nerves w...

  6. Reversible Conduction Block in Frog Sciatic Nerve for Three Different Concentrations of Bupivacaine

    OpenAIRE

    BÜYÜKAKILLI, Belgin; Çömeleko?lu, Ülkü; Ö?ENLER, Oya

    2003-01-01

    We examined the effects of various concentrations of the bupivacaine commonly used for spinal anaesthesia on the reversibility of conduction block in isolated frog sciatic nerves measured by the extracellular recording technique. Seventy-two isolated nerves were divided into 3 groups (n = 24), each of which was bathed in a different bupivacaine solution in a range of concentrations (10, 20 or 30 mM for 20 min). In each group, the extracellular action potentials were recorded before exposure t...

  7. Dexmedetomidine and propofol infusion on sedation characteristics in patients undergoing sciatic nerve block in combination with femoral nerve block via anterior approach

    Directory of Open Access Journals (Sweden)

    Abdulkadir Yekta?

    2015-10-01

    Full Text Available ABSTRACTOBJECTIVE: Dexmedetomidine is an a-2 adrenergic agonist having wide range of effects including sedation in mammalian brain, and has analgesic as well as sympatholytic properties. This study aimed to compare the effects of dexmedetomidine and propofol infusion on sedation characteristics in patients undergoing combined sciatic nerve and femoral nerve block via anterior approach for lower limb orthopedic procedure.METHODS: Forty patients, who were between 18 and 65 years old, this study was made at anesthesiology clinic of Bagcilar training and research hospital in 08 September 2011 to 07 June 2012, and underwent surgical procedure due to fractures lateral and medial malleol, were included. Sciatic nerve and femoral nerve block were conducted with an anterior approach on all patients included in the study, with an ultrasonography. The patients were randomly divided into dexmedetomidine [Group D (n = 20; 0.5 µg kg-1 h-1] and propofol [Group P (n = 20; 3 mg kg-1 h-1] infusion groups.RESULTS: The vital findings and intra-operative Ramsay sedation scale values were similar in both groups. Time taken for sedation to start and time required for sedation to become over of Group D were significantly higher than those of Group P (p < 0.001 for each.CONCLUSIONS: Substitution of dexmedetomidine instead of propofol prolongs the times to start of sedation, the times to end of sedation and duration of sedation.

  8. Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle

    Directory of Open Access Journals (Sweden)

    Harsha Shanthanna

    2014-01-01

    Full Text Available We report the anaesthetic management of two cases involving surgeries on the clavicle, performed under superficial cervical plexus block and selective C5 nerve root block under ultrasound (US guidance, along with general anaesthesia. Regional analgesia for clavicular surgeries is challenging. Our patients also had significant comorbidities necessitating individualised approach. The first patient had a history of emphysema, obesity, and was allergic to morphine and hydromorphone. The second patient had clavicular arthritis and pain due to previous surgeries. He had a history of smoking, Stevens-Johnson syndrome, along with daily marijuana and prescription opioid use. Both patients had an effective regional block and required minimal supplementation of analgesia, both being discharged on the same day. Interscalene block with its associated risks and complications may not be suitable for every patient. This report highlights the importance of selective regional blockade and also the use of US guidance for an effective and safe block.

  9. Reversible conduction block in isolated frog sciatic nerve by high concentration of bupivacaine.

    Science.gov (United States)

    Buyukakilli, Belgin; Comelekoglu, Ulku; Tataroglu, Cengiz; Kanik, Arzu

    2003-03-01

    We evaluated the effects of a high concentration of bupivacaine commonly used for spinal anaesthesia on the reversibility of conduction block and compound nerve action potential (CNAP) parameters in isolated frog sciatic nerve measured by extracellular recording technique. Isolated frog sciatic nerves were bathed in 1.3% bupivacaine solution for 20 min. In each nerve, action potentials were recorded before exposure to bupivacaine solution, which served as the control data. The extracellular action potentials were recorded after 20 min in the drug by using a BIOPAC MP 100 Acquisition System Version 3.5.7 (Santa Barbara, USA). The nerves were washed for 3h continuously with Ringer's solution and action potentials were recorded. The nerve was then soaked overnight in Ringer's solution at room temperature and tested for impulse recovery. There were significant differences among the experiments regarding CNAP peak-to-peak amplitude, area and duration but conduction velocities among the experiments did not show any statistical difference. In the presence of bupivacaine the extracellular action potential amplitude decreased by 46.99+/-29.31% relative to the control amplitude (P<0.05), recovered to 47.10+/-26.90% after 3h of wash, and reached 123.20+/-39.70% after the overnight soak process. This study showed that exposing nerve to high concentration of bupivacaine causes reversible impulse blockade and that bupivacaine does not cause neurotoxic effect on isolated frog sciatic nerve. PMID:12591019

  10. The Effect of Femoral Nerve Block on Strength and Patient-reported Outcomes Following ACL Reconstruction

    OpenAIRE

    Magnussen, Robert A.; Pottkotter, Kristy; DiStasi, Stephanie; Paterno, Mark V; Wordeman, Samuel Clayton; Schmitt, Laura; David C Flanigan; Kaeding, Christopher C.; Hewett, Timothy E.

    2014-01-01

    Objectives: Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament (ACL) reconstruction. Although numerous high level studies have assessed the efficacy of FNB’s, there has been little to no research into the effect of such blocks on post-operative strength and patient-reported outcomes. Exacerbation of post-operative quadriceps weakness by a FNB could negatively impact recovery, particularly in the early post-operative period. We hypothesized that p...

  11. Stellate ganglion block can relieve symptoms and pain and prevent facial nerve damage

    Science.gov (United States)

    Gogia, Anoop Raj; Chandra, Kumar Naren

    2015-01-01

    Ramsay hunt syndrome[1] is a varicella zoster virus infection of the geniculate ganglion of the facial nerve. It is typically associated with a red rash and blister (inflamed vesicles or tiny water filled sacks in the skin) in or around the ear and eardrum and sometimes on the roof of the mouth or tongue. Corticosteroid, oral acyclovir, and anticonvulsant are used for treatment of this. In addition to this sympathetic neural blockade via stellate ganglion block is used to prevent facial nerve damage and relieve symptoms. We present a case of Ramsay hunt syndrome in which pain and symptoms are not relieved by oral medication but by daily sittings of stellate ganglion block with local anesthetic and steroid, pain, and other symptoms are relieved, and facial nerve damage is prevented. PMID:25829913

  12. Proximal mandibular nerve block, using electrolocation, for rostral mandibulectomy in a geriatric dog.

    Science.gov (United States)

    Carotenuto, Alessandra M; Ravasio, Giuliano; Fonda, Diego; Stefanello, Damiano

    2011-05-01

    We describe a case of proximal mandibular nerve block with ropivacaine, using electrolocation, for perioperative pain management in a geriatric dog undergoing rostral mandibulectomy. The patient did not require intraoperative analgesia or analgesic supplementation for 8 h after the end of the surgery. PMID:22043072

  13. Proximal mandibular nerve block, using electrolocation, for rostral mandibulectomy in a geriatric dog

    OpenAIRE

    Carotenuto, Alessandra M.; Ravasio, Giuliano; Fonda, Diego; Stefanello, Damiano

    2011-01-01

    We describe a case of proximal mandibular nerve block with ropivacaine, using electrolocation, for perioperative pain management in a geriatric dog undergoing rostral mandibulectomy. The patient did not require intraoperative analgesia or analgesic supplementation for 8 h after the end of the surgery.

  14. Compartment syndrome diagnosed in due time by breakthrough pain despite continuous peripheral nerve block

    DEFF Research Database (Denmark)

    Munk-Andersen, H; Laustrup, T K

    2013-01-01

    We here present a paediatric case with development of acute compartment syndrome in the lower leg secondary to a tibial shaft fracture. The patient was diagnosed in time because of breakthrough pain, despite a well-functioning continuous peripheral nerve block with ropivacaine infusion. Compartment...

  15. Magnesium sulfate in femoral nerve block, does postoperative analgesia differ? A comparative study

    Directory of Open Access Journals (Sweden)

    Hossam A. ELShamaa

    2014-04-01

    Conclusion: The current study concluded that the admixture of magnesium to bupivacaine provides a profound prolongation of the femoral nerve block, in addition to a significant decrease in postoperative pain scores and total dose of rescue analgesia, with a longer bearable pain periods in the first postoperative day.

  16. Focal conduction block in compression neuropathy of the proximal sciatic nerve.

    OpenAIRE

    INABA, A.; Komori, T; Yamada, K.; Hirose, K.; T. Yokota

    1995-01-01

    Direct percutaneous stimulation of the proximal sciatic nerve with a high voltage electrical stimulator was given to a patient with acute sciatic compression neuropathy. Results clearly showed a focal conduction block at the sciatic notch, which could not be precisely localised and quantified by conventional electrodiagnostic methods.

  17. Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft

    DEFF Research Database (Denmark)

    Kristensen, Pia Kjær; Storm, Jens Ole; Pfeiffer-Jensen, Mogens; Thillemann, Theis Muncholm

    2014-01-01

    PURPOSE: Arthroscopic anterior cruciate ligament (ACL) reconstruction is a painful procedure requiring intensive postoperative pain management. Femoral nerve block is widely used in ACL surgery. However, femoral nerve block does not cover the donor site of the hamstring tendons. Local infiltration...

  18. Evidence of peripheral nerve blocks for cancer-related pain: a systematic review.

    Science.gov (United States)

    Klepstad, P; Kurita, G P; Mercadante, S; Sjøgren, P

    2015-07-01

    The European Association for Palliative Care has initiated a comprehensive program to achieve an over-all review of the evidence of multiple cancer pain management strategies in order to extend the current guideline for treatment of cancer pain. The present systematic review analyzed the existing evidence of analgesic efficacy for peripheral nerve blocks in adult patients with cancer. A search strategy was elaborated with words related to cancer, pain, peripheral nerve and block. The search was performed in PubMed, EMBASE, and Cochrane for the period until February 2014. The number of abstracts retrieved was 155. No controlled studies were identified. Sixteen papers presented a total of 79 cases. The blocks applied were paravertebral blocks (10 cases), blocks in the head region (2 cases), plexus blocks (13 cases), intercostal blocks (43 cases) and others (11 cases). In general, most cases reported good pain relief and no side effects. The use of peripheral blocks is based upon anecdotal evidence. However, this review only demonstrates the lack of studies, which does not equal a lack of effectiveness. PMID:25384692

  19. Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique

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    Alok Kumar

    2014-01-01

    Full Text Available Background: The established methods of nerve location were based on either proper motor response on nerve stimulation (NS or ultrasound guidance. In this prospective, randomised, observer-blinded study, we compared ultrasound guidance with NS for axillary brachial plexus block using 0.5% bupivacaine with the multiple injection techniques. Methods : A total of 120 patients receiving axillary brachial plexus block with 0.5% bupivacaine, using a multiple injection technique, were randomly allocated to receive either NS (group NS, n = 60, or ultrasound guidance (group US, n = 60 for nerve location. A blinded observer recorded the onset of sensory and motor blocks, skin punctures, needle redirections, procedure-related pain and patient satisfaction. Results: The median (range number of skin punctures were 2 (2-4 in group US and 3 (2-5 in group NS (P =0.27. Insufficient block was observed in three patient (5% of group US and four patients (6.67% of group NS (P > =0.35. Patient acceptance was similarly good in the two groups. Conclusion: Multiple injection axillary blocks with ultrasound guidance provided similar success rates and comparable incidence of complications as compared with NS guidance with 20 ml 0.5% bupivacaine.

  20. High-frequency stimulation selectively blocks different types of fibers in frog sciatic nerve.

    Science.gov (United States)

    Joseph, Laveeta; Butera, Robert J

    2011-10-01

    Conduction block using high-frequency alternating current (HFAC) stimulation has been shown to reversibly block conduction through various nerves. However, unlike simulations and experiments on myelinated fibers, prior experimental work in our lab on the sea-slug, Aplysia, found a nonmonotonic relationship between frequency and blocking thresholds in the unmyelinated fibers. To resolve this discrepancy, we investigated the effect of HFAC waveforms on the compound action potential of the sciatic nerve of frogs. Maximal stimulation of the nerve produces a compound action potential consisting of the A-fiber and C-fiber components corresponding to the myelinated and unmyelinated fibers' response. In our study, HFAC waveforms were found to induce reversible block in the A-fibers and C-fibers for frequencies in the range of 5-50 kHz and for amplitudes from 0.1-1 mA. Although the A-fibers demonstrated the monotonically increasing threshold behavior observed in published literature, the C-fibers displayed a nonmonotonic relationship, analogous to that observed in the unmyelinated fibers of Aplysia. This differential blocking behavior observed in myelinated and unmyelinated fibers during application of HFAC waveforms has diverse implications for the fields of selective stimulation and pain management. PMID:21859632

  1. Use of Peripheral Nerve Blocks with Sedation for Total Knee Arthroplasty in a Patient with Contraindication for General Anesthesia

    Science.gov (United States)

    Kamenetsky, Eric; Nader, Antoun; Kendall, Mark C.

    2015-01-01

    Although peripheral nerve blocks are commonly used to provide postoperative analgesia after total knee arthroplasty (TKA) and other lower extremity procedures, these blocks are rarely used for intraoperative anesthesia. Most TKAs are performed under general anesthesia (GA) or neuraxial anesthesia (NA). The knee has a complex sensory innervation that makes surgical anesthesia difficult with peripheral nerve blocks alone. Rarely are both GA and NA relatively contraindicated and alternatives are considered. We present a patient who underwent TKA performed under peripheral nerve block and sedation alone. PMID:26587290

  2. The Efficacy of Ilioinguinal and Iliohypogastric Nerve Block for Postoperative Pain After Caesarean Section

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    Melike Sakall?

    2010-01-01

    Full Text Available Background:: The effect of ilioinguinal and iliohypogastric (II-IH nerve block on postoperative pain is well documented when applied before Caesarean section but the efficacy remains unclear when applied after the surgical procedure. Therefore we investigated the effect of II-IH nerve block on postoperative pain and analgesic consumption in patients when applied after Caesarean Section. Methods: Sixty ASA I-II patients, scheduled for elective C/S were included in the study. After general anaesthesia was performed, the patients were allocated into 2 groups randomly. In Group I (n=30, bilateral II-IH block had been applied after the skin closure, with 10 ml of 0.5% ropivacaine on each side. In Group II (n=30 sham block had been applied. For postoperative analgesia all patients received tramadol via i.v patient controlled analgesia. VAS scores, tramadol consumption and side effects at 0th, 2nd, 4th, 6th, 8th, 12th, 16th, 20th, 24th hours were noted. Results: There was no difference between groups regarding demographical data. The mean VAS scores in Group I were significantly lower than in Group II at 6th (p=0.003, 8th (p=0.019, 12th (p=0.024, 24th hours (p=0.004 at rest and at 6th (p=0.022, 8th hours (p=0.047 with movement. Tramadol usage in Group I was significantly less than in Group II at all estimated time intervals (P=0.001. Total tramadol consumption was 331 ± 82 mg in Group I and 622±107 mg in group II (P=0.001. Conclusions: We observed that II-IH nerve block when applied after the surgery may reduce analgesic consumption after C/S. Key Words: Caesarean section, postoperative analgesia, Ilioinguinal and Iliohypogastric (II-IH nerve block.

  3. US-Guided Femoral and Sciatic Nerve Blocks for Analgesia During Endovenous Laser Ablation

    International Nuclear Information System (INIS)

    Endovenous laser ablation may be associated with significant pain when performed under standard local tumescent anesthesia. The purpose of this study was to investigate the efficacy of femoral and sciatic nerve blocks for analgesia during endovenous ablation in patients with lower extremity venous insufficiency. During a 28-month period, ultrasound-guided femoral or sciatic nerve blocks were performed to provide analgesia during endovenous laser ablation in 506 legs and 307 patients. The femoral block (n = 402) was performed at the level of the inguinal ligament, and the sciatic block at the posterior midthigh (n = 124), by injecting a diluted lidocaine solution under ultrasound guidance. After the blocks, endovenous laser ablations and other treatments (phlebectomy or foam sclerotherapy) were performed in the standard fashion. After the procedures, a visual analogue pain scale (1–10) was used for pain assessment. After the blocks, pain scores were 0 or 1 (no pain) in 240 legs, 2 or 3 (uncomfortable) in 225 legs, and 4 or 5 (annoying) in 41 legs. Patients never experienced any pain higher than score 5. The statistical analysis revealed no significant difference between the pain scores of the right leg versus the left leg (p = 0.321) and between the pain scores after the femoral versus sciatic block (p = 0.7). Ultrasound-guided femoral and sciatic nerve blocks may provide considerable reduction of pain during endovenous laser and other treatments, such as ambulatory phlebectomy and foam sclerotherapy. They may make these procedures more comfortable for the patient and easier for the operator.

  4. US-Guided Femoral and Sciatic Nerve Blocks for Analgesia During Endovenous Laser Ablation

    Energy Technology Data Exchange (ETDEWEB)

    Yilmaz, Saim, E-mail: ysaim@akdeniz.edu.tr; Ceken, Kagan; Alimoglu, Emel; Sindel, Timur [Akdeniz University School of Medicine, Department of Radiology (Turkey)

    2013-02-15

    Endovenous laser ablation may be associated with significant pain when performed under standard local tumescent anesthesia. The purpose of this study was to investigate the efficacy of femoral and sciatic nerve blocks for analgesia during endovenous ablation in patients with lower extremity venous insufficiency. During a 28-month period, ultrasound-guided femoral or sciatic nerve blocks were performed to provide analgesia during endovenous laser ablation in 506 legs and 307 patients. The femoral block (n = 402) was performed at the level of the inguinal ligament, and the sciatic block at the posterior midthigh (n = 124), by injecting a diluted lidocaine solution under ultrasound guidance. After the blocks, endovenous laser ablations and other treatments (phlebectomy or foam sclerotherapy) were performed in the standard fashion. After the procedures, a visual analogue pain scale (1-10) was used for pain assessment. After the blocks, pain scores were 0 or 1 (no pain) in 240 legs, 2 or 3 (uncomfortable) in 225 legs, and 4 or 5 (annoying) in 41 legs. Patients never experienced any pain higher than score 5. The statistical analysis revealed no significant difference between the pain scores of the right leg versus the left leg (p = 0.321) and between the pain scores after the femoral versus sciatic block (p = 0.7). Ultrasound-guided femoral and sciatic nerve blocks may provide considerable reduction of pain during endovenous laser and other treatments, such as ambulatory phlebectomy and foam sclerotherapy. They may make these procedures more comfortable for the patient and easier for the operator.

  5. Infraorbital nerve block within the Pterygopalatine fossa of the horse: anatomical landmarks defined by computed tomography

    International Nuclear Information System (INIS)

    In order to provide anaesthesia of the equine maxillary cheek teeth, a local nerve block of the infraorbital nerve in the pterygopalatine fossa had been proposed, which is referred to as the 'Palatine Bone Insertion' (PBI). As several complications with this method were reported, our study was designed to recommend a modified injection technique which avoids the risk of puncturing of relevant anatomical structures. Five cadaver heads and two living horses were examined by contrast medium injections and subsequent computed tomography (CT). Spinal needles were inserted using two different insertion techniques: The above mentioned (PBI), and a modification called 'Extraperiorbital Fat Body Insertion' (EFBI). Both techniques (PBI and EFBI) provide a consistent distribution of contrast medium around the infraorbital nerve. However, only the EFBI technique is appropriate to minimize the risk of complications. This study is an example for the permanent challenge of anatomists to supply a basis for clinical and surgical procedures

  6. 3-Tesla High-Field Magnetic Resonance Neurography for Guiding Nerve Blocks and Its Role in Pain Management.

    Science.gov (United States)

    Fritz, Jan; Dellon, Arnold Lee; Williams, Eric H; Belzberg, Allan J; Carrino, John A

    2015-11-01

    Interventional magnetic resonance (MR) neurography is a minimally invasive technique that affords targeting of small nerves in challenging areas of the human body for highly accurate nerve blocks and perineural injections. This cross-sectional technique uniquely combines high tissue contrast and high-spatial-resolution anatomic detail, which enables the precise identification and selective targeting of peripheral nerves, accurate needle guidance and navigation of the needle tip within the immediate vicinity of a nerve, as well as direct visualization of the injected drug for the assessment of appropriate drug distribution and documentation of the absence of spread to confounding nearby nerves. PMID:26499273

  7. Peripheral nerve blocks on the upper extremity: Technique of landmark-based and ultrasound-guided approaches.

    Science.gov (United States)

    Steinfeldt, T; Volk, T; Kessler, P; Vicent, O; Wulf, H; Gottschalk, A; Lange, M; Schwartzkopf, P; Hüttemann, E; Tessmann, R; Marx, A; Souquet, J; Häger, D; Nagel, W; Biscoping, J; Schwemmer, U

    2015-11-01

    The German Society of Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) established an expert panel to develop preliminary recommendations for the application of peripheral nerve blocks on the upper extremity. The present recommendations state in different variations how ultrasound and/or electrical nerve stimulation guided nerve blocks should be performed. The description of each procedure is rather a recommendation than a guideline. The anaesthesiologist should select the variation of block which provides the highest grade of safety according to his individual opportunities. The first section comprises recommendations regarding dosages of local anaesthetics, general indications and contraindications for peripheral nerve blocks and informations about complications. In the following sections most common blocks techniques on the upper extremity are described. PMID:26408023

  8. The spread of injectate during saphenous nerve block at the adductor canal : a cadaver study

    DEFF Research Database (Denmark)

    Andersen, H L; Andersen, S L

    2015-01-01

    BACKGROUND: The spread of injectate during a saphenous nerve block at the adductor canal has not been clearly described. METHODS: We examined the spread of 15?ml dyed injectate during ultrasound-guided saphenous nerve blocks at the adductor canal in 15 unembalmed cadavers' lower limbs followed by comparative dissections of the same limbs. RESULTS: The spread of the injectates was determined by the fascial limits and the muscles surrounding the adductor canal. The anteromedial limit of the adductor canal (the roof) was found to be a continuous fascia, with a thin proximal part and a thicker distal part (the vastoadductor membrane) covering the canal from the apex of the femoral triangle to the adductor hiatus. The fascial limits of the adductor canal formed a conduit around the femoral neurovascular bundle. The dyed aqueous injectate spread throughout the entire adductor canal to the femoral triangle and reached 1-2?cm into the popliteal fossa. Injections superficial to the adductor canal spread over the femoral artery within the subsartorial fat compartment resembling the injections within the canal but with ultrasonographic distinct features. These injections spread only half the length of the adductor canal. The only nerve observed within the adductor canal was the saphenous nerve. CONCLUSIONS: Injection of 15?ml dye was sufficient to spread throughout the adductor canal and beyond both proximally and distally. Distinct ultrasonographic features could be identified separating a subsartorial injection from an injection within the adductor canal with consequent differences in the spread.

  9. Lumbar Plexus and Sciatic Nerve Blocks for Fixation of Proximal Femoral Fractures in patients with Multiple Co-Morbidities

    Directory of Open Access Journals (Sweden)

    T.V.S Gopal

    2014-06-01

    Full Text Available Anaesthesia management for proximal femoral fractures of high risk patients with debilitating systemic co-morbidities is a challenging task. It is generally done under the effect of regional anaesthesia or general anaesthesia (GA, with systemic analgesics for alleviation of pain after surgery. A combination of lumbar plexus and sciatic nerve blocks can provide anaesthesia and analgesia to the entire lower extremity including the hip. Analgesic potency of lumbar plexus and sciatic nerve blocks is similar to epidural analgesia for hip surgery without the undesirable side effects. We describe here two cases of proximal femoral fractures which were done under combined lumbar plexus and sciatic nerve block.

  10. Is femoral nerve block necessary during total knee arthroplasty?: a randomized controlled trial.

    Science.gov (United States)

    Widmer, Benjamin J; Scholes, Corey J; Pattullo, Gavin G; Oussedik, Sam I; Parker, David A; Coolican, Myles R J

    2012-12-01

    There remains a lack of randomized controlled trials comparing methods of perioperative analgesia for total knee arthroplasty. To address this deficiency, a blinded, randomized controlled trial was conducted to compare the use of femoral nerve block (group F) and local anesthetic (group L). A sample of 55 patients who met the inclusion criteria were randomized to either group. No significant differences in the most severe pain score or 36-Item Short Form Health Survey, The Western Ontario and McMaster Universities Arthritis Index (WOMAC), or Oxford scores were observed between groups. However, the Knee Society score was significantly higher in group F. In addition, group F used significantly fewer micrograms of intravenous fentanyl in the first 24 hours. Balancing the risks of femoral nerve block with those of increased systemic narcotic delivery should be performed on a case-by-case basis. PMID:22658231

  11. Ultrasound-Guided Nerve Block with Botulinum Toxin Type A for Intractable Neuropathic Pain.

    Science.gov (United States)

    Moon, Young Eun; Choi, Jung Hyun; Park, Hue Jung; Park, Ji Hye; Kim, Ji Hyun

    2016-01-01

    Neuropathic pain includes postherpetic neuralgia (PHN), painful diabetic neuropathy (PDN), and trigeminal neuralgia, and so on. Although various drugs have been tried to treat neuropathic pain, the effectiveness of the drugs sometimes may be limited for chronic intractable neuropathic pain, especially when they cannot be used at an adequate dose, due to undesirable severe side effects and the underlying disease itself. Botulinum toxin type A (BoNT-A) has been known for its analgesic effect in various pain conditions. Nevertheless, there are no data of nerve block in PHN and PDN. Here, we report two patients successfully treated with ultrasound-guided peripheral nerve block using BoNT-A for intractable PHN and PDN. One patient had PHN on the left upper extremity and the other patient had PDN on a lower extremity. Due to side effects of drugs, escalation of the drug dose could not be made. We injected 50 Botox units (BOTOX(®), Allergan Inc., Irvine, CA, USA) into brachial plexus and lumbar plexus, respectively, under ultrasound. Their pain was significantly decreased for about 4-5 months. Ultrasound-guided nerve block with BoNT-A may be an effective analgesic modality in a chronic intractable neuropathic pain especially when conventional treatment failed to achieve adequate pain relief. PMID:26761032

  12. Ultrasound-Guided Nerve Block with Botulinum Toxin Type A for Intractable Neuropathic Pain

    Directory of Open Access Journals (Sweden)

    Young Eun Moon

    2016-01-01

    Full Text Available Neuropathic pain includes postherpetic neuralgia (PHN, painful diabetic neuropathy (PDN, and trigeminal neuralgia, and so on. Although various drugs have been tried to treat neuropathic pain, the effectiveness of the drugs sometimes may be limited for chronic intractable neuropathic pain, especially when they cannot be used at an adequate dose, due to undesirable severe side effects and the underlying disease itself. Botulinum toxin type A (BoNT-A has been known for its analgesic effect in various pain conditions. Nevertheless, there are no data of nerve block in PHN and PDN. Here, we report two patients successfully treated with ultrasound-guided peripheral nerve block using BoNT-A for intractable PHN and PDN. One patient had PHN on the left upper extremity and the other patient had PDN on a lower extremity. Due to side effects of drugs, escalation of the drug dose could not be made. We injected 50 Botox units (BOTOX®, Allergan Inc., Irvine, CA, USA into brachial plexus and lumbar plexus, respectively, under ultrasound. Their pain was significantly decreased for about 4–5 months. Ultrasound-guided nerve block with BoNT-A may be an effective analgesic modality in a chronic intractable neuropathic pain especially when conventional treatment failed to achieve adequate pain relief.

  13. Dental obturation materials

    Science.gov (United States)

    Stockton, Elizabeth; Chudej, Lauren; Bilyeu, Brian; Brostow, Witold

    2006-10-01

    During the last decades, people have tried to develop a better material for use in dental obturation materials. This new material should meet the following requirements: durability, wear resistance, biocompatibility and chemical adhesion to dentin enamel. Wear resistance is very important and it is related with the service life of dental replacements. We have obtained aesthetically promising novel nano composites that can be used as dental replacements. The main objective of this work is to study the scratch and wear resistance of these nano composites. To meet this goal, scratch tests are performed using a micro scratch tester machine (CSEM), where a diamond indenter is used to make the scratch and the penetration of this indenter is measured with high resolution (7nm). We will be looking at the penetration depth (Rp) and the residual (or healing) depth (Rh) to calculate the percent recovery. These measurements represent the scratch resistance of the material.

  14. Effectiveness of different obturation techniques in surpassing the ledge formed in simulated curved canals

    Scientific Electronic Library Online (English)

    Marilisa Carneiro Leão, Gabardo; Wander José da, Silva; Letícia Machado, Gonçalves; Marili Doro Andrade, Deonízio.

    2013-06-01

    Full Text Available AIM: To compare the effectiveness of different obturation techniques in surpassing the ledge formed in simulated curved root canals. METHODS: Eighty acrylic-resin blocks with curved canals were instrumented with Gates-Glidden drills to simulate a ledge formation. Then, a K-File #10 was used for tryi [...] ng to surpass the deviation, and the blocks that permitted surpassing were rejected. The remaining blocks were divided into 4 groups according to the obturation technique: lateral condensation, Tagger's Hybrid technique, Thermafil and System B. The blocks had their images digitalized using a scanner before and after the obturation procedures. The images were analyzed with Image Tool 3.0 software. Statistical analysis was performed by one-way ANOVA at a significant level of 5%. RESULTS: The System B resulted in the highest obturated area (p0.05). The lateral condensation resulted in the worst ability in filling the ledge space (p

  15. Appendicitis in an obturator hernia.

    Science.gov (United States)

    Camerlinck, Michael; Vanhoenacker, Filip; De Vuyst, Dimitri; Quanten, Inge

    2011-04-01

    We present a case of a 79-year-old female with a history of pain at the right groin for 9 days. Computer tomography of the pelvis showed herniation of the appendix through the obturator canal with a huge abscess surrounding the right hip joint. Laparotomy was performed and histopathology confirmed a perforated necrotic tip of the herniated appendix. An obturator hernia is a rare hernia of the pelvic floor. It is most common in old, emaciated, multiparous women and can cause groin pain with extension to the medial aspect of the thigh. In case of incarceration of bowel, patients also present with obstruction. Isolated incarceration of the appendix, however, does not cause obstruction. The diagnosis of an obturator hernia is often delayed, due to a non-specific clinical presentation. CT scan may offer the clue to the correct diagnosis and should be performed in case of a possible obturator hernia. PMID:20532882

  16. Fabricating a hollow bulb obturator

    Directory of Open Access Journals (Sweden)

    Fatih Sari

    2012-01-01

    Full Text Available

    Obturators are generally used in the rehabilitation of the maxillectomy defects. Ideally, obturators should be light, properly fit and construction should be made easily. By decreasing the weight of the prosthesis, the retention and stability may be optimized to allow the obturator for function comfortably during mastication, phonation, and deglutition. In this case, a 65-year-old male patient underwent surgical removal of left part of the maxilla due to the squamous cell carcinoma. In this technique fabrication of a hollow bulb obturator prosthesis as a single unit in heat-cured acrylic resin using a single-step flasking procedure was described. The patient’s functional and esthetic expectations were satisfied.

  17. Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft

    DEFF Research Database (Denmark)

    Kristensen, Pia Kjær; Storm, Jens Ole; Pfeiffer-Jensen, Mogens; Thillemann, Theis Muncholm

    2014-01-01

    PURPOSE: Arthroscopic anterior cruciate ligament (ACL) reconstruction is a painful procedure requiring intensive postoperative pain management. Femoral nerve block is widely used in ACL surgery. However, femoral nerve block does not cover the donor site of the hamstring tendons. Local infiltration...... would decrease pain and opioid consumption after ACL reconstruction with hamstring tendon graft. METHODS: Sixty patients undergoing primary ACL surgery with hamstring tendon graft were randomised to receive either local infiltration analgesia or femoral nerve block. Pain was scored on the numeric rating......, there were no differences between groups concerning side effects and range of motion. CONCLUSIONS: Local infiltration analgesia and femoral nerve block are similar in the management of postoperative pain after ACL reconstruction with hamstring tendon graft. Until randomised studies have investigated...

  18. [Anesthetic Management Using Frontal Nerve, Greater Occipital Nerve, and Superficial Cervical Plexus Block for Posterior Cervical Spinal Fusion in a Patient with Athetoid Cerebral Palsy].

    Science.gov (United States)

    Matsunami, Sayuri; Komasawa, Nobuyasu; Fujiwara, Shunsuke; Fujitate, Yasutaka; Soen, Masako; Minami, Toshiaki

    2015-05-01

    Here, we report successful anesthetic management of posterior cervical spinal fusion utilizing block of the frontal nerve, the greater occipital nerve, and the superficial cervical plexus in a patient with athetoid cerebral palsy. A 69-year-old woman (height 157 cm; weight 33 kg) with athetoid cerebral palsy was scheduled to undergo posterior cervical spinal fusion for cervical spondylotic myelopathy. After induction of general anesthesia, we performed tracheal intubation using the Pentax-AWS Airwayscope with a thin Intlock. After tracheal intubation, we used ropivacaine for the frontal nerve, greater occipital nerve, and superficial cervical plexus block. Anesthetic maintenance was performed with total intravenous anesthesia utilizing propofol and remifentanil. Continuous administration of dexmedetomidine was started during operation. Following surgery, smooth spontaneous ventilation was observed following uneventful extubation. No significant pain and no athetoid movement were observed under continuous administration of dexmedetomidine. PMID:26422967

  19. Nerve Blocks

    Science.gov (United States)

    ... CT scanner is typically a large, box-like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic ...

  20. Nerve Stimulator Guided Axillary Block in Painless Reduction of Distal Radius Fractures; a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Hossein Alimohammadi

    2013-12-01

    Full Text Available Introduction: Given the high prevalence of upper extremity fractures and increasing need to perform painless reduction in the emergency departments, the use of analgesic methods with fewer complications and more satisfaction appears to be essential. The aim of this study is comparison the nerve stimulator guided axillary block (NSAB with intravenous sedation in induction of analgesia for painless reduction of distal radius fractures. Methods: In the present randomized clinical trial, 60 patients (18-70 years of age suffered from distal radius fractures, were divided into two equal groups. One group received axillary nerve block by nerve stimulator guidance and the other procedural sedation and analgesia (PSA using midazolam/fentanyl. Onset of analgesia, duration of analgesic effect, total procedure time and pain scores were recorded using visual analogue scale (VAS and the outcomes were compared. Chi-squared and student t test were performed to evaluate differences between two groups. Results: Sixty patients were randomly divided into two groups (83.3% male. The mean age of patients was 31 ±0.7 years. While the onset of analgesia was significantly longer in the NSAB group, the mean total time of procedure was shorter than PSA (p<0.001. The NSAB group needed a shorter post-operative observation time (P<0.001. Both groups experienced equal pain relief before, during and after procedure (p>0.05. Conclusion: It seems that shorter post-operative monitoring time and consequently lesser total time of procedure, make nerve stimulator guided axillary block as an appropriate alternative for procedural sedation and analgesia in painless reduction of distal radius fractures in emergency department. 

  1. Percutaneous sciatic nerve block with tramadol induces analgesia and motor blockade in two animal pain models

    International Nuclear Information System (INIS)

    Local anesthetic efficacy of tramadol has been reported following intradermal application. Our aim was to investigate the effect of perineural tramadol as the sole analgesic in two pain models. Male Wistar rats (280-380 g; N = 5/group) were used in these experiments. A neurostimulation-guided sciatic nerve block was performed and 2% lidocaine or tramadol (1.25 and 5 mg) was perineurally injected in two different animal pain models. In the flinching behavior test, the number of flinches was evaluated and in the plantar incision model, mechanical and heat thresholds were measured. Motor effects of lidocaine and tramadol were quantified and a motor block score elaborated. Tramadol, 1.25 mg, completely blocked the first and reduced the second phase of the flinching behavior test. In the plantar incision model, tramadol (1.25 mg) increased both paw withdrawal latency in response to radiant heat (8.3 ± 1.1, 12.7 ± 1.8, 8.4 ± 0.8, and 11.1 ± 3.3 s) and mechanical threshold in response to von Frey filaments (459 ± 82.8, 447.5 ± 91.7, 320.1 ± 120, 126.43 ± 92.8 mN) at 5, 15, 30, and 60 min, respectively. Sham block or contralateral sciatic nerve block did not differ from perineural saline injection throughout the study in either model. The effect of tramadol was not antagonized by intraperitoneal naloxone. High dose tramadol (5 mg) blocked motor function as well as 2% lidocaine. In conclusion, tramadol blocks nociception and motor function in vivo similar to local anesthetics

  2. Percutaneous sciatic nerve block with tramadol induces analgesia and motor blockade in two animal pain models

    Directory of Open Access Journals (Sweden)

    A.M. Sousa

    2012-02-01

    Full Text Available Local anesthetic efficacy of tramadol has been reported following intradermal application. Our aim was to investigate the effect of perineural tramadol as the sole analgesic in two pain models. Male Wistar rats (280-380 g; N = 5/group were used in these experiments. A neurostimulation-guided sciatic nerve block was performed and 2% lidocaine or tramadol (1.25 and 5 mg was perineurally injected in two different animal pain models. In the flinching behavior test, the number of flinches was evaluated and in the plantar incision model, mechanical and heat thresholds were measured. Motor effects of lidocaine and tramadol were quantified and a motor block score elaborated. Tramadol, 1.25 mg, completely blocked the first and reduced the second phase of the flinching behavior test. In the plantar incision model, tramadol (1.25 mg increased both paw withdrawal latency in response to radiant heat (8.3 ± 1.1, 12.7 ± 1.8, 8.4 ± 0.8, and 11.1 ± 3.3 s and mechanical threshold in response to von Frey filaments (459 ± 82.8, 447.5 ± 91.7, 320.1 ± 120, 126.43 ± 92.8 mN at 5, 15, 30, and 60 min, respectively. Sham block or contralateral sciatic nerve block did not differ from perineural saline injection throughout the study in either model. The effect of tramadol was not antagonized by intraperitoneal naloxone. High dose tramadol (5 mg blocked motor function as well as 2% lidocaine. In conclusion, tramadol blocks nociception and motor function in vivo similar to local anesthetics.

  3. Ultrasound-Assisted Mental Nerve Block and Pulsed Radiofrequency Treatment for Intractable Postherpetic Neuralgia: Three Case Studies

    OpenAIRE

    Park, Hae Gyun; Park, Pyung Gul; Kim, Won Joong; Park, Yong Hee; Kang, Hyun; Baek, Chong Wha; Jung, Yong Hun; Woo, Young Cheol; Koo, Gill Hoi; Shin, Hwa Yong

    2013-01-01

    Postherpetic neuralgia (PHN) is one of the most difficult pain syndromes to treat. Invasive treatments may be considered when patients fail to obtain adequate pain relief from noninvasive treatment approaches. Here, we present three cases of PHN in the mandibular branch treated with ultrasound-assisted mental nerve block and pulsed radiofrequency treatment. None of the patients had adequate pain relief from the medical therapy, so we performed the mental nerve block on the affected side under...

  4. Ultrasound-Guided Greater Occipital Nerve Blocks and Pulsed Radiofrequency Ablation for Diagnosis and Treatment of Occipital Neuralgia

    OpenAIRE

    VanderHoek, Matthew David; Hoang, Hieu T; Goff, Brandon

    2013-01-01

    Occipital neuralgia is a condition manifested by chronic occipital headaches and is thought to be caused by irritation or trauma to the greater occipital nerve (GON). Treatment for occipital neuralgia includes medications, nerve blocks, and pulsed radiofrequency ablation (PRFA). Landmark-guided GON blocks are the mainstay in both the diagnosis and treatment of occipital neuralgia. Ultrasound is being utilized more and more in the chronic pain clinic to guide needle advancement when performing...

  5. Repeatable and adjustable on-demand sciatic nerve block with phototriggerable liposomes.

    Science.gov (United States)

    Rwei, Alina Y; Lee, Jung-Jae; Zhan, Changyou; Liu, Qian; Ok, Meryem T; Shankarappa, Sahadev A; Langer, Robert; Kohane, Daniel S

    2015-12-22

    Pain management would be greatly enhanced by a formulation that would provide local anesthesia at the time desired by patients and with the desired intensity and duration. To this end, we have developed near-infrared (NIR) light-triggered liposomes to provide on-demand adjustable local anesthesia. The liposomes contained tetrodotoxin (TTX), which has ultrapotent local anesthetic properties. They were made photo-labile by encapsulation of a NIR-triggerable photosensitizer; irradiation at 730 nm led to peroxidation of liposomal lipids, allowing drug release. In vitro, 5.6% of TTX was released upon NIR irradiation, which could be repeated a second time. The formulations were not cytotoxic in cell culture. In vivo, injection of liposomes containing TTX and the photosensitizer caused an initial nerve block lasting 13.5 ± 3.1 h. Additional periods of nerve block could be induced by irradiation at 730 nm. The timing, intensity, and duration of nerve blockade could be controlled by adjusting the timing, irradiance, and duration of irradiation. Tissue reaction to this formulation and the associated irradiation was benign. PMID:26644576

  6. [Operative management in axillary brachial plexus blocks: comparison of ultrasound and nerve stimulation].

    Science.gov (United States)

    Schwemmer, U; Schleppers, A; Markus, C; Kredel, M; Kirschner, S; Roewer, N

    2006-04-01

    Given a case-by-case accounting system, the analysis of medical performance becomes increasingly important. Quality of treatment and the time effort attached play an important role. Anaesthesia procedures require a high level of quality and safety. Moreover, they are personnel intensive. In the area of regional anaesthesia, new procedures such as the use of high definition ultrasonography for nerve blocks, allow a possible time gain as well as improved quality. The aim of this investigation was to analyze the impact on time and results when using ultrasonography or nerve stimulation for axillary brachial plexus blocks. Therefore, over a time period of 9 months, the ultrasound-guided plexus anaesthesia (Sono) and the neurostimulation methods (NStim) were investigated based upon the anaesthesia documentation of patients undergoing hand surgery. Only those cases were included where an axillary brachial plexus block had been performed, incomplete protocols were excluded and 1.5% mepivacaine was used as medication. Overall, a total of 130 cases fulfilled these criteria. The success rates, time consumption and timelines were evaluated. All data was stored on an Excel-sheet and statistically evaluated. The results revealed a significant increase in the success rate for the patient group where ultrasound was used (98.2% Sono vs 83.1% NStim) and the operation could begin 15 min earlier in the Sono group (5 min vs. 20 min, p<0.001). Furthermore, the duration of anaesthesia was significantly shorter (85 min vs. 120 min, p<0.001) and the necessity for post-operative observation was less (5.4% vs. 32.4%, p<0.001). The data provided in the study indicate that the use of ultrasound for the identification of the nerves can clearly improve quality and time-scales of axillary brachial plexus blocks. PMID:16463076

  7. Skin temperature measured by infrared thermography after specific ultrasound-guided blocking of the musculocutaneous, radial, ulnar, and median nerves in the upper extremity

    DEFF Research Database (Denmark)

    Lange, K H W; Jansen, T; Asghar, S; Kristensen, P L; Skjønnemand, M; Nørgaard, P

    2011-01-01

    Sympathetic block causes vasodilatation and increases in skin temperature (T(s)). However, the T(s) response after specific nerve blocking is unknown. In this study, we hypothesized that T(s) would increase after specific blocking of the nerve innervating that area.......Sympathetic block causes vasodilatation and increases in skin temperature (T(s)). However, the T(s) response after specific nerve blocking is unknown. In this study, we hypothesized that T(s) would increase after specific blocking of the nerve innervating that area....

  8. Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block

    Energy Technology Data Exchange (ETDEWEB)

    Suresh, S. [The Royal National Orthopaedic Hospital NHS Trust, London (United Kingdom); Berman, J. [The Royal National Orthopaedic Hospital NHS Trust, Anaesthetic Department, London (United Kingdom); Connell, David A. [The Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, London (United Kingdom)

    2007-05-15

    A 60-year-old man with a 4-year history of intractable neck pain and radicular pain in the C5 nerve root distribution presented to our department for a CT-guided transforaminal left C5 nerve root block. He had had a similar procedure on the right 2 months previously, and had significant improvement of his symptoms with considerable pain relief. On this occasion he was again accepted for the procedure after the risks and potential complications had been explained. Under CT guidance, a 25G spinal needle was introduced and after confirmation of the position of the needle, steroid was injected. Immediately the patient became unresponsive, and later developed a MR-proven infarct affecting the left vertebral artery (VA) territory. This is the first report of a major complication of a cervical root injection under CT guidance reported in the literature. We present this case report and the literature review of the potential complications of this procedure. (orig.)

  9. Peripheral nerve blocks in patients with Ehlers-Danlos syndrome, hypermobility type: a report of 2 cases.

    Science.gov (United States)

    Patzkowski, Michael S

    2016-03-01

    Ehlers-Danlos syndrome is an inherited disorder of collagen production that results in multiorgan dysfunction. Patients with hypermobility type display skin hyperextensibility and joint laxity, which can result in chronic joint instability, dislocation, peripheral neuropathy, and severe musculoskeletal pain. A bleeding diathesis can be found in all subtypes of varying severity despite a normal coagulation profile. There have also been reports of resistance to local anesthetics in these patients. Several sources advise against the use of regional anesthesia in these patients citing the 2 previous features. There have been reports of successful neuraxial anesthesia, but few concerning peripheral nerve blocks, none of which describe nerves of the lower extremity. This report describes 2 cases of successful peripheral regional anesthesia in the lower extremity. In case 1, a 16-year-old adolescent girl with hypermobility type presented for osteochondral grafting of tibiotalar joint lesions. She underwent a popliteal sciatic (with continuous catheter) and femoral nerve block under ultrasound guidance. She proceeded to surgery and tolerated the procedure under regional block and intravenous sedation. She did not require any analgesics for the following 15 hours. In case 2, an 18-year-old woman with hypermobility type presented for medial patellofemoral ligament reconstruction for chronic patella instability. She underwent a saphenous nerve block above the knee with analgesia in the distribution of the saphenous nerve lasting for approximately 18 hours. There were no complications in either case. Prohibitions against peripheral nerve blocks in patients with Ehlers-Danlos syndrome, hypermobility type, appear unwarranted. PMID:26897449

  10. Feasibility and safety of ultrasound-guided nerve block for management of limb injuries by emergency care physicians

    Directory of Open Access Journals (Sweden)

    Sanjeev Bhoi

    2012-01-01

    Full Text Available Background: Patients require procedural sedation and analgesia (PSA for the treatment of acute traumatic injuries. PSA has complications. Ultrasound (US guided peripheral nerve block is a safe alternative. Aim: Ultrasound guided nerve blocks for management of traumatic limb emergencies in Emergency Department (ED. Setting and Design: Prospective observational study conducted in ED. Materials and Methods: Patients above five years requiring analgesia for management of limb emergencies were recruited. Emergency Physicians trained in US guided nerve blocks performed the procedure. Statistical analysis: Effectiveness of pain control, using visual analogue scale was assessed at baseline and at 15 and 60 minutes after the procedure. Paired t test was used for comparison. Results: Fifty US guided nerve blocks were sciatic- 4 (8%, femoral-7 (14%, brachial- 29 (58%, median -6 (12%, and radial 2 (4% nerves. No patients required rescue PSA. Initial median VAS score was 9 (Inter Quartile Range [IQR] 7-10 and at 1 hour was 2(IQR 0-4. Median reduction in VAS score was 7.44 (IQR 8-10(75%, 1-2(25% (P=0.0001. Median procedure time was 9 minutes (IQR 3, 12 minutes and median time to reduction of pain was 5 minutes (IQR 1,15 minutes. No immediate or late complications noticed at 3 months. Conclusion: Ultrasound-guided nerve blocks can be safely and effectively performed for upper and lower limb emergencies by emergency physicians with adequate training.

  11. Comparative Evaluation of Fracture Resistance of Endodontically Treated Teeth Obturated with Resin Based Adhesive Sealers with Conventional Obturation Technique: An In vitro Study

    Science.gov (United States)

    Langalia, Akshay K; Dave, Bela; Patel, Neeta; Thakkar, Viral; Sheth, Sona; Parekh, Vaishali

    2015-01-01

    Background: To compare fracture resistance of endodontically treated teeth obturated with different resin-based adhesive sealers with a conventional obturation technique. Materials and Methods: A total of 60 Single canaled teeth were divided into five groups. The first group was taken as a negative control. The rest of the groups were shaped using ProFile rotary files (Dentsply Maillefer, Ballaigues, Switzerland). The second group was obturated with gutta-percha and a ZOE-based sealer Endoflas FS (Sanlor Dental Products, USA). The third group was obturated with gutta-percha and an epoxy-based sealer AH Plus (Dentsply, DeTrey, Germany). The fourth group was obturated with Resilon (Pentron Clinical Technologies, Wallingford, CT) and RealSeal sealer (Pentron Clinical Technologies). The fifth group was obturated with EndoREZ points and EndoREZ sealer (both from Ultradent, South Jordan, UT). Roots were then embedded into acrylic blocks and were then fixed into a material testing system and loaded with a stainless steel pin with a crosshead speed of 5 mm/min until fracture. The load at which the specimen fractured was recorded in Newtons. Results: It was found that forces at fracture were statistically significant for the newer resin systems, Resilon, and EndoREZ. Conclusion: It was concluded that roots obturated with newer resin systems (Resilon and EndoREZ) enhanced the root strength almost up to the level of the intact roots. PMID:25859099

  12. Vagus nerve stimulation blocks vascular permeability following burn injury in both local and distal sites

    OpenAIRE

    Ortiz-Pomales, Yan T; Krzyzaniak, Michael; Coimbra, Raul; Baird, Andrew; Eliceiri, Brian P

    2012-01-01

    Recent studies have shown that vagus nerve stimulation (VNS) can block the burn injury-induced systemic inflammatory response (SIRS). In this study we examined the potential for VNS to modulate vascular permeability (VP) in local sites (i.e. skin) and in secondary sites (i.e. lung) following burn injury. In a 30% total body surface area burn injury model, VP was measured using intravascular fluorescent dextran for quantification of the VP response in skin and lung. A peak in VP of the skin wa...

  13. Duration of Action of Bupivacaine Hydrochloride Used for Palatal Sensory Nerve Block in Infant Pigs

    OpenAIRE

    Holman, Shaina Devi; Gierbolini-Norat, Estela M.; LUKASIK, STACEY L.; Campbell-Malone, Regina; Ding, Peng; German, Rebecca Z.

    2014-01-01

    Bupivacaine hydrochloride is frequently used in veterinary dental procedures to reduce the amount of general anesthesia needed and to reduce post-procedural pain. The aim of this study was to develop a novel method to test local anesthetic duration in mammals. Six infant pigs were placed under deep/surgical anesthesia with 3 % isoflurane and oxygen while 0.5 ml of 0.5 % bupivacaine hydrochloride was injected to block the two greater palatine and the nasopalatine nerves. They were then maintai...

  14. [Comparative study of performance of lower extremities blocks under ultrasonography and nerve stimulator guidance].

    Science.gov (United States)

    Bubnov, R V; Strokan', A M; Abdullaiev, R Ia

    2011-01-01

    The aim of the study was to conduct a comparative analysis of regional anesthesia under neurostimulator, ultrasound guidance, and under combined guidance of the neurostimulator and ultrasound to ensure the safe and effective control of regional anesthesia with minimal discomfort for the patient. Ultrasound allows to gain significantly higher quality scores of local anesthesia than nerve stimulator control, to significantly reduce the number of needle extra insertions, needling cases, transposition, addition of general anesthesia, the number of unsuccessful blocks, reduce needle manipulation, significantly increase the occurrence of cases of complete blockade (sensitive and motor) on 30 min., causes less discomfort for patients. The use of ultrasound does not exclude the use of nerve stimulator as an additional means of verification of correct needle placement, particularly in the early stages of mastering the technique. The research combined use of ultrasound and nerve stimulator significantly decrease unsuccessful blockade and transposition need for a needle during manipulation. However, the difference between some indicators of quality of regional anesthesia is statistically unreliable; it requires further randomized and double blind studies on large patient groups, for different blockages. PMID:21954647

  15. Essential oil of Croton zehntneri and its main constituent anethole block excitability of rat peripheral nerve.

    Science.gov (United States)

    da Silva-Alves, Kerly Shamyra; Ferreira-da-Silva, Francisco Walber; Coelho-de-Souza, Andrelina Noronha; Albuquerque, Aline Alice Cavalcante; do Vale, Otoni Cardoso; Leal-Cardoso, José Henrique

    2015-03-01

    Croton zehntneri is an aromatic plant native to Northeast Brazil and employed by local people to treat various diseases. The leaves of this plant have a rich content of essential oil. The essential oil of C. zehntneri samples, with anethole as the major constituent and anethole itself, have been reported to have several pharmacological activities such as antispasmodic, cardiovascular, and gastroprotective effects and inducing the blockade of neuromuscular transmission and antinociception. Since several works have demonstrated that essential oils and their constituents block cell excitability and in view of the multiple effects of C. zehntneri essential oil and anethole on biological tissues, we undertook this investigation aiming to characterize and compare the effects of this essential oil and its major constituent on nerve excitability. Sciatic nerves of Wistar rats were used. They were mounted in a moist chamber, and evoked compound action potentials were recorded. Nerves were exposed in vitro to the essential oil of C. zehntneri and anethole (0.1-1?mg/mL) up to 180?min, and alterations in excitability (rheobase and chronaxie) and conductibility (peak-to-peak amplitude and conduction velocity) parameters of the compound action potentials were evaluated. The essential oil of C. zehntneri and anethole blocked, in a concentration-dependent manner with similar pharmacological potencies (IC50: 0.32?±?0.07 and 0.22?±?0.11?mg/mL, respectively), rat sciatic nerve compound action potentials. Strength-duration curves for both agents were shifted upward and to the right compared to the control curve, and the rheobase and chronaxie were increased following essential oil and anethole exposure. The time courses of the essential oil of C. zehntneri and anethole effects on peak-to-peak amplitude of compound action potentials followed an exponential decay and reached a steady state. The essential oil of C. zehntneri and anethole caused a similar reduction in conduction velocities of the compound action potential waves investigated. In conclusion, we demonstrated here that the essential oil of C. zehntneri blocks neuronal excitability and that this effect, which can be predominantly attributable to its major constituent, anethole, is important since these agents have several pharmacological effects likely related to the alteration of excitability. This finding is relevant due to the use of essential oils in aromatherapy and the low acute toxicity of this agent, which exhibits other effects of potential therapeutic usefulness. PMID:25714722

  16. Skin temperature measured by infrared thermography after specific ultrasound-guided blocking of the musculocutaneous, radial, ulnar, and median nerves in the upper extremity

    DEFF Research Database (Denmark)

    Lange, K H W; Jansen, T

    2011-01-01

    Sympathetic block causes vasodilatation and increases in skin temperature (T(s)). However, the T(s) response after specific nerve blocking is unknown. In this study, we hypothesized that T(s) would increase after specific blocking of the nerve innervating that area.

  17. ULTRASOUND GUIDED ILIOINGUINAL AND ILIOHYPOGASTRIC NERVE BLOCK FOR INGUINAL HERNIA REPAIR IN ARTHROGRYPOSIS MULTIPLEX CONGENITA

    Directory of Open Access Journals (Sweden)

    Paul O.

    2015-06-01

    Full Text Available Arthrogryposis multiplex congenita (AMC refers to a syndrome of unknown etiology with multiple congenital contractures in one or more joints with a concomitant inability of passive extension and flexion . The overall prevalence of arthrogryposis is one in 3000 live births . The extensive contractures , tense skin , minimal muscle mass and subcutaneous tissue pose challenges in anaesthetic management. We report a seven year old boy (15 kg , known case of AMC with congenital talipes equino varus (CTEV and bilateral hip dislocation posted for right sided herniot omy and orchidopexy. We planned to combine general anaesthesia without muscle relaxants and regional nerve block. The child was induced with propofol and Classic LMA Size 2 was inserted. An ilioinguinal and i liohypogastric nerve block was given under ultrasound guidance using 0.2% ropivacaine. Pateint remained hemodynamically stable during surgery with minimal anaesthetic requirement and no anlgesics. Analgesia lasted for 8 hours postoperatively. Combining narcosis with regional anaesthesia leads to a reduced demand for anaesthetics , stable circulatory conditions , maintenance of spontaneous breathing , prevention of stress and sufficient postoperative analgesia

  18. Femoral Nerve Block - A Guide for Medical Students and Junior Doctors

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    Andrew R Bogacz

    2012-08-01

    Full Text Available A femoral fracture is a painful and distressing traumatic injury that is commonly encountered when working in an emergency department. The incidence of femoral shaft fracture has been estimated at 1.0-1.3 per 10,000 of population. The acute treatment of such an injury involves placement of the injured limb into a Thomas traction splint, which requires the provision of pain relief, commonly through use of a femoral nerve block. A femoral nerve block is a specific regional anaesthetic technique used by doctors in emergency medicine to provide anaesthesia and analgesia of the affected leg, to allow relief of pain from the fracture and facilitate movement of the injured limb into a splint. This article provides an educational overview of this practical procedure for junior doctors and medical students alike. We describe the technique as traditionally performed, as well as highlighting an increasingly favoured method using ultrasound as an adjunct to improve the accuracy and safety of the procedure.

  19. Prospective, double-blind, randomized controlled trial of electrophysiologically guided femoral nerve block in total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Youm YS

    2013-03-01

    Full Text Available Yoon Seok Youm,1 Sung Do Cho,1 Chang Ho Hwang21Department of Orthopedic Surgery, 2Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of KoreaBackground: The purpose of this study was to compare electrophysiologically guided and traditional nerve stimulator analgesia femoral nerve block after total knee arthroplasty.Methods: Patients scheduled for unilateral total knee arthroplasty were randomized to electrophysiologically guided or traditional nerve stimulator analgesia by pre-emptive single injection femoral nerve block with corresponding assistance. We assessed pain scores using a visual analog scale (VAS, 0 = no pain, 100 = the worst pain and the volumes of morphine consumed at 4, 24, 48, and 72 hours after total knee arthroplasty.Results: Of the 60 patients enrolled, eight withdrew from the study. The remaining 52 patients were randomized to the electrophysiologically guided group (n = 27 or traditional nerve stimulator analgesia (n = 25 group. Four hours after total knee arthroplasty, VAS scores were significantly lower in the electrophysiologically guided group than in the traditional nerve stimulator group at rest (4.8 ± 1.4 versus 5.9 ± 0.8, P < 0.01 and while moving (6.2 ± 1.1 versus 6.9 ± 0.9, P < 0.01. The total volumes of morphine injected at 24, 48, and 72 hours were significantly decreased in the electrophysiologically guided group (P < 0.05 each. Variable × time interaction of VAS was significant in the electrophysiologically guided group (P < 0.05, with each VAS score at 24, 48, and 72 hours being significantly lower than the baseline score (P < 0.05. VAS scores at every time point were significantly lower in the electrophysiologically group guided than in the traditional nerve stimulator group (P < 0.05.Conclusion: Electrophysiologically guided single injection femoral nerve block may provide better postoperative analgesia and a greater reduction in the demand for pain killers than femoral nerve block using traditional nerve stimulator analgesia.Keywords: femoral nerve, nerve block, electrophysiologic concepts, arthroplasty, knee, ropivacaine

  20. Preoperatıve Ultrasound-Guıded Suprascapular Nerve Block for Postthoracotomy Shoulder Paın ☆

    OpenAIRE

    Özyuvaci, Emine; Akyol, Onat; Şitilci, Tolga; Dübüs¸, Türkan; Topac¸ogˇlu, Hakan; Leblebici, Hülya; Ac¸ikgöz, Alican

    2013-01-01

    Background Acute postthoracotomy pain is a well-known potential problem, with pulmonary complications, ineffective respiratory rehabilitation, and delayed mobilization in the initial postoperative period, and it is followed by chronic pain. The type of thoracotomy, intercostal nerve damage, muscle retraction, costal fractures, pleural irritation, and incision scar are the most responsible mechanisms. Objective Our aim was to assess whether preoperative ultrasound suprascapular nerve block wit...

  1. Continuous perineural block of the palmar nerves: a new technique for pain relief in the distal equine forelimb.

    OpenAIRE

    Zarucco, Laura

    2007-01-01

    Pain therapy is an important aspect of equine orthopedic and trauma surgery. Although long-term epidural analgesia has become an almost routine method of treatment for painful conditions in the horse’s hind limb, a similarly effective technique for management of pain originating in the horse’s front limb has not yet been developed. Continuous perineural nerve block (CPNB) is a method that entails continuous low-volume infusion of local anesthetics via catheters placed along peripheral nerv...

  2. Population pharmacokinetics of bupivacaine in combined lumbar and sciatic nerve block

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    Hanene Eljebari

    2014-01-01

    Full Text Available Objectives: The primary aim of this study was to establish the population pharmacokinetic (PPK model of bupivacaine after combined lumbar plexus and sciatic nerve blocks and secondary aim is to assess the effect of patient′s characteristics including age, body weight and sex on pharmacokinetic parameters. Materials and Methods: A total of 31 patients scheduled for elective lower extremity surgery with combined lumbar and sciatic nerve block using plain bupivacaine 0.5% were included. The total bupivacaine plasma concentrations were measured before injection and after two blocks placement and at selected time points. Monitoring of bupivacaine was made by high performance liquid chromatography (HPLC with ultraviolet detection. Non-linear mixed effects modeling was used to analyze the PPK of bupivacaine. Results: One compartment model with first order absorption, two input compartments and a central elimination was selected. The Shapiro-Wilks test of normality for normalized prediction distribution errors for this model (P = 0.156 showed this as a valid model. The selected model predicts a population clearance of 930 ml/min (residual standard error [RSE] = 15.48%, IC 95% = 930 ± 282.24 with inter individual variability of 75.29%. The central volume of distribution was 134 l (RSE = 12.76%, IC = 134 ± 33.51 L with inter individual variability of 63.40%. The absorption of bupivacaine in two sites Ka1 and Ka2 were 0.00462/min for the lumbar site and 0.292/min for the sciatic site. Age, body weight and sex have no effect on the bupivacaine pharmacokinetics in this studied population. Conclusion: The developed model helps us to assess the systemic absorption of bupivacaine at two injections sites.

  3. Low cost continuous femoral nerve block for relief of acute severe cancer related pain due to pathological fracture femur

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    Rachel Cherian Koshy

    2010-01-01

    Full Text Available Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being.

  4. Pain during Transrectal Ultrasound-Guided Prostate Biopsy and the Role of Periprostatic Nerve Block: What Radiologists Should Know

    Energy Technology Data Exchange (ETDEWEB)

    Nazir, Babar [Dept. of Oncologic Imaging, National Cancer Centre, Singapore (Singapore)

    2014-10-15

    Early prostate cancers are best detected with transrectal ultrasound (TRUS)-guided core biopsy of the prostate. Due to increased longevity and improved prostate cancer screening, more men are now subjected to TRUS-guided biopsy. To improve the detection rate of early prostate cancer, the current trend is to increase the number of cores obtained. The significant pain associated with the biopsy procedure is usually neglected in clinical practice. Although it is currently underutilized, the periprostatic nerve block is an effective technique to mitigate pain associated with prostate biopsy. This article reviews contemporary issues pertaining to pain during prostate biopsy and discusses the practical aspects of periprostatic nerve block.

  5. Pain during Transrectal Ultrasound-Guided Prostate Biopsy and the Role of Periprostatic Nerve Block: What Radiologists Should Know

    International Nuclear Information System (INIS)

    Early prostate cancers are best detected with transrectal ultrasound (TRUS)-guided core biopsy of the prostate. Due to increased longevity and improved prostate cancer screening, more men are now subjected to TRUS-guided biopsy. To improve the detection rate of early prostate cancer, the current trend is to increase the number of cores obtained. The significant pain associated with the biopsy procedure is usually neglected in clinical practice. Although it is currently underutilized, the periprostatic nerve block is an effective technique to mitigate pain associated with prostate biopsy. This article reviews contemporary issues pertaining to pain during prostate biopsy and discusses the practical aspects of periprostatic nerve block.

  6. Experimental study of carotid sinus nerve block in prevention and treatment of hemodynamics instability caused by carotid sinus stimulation

    International Nuclear Information System (INIS)

    Objective: To evaluate the role of carotid sinus nerve block in prevention and treatment of hemodynamics instability caused by carotid sinus stimulation. Methods: Twenty-four Japanese white rabbits were randomized into three groups (8 in each). Respectively, one side of their carotid sinus nerves were blocked by normal saline (NS) (group A1), lidocaine (group A2) and both side were blocked by lidocaine (group A3), and then the blood pressure (BP) and heart rate (HR) were measured in two hours. 7 days later, the 24 rabbits were randomized into 2 groups averagely. The first 12 rabbits were randomized into 2 subgroups (6 in each). After blocking carotid sinus nerve with NS (group B1) or lidocaine (group B2), in two hours, the carotid sinus was stimulated repeatedly by stretching the common carotid artery (CCA), and contrasted the change of BP. The second 12 were randomized into two subgroups too (6 in each). One of each rabbit's CCA was continuously stretched. 3 minutes later, the carotid sinus nerves were blocked with NS (group C1) or lidocaine (group C2). BP in 60 minutes was contrasted between the two groups. Results: BP had no significant change in group A1 and A2 (F 0.31, P > 0.05; F = 0.65, P > 0.05), but BP rose significantly and transiently in group A3 (In 10 minutes all t > 2.60, P 0.05). Each stimulation could lead to BP downfall in group B1 (At all stimulating times t > 2.63, P 0.05). After the block with NS or lidocaine, hypotension had lasted for 17 minutes in group C1 (All t > 1.98, P 0.05). Conclusion: Mono-side carotid sinus nerve block has no significant influence on hemodynamics of normal rabbits, but has reliable preventional and therapeutic role on hemodynamics instability caused by carotid sinus stimulation

  7. Excitation block in a nerve fibre model owing to potassium-dependent changes in myelin resistance

    DEFF Research Database (Denmark)

    Brazhe, Alexey; Maksimov, G. V.; Mosekilde, Erik; Sosnovtseva, O. V.

    2011-01-01

    The myelinated nerve fibre is formed by an axon and Schwann cells or oligodendrocytes that sheath the axon by winding around it in tight myelin layers. Repetitive stimulation of a fibre is known to result in accumulation of extracellular potassium ions, especially between the axon and the myelin....... Uptake of potassium leads to Schwann cell swelling and myelin restructuring that impacts the electrical properties of the myelin. In order to further understand the dynamic interaction that takes place between the myelin and the axon, we have modelled submyelin potassium accumulation and related changes...... in myelin resistance during prolonged high-frequency stimulation. We predict that potassium-mediated decrease in myelin resistance leads to a functional excitation block with various patterns of altered spike trains. The patterns are found to depend on stimulation frequency and amplitude and to range...

  8. An unforeseen complication arising from inferior alveolar nerve block: is anemia possible?

    Science.gov (United States)

    Ezirganli, Seref; Kazancioglu, Hakki Oguz

    2013-11-01

    Complications after administration of local anesthesia for dental procedures are well recognized. We present here 2 cases of patients with anemic areas on their faces resulting from inferior alveolar nerve block (IANB). The precise cause of this complication is unknown; however, it may be derived from anastomosis of the maxillary artery, rapid injection of local anesthetic solution, misdirection of the needle, and spread of the solution to the upper region of the mandible. Although neurologic occurrences resulting from IANB are rare, dentists should keep in mind that certain dental procedures such as administering IANB could cause anemic areas on the face. Henceforth, dentists should consider the possibility of anemia after administration of IANB and pay attention to avoid complications during the procedure. PMID:24220435

  9. Ophthalmic Complication Following Posterior Superior Alveolar Nerve Block for Tooth Extraction! A Rare Occurrence.

    Science.gov (United States)

    Ghosh, Abhishek; Vaibhav, N; Raut, Rohan; Venkatesh, Anchita

    2015-09-01

    One of the most commonly asked question by a patient who comes for extraction especially in the rural areas is whether the procedure will cause problems to the eye!! In reality however, ophthalmic complications following routine maxillary molar extractions are practically unheard of. When they occur they can be extremely unnerving not just to the patient but also to the surgeon. Patients generally panic which makes it tougher for the clinician to assess the situation. We present a case of a 26 year old female patient developing ophthalmic complication following local anesthesia administration during extraction of upper left maxillary third molar. In this article, ophthalmic complications arising from posterior superior alveolar nerve block are discussed and management guidelines are highlighted. PMID:26225091

  10. Influences of continuous femoral nerve block on knee function and quality of life in patients following total knee arthroplasty

    Science.gov (United States)

    Wang, Fen; Zhou, Yingjie; Sun, Jiajun; Yang, Chunxi

    2015-01-01

    Objective: Continuous femoral nerve block (CFNB), guided by ultrasound combined nerve stimulations, offers advantages for both sides and provides effective postoperative analgesia after total knee arthroplasty (TKA). The objective of this study was to evaluate the medium-term impact of continuous femoral nerve block on knee function and quality of life in patients following TKA. Methods: This was a follow-up study. Total 168 adult patients scheduled for elective TKA were randomly allocated to receive postoperative continuous femoral nerve block guided by ultrasound combined nerve stimulator (group CFNB, n = 82) or patient-controlled epidural analgesia (group PCEA, n = 86). Quality of life, knee function, patient satisfaction, pain medication and associated adverse effects were compared at 1, 3, 6, and 12 months postoperatively. Quality of life was assessed using the Medical Outcomes Study Short Form-36 Health Survey (MOS SF-36), and clinical results were assessed using the Hospital for Special Surgery (HSS) Knee Scoring System. Patient satisfaction scores were divided into four categories. Results: A total of 162 patients completed the 12-month follow-up. The CFNB group patients had significantly improved SF-36 scores and physical function at 1 month postoperatively (P TKA. PMID:26770542

  11. Perioperative pain control after total knee arthroplasty: An evidence based review of the role of peripheral nerve blocks.

    Science.gov (United States)

    Danninger, Thomas; Opperer, Mathias; Memtsoudis, Stavros G

    2014-07-18

    Over the last decades, the number of total knee arthroplasty procedures performed in the United States has been increasing dramatically. This very successful intervention, however, is associated with significant postoperative pain, and adequate postoperative analgesia is mandatory in order to allow for successful rehabilitation and recovery. The use of regional anesthesia and peripheral nerve blocks has facilitated and improved this goal. Many different approaches and techniques for peripheral nerve blockades, either landmark or, more recently, ultrasound guided have been described over the last decades. This includes but is not restricted to techniques discussed in this review. The introduction of ultrasound has improved many approaches to peripheral nerves either in success rate and/or time to block. Moreover, ultrasound has enhanced the safety of peripheral nerve blocks due to immediate needle visualization and as consequence needle guidance during the block. In contrast to patient controlled analgesia using opioids, patients with a regional anesthetic technique suffer from fewer adverse events and show higher patient satisfaction; this is important as hospital rankings and advertisement have become more common worldwide and many patients use these factors in order to choose a certain institution for a specific procedure. This review provides a short overview of currently used regional anesthetic and analgesic techniques focusing on related implications, considerations and outcomes. PMID:25035824

  12. Ultrasound-guided continuous suprascapular nerve block for adhesive capsulitis: one case and a short topical review

    DEFF Research Database (Denmark)

    Neimann, Jens Dupont Børglum; Bartholdy, Anne; Hautopp, H; Krogsgaard, M R; Jensen, Kenneth

    2011-01-01

    We present a case with an ultrasound-guided (USG) placement of a perineural catheter beneath the transverse scapular ligament in the scapular notch to provide a continuous block of the suprascapular nerve (SSN). The patient suffered from a severe and very painful adhesive capsulitis of the left...

  13. Intra-articular versus intravenous magnesium-sulfate as adjuvant to femoral nerve block in arthroscopic knee sur

    Directory of Open Access Journals (Sweden)

    Mohamed Abdulatif

    2015-07-01

    Conclusion: The combined use of femoral nerve block with IA or IV MgSO4 is associated with significant reduction of the intensity and duration of postoperative pain and postoperative analgesic requirements in patients undergoing arthroscopic knee surgery with the IA MgSO4 being superior to IV route of administration.

  14. Phrenic nerve block with ultrasound-guidance for treatment of hiccups: a case report

    Directory of Open Access Journals (Sweden)

    Pyylampi Ville

    2011-10-01

    Full Text Available Abstract Introduction Persistent hiccups can be more than a simple and short-lived nuisance and therefore sometimes call for serious consideration. Hiccupping episodes that last only a few minutes may be annoying, but persistent hiccups may initiate many major complications. Case presentation A 72-year-old Caucasian man with spinal stenosis presented for L4-5 laminectomy under spinal anesthesia. The surgery and anesthesia, as well as the perioperative period, passed without any incident, except for persistent postoperative hiccups not responding to conservative and pharmacological treatment. Hiccups resulted in a prolonged hospital stay as they lasted until the seventh postoperative day. On that day, a right-sided ultrasound-guided phrenic nerve block with 5 ml of bupivacaine 5 mg/ml with epinephrine was performed successfully with a single-injection technique. Ten minutes after the procedure the hiccups vanished and a partial sensomotoric block of his right shoulder developed. No adverse effect occurred; our patient could be discharged on the same day and the hiccups did not return. Conclusion Ultrasound provides us with non-invasive information regarding anatomy and allows anesthesiologists to visualize needle insertion, to identify the exact location of the injected solution and to avoid such structures as arteries or veins. As such, this method should be actively utilized. In cases where both pharmacological and non-pharmacological treatments prove to be ineffective when treating persistent hiccups, a single-shot ultrasound-guided technique should be considered before the patient becomes exhausted.

  15. Management of low back pain with facet joint injections and nerve root blocks under computed tomography guidance. A prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Fotiadou, Anastasia; Wojcik, Andrew; Shaju, Antony [Hinchingbrooke Hospital NHS Trust, Huntingdon, Cambridge (United Kingdom)

    2012-09-15

    The aim of this work was to assess the performance of facet joint and nerve root infiltrations under computed tomography guidance for the management of low back pain and to investigate the complications and patient tolerance. The study was board-certified and informed consent was obtained from all patients. In 1 year, 86 consecutive patients (47 male, 39 female, age range 47-87 years, mean age 63) with low back pain for more than 2 years were included. All patients were clinically examined and had cross-sectional imaging performed before the procedure. Fifty-five facet joint infiltrations and 31 nerve blocks were performed under computed tomography guidance. All patients completed two valid pain questionnaires before and 3 months after the procedures. At the same time, they were clinically examined by the referring Orthopaedic Surgeon. The pain response was assessed by comparing the scores of the questionnaires. The improvement in clinical examination findings was assessed as well. In patients who underwent facet joint infiltrations, long-term pain improvement was achieved in 79% and in those with nerve blocks in 85%. Immediate pain relief was demonstrated in 83% of patients with nerve infiltrations. No complications were observed. All procedures were very well tolerated by patients. Facet joint and nerve infiltrations under computed tomography guidance constitute an accurate and safe method that could be used to relieve low back pain and minimize the risk of disability. (orig.)

  16. Management of low back pain with facet joint injections and nerve root blocks under computed tomography guidance. A prospective study

    International Nuclear Information System (INIS)

    The aim of this work was to assess the performance of facet joint and nerve root infiltrations under computed tomography guidance for the management of low back pain and to investigate the complications and patient tolerance. The study was board-certified and informed consent was obtained from all patients. In 1 year, 86 consecutive patients (47 male, 39 female, age range 47-87 years, mean age 63) with low back pain for more than 2 years were included. All patients were clinically examined and had cross-sectional imaging performed before the procedure. Fifty-five facet joint infiltrations and 31 nerve blocks were performed under computed tomography guidance. All patients completed two valid pain questionnaires before and 3 months after the procedures. At the same time, they were clinically examined by the referring Orthopaedic Surgeon. The pain response was assessed by comparing the scores of the questionnaires. The improvement in clinical examination findings was assessed as well. In patients who underwent facet joint infiltrations, long-term pain improvement was achieved in 79% and in those with nerve blocks in 85%. Immediate pain relief was demonstrated in 83% of patients with nerve infiltrations. No complications were observed. All procedures were very well tolerated by patients. Facet joint and nerve infiltrations under computed tomography guidance constitute an accurate and safe method that could be used to relieve low back pain and minimize the risk of disability. (orig.)

  17. A comparison between acute pressure block of the sciatic nerve and acupressure: methodology, analgesia, and mechanism involved

    Directory of Open Access Journals (Sweden)

    Luo D

    2013-07-01

    Full Text Available Danping Luo,1,2 Xiaolin Wang,1 Jiman He1,31Pain Medicine Program, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; 2The First Affiliated Hospital of Guangdong College of Pharmacy, Guangzhou, People's Republic of China; 3Department of Medicine, Brown University, Providence, RI, USAAbstract: Acupressure is an alternative medicine methodology that originated in ancient China. Treatment effects are achieved by stimulating acupuncture points using acute pressure. Acute pressure block of the sciatic nerve is a newly reported analgesic method based on a current neuroscience concept: stimulation of the peripheral nerves increases the pain threshold. Both methods use pressure as an intervention method. Herein, we compare the methodology and mechanism of these two methods, which exhibit several similarities and differences. Acupressure entails variation in the duration of manipulation, and the analgesic effect achieved can be short- or long-term. The acute effect attained with acupressure presents a scope that is very different from that of the chronic effect attained after long-term treatment. This acute effect appears to have some similarities to that achieved with acute pressure block of the sciatic nerve, both in methodology and mechanism. More evidence is needed to determine whether there is a relationship between the two methods.Keywords: acupressure, acute pressure block, sciatic nerve, pain

  18. Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture

    Directory of Open Access Journals (Sweden)

    Ashok Jadon

    2014-01-01

    Full Text Available Background: Spinal anaesthesia is the preferred technique to fix fracture of the femur. Extreme pain does not allow ideal positioning for this procedure. Intravenous fentanyl and femoral nerve block are commonly used techniques to reduce the pain during position for spinal anaesthesia however; results are conflicting regarding superiority of femoral nerve block over intravenous fentanyl. Aims: We conducted this study to compare the analgesic effect provided by femoral nerve block (FNB and intra- venous (IV fentanyl prior to positioning for central neuraxial block in patients undergoing surgery for femur fracture. Patients and Methods: In this randomized prospective study 60 patients scheduled for fracture femur operation under spinal were included. Patients were distributed in two groups through computer generated random numbers table; Femoral nerve block group (FNB and Intravenous fentanyl group (FENT. In FNB group patients received FNB guided by a peripheral nerve stimulator (Stimuplex; B Braun, Melsungen, AG 5 minutes prior to positioning. 20mL, 1.5% lidocaine with adrenaline (1:200,000 was injected incrementally after a negative aspiration test. Patients in the fentanyl group received injection fentanyl 1 ?g/kg IV 5 mins prior to positioning. Spinal block was performed and pain scores before and during positioning were recorded. Statistical analysis was done with Sigmaplot version-10 computer software. Student t-test was applied to compare the means and P < 0.05 was taken as significant. Results: VAS during positioning in group FNB: 0.57 ± 0.31 versus FENT 2.53 ± 1.61 (P = 0.0020. Time to perform spinal anesthesia in group FNB: 15.33 ± 1.64 min versus FENT 19.56 ± 3.09 min (P = 0.000049. Quality of patient positioning for spinal anesthesia in group FNB 2.67± 0.606 versus FENT 1.967 ± 0.85 (P = 0.000027. Patient acceptance was less in group FENT (P = 0.000031. Conclusion: Femoral nerve block provides better analgesia, patient satisfaction and satisfactory positioning than IV fentanyl for position during spinal anaesthesia in patients of fracture femur.

  19. Effect of analgesic nerve block electrical stimulation in a patient with adhesive capsulitis.

    Science.gov (United States)

    Gulick, Dawn T; Borger, Amy; McNamee, Lauren

    2007-01-01

    Although the pathophysiology of adhesive capsulitis is poorly understood, the primary goal of therapeutic intervention is to restore pain-free, functional range of motion (ROM) of the shoulder. Pain and muscle guarding, particularly of the subscapularis muscle, are common impairments that occur with adhesive capsulitis. The purpose of this case report is to describe a novel approach to help the pain-muscle guarding-pain cycle associated with pain and limited shoulder motion in a patient with a medical diagnosis of adhesive capsulitis. The patient was a 64-year-old female with adhesive capsulitis. Outcome variables were the Shoulder Pain and Disability Index (SPADI), internal rotation (IR) and external rotation (ER) ROM, and rotational lack. Twelve treatments of moist heat, analgesic nerve block electrical stimulation, contract/relax exercises for shoulder IR/ER, and Pendulum/Codman exercises were administered. After both 2 and 4 weeks of treatment, the patient demonstrated marked improvements in all areas. Overall, there was a 78-106% increase in ROM (IR and ER) and a 50-83% improvement in functional mobility (rotational lack & SPADI). It appears that analgesic electrical stimulation may have helped decrease the pain-muscle guarding cycle associated with adhesive capsulitis to enhance functional outcomes in a timely manner. PMID:17454799

  20. NERVE BLOCKING (PAIN CONTROL AFTER THORACOTOMY WITH BUPIVACAINE:EPIDURAL VS INTERCOSTAL

    Directory of Open Access Journals (Sweden)

    A GHAFOURI

    2001-09-01

    Full Text Available Introduction. Use of analgesics is an evitable and necessary part of thoracic surgery. This study was designed to compare analgesic effects of persistent thoracic epidural anesthesia versus persistent intercostal nerve block and determine their role in opioid need after thoracotomy. Methods. 116 patients above 20 years old who were candidate for thoracotomy through either posterolateral or thoracoabdominal incision were situatedin one of three group for pain relief. For the first group, pain relieved by petidine and pentazosin. In 2nd group, pain relived by thoracic epidural anesthesia with bupivacaine catheters which were inserted between costal and plural space. In 3rd group, bupivacaine was introduced through 3rd and 4th intercostal space by catheter (2 mg/kg in devided doses. Pain was meseared by visual analogue scale and quantified by surgical residents through a method bupivacaine was injected. If Bupivacaine did not relieve pain, then opioid was used as adjuvant. Results. The study showed that epidural group needed less opioids and had more cooperation in comparison with two other group. The intercostal group complained of pain at chest tube site. Discussion. In thoracotomized patients, pain control is more effective via epidural anesthesia in turns of opioid side effects, expenses and patient comfort.

  1. Scalp Nerve Block in Children Undergoing a Supratentorial Craniotomy; A Randomized Controlled Study

    Directory of Open Access Journals (Sweden)

    Manal el Gohary

    2009-01-01

    Full Text Available The aim of this randomized double blinded controlled study was to evaluate the effect of SNB during craniotomies for supratentorial tumors in pediatric patients, with respect to intra- and postoperative hemodynamics, intraoperative anesthetic and analgesic consumption and postoperative analgesic requirements. Thirty children, aged 6 to 12 years, scheduled for elective craniotomies for supratentorial tumors were randomly assigned to one of two groups: control group (n = 15 and Scalp Nerve Block (SNB group (n = 15. After a standardized induction and 5 min prior to head pinning, a SNB was performed. In the control group the block was performed with normal saline, while in the SNB group the block was performed with bupivacaine 0.25%. Intraoperative Mean Arterial blood Pressure (MAP and Heart Rate (HR were recorded before induction (baseline, 5 min after induction, at head pinning and at skin incision, together with sevoflurane and fentanyl consumption. Postoperative MAP and HR were measured and recorded. Postoperative pain assessment was done using Visual Analogue Scale (VAS score. Rescue analgesia (IV paracetamol, 15 mg kg-1 was given for a VAS>3. Time to first rescue analgesic, number of patients who required analgesia as well as number of paracetamol doses in the first 24 h postoperative were recorded. The SNB group showed more stable intraoperative and postoperative hemodynamics and a significant reduction in the total intraoperative fentanyl dose required. VAS scores were significantly lower in the SNB group compared to the control group till 12 h postoperative. Significantly fewer patients in the SNB group required rescue analgesic in the first 24 h postoperative (8 vs. 15, p<0.05. Time to first rescue analgesic was significantly longer in the SNB group compared to the control group (6.6±1.9 h vs. 1.7±0.8 h, p<0.05. Number of paracetamol doses required in the first 24 h postoperative was significantly higher in the control group compared to the SNB group. We conclude that SNB using bupivacaine 0.25% results in decreased intraoperative analgesic requirements and more stable intra- and postoperative hemodynamics. It also reduces postoperative pain leading to decreased postoperative analgesic consumption.

  2. Fracture resistance of roots obturated with novel hydrophilic obturation systems

    Directory of Open Access Journals (Sweden)

    Vibha Hegde

    2015-01-01

    Full Text Available Aim: Comparative assessment of fracture resistance of roots obturated with three hydrophilic systems - novel CPoint system, Resilon/Epiphany system, and EndoSequence BC sealer; and one hydrophobic gold standard gutta-percha/AHPlus system. Materials and Methods: Ninety freshly extracted, human, single-rooted mandibular premolars were selected. The specimens were decoronated and standardized to a working length of 13 mm. The teeth were randomly divided into six groups (n = 15. In Group A, teeth were left unprepared and unfilled (negative control. Rest of the groups were prepared by using ProTaper system up to a master apical file F3; followed by which Group B was left unobturated (positive control; Group C, novel CPoint System; group D, Resilon/Epiphany system, Group E EndoSequence BC sealer, and Group F gutta-percha and AH Plus. Specimens were stored for 2 weeks at 100% humidity. Each group was then subjected to fracture testing by using a universal testing machine. The force required to fracture each specimen was recorded and the data was analyzed statistically using analysis of variance (ANOVA test and Tukey?s post-hoc test. Results: The hydrophilic obturation systems have shown to exhibit significantly higher fracture resistance as shown by the values in Groups C, D, and E (P 0.05. Conclusion: In contrast to hydrophobic systems, hydrophilic systems showed higher fracture resistance in a single-rooted premolar.

  3. Fracture resistance of roots obturated with novel hydrophilic obturation systems

    Science.gov (United States)

    Hegde, Vibha; Arora, Shashank

    2015-01-01

    Aim: Comparative assessment of fracture resistance of roots obturated with three hydrophilic systems — novel CPoint system, Resilon/Epiphany system, and EndoSequence BC sealer; and one hydrophobic gold standard gutta-percha/AHPlus system. Materials and Methods: Ninety freshly extracted, human, single-rooted mandibular premolars were selected. The specimens were decoronated and standardized to a working length of 13 mm. The teeth were randomly divided into six groups (n = 15). In Group A, teeth were left unprepared and unfilled (negative control). Rest of the groups were prepared by using ProTaper system up to a master apical file F3; followed by which Group B was left unobturated (positive control); Group C, novel CPoint System; group D, Resilon/Epiphany system, Group E EndoSequence BC sealer, and Group F gutta-percha and AH Plus. Specimens were stored for 2 weeks at 100% humidity. Each group was then subjected to fracture testing by using a universal testing machine. The force required to fracture each specimen was recorded and the data was analyzed statistically using analysis of variance (ANOVA) test and Tukey's post-hoc test. Results: The hydrophilic obturation systems have shown to exhibit significantly higher fracture resistance as shown by the values in Groups C, D, and E (P 0.05). Conclusion: In contrast to hydrophobic systems, hydrophilic systems showed higher fracture resistance in a single-rooted premolar. PMID:26069417

  4. System to obturate a hole

    International Nuclear Information System (INIS)

    The description is given of a system to obturate a hole inside a containment fitted with an access aperture smaller in cross section than that of the aperture to be closed. It includes a cover in several parts and a cover bearing surface. The cover is composed of a central unit and two C shaped side parts, the dimensions of which allow passage in the access aperture. This system is specially designed for steam generators in nuclear power stations and particularly of the pressurised water type, but it can obviously be employed whenever the need arises to close an aperture giving into a containment fitted with a small cross section access aperture

  5. Perioperative pain control after total knee arthroplasty: An evidence based review of the role of peripheral nerve blocks

    OpenAIRE

    Danninger, Thomas; Opperer, Mathias; Memtsoudis, Stavros G

    2014-01-01

    Over the last decades, the number of total knee arthroplasty procedures performed in the United States has been increasing dramatically. This very successful intervention, however, is associated with significant postoperative pain, and adequate postoperative analgesia is mandatory in order to allow for successful rehabilitation and recovery. The use of regional anesthesia and peripheral nerve blocks has facilitated and improved this goal. Many different approaches and techniques for periphera...

  6. Ultrasound-guided continuous suprascapular nerve block for adhesive capsulitis: one case and a short topical review

    DEFF Research Database (Denmark)

    Neimann, Jens Dupont Børglum; Bartholdy, Anne; Hautopp, H; Krogsgaard, M R; Jensen, Kenneth

    2011-01-01

    We present a case with an ultrasound-guided (USG) placement of a perineural catheter beneath the transverse scapular ligament in the scapular notch to provide a continuous block of the suprascapular nerve (SSN). The patient suffered from a severe and very painful adhesive capsulitis of the left shoulder secondary to an operation in the same shoulder conducted 20 weeks previously for impingement syndrome and a superior labral anterior-posterior tear. Following a new operation with capsular releas...

  7. Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality

    OpenAIRE

    Thapa, Deepak; Ahuja, Vanita

    2014-01-01

    Plantar fasciitis (PF) is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF). Following a diagnostic medial calcaneal nerve (MCN) block at its origin, we observed re...

  8. A novel concept for continuous peripheral nerve blocks. Presentation of a new ultrasound-guided device

    DEFF Research Database (Denmark)

    Rothe, C; Steen-Hansen, C; Madsen, Mikkel Herold; Lange, K H W

    2015-01-01

    sciatic nerve in the popliteal fossa. Circumferential spread of 3-ml isotonic saline around the sciatic nerve was observed on ultrasound images in both conditions. CONCLUSION: Preliminary proof of concept of this novel method demonstrates that precise in-plane ultrasound-guided initial placement and......BACKGROUND: Existing techniques for placing and maintaining the position of peripheral nerve catheters are associated with variable success rates and frequent secondary failures. These factors may affect the clinical efficacy and usefulness of peripheral nerve catheters. METHODS: We developed a new...... concept and prototype for ultrasound-guided in-plane positioning and readjustment of peripheral nerve catheters (patent pending). The integrated catheter-needle prototype comprises three parts: a curved needle, a catheter with clear echogenic markings attached to the needle tail and a detachable hub...

  9. Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block following arthroscopic rotator-cuff repair

    Directory of Open Access Journals (Sweden)

    Yamakado K

    2014-05-01

    Full Text Available Kotaro YamakadoDepartment of Orthopaedics, Fukui General Hospital, Fukui, JapanBackground: Rotator-cuff surgery is well recognized to be a painful procedure.Objectives: The purpose of this study was to examine the effectiveness of an arthroscopically placed perineural catheter at the scapular notch to provide a continuous block of the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block [ca-SSNB] following arthroscopic rotator-cuff repair (ARCR.Materials and methods: This level II, prospective, randomized, controlled trial without postoperative blinding included 40 patients, who had a 48-hour pain pump, with 0.2% ropivacaine infusion and a continuous rate of 3 mL/hour, placed via an arthroscopically placed catheter following ARCR with arthroscopic release of the superior transverse ligament: 21 patients had a ca-SSNB, and 19 patients had a continuous subacromial bursal block (SAB. The visual analog scale (at 6 hours and on the first, second, and third postoperative days and the total number of additional pain-reduction attempts during the 3 postoperative days were calculated.Results: The respective visual analog scale scores (mm obtained from the ca-SSNB and SAB groups were 62.4 and 67.6 (P=0.73 before surgery, 9.1 and 19.4 (P=0.12 at 6 hours after surgery, 24.4 and 44.6 (P=0.019 on the first postoperative day, 19.4 and 40.4 (P=0.0060 on the second postoperative day, and 18.5 and 27.8 (P=0.21 on the third postoperative day. Total additional pain-reduction attempts recorded for the ca-SSNB and SAB groups during the 3 postoperative days were 0.3 times and 1.2 times (P=0.0020, respectively.Conclusion: ca-SSNB was highly effective in controlling postoperative pain after ARCR.Keywords: shoulder, rotator cuff tear, postoperative pain control, continuous suprascapular nerve block, arthroscopic rotator cuff repair

  10. Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality

    Directory of Open Access Journals (Sweden)

    Deepak Thapa

    2014-01-01

    Full Text Available Plantar fasciitis (PF is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF. Following a diagnostic medial calcaneal nerve (MCN block at its origin, we observed reduction in verbal numerical rating scale (VNRS in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF. All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF.

  11. Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients

    Directory of Open Access Journals (Sweden)

    Liu JL

    2014-05-01

    Full Text Available Jun Le Liu,1,* Xiao Lin Wang,1,* Mao Wei Gong,1,* Hai Xing Mai,2 Shu Jun Pei,1 Wei Xiu Yuan,1 Hong Zhang11Anesthesia and Operation Center, Chinese People’s Liberation Army General Hospital and Medical School of Chinese People’s Liberation Army, Beijing, People’s Republic of China; 2Department of Urology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People’s Republic of China*These authors contributed equally to this workBackground: Geriatric patients undergoing hemiarthroplasty for hip fractures have unacceptably high rates of postoperative complications and mortality. Whether anesthesia type can affect the outcomes has still been inconclusive.Objectives: We compared general anesthesia (GA and peripheral nerve blocks (PNBs on postoperative complications and mortality in elderly patients with femoral neck fractures (FNF undergoing hemiarthroplasty.Materials and methods: This retrospective study involved data collection from an electronic database. Two hundred and seventeen patients underwent hemiarthroplasty for FNF between January 2008 and December 2012 at the Chinese People’s Liberation Army General Hospital. Data on mortality within in-hospital, 30-day, and 1-year, complications, comorbidities, blood loss and transfusion, operative time, postoperative hospital length of stay, intensive care unit admission, and hospital charge were collected and analyzed. Univariate and multivariate Cox regression analyses of all variables were used for 30-day and 1-year mortality.Results: Seventy-two patients receiving GA and 145 receiving PNBs were eventually submitted and analyzed. Mortality was 6.9%, 14.7%, and 23.5% at in-hospital, 30-day, and 1-year, respectively postoperatively, while mortality and cardiovascular complications did not differ between the two anesthetic techniques. Preoperative comorbidities and intraoperative parameters were not statistically different except that patients receiving GA were more likely to have dementia (χ2=10.45, P=0.001. The most common complications were acute cardiovascular events, electrolyte disturbances, and delirium. Postoperative acute respiratory events and hypoxemia both were also common, but no differences were found between groups (χ2=0.68, P=0.410; χ2=3.42, P=0.065, respectively. Key factors negatively influencing mortality included: age, male gender, American Society of Anesthesiologists status, dementia, perioperative cardiovascular events and respiratory events, postoperative stroke, myocardial infarction, and hypoxia. Conclusion: Mortality and postoperative complications are not statistically significantly different between PNBs and GA among eldery patients undergoing hemiarthroplasty for FNF.Keywords: femoral neck fractures, elderly, mortality, postoperative complications

  12. Two-piece hollow bulb obturator

    Directory of Open Access Journals (Sweden)

    Subramaniam Elangovan

    2011-01-01

    Full Text Available There are various types of obturator fabrication achievable by prosthodontist. Maxillectomy, which is a term used by head and neck surgeons and prosthodontists to describe the partial or total removal of the maxilla in patients suffering from benign or malignant neoplasms is a defect for which to provide an effective obturator is a difficult task for the maxillofacial prosthodontist. Multidisciplinary treatment planning is essential to achieve adequate retention and function for the prosthesis. Speech is often unintelligible as a result of the marked defects in articulation and nasal resonance. This paper describes how to achieve the goal for esthetics and phonetics and also describes the fabrication of a hollow obturator by two piece method, which is simple and maybe used as definitive obturator for maximum comfort of the patient.

  13. A novel concept for continuous peripheral nerve blocks. Presentation of a new ultrasound-guided device

    DEFF Research Database (Denmark)

    Rothe, C; Steen-Hansen, C

    2015-01-01

    BACKGROUND: Existing techniques for placing and maintaining the position of peripheral nerve catheters are associated with variable success rates and frequent secondary failures. These factors may affect the clinical efficacy and usefulness of peripheral nerve catheters. METHODS: We developed a new concept and prototype for ultrasound-guided in-plane positioning and readjustment of peripheral nerve catheters (patent pending). The integrated catheter-needle prototype comprises three parts: a curved needle, a catheter with clear echogenic markings attached to the needle tail and a detachable hub allowing injection of local anesthetic while advancing the needle in the tissue. The system works like a suture and is introduced through the skin, passes in close relation to the nerve and exits through the skin. This allows in-plane ultrasound guidance throughout the procedure both during initial positioning as well as during later in-plane readjustment of the catheter. We tested the system in the popliteal region oftwo fresh cadavers in a preliminary proof of concept study. RESULTS: Both initial placement and secondary readjustment were precise, judged by the catheter orifices placed close to the sciatic nerve in the popliteal fossa. Circumferential spread of 3-ml isotonic saline around the sciatic nerve was observed on ultrasound images in both conditions. CONCLUSION: Preliminary proof of concept of this novel method demonstrates that precise in-plane ultrasound-guided initial placement and secondary in-plane readjustment is possible in fresh cadavers. Future studies should address the clinical efficacy and usefulness of this novel concept.

  14. Palatal obturators in patients after maxillectomy

    OpenAIRE

    Cardelli, P; BIGELLI, E.; VERTUCCI, V.; Balestra, F.; Montani, M.; Carli, S; ARCURI, C.

    2015-01-01

    Prosthodontic management of palatal defects is fundamental to improve patient’s life undergoing to a maxillary surgical treatment. A lot of maxillary defects are a direct consequence of surgical treatment of malformations, neoplasms or trauma. The obturators are prosthesis used to close palatal defects after maxillectomy, to restore masticatory function and to improve speech. The primary goals of the obturator prosthesis are to preserve the remaining teeth and tissue and to provide comfort, f...

  15. Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength, Mobilization, and Pain After Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Grevstad, Ulrik; Mathiesen, Ole; Valentiner, Laura Risted Staun; Jaeger, Pia; Hilsted, Karen Lisa; Dahl, Jørgen B

    2015-01-01

    BACKGROUND AND OBJECTIVES: Total knee arthroplasty (TKA) is often associated with severe pain. Different regional anesthetic techniques exist, all with varying degrees of motor blockade. We hypothesized that pain relief provided by the adductor canal block (ACB) could increase functional muscle s...

  16. Medial and Lateral Pectoral Nerve Block with Liposomal Bupivacaine for the Management of Postsurgical Pain after Submuscular Breast Augmentation

    Directory of Open Access Journals (Sweden)

    David Leiman, MD

    2014-12-01

    Full Text Available Summary: This report describes an ultrasound-guided medial and lateral pectoralis nerve block using liposome bupivacaine, performed before the surgical incision, in a patient undergoing submuscular breast augmentation. The anatomic basis and technique are described. This procedure may be offered to patients undergoing submuscular insertion of a breast implant or tissue expander. Advancements in ultrasound guidance allow for more precise anatomic placement of local anesthetic agents. The injection technique used for this procedure resulted in complete relaxation of the pectoralis major, facilitating the surgical dissection and markedly diminishing postsurgical pain and muscle spasms.

  17. Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength, Mobilization, and Pain After Total Knee Arthroplasty : A Randomized, Blinded Study

    DEFF Research Database (Denmark)

    Grevstad, Ulrik; Mathiesen, Ole

    2015-01-01

    BACKGROUND AND OBJECTIVES: Total knee arthroplasty (TKA) is often associated with severe pain. Different regional anesthetic techniques exist, all with varying degrees of motor blockade. We hypothesized that pain relief provided by the adductor canal block (ACB) could increase functional muscle strength. METHODS: We included 50 TKA patients with severe movement-related pain; defined as having visual analog scale pain score of greater than 60 mm during active flexion of the knee. The ACB group received an ACB with ropivacaine 0.2% 30 mL and a femoral nerve block (FNB) with 30 mL saline. The FNB group received an ACB with 30 mL saline and an FNB with ropivacaine 0.2% 30 mL. We compared the effect of the ACB versus FNB on maximum voluntary isometric contraction of the quadriceps muscle relative to a postoperative baseline value. Secondary end points were differences between groups in ability to ambulate and changes in pain scores (Clinicaltrials.gov identifier NCT01922596). RESULTS: After block, the quadricepsmaximum voluntary isometric contraction increased to 193% (95% confidence interval [CI], 143-288) of the baseline value in the ACB group and decreased to 16% (95% CI, 3-33) in the FNB group with an estimated difference of 178% (95% CI, 136-226), P < 0.0001. Pain scores were similar between groups. Before block, 2 of 25 patients in each group were unable to perform the Timed-Up-and-Go test; after block, this number increased to 7 of 25 in the FNB group and decreased to 0 of 25 in the ACB group. CONCLUSION: Adductor canal block provides a clinically relevant and statistically significant increase in quadriceps muscle strength for patients in severe pain after TKA.

  18. The furcal nerve revisited

    Directory of Open Access Journals (Sweden)

    Nanjundappa S. Harshavardhana

    2014-10-01

    Full Text Available Atypical sciatica and discrepancy between clinical presentation and imaging findings is a dilemma for treating surgeon in management of lumbar disc herniation. It also constitutes ground for failed back surgery and potential litigations thereof. Furcal nerve (Furcal = forked is an independent nerve with its own ventral and dorsal branches (rootlets and forms a link nerve that connects lumbar and sacral plexus. Its fibers branch out to be part of femoral and obturator nerves in-addition to the lumbosacral trunk. It is most commonly found at L4 level and is the most common cause of atypical presentation of radiculopathy/sciatica. Very little is published about the furcal nerve and many are unaware of its existence. This article summarizes all the existing evidence about furcal nerve in English literature in an attempt to create awareness and offer insight about this unique entity to fellow colleagues/ professionals involved in spine care.

  19. Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft : a randomised controlled trial

    DEFF Research Database (Denmark)

    Kristensen, Pia Kjær; Storm, Jens Ole

    2014-01-01

    PURPOSE: Arthroscopic anterior cruciate ligament (ACL) reconstruction is a painful procedure requiring intensive postoperative pain management. Femoral nerve block is widely used in ACL surgery. However, femoral nerve block does not cover the donor site of the hamstring tendons. Local infiltration analgesia is a simple technique that has proven effective in postoperative pain management after total knee arthroplasty. Further, local infiltration analgesia covers the donor site and is associated with few complications. It was hypothesised that local infiltration analgesia at the donor site and wounds would decrease pain and opioid consumption after ACL reconstruction with hamstring tendon graft. METHODS: Sixty patients undergoing primary ACL surgery with hamstring tendon graft were randomised to receive either local infiltration analgesia or femoral nerve block. Pain was scored on the numeric rating scale, and use of opioid, range of motion and adverse effects were assessed at the postoperative recovery unit (0 h), 3, 24 and 48 h, postoperatively. RESULTS: There were no significant differences between the groups in pain intensity or total opioid consumption at any of the follow-up points. Further, there were no differences between groups concerning side effects and range of motion. CONCLUSIONS: Local infiltration analgesia and femoral nerve block are similar in the management of postoperative pain after ACL reconstruction with hamstring tendon graft. Until randomised studies have investigated femoral nerve block combined with infiltration at the donor site, we recommend local infiltration analgesia in ACL reconstruction with hamstring tendon graft.

  20. Diagnosis and treatment of obturator hernia

    Energy Technology Data Exchange (ETDEWEB)

    Nakayama, Takamori; Kobayashi, Seiji; Shiraishi, Kou; Nishiumi, Takao; Mori, Syunji; Isobe, Kiyoshi; Furuta, Yoshiaki [Shizuoka Red Cross Hospital (Japan)

    2002-09-01

    Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n=7) or an inguinal approach (n=5). The hernial orifice was closed using the uterine fundus (n=6), a patch (n=5), and direct suture (n=1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery. (author)

  1. Apical leakage of root canal system obturation materials

    OpenAIRE

    Miti? Aleksandar; Miti? Nadica; Toši? Goran

    2005-01-01

    Hermetical obturation on dentine-cement junction is one of the conditions for success in endodontic treatment. The aim of this paper was to evaluate apical obturation of three different root canal obturation materials. Methods consisted of in vitro semiquantitatively measured penetration of colored solutions. Total number of 55 single-canal teeth was used and obturation test materials were AH-plus, Ketac-Endo and Endomethasone. Linear color penetration was evaluated following illumination of ...

  2. MR Imaging Features of Obturator Internus Bursa of the Hip

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Ji Young; Lee, Sun Wha; Kim, Jong Oh [School of Medicine, Ewha Womans University, Seoul (Korea, Republic of)

    2008-08-15

    The authors report two cases with distension of the obturator internus bursa identified on MR images, and describe the location and characteristic features of obturator internus bursitis; the 'boomerang'-shaped fluid distension between the obturator internus tendon and the posterior grooved surface of the ischium

  3. Ultrasound Guided Transversus Abdominis Plane Block for Anterior Cutaneous Nerve Entrapment Syndrome.

    Science.gov (United States)

    Sahoo, Rajendra Kumar; Nair, Abhijit S

    2015-10-01

    Anterior cutaneous nerve entrapment syndrome (ACNES) is one the most common cause of chronic abdominal wall pain. The syndrome is mostly misdiagnosed, treated wrongly and inadequately. If diagnosed correctly by history, examination and a positive carnett test, the suffering of the patient can be relieved by addressing the cause i.e. local anaesthetic with steroid injection at the entrapment site. Conventionally, the injection is done by landmark technique. In this report, we have described 2 patients who were diagnosed with ACNES who were offered ultrasound guided transverses abdominis plane (TAP) injection who got significant pain relief for a long duration of time. PMID:26495084

  4. Therapeutic effectiveness of epicranial nerve blocks on post-traumatic syndrome from head injury

    Directory of Open Access Journals (Sweden)

    C. A. Caputi

    2011-03-01

    Full Text Available The autor describes the case of a 53-year-old woman suffering from headache and dizziness, sometimes nausea, tinnitus in the right ear, and diffuse scalp allodynia following an occupational accident involving a head injury. Hyposensitizing treatment by anesthetic blockade at the emergence points of the epicranial nerves, which were hyperalgesic to fi nger pressure, rapidly controlled the allodynia and eventually the headache. Unexpectedly, the patient also reported reduced dizziness and resolution of the tinnitus. The unforeseen outcome highlights the unpredictable therapeutic potential of a simple and modestly invasive procedure. The neuropathophysiological interpretation is consequently very interesting.

  5. Unrecorded origin of external pudendal artery with variant obturator vessels

    Directory of Open Access Journals (Sweden)

    El-Sawaf ME

    2010-08-01

    Full Text Available During routine dissection of a female cadaver for teaching purposes, the vessels in the ilioinguinal region in both sides showed some anatomical variations. In the right side, the external iliac artery gave off the obturator artery and a common trunk for both external pudendal artery and inferior epigastric artery. The obturator vein followed the variant obturator artery while the external pudendal vein showed a normal course. Meanwhile, the obturator artery in the left side originated from the inferior epigastric artery and the obturator vein drained into the external iliac vein. These anatomical findings may have important clinical implications.

  6. Greater Occipital Nerve Block by Bupivacaine/Methyl Prednisolone Vs. Bupivacaine/Normal Saline in Medication Overuse Headache

    Directory of Open Access Journals (Sweden)

    M Toghae

    2012-08-01

    Full Text Available Background: Medication overuse headaches (MOH include headaches that last more than 15 days a month and usually occur after long-term use of analgesic. Most methods of medical treatment are ineffective. In some studies, great occipital nerve block is used to treat the headaches.Methods: This double-blind experimental study was performed in adult patients with MOH who attended Sina Hospital in Tehran from June 2009 to June 2011. Greater occipital nerve (GON block was done in the two groups of patients by administering a combination of 3 ml of 0.5% bupivacaine and 2 ml of 5% saline or 3 ml of 0.5% bupivacaine and 80 mg of methyl prednisolone. We evaluated headache severity by Visual analog scale (VAS and recorded days without headache. If patients were taking pain medications, preventive medications were given as usual before and after the injection. Student's t-test was performed for statistical analysis and a P<0.05 was considered significant.Results: Overall, 13 male and 19 female patients with a mean age of 39.88±8.76 years participated in the study. The mean reduction in headache severity one hour after injection was 5.56±1.03 and 4.63±1.92 in the first and second groups, respectively. Average days without headache one month after injection were 8.75 and 4.75 days in the first and second groups, respectively. There were no significant differences between the two groups.Conclusion: Both methods seem to be effective in medication overuse headaches treatment. This finding is important as non-responders to conventional methods will otherwise have a decreased quality of life.

  7. Effect of preemptive nerve block on inflammation and hyperalgesia after human thermal injury

    DEFF Research Database (Denmark)

    Pedersen, J L; Crawford, M E; Dahl, J B; Brennum, J; Kehlet, H

    1996-01-01

    BACKGROUND: Postoperative pain relief may be improved by reducing sensitization of nociceptive pathways caused by surgical trauma. Such a reduction may depend on the timing and efficacy of analgesia and the duration of the nociceptive block versus the duration of the nociceptive input. We examine...

  8. CT-guided percutaneous ethanol nerve block therapy of celiac plexus embedded in metastatic lymph nodes for the treatment of intractable carcinomatous abdominal pain

    International Nuclear Information System (INIS)

    Objective: To evaluate CT-guided percutaneous ethanol nerve block therapy of celiac plexus embedded in metastatic lymph nodes in treating intractable carcinomatous abdominal pain. Methods: A total of 104 patients with late stage cancers were enrolled in this study. All patients suffered from serious carcinomatous pain at upper abdomen and their retroperitoneal lymph nodes were extensively enlarged and fused, together with the involved celiac plexus, into a hard crumb. As the patients failed to respond to narcotic analgesics CT-guided ethanol nerve block therapy of celiac plexus was carried out by pushing the puncture needle through the fused lymphatic mass to celiac plexus site. The analgesic effects and complications were observed and the therapeutic results were evaluated. Results: The analgesic effective rate of ethanol nerve block therapy immediately after the procedure was 100%, and at 2 weeks, 1, 2, 3 and 4 months after the treatment it was 100%, 100%, 98.0%, 96.9% and 92.6%, respectively. No serious complications occurred during perioperative period. The living quality was markedly improved in all patients. Conclusion: For the treatment of intractable carcinomatous abdominal pain in patients with their celiac plexus being embedded in mass-like metastatic retroperitoneal lymph nodes CT-guided percutaneous ethanol nerve block therapy by pushing the puncture needle through the fused lymphatic mass to celiac plexus site is of great clinical value in relieving carcinomatous abdominal pain. (authors)

  9. Fentanyl Patches to Supplement Ultrasound-Guided Nerve Blocks for Improving Pain Control After Foot and Ankle Surgery: A Prospective Study.

    Science.gov (United States)

    Song, Jae-Hwang; Kang, Chan; Hwang, Deuk-Soo; Hwang, Jung-Mo; Shin, Byung-Kon

    2016-01-01

    The analgesic effects of preoperative ultrasound-guided nerve blocks wear off after about 12 hours, leaving some patients in substantial pain. Transdermal fentanyl concentrations peak at 12 to 24 hours after application and maintain this concentration for approximately 72 hours. We sought to determine whether combining the use of a transdermal fentanyl patch with either a sciatic or femoral-sciatic nerve block would improve pain control in patients undergoing foot and/or ankle surgery. Consecutive patients in the no-patch control group (n = 104) were enrolled from July 2011 to October 2011, and those in the treatment group (n = 232) were enrolled from November 2011 to May 2012 and received a transdermal patch (4.125 mg/7.5 cm(2) releasing 25 ?g of fentanyl per hour) applied to their chest postoperatively. Pain was assessed using a visual analog scale at 6, 12, 24, and 48 hours after surgery. The primary outcome measure was the number of requests for additional postoperative pain medication. Additional postoperative analgesia was requested by 49 of the 104 control patients (47.1%) and 63 of the 232 treated patients (27.1%; p = .002). The mean pain scores were also lower in the treatment group, with a statistically significant difference (p pain control than did those receiving a nerve block alone. In conclusion, a fentanyl patch is a useful adjunct to an ultrasound-guided nerve block in foot and ankle surgery. PMID:26422649

  10. Comparison of two needle models in terms of bevel deformation during truncal block of the inferior alveolar nerve

    Scientific Electronic Library Online (English)

    Nieves, Almendros Marqués; Esther, Delgado Molina; Meritxell, Tamarit Borrás; Leonardo, Berini Aytés; Cosme, Gay Escoda.

    2007-08-01

    Full Text Available Objetivos: Evaluar las posibles diferencias existentes en cuanto a la deformación del bisel de dos tipos de aguja de igual longitud y calibre externo, pero de distinto diámetro interno, durante el bloqueo troncal del nervio dentario inferior. Diseño del estudio: Cuatro operadores de similar formació [...] n quirúrgica realizaron el bloqueo troncal del nervio dentario inferior y la anestesia infiltrativa del nervio bucal para proceder a la extracción quirúrgica o convencional del tercer molar inferior en 266 pacientes. Para efectuar el bloqueo troncal se utilizó en todos los casos un sistema de jeringa no auto-aspirante (Uniject K®; Hoechst AG, Frankfurt, Alemania) y dos tipos de aguja: una aguja Monoprotect® de 27G x 35 mm con un calibre interno de 0.215 mm (Sofic SA, Mazamet, Francia) o una aguja XL Monoprotect® de 27G x 35 mm con un calibre interno de 0.265 mm (Sofic SA, Mazamet, Francia). Para hacer la anestesia infiltrativa del nervio bucal se utilizó el mismo tipo de jeringa y otros dos tipos de aguja: la Monoprotect®o la XL Monoprotect®, ambas con un calibre de 30G y 25 mm de longitud, diferenciándose en su calibre interno (0.215 y 0.265 mm, respectivamente) (Sofic SA, Mazamet, Francia). En cada paciente fue recopilada de forma sistemática la siguiente información: el tipo de aguja, la técnica anestésica utilizada (troncular directa o indirecta) y el número de veces que se había contactado con el hueso durante ésta, el lado de trabajo del operador, el lado del diente a extraer, el operador que hizo la intervención quirúrgica, así como la presencia o ausencia de deformación del bisel tras la técnica anestésica. Resultados: Para la técnica troncular, sólo se observó una asociación estadísticamente significativa entre la deformación de los biseles de las agujas y el operador que efectuó la técnica anestésica, mientras que para la técnica infiltrativa, se encontró una asociación estadísticamente significativa (p Abstract in english Objectives: To evaluate the differences in terms of bevel deformation between two types of needle of the same length and external caliber, but with different internal diameters, during truncal block of the inferior alveolar nerve. Study design: Four operators performed truncal block of the inferior [...] alveolar nerve and infiltrating anesthesia of the buccal nerve for the extraction of a lower third molar in 266 patients. The truncal block was carried out using a standard 27G x 35 mm needle with an internal caliber of 0.215 mm, or a 27G x 35 mm XL Monoprotect® needle with an internal caliber of 0.265 mm. The infiltrating anesthesia was made with a Monoprotect® or XL Monoprotect® needle, both with a caliber of 30G and a length of 25 mm, but with different internal calibers (0.215 and 0.265 mm, respectively). The type of needle used, the anesthetic technique and the number of bone contacts was established during the procedure, the operator working side, the side of the tooth to be removed, the operator in charge of the intervention and the presence of bevel deformation after the anesthetic technique were collected for each patient. Results: A statistically significant association was observed between bevel deformation and the operator performing the truncal block, while a statistically significant association (p

  11. Neuraxial and peripheral nerve blocks in patients taking anticoagulant or thromboprophylactic drugs: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Li J

    2015-08-01

    Full Text Available Jinlei Li, Thomas Halaszynski Department of Anesthesiology, Yale University, Yale New Haven Hospital, New Haven, CT, USA Abstract: Incidence of hemorrhagic complications from neuraxial blockade is unknown, but classically cited as 1 in 150,000 epidurals and 1 in 220,000 spinals. However, recent literature and epidemiologic data suggest that for certain patient populations the frequency is higher (1 in 3,000. Due to safety concerns of bleeding risk, guidelines and recommendations have been designed to reduce patient morbidity/mortality during regional anesthesia. Data from evidence-based reviews, clinical series and case reports, collaborative experience of experts, and pharmacology used in developing consensus statements are unable to address all patient comorbidities and are not able to guarantee specific outcomes. No laboratory model identifies patients at risk, and rarity of neuraxial hematoma defies prospective randomized study so “patient-specific” factors and “surgery-related” issues should be considered to improve patient-oriented outcomes. Details of advanced age, older females, trauma patients, spinal cord and vertebral column abnormalities, organ function compromise, presence of underlying coagulopathy, traumatic or difficult needle placement, as well as indwelling catheter(s during anticoagulation pose risks for significant bleeding. Therefore, balancing between thromboembolism, bleeding risk, and introduction of more potent antithrombotic medications in combination with regional anesthesia has resulted in a need for more than “consensus statements” to safely manage regional interventions during anticoagulant/thromboprophylactic therapy. Keywords: antithrombotics, novel oral anticoagulant, regional, neurologic dysfunction, hematoma, peripheral nerve blockade

  12. Surface biology of collagen scaffold explains blocking of wound contraction and regeneration of skin and peripheral nerves.

    Science.gov (United States)

    Yannas, I V; Tzeranis, D; So, P T

    2015-01-01

    We review the details of preparation and of the recently elucidated mechanism of biological (regenerative) activity of a collagen scaffold (dermis regeneration template, DRT) that has induced regeneration of skin and peripheral nerves (PN) in a variety of animal models and in the clinic. DRT is a 3D protein network with optimized pore size in the range 20-125 µm, degradation half-life 14 ± 7 d and ligand densities that exceed 200 µM α1β1 or α2β1 ligands. The pore has been optimized to allow migration of contractile cells (myofibroblasts, MFB) into the scaffold and to provide sufficient specific surface for cell-scaffold interaction; the degradation half-life provides the required time window for satisfactory binding interaction of MFB with the scaffold surface; and the ligand density supplies the appropriate ligands for specific binding of MFB on the scaffold surface. A dramatic change in MFB phenotype takes place following MFB-scaffold binding which has been shown to result in blocking of wound contraction. In both skin wounds and PN wounds the evidence has shown clearly that contraction blocking by DRT is followed by induction of regeneration of nearly perfect organs. The biologically active structure of DRT is required for contraction blocking; well-matched collagen scaffold controls of DRT, with structures that varied from that of DRT, have failed to induce regeneration. Careful processing of collagen scaffolds is required for adequate biological activity of the scaffold surface. The newly understood mechanism provides a relatively complete paradigm of regenerative medicine that can be used to prepare scaffolds that may induce regeneration of other organs in future studies. PMID:26694657

  13. In with the new, out with the old? Comparison of two approaches for psoas compartment block.

    LENUS (Irish Health Repository)

    Mannion, Stephen

    2012-02-03

    We compared the approaches of Winnie and Capdevila for psoas compartment block (PCB) performed by a single operator in terms of contralateral spread, lumbar plexus blockade, and postoperative analgesic efficacy. Sixty patients underwent PCB (0.4 mL\\/kg levobupivacaine 0.5%) and subsequent spinal anesthesia for primary joint arthroplasty (hip or knee) in a prospective, double-blind study. Patients were randomly allocated to undergo PCB by using the Capdevila (group C; n = 30) or a modified Winnie (group W; n = 30) approach. Contralateral spread and lumbar plexus blockade were assessed 15, 30, and 45 min after PCB. Contralateral spread (bilateral from T4 to S5) and femoral and lateral cutaneous nerve block were evaluated by sensory testing, and obturator motor block was assessed. Bilateral anesthesia occurred in 10 patients in group C and 12 patients in group W (P = 0.8). Blockade of the femoral, lateral cutaneous, and obturator nerves was 90%, 93%, and 80%, respectively, for group C and 93%, 97%, and 90%, respectively, for group W (P > 0.05). No differences were found in PCB procedure time, pain scores, 24-h morphine consumption, or time to first morphine analgesia.

  14. Glans ischemia after circumcision and dorsal penile nerve block: Case report and review of the literature.

    Science.gov (United States)

    Garrido-Abad, Pablo; Suárez-Fonseca, Carlos

    2015-01-01

    Circumcision is an easy commonly performed surgical procedure in childhood. However, it is not free of a low number of complications, (1-5-5%). Here we report a case of a 3-year-old boy with glans superficial necrosis after circumcision, managed with topical (nitroglycerin, gentamicin), oral (pentoxifylline) and epidural (urgent caudal block with bupivacaine) treatment. A review of the literature and the different treatments reported by other authors was done. After 7 days of treatment, local signs of ischemia and severe pain disappeared, without adverse events related to treatment. Although the ischemia or necrosis of the glans after circumcision are rare, we may suspect them in case of presence of severe acute pain or dark color. We report the successful management of this complication. PMID:26692685

  15. Analgesic efficacy of continuous femoral nerve block commenced prior to operative fixation of fractured neck of femur

    LENUS (Irish Health Repository)

    Szucs, Szilard

    2012-06-27

    AbstractBackgroundPeripheral nerve blocks are effective in treating acute pain, thereby minimizing the requirement for opiate analgesics. Fractured neck of femur (FNF) is a common, painful injury. The provision of effective analgesia to this cohort is challenging but an important determinant of their functional outcome. We investigated the analgesic efficacy of continuous femoral nerve block (CFNB) in patients with FNF.MethodsFollowing institutional ethical approval and with informed consent, patients awaiting FNF surgery were randomly allocated to receive either standard opiate-based analgesia (Group 1) or a femoral perineural catheter (Group 2). Patients in Group 1 received parenteral morphine as required. Those in Group 2 received a CFNB comprising a bolus of local anaesthetic followed by a continuous infusion of 0.25% bupivacaine. For both Groups, rescue analgesia consisted of intramuscular morphine as required and all patients received paracetamol regularly. Pain was assessed using a visual analogue scale at rest and during passive movement (dynamic pain score) at 30 min following first analgesic intervention and six hourly thereafter for 72 hours. Patient satisfaction with the analgesic regimen received was recorded using verbal rating scores (0-10). The primary outcome measured was dynamic pain score from initial analgesic intervention to 72 hours later.ResultsOf 27 recruited, 24 patients successfully completed the study protocol and underwent per protocol analysis. The intervals from recruitment to the study until surgery were similar in both groups [31.4(17.7) vs 27.5(14.2) h, P = 0.57]. The groups were similar in terms of baseline clinical characteristics. For patients in Group 2, pain scores at rest were less than those reported by patients in Group 1 [9.5(9.4) vs 31(28), P = 0.031]. Dynamic pain scores reported by patients in Group 2 were less at each time point from 30 min up to 54 hours [e.g at 6 h 30.7(23.4) vs 67.0(32.0), P = 0.004]. Cumulative morphine consumption over 72 h was less in Group 2. Patient satisfaction scores were greater in Group 2 [9.4(1.1) vs 7.6(1.8), P = 0.014].ConclusionsCFNB provides more effective perioperative analgesia than a standard opiate-based regimen for patients undergoing fixation of FNF. It is associated with lesser opiate use and greater patient satisfaction.

  16. Apical leakage of root canal system obturation materials

    Directory of Open Access Journals (Sweden)

    Miti? Aleksandar

    2005-01-01

    Full Text Available Hermetical obturation on dentine-cement junction is one of the conditions for success in endodontic treatment. The aim of this paper was to evaluate apical obturation of three different root canal obturation materials. Methods consisted of in vitro semiquantitatively measured penetration of colored solutions. Total number of 55 single-canal teeth was used and obturation test materials were AH-plus, Ketac-Endo and Endomethasone. Linear color penetration was evaluated following illumination of teeth in 2% sol. Metylsalicilate. Results obtained have shown better adhesion between sealer and root canal walls, i.e. better apical obturation when AH-plus (0.25mm and Ketac-Endo (0.52mm were used and highest rate of apical leakage when Endomethasone was used (2.35mm. None of the tested obturation materials have sealed apical portion completely.

  17. CT diagnosis of obturator hernia: report of 2 cases

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Won Don; Koh, Byung Hee; Cho, On Koo; Kim, Soon Yong; Kim, Yong Il; Jun, Kyu Young [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

    1991-01-15

    The clinical diagnosis of obturator hernia is difficult because of its uncommon incidence, deep location, and infrequent specific sign or symptoms. Recently we have experienced 2 cases of obturator hernia, exactly diagnosed preoperatively by CT scan in elderly debilitated women presenting with small bowel obstruction sign. CT diagnosis was based on demonstration of herniated bowel loop through the obturator canal located between the pectineus and the external obturator muscle. CT scan is indicated when there is small bowel obstruction with unclear cause in old aged woman.

  18. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial.

    DEFF Research Database (Denmark)

    Toftdahl, Karen; Nikolajsen, Lone

    2007-01-01

    BACKGROUND: Postoperative pain after total knee arthroplasty (TKA) can be difficult to manage and may delay recovery. Recent studies have suggested that periarticular infiltration with local anesthetics may improve outcome. METHODS: 80 patients undergoing TKA under spinal anesthesia were randomized to receive continuous femoral nerve block (group F) or peri- and intraarticular infiltration and injection (group I). Group I received a solution of 300 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine by infiltration of the knee at the end of surgery, and 2 postoperative injections of these substances through an intraarticular catheter. RESULTS: More patients in group I than in group F could walk <3 m on the first postoperative day (29/39 vs. 7/37, p <0.001). Group I also had significantly lower pain scores during activity and lower consumption of opioids on the first postoperative day. No differences between groups were seen regarding side effects or length of stay. INTERPRETATION: Peri- and intraarticularapplication of analgesics by infiltration and bolus injections can improve early analgesia and mobilization for patients undergoing TKA. Further studies of optimal drugs, dosage, and duration of this treatment are warranted. Udgivelsesdato: 2007-Apr

  19. Long term outcomes from CT-guided indirect cervical nerve root blocks and their relationship to the MRI findings. A prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Bensler, Susanne; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K. [Orthopedic University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2015-11-15

    To investigate long-term pain reduction and 'improvement' in patients with indirect cervical nerve-root-blocks in comparison to MRI findings. One hundred and twelve patients with MRI confirmed cervical radiculopathy and an indirect cervical nerve-root-block were included. Two radiologists independently evaluated the MRI examinations. 12 different MRI abnormalities at the level and side of infiltration were compared to pain relief and 'improvement' at 1-month, 3-months and 1-year post injection. The proportion of patients reporting clinically relevant 'improvement' was 36.7 % at 1-month, 53.9 % at 3-months and 68.1 % at 1-year. At 1-month post injection, a statistically significantly lower percentage of patients eventually requiring surgery reported improvement and lower NRS change scores compared to those who did not undergo surgery (p = 0.001). Patients with extrusion of the disc were around 4-times more likely to have surgery. At 1-year post-injection the presence of nerve-root compromise was significantly linked to treatment outcome (p = 0.011). Patients with nerve root compression were more likely to report improvement at 1 year. Patients with disc extrusions have less pain relief and are 4 times more likely to go to surgery than patients with disc protrusions. (orig.)

  20. Bloqueos nerviosos periféricos de la extremidad inferior para analgesia postoperatoria y tratamiento del dolor crónico / Lower limb continuous peripheral nerve blocks for postoperative analgesia and chronic pain

    Scientific Electronic Library Online (English)

    V., Domingo; J. L., Aguilar; R., Pelaez.

    2004-05-01

    Full Text Available Existe un interés creciente por la realización de los bloqueos de nervio periférico (BNP) debido a sus potenciales beneficios como los concernientes a las interacciones de los fármacos anticoagulantes y los bloqueos neuroaxiales. Los BNP de la extremidad inferior, y sobre todo, los bloqueos periféri [...] cos del nervio ciático son el pariente pobre de las técnicas de anestesia regional y, en general, son poco conocidos y por tanto poco utilizados. En este artículo se realiza una revisión de los bloqueos del plexo lumbosacro, realizando especial énfasis en los bloqueos continuos mediante catéteres para analgesia postoperatoria y para el tratamiento del dolor crónico. La utilización de anestésicos locales de larga duración de acción, asociada a un escaso bloqueo motor, como es el caso de la ropivacaína, nos permite combinar técnicas de punción única para conseguir una adecuada analgesia intraoperatoria, con las técnicas de perfusión continua para analgesia postoperatoria. Es necesario un conocimiento anatómico preciso, así como de los territorios cutáneos de inervación de las ramas del plexo lumbosacro, para la realización de estas técnicas de bloqueo. La introducción de diferentes técnicas de imagen, fundamentalmente la ultrasonografía, para la localización de las estructuras nerviosas, facilita la realización de estos bloqueos y disminuye el riesgo de lesiones de los órganos adyacentes. La realización de los bloqueos continuos de nervio periférico ofrece el beneficio de una analgesia postoperatoria prolongada, con menores efectos adversos, mayor grado de satisfacción del paciente, y una recuperación funcional más rápida después de la cirugía. Abstract in english There is increasing interest in peripheral nerve blocks (PNB) because of potential benefits relative to interactions of anticoagulants and central neuraxial techniques. Among all the regional anesthesia procedures, PNB of the lower limb, and specially sciatic nerve block, are the less known and rare [...] ly used. In this paper, we summarize the recent advances in lumbosacral plexus block, with special remark on continuous catheter blocks for postoperative analgesia and chronic pain treatment. The use of long action local anes-thetics combined with a weak motor block, like ropivacaine, permits the combination of a single skin injection technique to achieve an adequate intraoperative analgesia with continuous infusion ones for postoperative analgesia. A detailed knowledge of anatomy as well as cutaneous nerve distribution is needed for the performance of these techniques. The introduction of several image-based techniques, principally ultrasound imaging, may improve the accuracy of nerve localization and needle placement. It also can help to prevent accidental puncture to vessels and other neighbouring structures. Continuous plexus and peripheral nerve blocks offer the potential benefits of prolonged analgesia with fewer side effects, greater patient satisfaction, and faster functional recovery after surgery.

  1. Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back Pain: A Randomized, Double-Blind, Controlled Trial with a 2-Year Follow-Up

    Directory of Open Access Journals (Sweden)

    Laxmaiah Manchikanti, Vijay Singh, Frank J.E. Falco, Kimberly A. Cash, Vidyasagar Pampati

    2010-01-01

    Full Text Available Study Design: A randomized, double-blind, controlled trial. Objective: To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks with or without steroids in managing chronic low back pain of facet joint origin. Summary of Background Data: Lumbar facet joints have been shown as the source of chronic pain in 21% to 41% of low back patients with an average prevalence of 31% utilizing controlled comparative local anesthetic blocks. Intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin. Methods: The study included 120 patients with 60 patients in each group with local anesthetic alone or local anesthetic and steroids. The inclusion criteria was based upon a positive response to diagnostic controlled, comparative local anesthetic lumbar facet joint blocks. Outcome measures included the numeric rating scale (NRS, Oswestry Disability Index (ODI, opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months. Results: Significant improvement with significant pain relief of ? 50% and functional improvement of ? 40% were observed in 85% in Group 1, and 90% in Group II, at 2-year follow-up. The patients in the study experienced significant pain relief for 82 to 84 weeks of 104 weeks, requiring approximately 5 to 6 treatments with an average relief of 19 weeks per episode of treatment. Conclusions: Therapeutic lumbar facet joint nerve blocks, with or without steroids, may provide a management option for chronic function-limiting low back pain of facet joint origin.

  2. Neurotoxicity of perineural vs intraneural-extrafascicular injection of liposomal bupivacaine in the porcine model of sciatic nerve block.

    Science.gov (United States)

    Damjanovska, M; Cvetko, E; Hadzic, A; Seliskar, A; Plavec, T; Mis, K; Vuckovic Hasanbegovic, I; Stopar Pintaric, T

    2015-12-01

    Liposomal bupivacaine is a prolonged-release local anaesthetic, the neurotoxicity of which has not yet been determined. We used quantitative histomorphometric and immunohistochemical analyses to evaluate the neurotoxic effect of liposomal bupivacaine after perineural and intraneural (extrafascicular) injection of the sciatic nerve in pigs. In this double-blind prospective randomised trial, 4 ml liposomal bupivacaine 1.3% was injected either perineurally (n = 5) or intraneurally extrafascicularly (n = 5). Intraneural-extrafascicular injection of saline (n = 5) was used as a control. After emergence from anaesthesia, neurological examinations were conducted over two weeks. After harvesting the sciatic nerves, no changes in nerve fibre density or myelin width indicative of nerve injury were observed in any of the groups. Intraneural injections resulted in longer sensory blockade than perineural (p bupivacaine in pigs did not result in histological evidence of nerve injury. PMID:26338496

  3. Randomized Double Blind Comparison Between Sciatic-Femoral Nerve Block and Propofol-Remifentanil, Propofol-Alfentanil General Anesthetics in Out-Patient Knee Arthroscopy

    Directory of Open Access Journals (Sweden)

    Hala Mostafa

    2008-01-01

    Full Text Available The aim of this study is the evaluation preparation and discharge times as well as the side-effects, patient satisfaction and costs after out-patient knee arthroscopy performed with a combined sciatic-femoral nerve block or a propofol-remifentanil, propofol-alfentanil general anesthetics. Sixty patients, (remifentanil group 1, n = 20, (alfentanil group 2, n = 20 and a combined sciatic-femoral nerve block (PNB group 3, n = 20. In group 1, anesthesia was induced with remifentanil (1 mic kg-1 followed by 0.5 mic kg-1 min-1 i.v, in group 2 alfentanil (20 mic kg-1 followed by 2 mic kg-1 min-1 i.v, in both groups (group 1, 2 propofol was given 2 mg kg-1 i.v followed by 9 mg kg-1 h-1 i.v. Patients then received atracurium 0.6 mg kg-1 i.v. to facilitate endotracheal intubation. In the PNB group (group 3, patients received a sciatic-femoral nerve block with ropivacaine 25 mL 0.75 mg using a multiple injection technique aided by a nerve stimulator and a short, bevelled, Teflon®-coated stimulating needle. There was no significant difference in the duration of stay in the post anesthesia care unit and day surgery unit between groups, there was significant increase in the time to first urination in PNB group than the other two groups. Also there was no significant difference in the stay in delay surgery. The cost of disposal materials, preoperative and post operative times were higher in PNB group. The cost of drugs was higher in remifentanil and alfentanil groups than PNB group; the total cost was insignificant in the three groups. In conclusion, this prospective randomized study suggests that in patients undergoing out-patient arthroscopy, a combined sciatic-femoral nerve block (using a small volume of ropivacaine 0.75% compared with a propofol-remifentanil or propofol-alfentanil general anesthetics techniques may provide similar intraoperative analgesic efficacy, a shorter length of stay in the PACU and an increased likelihood of bypassing the first phase of postoperative recovery.

  4. Variability in the origin of the obturator artery

    Directory of Open Access Journals (Sweden)

    Mangala M. Pai

    2009-01-01

    Full Text Available INTRODUCTION: General surgeons dealing with laparoscopic herniorrhaphy should be aware of the aberrant obturator artery that crosses the superior pubic ramus and is susceptible to injuries during dissection of the Bogros space and mesh stapling onto Cooper's ligament. The obturator artery is usually described as a branch of the anterior division of the internal iliac artery, although variations have been reported. MATERIALS AND METHODS: The present study was conducted on 98 pelvic halves of embalmed cadavers, and the origin and course of the obturator artery were traced and noted. RESULTS: In 79% of the specimens, the obturator artery was a branch of the internal iliac artery. It branched off at different levels either from the anterior division or posterior division, individually or with other named branches. In 19% of the cases, the obturator artery branched off from the external iliac artery as a separate branch or with the inferior epigastric artery. However, in the remaining 2% of the specimens, both the internal and the external iliac arteries branched to form an anastomotic structure within the pelvic cavity. CONCLUSION: The data obtained in this study show that it is more common to find an abnormal obturator artery than was reported previously, and this observation has implications for pelvic surgeons and is of academic interest to anatomists. Surgeons dealing with direct, indirect, femoral, or obturator hernias need to be aware of these variations and their close proximity to the femoral ring.

  5. Variability in the origin of the obturator artery

    Scientific Electronic Library Online (English)

    Mangala M., Pai; Ashwin, Krishnamurthy; Latha V, Prabhu; Manohar V., Pai; Senthil A., Kumar; Gavishiddappa A., Hadimani.

    Full Text Available INTRODUCTION: General surgeons dealing with laparoscopic herniorrhaphy should be aware of the aberrant obturator artery that crosses the superior pubic ramus and is susceptible to injuries during dissection of the Bogros space and mesh stapling onto Cooper's ligament. The obturator artery is usually [...] described as a branch of the anterior division of the internal iliac artery, although variations have been reported. MATERIALS AND METHODS: The present study was conducted on 98 pelvic halves of embalmed cadavers, and the origin and course of the obturator artery were traced and noted. RESULTS: In 79% of the specimens, the obturator artery was a branch of the internal iliac artery. It branched off at different levels either from the anterior division or posterior division, individually or with other named branches. In 19% of the cases, the obturator artery branched off from the external iliac artery as a separate branch or with the inferior epigastric artery. However, in the remaining 2% of the specimens, both the internal and the external iliac arteries branched to form an anastomotic structure within the pelvic cavity. CONCLUSION: The data obtained in this study show that it is more common to find an abnormal obturator artery than was reported previously, and this observation has implications for pelvic surgeons and is of academic interest to anatomists. Surgeons dealing with direct, indirect, femoral, or obturator hernias need to be aware of these variations and their close proximity to the femoral ring.

  6. Intermuscular pterygoid-temporal abscess following inferior alveolar nerve block anesthesia–A computer tomography based navigated surgical intervention: Case report and review

    Science.gov (United States)

    Wallner, Jürgen; Reinbacher, Knut Ernst; Pau, Mauro; Feichtinger, Matthias

    2014-01-01

    Inferior alveolar nerve block (IANB) anesthesia is a common local anesthetic procedure. Although IANB anesthesia is known for its safety, complications can still occur. Today immediately or delayed occurring disorders following IANB anesthesia and their treatment are well-recognized. We present a case of a patient who developed a symptomatic abscess in the pterygoid region as a result of several inferior alveolar nerve injections. Clinical symptoms included diffuse pain, reduced mouth opening and jaw's hypomobility and were persistent under a first step conservative treatment. Since image-based navigated interventions have gained in importance and are used for various procedures a navigated surgical intervention was initiated as a second step therapy. Thus precise, atraumatic surgical intervention was performed by an optical tracking system in a difficult anatomical region. A symptomatic abscess was treated by a computed tomography-based navigated surgical intervention at our department. Advantages and disadvantages of this treatment strategy are evaluated. PMID:24987612

  7. A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision.

    LENUS (Irish Health Repository)

    Long, Ronan M

    2012-01-31

    OBJECTIVE: To determine the sensory innervation of the penis, as regional anaesthesia is often used either for postoperative analgesia or as the sole anaesthetic technique for circumcision. Since first described in 1978 the dorsal penile nerve block has become the standard technique, but some blocks are ineffective; a better understanding of the sensory innervation of the penis might improve the efficacy of the dorsal penile block technique. PATIENTS AND METHODS: In 13 men undergoing circumcision with local anaesthetic, cutaneous sensation was tested before and after infiltration of the dorsal aspect of the penis, and then again after infiltration of the ventral aspect. The area of anaesthesia was mapped using pin-prick sensation. RESULTS: Ten of the 13 patients showed a similar pattern of sensory distribution. After the dorsal block, the dorsal aspect of the shaft of the penis and glans penis became insensate. The ventral aspect of the shaft remained sensate up to and including the frenulum. After successful ventral infiltration all sensate areas became insensate and circumcision proceeded. In one case the frenulum and distal ventral foreskin was anaesthetized after the dorsal block and ventral infiltration was not required. No patient experienced pain during circumcision. CONCLUSION: For consistently successful regional anaesthesia of the foreskin in circumcision, a dorsal block must be used. This should be combined with ventral infiltration at the site of incision. This method will avoid inconsistencies and allow pain-free circumcision using local anaesthesia in most men.

  8. Does audiovisual stimulation with music and nature sights (MuViCure) reduce pain and discomfort during placement of a femoral nerve block?

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Lyndgaard, Kirsten; Schriver, Nina Billenstein; Møller, Jytte Frandsen

    2009-01-01

    MuViCure (Photobia ApS, Copenhagen, Denmark) is a new program for audiovisual stimulation. We hypothesized that audiovisual stimulation would reduce pain and discomfort and improve patients' well-being during placement of a femoral nerve block. Fifty-five outpatients scheduled for anterior cruciate...... ligament reconstruction were randomly allocated into three groups: the first group received audiovisual stimulation (MuViCure), the second group received audio stimulation (MusiCure, Gefion Records ApS, Virum, Denmark), and the third group received no intervention (control). Ten of the 55 patients...

  9. ULTRASOUND GUIDED DORSAL RAMUS NERVE BLOCK FOR REDUCTION OF POSTOPERATIVE PAIN IN PATIENTS UNDERGOING LUMBAR SPINE SURGERY: A CASE SERIES IMAGING STUDY.

    Science.gov (United States)

    Al-Alami, Achir; Abou El Ezz, Ashraf; Kassab, Farid

    2015-06-01

    In patients undergoing spine surgery postoperative pain management can often be complicated with side effects associated with high dose narcotic such as respiratory depression and those associated with non-steroidal anti-inflammatory drugs such as interference with bone healing process. Local anesthetics can help in both decreasing postoperative pain and minimizing side effects associated with systematically administered analgesics. This report describes the use of preoperative ultrasound guided dorsal ramus nerve block to reduce postoperative pain in six patients undergoing lumbar spine surgery under general anesthesia. PMID:26442404

  10. CT-guided plexus and splanchnic nerve neurolytic block. Experience in 150 cases and techniques optimization; Il blocco neurolitico del plesso celiaco e dei nervi splancnici con tomografia computerizzata

    Energy Technology Data Exchange (ETDEWEB)

    Marra, V.; Frigerio, A.; Menna, S.; Di Virgilio, M.R. [Ospedale San Giovanni, Turin (Italy). Serv. di Radiologia; Debernardi, F.; Musso, L. [Ospedale San Giovanni, Turin (Italy). Serv. di Anestesia, Rianimazione e Terapia Antalgica

    1999-09-01

    The paper reports the personal experience in computerized tomography guided celiac plexus and splanchnic nerve neurolytic block blocks. [Italian] Scopo del lavoro e' illustrare l'esperienza personale nell'uso della tomografia computerizzata nel trattamento del dolore da neoplasie addominali superiori, rivoluzionando le tecniche di esecuzione, aumentandone la precisione e riducendone notevolmente il rischio di complicanze.

  11. Trans-obturator Tape in surgical treatment of urinary incontinence

    Directory of Open Access Journals (Sweden)

    Ashrafi M

    2008-06-01

    Full Text Available Background: The aim of this study was to assess the efficacy and safety of a new minimally-invasive surgical procedure using trans-obturator Tape (TOT to treat female stress urinary incontinence.Methods: This clinical trial study was performed from 2003 to 2004 in the Gynecology Department of Imam Hospital, Vali-e-Asr, Tehran, Iran. A total of 35 women with stress urinary incontinence underwent the TOT procedure. All patients underwent pre-operative clinical examination, cough-stress test (full bladder, uroflowmetry and post-voiding residual volume assessment. Results: The mean age of patients was 50 years, ranging from 26 to 74 years, with an average urinary stress incontinence duration of six years. The mean time of follow-up was 14 months (at 1, 6, 12 and 24 months and the average duration of surgery was about 20 minutes. The perioperative complication rate was 9% with no vascular, nerve or bowel injuries. The rate of hemorrhagic side effects (spontaneously-absorbed hematoma and blood loss not requiring blood transfusion was 2.9%. Post-operative urinary retention and vaginal erosion occurred in one case each; the former was treated by intermittent self-catheterization. In total, 91.4% of patients were completely cured and 8.6% were improved without failure of treatment. Conclusions: The present study confirms the results obtained by Delorme and coworkers, and allows us to consider TOT as a safe, minimally invasive and efficient short-term surgical technique for the treatment of female stress urinary incontinence, alone or in combination with prolapse repair. Following this study, a randomized control trial is recommended to compare TOT with the gold standard surgery for women with urinary incontinence.

  12. Obturator hernia: Little old lady’s hernia.

    OpenAIRE

    Jason ON

    2013-01-01

    Obturator hernias are a rare occurrence and any delay in diagnosis may lead to prolonged bowel ischaemia and subsequent infarction which is associated with increased morbidity and mortality. This is a case of a frail and cachectic 85-year-old lady who presented with eight day history of abdominal pain, vomiting, absolute constipation and right hip pain on walking. Imaging showed a strangulated obturator hernia that was successfully managed with surgery.

  13. Lack of correlation between obturation limits and apical leakage

    Scientific Electronic Library Online (English)

    Ricardo, Machado; Ulisses Xavier da, Silva Neto; Sergio Aparecido, Ignacio; Rodrigo Sanches, Cunha.

    2013-07-01

    Full Text Available The aim of this paper was to evaluate a possible correlation between obturation limits and leakage. Thirty-six extracted human mandibular incisors were used, characterized by straight and single canals, non-anatomical complexities, absence of previous end [...] odontic treatment, complete root formation and patent foramen. For standardization of the specimens for the leakage analysis, foraminal instrumentation was performed up to a Flexofile #25 (Dentsply-Maillefer, Ballaigues, Switzerland). All specimens were instrumented and filled following the same protocol, and the obturation limits were measured using Axiovision 4.5 Software (Carl Zeiss Vision, Hallbergmoos, Germany). The specimens were then separated into three groups (n = 12) according to the following variables: Group I - obturation limits ranging from 0 mm to 0.76 mm of the main apical foramen. Group II - obturation limits ranging from 0.77 mm to 0.98 mm of the main apical foramen. Group III - obturation limits ranging from 0.99 mm to 1.68 mm of the main apical foramen. Apical leakage was quantified by fluid filtration. The analyses were confronted using Pearson's test (p > 0.05). Groups I, II and III showed Pearson correlation values (r2) of -0.152, -0.186 and 0.058, respectively. No correlation was found between the obturation limits and apical leakage

  14. Evaluating Femoral-Sciatic Nerve Blocks, Epidural Analgesia, and No Use of Regional Analgesia in Dogs Undergoing Tibia-Plateau-Leveling-Osteotomy.

    Science.gov (United States)

    Boscan, Pedro; Wennogle, Sara

    2016-01-01

    This is a retrospective study evaluating femoral-sciatic nerve blocks (FSBs), epidural analgesia, and non-regional analgesia (NRA) in dogs undergoing tibia-plateau-leveling-osteotomy surgery. Thirty-five records met the criteria for each of the FSB and epidural analgesia groups. Seventeen anesthesia records met the criteria for the NRA or control group. The parameters reported were: isoflurane vaporizer setting, rescue analgesia/anesthesia drugs received, heart rate, systolic blood pressure, and recovery quality (0-4, with 0 being poor and 4 being good). Rescue analgesia-anesthesia during surgery was performed with either fentanyl, ketamine, or propofol. A larger percentage of dogs in the NRA group required rescue analgesia during surgery. The FSB group had a higher recovery quality with median (95% confidence interval of four (±0.3) when compared to two (±0.8) in NRA (p tibia-plateau-leveling-osteotomy surgery, the use of femoral and sciatic nerves blocks with bupivacaine appears to be an alternative technique to help with analgesia and anesthesia during surgery. PMID:26808436

  15. Combined spinal/general anesthesia with postoperative femoral nerve block for total knee replacement in a patient with familial hyperkalemic periodic paralysis: a case report.

    Science.gov (United States)

    Barker, Maria C

    2010-06-01

    Familial hyperkalemic periodic paralysis (HYPP) is a rare genetic disorder in which the sodium channels in skeletal muscle cells have altered structure and function. Small elevations in serum potassium lead to inactivation of sodium channels, causing episodic weakness or paralysis. Exposure to cold, anesthesia, fasting, emotional stress, potassium ingestion, and rest after exercise can stimulate an attack. This case report describes a 65-year-old man with HYPP who was admitted for a right total knee arthroplasty. He had a history of arteriosclerotic heart disease and stenting 8 years earlier, previous inferior wall myocardial infarction with ejection fraction of 65%, anxiety, degenerative joint disease, well-controlled type 2 diabetes mellitus, and a body mass index of 53.3 kg/m2. A combined spinal/general anesthetic with a femoral nerve block for postoperative pain control was chosen. Careful attention was given to monitoring and maintenance of core temperature, use of insulin and glucose to maintain normokalemia, and carbohydrate loading the night before surgery. The patient recovered from the anesthetic without complication and had pain relief for approximately 22 hours postoperatively because of the femoral nerve block. The patient was without weakness or paralysis related to HYPP in the postanesthesia care unit or throughout his hospitalization. PMID:20572404

  16. Painful stimulation and transient blocking of nerve transduction due to local anesthesia evoke perceptual distortions of the face in healthy volunteers

    DEFF Research Database (Denmark)

    Skyt, Ina; Dagsdóttir, Lilja

    2015-01-01

    Anecdotally, orofacial pain patients sometimes report that the painful face area feels 'swollen'. Because there are no clinical signs of swelling, such illusions may represent perceptual distortions. In this study, we examine whether nociceptive stimulation can lead to perceptual distortion of the face in a way similar to that of local anesthesia. Sixteen healthy participants received injections of 0.4 mL hypertonic saline to induce short-term nociceptive stimulation, 0.4 mL Mepivacain (local anesthetics) to transiently block nerve transduction and 0.4 mL isotonic saline as a control condition. Injections were performed in both the infraorbital and the mental nerve region. Perceptual distortions were conceptualized as perceived changes in magnitude of the injected areas and the lips, and it was measured using 1) a verbal subjective rating scale and 2) a warping procedure. Prior to the study, participants filled in several psychological questionnaires. This study shows that both nociceptive stimulation (p<0.05) and transient blocking of nerve transduction (p<0.05) can lead to perceptual distortion of the face. A test-retest experiment including nine new healthy subjects supported the results. Perceptual distortions were positively correlated with the psychological variable dissociation in several conditions (p<0.05). Perceptual distortions may therefore be influenced by somatosensory changes and psychological mechanisms. PERSPECTIVE: Knowledge of the factors that influence the perception of the face is important to understand the possible implications of perceptual distortions in orofacial pain disorders (and possibly other chronic pain states). Such information may ultimately open up for new treatment strategies for persistent orofacial pain.

  17. Resistance to Fracture of Dental Roots Obturated with Different Materials

    Science.gov (United States)

    Uzuntas, Ceren Feriha; Gulsahi, Kamran

    2015-01-01

    The aim of this study was to compare the vertical fracture resistance of roots obturated with different root canal filling materials and sealers. Crowns of 55 extracted mandibular premolar teeth were removed to provide root lengths of 13?mm. Five roots were saved as negative control group (canals unprepared and unfilled). Fifty root canals were instrumented and then five roots were saved as positive control group (canals prepared but unfilled). The remaining 45 roots were randomly divided into three experimental groups (n = 15 root/group) and obturated with the following procedures: in group 1, glass ionomer-based sealer and cone (ActiV GP obturation system); in group 2, bioceramic sealer and cone (EndoSequence BC obturation system); and in group 3, roots were filled with bioceramic sealer and cone (Smartpaste bio obturation system). All specimens were tested in a universal testing machine for measuring fracture resistance. For each root, the force at the time of fracture was recorded in Newtons. The statistical analysis was performed by using Kruskal-Wallis and post hoc test. There were no significant differences between the three experimental groups. The fracture values of three experimental and negative control groups were significantly higher than the positive control group. Within the limitations of this study, all materials increased the fracture resistance of instrumented roots. PMID:25756048

  18. Speech rehabilitation of maxillectomy patients with hollow bulb obturator

    Directory of Open Access Journals (Sweden)

    Pravesh Kumar

    2012-01-01

    Full Text Available Aim: To evaluate the effect of hollow bulb obturator prosthesis on articulation and nasalance in maxillectomy patients. Materials and Methods: A total of 10 patients, who were to undergo maxillectomy, falling under Aramany classes I and II, with normal speech and hearing pattern were selected for the study. They were provided with definitive maxillary obturators after complete healing of the defect. The patients were asked to wear the obturator for six weeks and speech analysis was done to measure changes in articulation and nasalance at four different stages of treatment, namely, preoperative, postoperative (after complete healing, that is, 3-4 months after surgery, after 24 hours, and after six weeks of providing the obturators. Articulation was measured objectively for distortion, addition, substitution, and omission by a speech pathologist, and nasalance was measured by Dr. Speech software. Results: The statistical comparison of preoperative and six weeks post rehabilitation levels showed insignificance in articulation and nasalance. Comparison of post surgery complete healing with six weeks after rehabilitation showed significant differences in both nasalance and articulation. Conclusion: Providing an obturator improves the speech closer to presurgical levels of articulation and there is improvement in nasality also.

  19. Three-dimensional helical computed tomographic evaluation of three obturation techniques: In vitro study

    Directory of Open Access Journals (Sweden)

    M Chokkalingam

    2011-01-01

    Full Text Available Aim: The purpose of this study was to evaluate the adequacy of three obturation techniques namely lateral condensation, EQ Fil (backfill obturation and thermafil (core carrier obturation techniques using three-dimensional (3D helical computed tomography (CT by volume rendering method. Materials and Methods: Thirty freshly extracted teeth were randomly divided into three groups of 10 teeth each. Biomechanical preparation was done in all the teeth using rotary instruments. All three sets of teeth were placed in helical CT slice scanner and were imaged before obturation. The three sets were then obturated by following methods: Group I: lateral condensation, Group II: EQ Fil (backfill and Group III: thermafil (core carrier obturation.Volume of the pulp chamber and gutta-percha after obturation were calculated using volume rendering technique and adequacy of the obturation techniques were calculated. Statistical Analysis Used: One-way ANOVA and Multiple-Range Tukey Test by Tukey-HSD procedure Results: Mean change in lateral condensation (0.005±0.002 was significantly higher than that of thermafil obturation (0.002±0.001 [P<0.05]. Conclusions: Conventional lateral condensation technique showed maximal inadequacy of obturation and thermafil obturation technique showed the least inadequacy of obturation when the volume of the specimens were calculated and reconstructed

  20. Bloqueio do nervo supraescapular: procedimento importante na prática clínica. Parte II Suprascapular nerve block: important procedure in clinical practice. Part II

    Directory of Open Access Journals (Sweden)

    Marcos Rassi Fernandes

    2012-08-01

    Full Text Available O bloqueio do nervo supraescapular é um método de tratamento reprodutível, confiável e extremamente efetivo no controle da dor no ombro. Esse método tem sido amplamente utilizado por profissionais na prática clínica, como reumatologistas, ortopedistas, neurologistas e especialistas em dor, na terapêutica de enfermidades crônicas, como lesão irreparável do manguito rotador, artrite reumatoide, sequelas de AVC e capsulite adesiva, o que justifica a presente revisão (Parte II. O objetivo deste estudo foi descrever as técnicas do procedimento e suas complicações descritas na literatura, já que a primeira parte reportou as indicações clínicas, drogas e volumes utilizados em aplicação única ou múltipla. Apresentamse, detalhadamente, os acessos para a realização do procedimento tanto direto como indireto, anterior e posterior, lateral e medial, e superior e inferior. Diversas são as opções para se realizar o bloqueio do nervo supraescapular. Apesar de raras, as complicações podem ocorrer. Quando bem indicado, este método deve ser considerado.The suprascapular nerve block is a reproducible, reliable, and extremely effective treatment method in shoulder pain control. This method has been widely used by professionals in clinical practice such as rheumatologists, orthopedists, neurologists, and pain specialists in the treatment of chronic diseases such as irreparable rotator cuff injury, rheumatoid arthritis, stroke sequelae, and adhesive capsulitis, which justifies the present review (Part II. The objective of this study was to describe the techniques and complications of the procedure described in the literature, as the first part reported the clinical indications, drugs, and volumes used in single or multiple procedures. We present in details the accesses used in the procedure: direct and indirect, anterior and posterior, lateral and medial, upper and lower. There are several options to perform suprascapular nerve block. Although rare, complications can occur. When properly indicated, this method should be considered.

  1. Bloqueio do nervo supraescapular: procedimento importante na prática clínica. Parte II / Suprascapular nerve block: important procedure in clinical practice. Part II

    Scientific Electronic Library Online (English)

    Marcos Rassi, Fernandes; Maria Alves, Barbosa; Ana Luiza Lima, Sousa; Gilson Cassem, Ramos.

    2012-08-01

    Full Text Available O bloqueio do nervo supraescapular é um método de tratamento reprodutível, confiável e extremamente efetivo no controle da dor no ombro. Esse método tem sido amplamente utilizado por profissionais na prática clínica, como reumatologistas, ortopedistas, neurologistas e especialistas em dor, na terapê [...] utica de enfermidades crônicas, como lesão irreparável do manguito rotador, artrite reumatoide, sequelas de AVC e capsulite adesiva, o que justifica a presente revisão (Parte II). O objetivo deste estudo foi descrever as técnicas do procedimento e suas complicações descritas na literatura, já que a primeira parte reportou as indicações clínicas, drogas e volumes utilizados em aplicação única ou múltipla. Apresentamse, detalhadamente, os acessos para a realização do procedimento tanto direto como indireto, anterior e posterior, lateral e medial, e superior e inferior. Diversas são as opções para se realizar o bloqueio do nervo supraescapular. Apesar de raras, as complicações podem ocorrer. Quando bem indicado, este método deve ser considerado. Abstract in english The suprascapular nerve block is a reproducible, reliable, and extremely effective treatment method in shoulder pain control. This method has been widely used by professionals in clinical practice such as rheumatologists, orthopedists, neurologists, and pain specialists in the treatment of chronic d [...] iseases such as irreparable rotator cuff injury, rheumatoid arthritis, stroke sequelae, and adhesive capsulitis, which justifies the present review (Part II). The objective of this study was to describe the techniques and complications of the procedure described in the literature, as the first part reported the clinical indications, drugs, and volumes used in single or multiple procedures. We present in details the accesses used in the procedure: direct and indirect, anterior and posterior, lateral and medial, upper and lower. There are several options to perform suprascapular nerve block. Although rare, complications can occur. When properly indicated, this method should be considered.

  2. Differential efficacy of endodontic obturation procedures: an ex vivo study.

    Science.gov (United States)

    Ardizzoni, Andrea; Generali, Luigi; Righi, Elena; Baschieri, Maria C; Cavani, Francesco; Manca, Lidia; Lugli, Eleonora; Migliarese, Luigi; Blasi, Elisabetta; Neglia, Rachele G

    2014-07-01

    By means of a double-chamber model, different root canal filling materials and procedures were compared. Briefly, the root canals of single-rooted human teeth, extracted for periodontal reasons, were instrumented and obturated by gutta-percha/Pulp Canal Sealer EWT (PCS) or by Resilon, in association with different sealers (Real Seal, RelyX Unicem or Meta). Obturation was achieved by traditional continuous wave of condensation technique (TCWCT), a modified version of it (MCWCT), or single cone technique (SCT). The obturated roots, inserted in a double-chamber model, were sterilized by gamma irradiation. Next, Enterococcus faecalis was added to the upper chamber and the specimens were incubated at 37 °C for up to 120 days; the development of turbidity in the lower chambers' broths indicated bacterial leakage through the obturated root canals. The kinetics of leakage were analyzed in different groups by means of Kaplan-Meier statistics and compared by log-rank test. The results showed that root canals obturated with either gutta-percha/PCS using the MCWCT, Resilon/Real Seal SCT or Resilon/RelyX Unicem using the TCWCT displayed significantly better performance than the remaining groups (p < 0.01). Histological evaluation, performed to investigate microbial localization inside specimens, confirmed that this parameter varied according to the obturation procedures and materials employed. This ex vivo study indicates that gutta-percha/PCS, if used with the MCWCT, is as effective as Resilon when coupled to Real Seal with the SCT or, interestingly, to RelyX Unicem with the TCWCT. These data suggest that further improvement of the currently employed root canal filling procedures is achievable, depending on both the filling materials and the technique employed, thus encouraging clinical studies in this direction. PMID:23836051

  3. Essential oil of Lippia alba and its main constituent citral block the excitability of rat sciatic nerves.

    Science.gov (United States)

    Sousa, D G; Sousa, S D G; Silva, R E R; Silva-Alves, K S; Ferreira-da-Silva, F W; Kerntopf, M R; Menezes, I R A; Leal-Cardoso, J H; Barbosa, R

    2015-08-01

    Lippia alba is empirically used for infusions, teas, macerates, and hydroalcoholic extracts because of its antispasmodic, analgesic, sedative, and anxiolytic effects. Citral is a mixture of trans-geranial and cis-neral and is the main constituent of L. alba essential oil and possesses analgesic, anxiolytic, anticonvulsant, and sedative effects. The present study evaluated the effects of the essential oil of L. alba (EOLa) and citral on compound action potentials (CAPs) in Wistar rat sciatic nerves. Both drugs inhibited CAP in a concentration-dependent manner. The calculated half-maximal inhibitory concentrations (IC50) of peak-to-peak amplitude were 53.2 µg/mL and 35.00 µg/mL (or 230 µM) for EOLa and citral, respectively. Peak-to-peak amplitude of the CAP was significantly reduced by 30 µg/mL EOLa and 10 µg/mL citral. EOLa and citral (at 60 and 30 µg/mL, values close to their respective IC50 for CAP blockade) significantly increased chronaxy and rheobase. The conduction velocity of the first and second CAP components was statistically reduced to ?86% of control with 10 µg/mL EOLa and ?90% of control with 3 µg/mL citral. This study showed that EOLa inhibited nerve excitability and this effect can be explained by the presence of citral in its composition. Both EOLa and citral showed inhibitory actions at lower concentrations compared with other essential oils and constituents with local anesthetic activity. In conclusion, these data demonstrate that EOLa and citral are promising agents in the development of new drugs with local anesthetic activity. PMID:26132093

  4. Essential oil of Lippia alba and its main constituent citral block the excitability of rat sciatic nerves

    Directory of Open Access Journals (Sweden)

    D.G. Sousa

    2015-08-01

    Full Text Available Lippia alba is empirically used for infusions, teas, macerates, and hydroalcoholic extracts because of its antispasmodic, analgesic, sedative, and anxiolytic effects. Citral is a mixture of trans-geranial and cis-neral and is the main constituent of L. alba essential oil and possesses analgesic, anxiolytic, anticonvulsant, and sedative effects. The present study evaluated the effects of the essential oil of L. alba (EOLa and citral on compound action potentials (CAPs in Wistar rat sciatic nerves. Both drugs inhibited CAP in a concentration-dependent manner. The calculated half-maximal inhibitory concentrations (IC50 of peak-to-peak amplitude were 53.2 µg/mL and 35.00 µg/mL (or 230 µM for EOLa and citral, respectively. Peak-to-peak amplitude of the CAP was significantly reduced by 30 µg/mL EOLa and 10 µg/mL citral. EOLa and citral (at 60 and 30 µg/mL, values close to their respective IC50 for CAP blockade significantly increased chronaxy and rheobase. The conduction velocity of the first and second CAP components was statistically reduced to ?86% of control with 10 µg/mL EOLa and ?90% of control with 3 µg/mL citral. This study showed that EOLa inhibited nerve excitability and this effect can be explained by the presence of citral in its composition. Both EOLa and citral showed inhibitory actions at lower concentrations compared with other essential oils and constituents with local anesthetic activity. In conclusion, these data demonstrate that EOLa and citral are promising agents in the development of new drugs with local anesthetic activity.

  5. Essential oil of Lippia alba and its main constituent citral block the excitability of rat sciatic nerves

    Scientific Electronic Library Online (English)

    D.G., Sousa; S.D.G., Sousa; R.E.R., Silva; K.S., Silva-Alves; F.W., Ferreira-da-Silva; M.R., Kerntopf; I.R.A., Menezes; J.H., Leal-Cardoso; R., Barbosa.

    Full Text Available Abstract Lippia alba is empirically used for infusions, teas, macerates, and hydroalcoholic extracts because of its antispasmodic, analgesic, sedative, and anxiolytic effects. Citral is a mixture of trans-geranial and cis-neral and is the main constituent of L. alba essential oil and possesses analg [...] esic, anxiolytic, anticonvulsant, and sedative effects. The present study evaluated the effects of the essential oil of L. alba (EOLa) and citral on compound action potentials (CAPs) in Wistar rat sciatic nerves. Both drugs inhibited CAP in a concentration-dependent manner. The calculated half-maximal inhibitory concentrations (IC50) of peak-to-peak amplitude were 53.2 µg/mL and 35.00 µg/mL (or 230 µM) for EOLa and citral, respectively. Peak-to-peak amplitude of the CAP was significantly reduced by 30 µg/mL EOLa and 10 µg/mL citral. EOLa and citral (at 60 and 30 µg/mL, values close to their respective IC50 for CAP blockade) significantly increased chronaxy and rheobase. The conduction velocity of the first and second CAP components was statistically reduced to ?86% of control with 10 µg/mL EOLa and ?90% of control with 3 µg/mL citral. This study showed that EOLa inhibited nerve excitability and this effect can be explained by the presence of citral in its composition. Both EOLa and citral showed inhibitory actions at lower concentrations compared with other essential oils and constituents with local anesthetic activity. In conclusion, these data demonstrate that EOLa and citral are promising agents in the development of new drugs with local anesthetic activity.

  6. Bloqueio do nervo supraescapular: procedimento importante na prática clínica / Suprascapular nerve block: important procedure in clinical practice / Bloqueo del nervio supraescapular: procedimiento importante en la práctica clínica

    Scientific Electronic Library Online (English)

    Marcos Rassi, Fernandes; Maria Alves, Barbosa; Ana Luiza Lima, Sousa; Gilson Cassem, Ramos.

    2012-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A dor no ombro é uma queixa frequente que ocasiona grande incapacidade funcional no membro acometido, assim como redução na qualidade de vida dos pacientes. O bloqueio do nervo supraescapular é um método terapêutico eficaz e vem sendo cada vez mais utilizado pelos anestesi [...] ologistas tanto para anestesia regional quanto para analgesia pós-operatória de cirurgias realizadas nesta articulação, o que justifica a presente revisão, cujo objetivo principal é descrever a técnica aplicada e as indicações clínicas. CONTEÚDO: Apresenta-se a anatomia do nervo supraescapular, desde a sua origem do plexo braquial até os seus ramos terminais, assim como as características gerais e a técnica empregada na execução do bloqueio deste nervo, as principais drogas utilizadas e o volume e as situações em que se faz jus a sua aplicação. CONCLUSÕES: O bloqueio do nervo supraescapular é um procedimento seguro e extremamente eficaz na terapia da dor no ombro. Também de fácil reprodutibilidade, está sendo muito utilizado por profissionais de várias especialidades médicas. Quando bem indicado, este método deve ser considerado Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El dolor en el hombro es un quejido frecuente que ocasiona una gran incapacidad funcional en el miembro perjudicado, como también la reducción en la calidad de vida de los pacientes. El bloqueo del nervio supraescapular es un método terapéutico eficaz y ha venido siendo ca [...] da vez más utilizado por los anestesiólogos tanto para la anestesia regional como para la analgesia postoperatoria de cirugías realizadas en esa articulación, lo que justifica la presente revisión cuyo objetivo principal es describir la técnica aplicada y las indicaciones clínicas. CONTENIDO: Presentamos la anatomía del nervio supraescapular, desde su origen, y desde el plexo braquial hasta sus ramas terminales, como también las características generales y la técnica usada en la ejecución del bloqueo de ese nervio, los principales fármacos utilizados y el volumen y las situaciones en que se justifica su aplicación. CONCLUSIONES: El bloqueo del nervio supraescapular es un procedimiento seguro y extremadamente eficaz en la terapia del dolor en el hombro. También es fácilmente reproducible y está siendo muy utilizado por profesionales de varias especialidades médicas. Cuando está bien indicado, el método debe ser tenido en cuenta Abstract in english BACKGROUND AND OBJECTIVES: Shoulder pain is a frequent complaint that results in great functional disability in the affected shoulder as well as the decrease in patients' quality of life. Suprascapular nerve block is an effective therapeutic method and has been increasingly used by anesthesiologists [...] both for regional anesthesia and postoperative analgesia of surgeries carried out in this articulation, which justifies this review, whose main purpose was to describe the applied technique and clinical indications. CONTENT: It is presented the anatomy of suprascapular nerve, since its brachial plexus origin until its terminal branches, as well as general characteristics and technique employed to carry out the block of this nerve, main drugs used, volume and situations that give rise to its applications. CONCLUSIONS: Suprascapular nerve block is a safe and extremely effective procedure in shoulder pain therapy. It also has an easy reproducibility and has been very used by professionals of many medical specialties. When it is well-indicated, this method must be taken into consideration

  7. Study of Brass Obturator Design for Combustible Cartridge Case for 105mm Tank Gun Ammunition

    Directory of Open Access Journals (Sweden)

    R.K. Syal

    1997-07-01

    Full Text Available Brass cartridge case provides rearward obturation in the tank gun ammunition where the gun systedt has a sliding breech mechanism. In the case of semi-combustible cartridge case (SCCC ammunition, obturation is provided by a smal1 metal stub. The mechanism of obturation and obturator design for kinetic energy and high explosive squash heat (HESH, SCCC ammunition of 105mm tank gun have been studied. The dynamic firing results for SCCC ammunition for 105 mm tank gun reveal height 115 mm provides perfect obturation. The ballistic performance of SCCC ammunition is comparable with that of the brass-cartridged round in the pressure range 150-450 MPa.

  8. Stress analysis in oral obturator prostheses: imaging photoelastic

    Science.gov (United States)

    Pesqueira, Aldiéris Alves; Goiato, Marcelo Coelho; dos Santos, Daniela Micheline; Haddad, Marcela Filié; Andreotti, Agda Marobo; Moreno, Amália

    2013-06-01

    Maxillary defects resulting from cancer, trauma, and congenital malformation affect the chewing efficiency and retention of dentures in these patients. The use of implant-retained palatal obturator dentures has improved the self-esteem and quality of life of several subjects. We evaluate the stress distribution of implant-retained palatal obturator dentures with different attachment systems by using the photoelastic analysis images. Two photoelastic models of the maxilla with oral-sinus-nasal communication were fabricated. One model received three implants on the left side of the alveolar ridge (incisive, canine, and first molar regions) and the other did not receive implants. Afterwards, a conventional palatal obturator denture (control) and two implant-retained palatal obturator dentures with different attachment systems (O-ring; bar-clip) were constructed. Models were placed in a circular polariscope and a 100-N axial load was applied in three different regions (incisive, canine, and first molar regions) by using a universal testing machine. The results were photographed and analyzed qualitatively using a software (Adobe Photoshop). The bar-clip system exhibited the highest stress concentration followed by the O-ring system and conventional denture (control). Images generated by the photoelastic method help in the oral rehabilitator planning.

  9. Closure of a septal perforation by means of an obturator.

    Science.gov (United States)

    van Dishoeck, E A; Lashley, F O

    1975-06-01

    The surgical closure of a naso-septal perforation is accompanied by many problems which can interfere with the good result. The authors describe a technique by which a naso-septal perforation can be closed by placing an obturator without performing any surgery. PMID:1224124

  10. Tacrolimus reduces scar formation and promotes sciatic nerve regeneration?

    OpenAIRE

    Que, Jun; Cao, Quan; SUI, TAO; Du, Shihao; Zhang, Ailiang; Kong, Dechao; Cao, Xiaojian

    2012-01-01

    A sciatic nerve transection and repair model was established in Sprague-Dawley rats by transecting the tendon of obturator internus muscle in the greater sciatic foramen and suturing with nylon sutures. The models were treated with tacrolimus gavage (4 mg/kg per day) for 0, 2, 4 and 6 weeks. Specimens were harvested at 6 weeks of intragastric administration. Masson staining revealed that the collagen fiber content and scar area in the nerve anastomosis of the sciatic nerve injury rats were si...

  11. Does audiovisual stimulation with music and nature sights (MuViCure) reduce pain and discomfort during placement of a femoral nerve block?

    Science.gov (United States)

    Nikolajsen, Lone; Lyndgaard, Kirsten; Schriver, Nina B; Moller, Jytte F

    2009-02-01

    MuViCure (Photobia ApS, Copenhagen, Denmark) is a new program for audiovisual stimulation. We hypothesized that audiovisual stimulation would reduce pain and discomfort and improve patients' well-being during placement of a femoral nerve block. Fifty-five outpatients scheduled for anterior cruciate ligament reconstruction were randomly allocated into three groups: the first group received audiovisual stimulation (MuViCure), the second group received audio stimulation (MusiCure, Gefion Records ApS, Virum, Denmark), and the third group received no intervention (control). Ten of the 55 patients underwent a qualitative in-depth interview 1-2 days after surgery. Pain and discomfort during the procedure were more prominent in the MuViCure group when compared with the other two groups. Despite these negative results, 14 of the 19 patients in the MuViCure group answered that MuViCure had a positive effect on their well-being. The qualitative interviews revealed that a number of factors other than the audiovisual stimulation had a significant impact on the patients' experience. The use of MuViCure may be more appropriate in other settings. PMID:19185817

  12. Effect of preoperative medications on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A placebo-controlled clinical study

    Directory of Open Access Journals (Sweden)

    Amit Jena

    2013-01-01

    Full Text Available Background: The purpose of this prospective, randomized, double-blind, placebo-controlled study was to compare the effect of the administration of preoperative ibuprofen, ketorolac, combination of etodolac with paracetamol and combination of aceclofenac with paracetamol versus placebo for the potential increased effectiveness of the inferior alveolar nerve block [IANB] anesthesia. Materials and Methods: A total of 100 endodontic emergency patients in moderate to severe pain diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, either a drug or placebo 30 minutes before the administration of a conventional IANB. Cold testing was done before administration of anesthesia to determine level of pain using Heft-Parker Visual Analogue Scale (VAS score. Success was defined as no pain or pain (VAS on access or initial instrumentation. Results: Overall success was 54% for all the groups. Success was highest (70% for the ketorolac group, 55% for both ibuprofen group and combination of aceclofenac with paracetamol group, 50% for combination of etodolac with paracetamol group, and 40% for the placebo group. Conclusions: Under the conditions of this study, the use of preoperative medication did improve the anesthetic efficacy of IANB for the treatment of teeth diagnosed with irreversible pulpitis but not significantly.

  13. A description of the spread of injectate after psoas compartment block using magnetic resonance imaging.

    LENUS (Irish Health Repository)

    Mannion, Stephen

    2012-02-03

    BACKGROUND AND OBJECTIVES: Magnetic resonance imaging (MRI) provides for excellent visualization of spread of solution after peripheral nerve block. The aim of this observational study was to utilize MRI to describe the distribution of injectate (gadopentetate dimeglumine) administered for continuous psoas compartment block (PCB) performed by use of two approaches (Capdevila and modified Winnie) and to describe the spread of injectate to the lumbar plexus. METHODS: Four volunteers were enrolled in a prospective crossover study. Each volunteer underwent PCB with catheter placement performed by use of Capdevila\\'s approach followed 1 week later by PCB, with catheter placement performed by use of a modified Winnie approach. MRI of injectate distribution was performed after each PCB. RESULTS: The catheter was unable to be inserted in 1 volunteer undergoing Winnie\\'s approach; therefore, 7 sets of MR images were analyzed. In 6 of 7 cases (4 Capdevila and 2 Winnie) spread was primarily within the psoas muscle. Contrast surrounded the L2-3 lumbar branch of the femoral nerve at L4 and cleaved the fascial plane within the psoas muscle and spread cephalad to reach the lumbar nerve roots. In 1 case (Winnie approach) contrast spread between the psoas and quadratus lumborum muscles. Contrast surrounded the femoral and obturator nerves where they lie outside the psoas muscle at L5. CONCLUSION: The most common pattern of injectate spread seen on MRI with both approaches to PCB was spread within the body of the psoas muscle around the lumbar branches (L2-4), with cephalad spread to the lumbar nerve roots. One catheter resulted in injectate between the psoas and quadratus lumborum muscles.

  14. Lidocaine versus ropivacaine for postoperative continuous paravertebral nerve blocks in patients undergoing laparoscopic bowel surgery: a randomized, controlled, double- blinded, pilot study

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-09-01

    Full Text Available Daniela Ghisi,1,3 Andrea Fanelli,1,2 Julie Jouguelet-Lacoste,1 Luca La Colla,1,4 Anne-Sophie Auroux,1,5 Jacques E Chelly1 1Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Anesthesia and Intensive Care Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy; 3Department of Anesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy; 4Department of Anesthesia, Intensive Care and Pain Therapy, Università degli Studi di Parma, Parma, Italy 5Institut des Sciences Pharmaceutiques et Biologiques-Faculté de Pharmacie de Lyon Université Claude Bernard Lyon, FranceBackground and objectives: Lidocaine could provide many advantages in continuous regional anesthesia techniques, including faster onset, greater titratability, and lower cost than long-acting local anesthetics. This prospective, randomized, double-blinded, pilot study is therefore intended to compare lidocaine to ropivacaine in bilateral continuous paravertebral blocks using a multimodal approach for postoperative pain management following laparoscopic bowel surgery.Methods: Thirty-five ASA I–III consecutive patients undergoing elective laparoscopic bowel surgery and bilateral thoracic paravertebral continuous blocks were analyzed: bilateral thoracic paravertebral infusions of ropivacaine 0.2% (Group Ropi, n=18 or lidocaine 0.25% (Group Lido, n=17 were started at 7 mL/h in the postanesthesia care unit. For each patient, we collected numerical rating scores (NRS for pain at rest and during movement at baseline, at postanesthesia care unit discharge, at 24 hours and 48 hours after the end of surgery, as well as hydromorphone patient-controlled analgesia requirements, local anesthetic consumption, side effects, postoperative complications, and functional outcomes.Results: No effect of group distribution on NRS scores for pain at rest or at movement (P=0.823 and P=0.146, nor on hydromorphone (P=0.635 or local anesthetic consumption (P=0.063 was demonstrated at any analyzed time point. Hospital length of stay and spontaneous ambulation were comparable between groups (P=0.636 and P=0.148. In the context of a multimodal approach, the two drugs showed comparable safety profiles.Discussion: Lidocaine 0.25% and ropivacaine 0.2% provided similar analgesic profiles after elective abdominal surgeries, without any difference in terms of functional outcomes. The easier titratability of lidocaine together with its lower cost induced our clinical practice to definitely switch from ropivacaine to lidocaine for postoperative bilateral paravertebral continuous infusions.Keywords: laparoscopic bowel surgery, lidocaine, ropivacaine, continuous paravertebral nerve blocks, pilot study

  15. High division of sciatic nerve

    Directory of Open Access Journals (Sweden)

    Tripti Shrivastava

    2014-04-01

    Results: In all except two cadavers, the nerve divided at the apex of the popliteal fossa. In two cadavers the sciatic nerve divided bilaterally in the upper part of thigh. Conclusion: The high division presented in this study can make popliteal nerve blocks partially ineffective. The high division of sciatic nerve must always be borne in mind as they have important clinical implications. [Int J Res Med Sci 2014; 2(2.000: 686-688

  16. Obturating surfaces in the junction of two CANDU fuel bundles

    International Nuclear Information System (INIS)

    In the Institute of Nuclear Research at Pitesti a general computer code was developed devoted to automatic designing of CANDU type bundles. It may be applied to compute the areas of the obturating surfaces formed at the joints of fuel bundles in each of the 360 positions corresponding to a degree by degree relative rotation of one bundle against the other. Also, the code can evaluate all the pressure drops along a column of 12 fuel bundles, namely: the local drops (at entrance in upstream bundle, at the exit from downstream bundle, in the spacers', bearing pads', and joints' zones), the drops along the fuel bundle segments without appendices, and the total drop (i.e. the sum of local and distributed pressure drops). The paper presents graphically the degree-by-degree variations from 0 angle to 360 angle of the obturating surfaces for a number of 68 specific joints formed by combinations of four different types of fuel bundles. (authors)

  17. Tailor-made endodontic obturator for the management of Blunderbuss canal

    OpenAIRE

    Smitha Reddy; V. G Sukumaran; Narasimha Bharadwaj

    2011-01-01

    The complex anatomy of the blunderbuss root canal often poses a major challenge to accomplish adequate obturation for a biological seal. Moreover, the roll-cone, Gutta-percha obturation technique, which is routinely practiced, also results in a mismatch and failure to configure to the canal volume in the absence of an apical barrier. Hence, an attempt has been made to tailor-make a heat polymerized polymethyl methacrylate resin as an endodontic obturator, to match the canal volume, which has ...

  18. The Effect of Saphenous Nerve Block on the Surgical Stress Induced by Pain Following the Surgical Realignment of Medial Patellar Luxation in Dogs

    Directory of Open Access Journals (Sweden)

    Sung Chul Lim

    2012-01-01

    Full Text Available The purpose of this study was to verify the efficacy of a Saphenous Nerve Block (SNB in the decrease of surgical stress induced by post-operative pain following surgical realignment of the medial patellar luxation in dogs. All subjects were divided into 3 groups according to post-operative analgesic methods: a group with SNB (Sn, n = 5, a group with the intra-articular injection using bupivacaine (Ac, n = 5 and a control group with SNB using saline (Ct, n = 5. Surgical stress from pain was assessed at variable times after surgery using Heart Rate Variability (HRV, a Numerical Rating Scale (NRS and measurement of blood glucose level. No significant differences in HRV were found between the Sn and Ac groups while there were significant differences between the Ac and control groups. However, the LF of the Sn group was significantly higher than that of the Ct group at 30 min. The values of the NRS in the Ac and Sn groups decreased significantly more than that of the Ct group. However, no statistical differences were found in the NRS between the Ac and Sn groups. There were no statistical differences among the groups in terms of blood glucose levels. Some evidence was found to suggest that SNB for pain reduction after realignment surgery of the medial patellar luxation in dogs is an easy technique to acquire some analgesic effects. However, the single use of SNB for pain control in realignment surgery of the medial patellar luxation is not recommended because of its weak analgesic effects.

  19. Relationship between Mandibular Nerve Block Anesthesia and Body Mass Index in Children / Relación entre la Anestesia del Nervio Mandibular y el Índice de Masa Corporal en Niños

    Scientific Electronic Library Online (English)

    Viviana, Castillo; Andrea, Cerón; Ricardo, Cartes-Velásquez; Pedro, Aravena.

    2012-04-01

    Full Text Available El objetivo de este trabajo fue observar la relación entre el bloqueo anestésico efectivo (BAE) del nervio mandibular, inyectando 1,8 ml de lidocaína al 2% con epinefrina 1:100.000, en niños y su índice de masa corporal (IMC). Fue diseñado un estudio de cohorte prospectivo. Se seleccionó una muestra [...] de 93 niños que se atienden en el Módulo Dental de JUNAEB de Frutillar entre abril y julio de 2011. Se registró edad, sexo, motivo de la exodoncia y tipo de diente (permanente o deciduo). Se calculó el IMC para cada niño, que fue categorizado en 2 cohortes de acuerdo al criterio de la OMS: “bajo peso - normal” (BPN) para aquellos con un IMC p85. Después de aplicar la técnica anestésica, a los 10 minutos se evaluó su efectividad registrando el BAE. Se analizó la relación estadística entre IMC y BAE mediante Test exacto de Fisher (p Abstract in english The aim of this study was to observe the relationship between the anesthetic block sucess (ABS) of mandibular nerve, by injecting 1.8 ml of lidocaine 2% with epinephrine 1:100,000, in children and their body mass index (BMI). A prospective cohort study was designed. A sample of 93 6-13 years childre [...] n attended in JUNAEB Dental Module of Frutillar between April and July 2011. We recorded age, gender, reason for tooth extraction and tooth type (permanent or deciduous). BMI was calculated for each child and categorized into two cohorts of study according to WHO criteria: those with a BMI p85 as "over weight - obese" (OWO). After applying the anesthetic technique, effect was evaluated at 10 minutes recording its effectivenes. We analyzed statistically significant relationship between ABS and BMI using Fisher's exact test with (p

  20. An in vitro comparative evaluation of fracture resistance of endodontically treated teeth obturated with different materials

    Directory of Open Access Journals (Sweden)

    Rupali Chadha

    2010-01-01

    Full Text Available The aim of this study was to evaluate the in vitro effect of various obturating materials on fracture resistance of root canal treated teeth. Sixty freshly extracted human mandibular premolars were used. After standardizing the length to 13 mm, the teeth were biomechanically prepared and divided into four groups based on type of obturating materials used. Teeth were embedded in acrylic resin and fracture strength was measured using a universal testing machine. Data obtained was evaluated statistically using one-way ANOVA and the unpaired t-test. Teeth obturated with AH Plus and gutta percha showed higher fracture resistance than those obturated with Resilon-Epiphany. The results suggested that the group obturated with gutta percha and zinc oxide-eugenol sealer had the lowest fracture resistance. No statistically significant difference was found between the unobturated (control group and the zinc oxide-eugenol group.

  1. Fetal Development of the Human Obturator Internus Muscle With Special Reference to the Tendon and Pulley.

    Science.gov (United States)

    Naito, Michiko; Suzuki, Ryoji; Abe, Hiroshi; Rodriguez-Vazquez, Jose Francisco; Murakami, Gen; Aizawa, Shin

    2015-07-01

    To examine the development of the tendon pulley of the obturator internus muscle (OI), we observed paraffin sections of 26 human embryos and fetuses (?6-15 weeks of gestation). The OI was characterized by early maturation of the proximal tendon in contrast to the delayed development of the distal tendon. At 6 weeks, the ischium corresponded to a simple round mass similar to the tuberosity in adults. At 8 weeks, before development of the definite lesser notch of the ischium, initial muscle fibers of the OI, running along the antero-posterior axis, converged onto a thick and tight but short tendon running along the left-right axis. Thus, at the beginning of development, the OI muscle belly and tendon met almost at a right angle. At 10 weeks, the OI tendon extended inferiorly along the sciatic nerve, but the distal part remained thin and loose and it was embedded in the gluteus medius tendon. At 15 weeks, in association with the gemellus muscles, the distal OI tendon was established. The mechanically strong sciatic nerve was first likely to catch the OI muscle fibers to provide a temporary insertion. Next, the ischium developing upward seemed to push the tendon to make the turn more acute along the cartilaginous ridge. Finally, the gemellus muscle appeared to provide inferior traction to the OI tendon for separation from the gluteus medius to create the final, independent insertion. Without such guidance, the piriformis tendon first attached to the OI tendon and then merged with the gluteus medius tendon. PMID:25683268

  2. Strangulated obturator hernia - an unusual presentation of intestinal obstruction.

    LENUS (Irish Health Repository)

    Zeeshan, Saqib

    2012-01-31

    An 81-year-old Caucasian emaciated female presented with 3 days history of colicky abdominal pain nausea, projectile vomiting and abdominal distension. A pre-operative diagnosis of mechanical bowel obstruction was made. The absence of characteristic clinical signs in this thin elderly woman with a small bowel obstruction failed to provide a pre-operative diagnosis. She underwent a midline laparotomy and resection and anastomosis of small bowel and repair of the strangulated right obturator hernia. The high mortality rate associated with this type of abdominal hernias requires a high index of suspicion to facilitate rapid diagnosis and prompt surgical intervention if the survival rate is to be improved.

  3. Strangulated obturator hernia - an unusual presentation of intestinal obstruction.

    Science.gov (United States)

    Zeeshan, Saqib; Muhammad, Khalid; Chughtai, Jehanzeb; Ademola, Moses; Masood, Aqsa; Johnston, Sean

    2009-09-01

    An 81-year-old Caucasian emaciated female presented with 3 days history of colicky abdominal pain nausea, projectile vomiting and abdominal distension. A pre-operative diagnosis of mechanical bowel obstruction was made. The absence of characteristic clinical signs in this thin elderly woman with a small bowel obstruction failed to provide a pre-operative diagnosis. She underwent a midline laparotomy and resection and anastomosis of small bowel and repair of the strangulated right obturator hernia. The high mortality rate associated with this type of abdominal hernias requires a high index of suspicion to facilitate rapid diagnosis and prompt surgical intervention if the survival rate is to be improved. PMID:19728946

  4. Landmark-based versus ultrasound-guided ilioinguinal/iliohypogastric nerve blocks in the treatment of chronic postherniorrhaphy groin pain: a retrospective study

    Directory of Open Access Journals (Sweden)

    Trainor D

    2015-10-01

    Full Text Available Drew Trainor,1 Susan Moeschler,2 Matthew Pingree,1,2 Brian Hoelzer,2 Zhen Wang,2 William Mauck,2 Wenchun Qu1,2 1Department of Physical Medicine and Rehabilitation, 2Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USABackground: Chronic postherniorrhaphy groin pain (CPGP is a debilitating condition, which is often refractory to conservative medical management. To our knowledge, there have been no studies directly comparing landmarked-based and ultrasound-guided approaches in this population.Objective: To compare the effectiveness of landmark-based and ultrasound-guided ilioinguinal/iliohypogastric nerve blocks in the treatment of CPGP.Study design: This is a retrospective chart review of patients who presented to our tertiary care pain medicine clinic with a diagnosis of CPGP. Inclusion criteria were the following: age >18 years, diagnosis of groin pain, and prior history of herniorrhaphy. Exclusion criteria included those who were seen for initial consultation but were lost to follow-up. Primary outcomes were 50% or greater reduction in pain on visual analog scale (VAS. Secondary outcomes were 30% or greater reduction in VAS pain score, changes in VAS pain scores, and reported complications.Results: A total of 36 patients were included in the study. Of them, 20 patients underwent the landmark-based and 16 underwent the ultrasound-guided techniques. There was no significant difference in baseline demographics. The average VAS score preinjection was 7.08 in the landmark-based and 7.0 in the ultrasound-guided groups (P=0.65. A total of 14 patients (70% in the landmark-based and eleven patients (79% in the ultrasound-guided groups experienced at least a 50% reduction in VAS scores. There was no statistically significant difference between the two groups (P=1.0, and no complications were noted. We also did not find a significant difference in terms of number of patients with 30% or greater reduction (P=0.71 and changes in VAS pain scores (P=0.64. No complications were reported in either group.Conclusion: In our study, there was no statistically significant difference between the landmark-based and ultrasound-guided groups in terms of a reduction in VAS pain scores, and no complications were noted in either group.Keywords: abdominal wall, intramuscular injections, ultrasound, anatomic landmarks

  5. Bloqueo nervioso lumbar selectivo guiado por tomografía computada. Nuestra experiencia en un hospital universitario / Computed tomography guided selective lumbar nerve block: Our experience in a university hospital

    Scientific Electronic Library Online (English)

    A.J, Nielsen; G, Criscuolo; S, González Calvo; N, Larrañaga; J.C, Gallo; S, Kozima.

    2013-09-01

    Full Text Available Objetivos: Presentar nuestra experiencia en el tratamiento mínimamente invasivo de la lumbociatalgia con la inyección de corticoides y anestésicos locales bajo control tomográfico. Materiales y métodos: Se realizaron bloqueos selectivos lumbares bajo control tomográfico a 102 pacientes con lumbociat [...] algia crónica, en un período comprendido entre agosto del 2011 y junio del 2012. Del total de pacientes, se infiltraron 65 a nivel foraminal (64%), 29 a nivel epidural (28%) y 8 a ambos niveles (8%). Los procedimientos se realizaron en forma ambulatoria con anestesia local. Todos los pacientes recibieron tratamiento con antiinflamatorios no esteroides (AINES) vía oral y se utilizó la escala numérica del dolor y el índice de Oswestry (IDO) para medir la discapacidad funcional en cada caso. Resultados: El 100% de los pacientes mostró disminución significativa de la sintomatología apenas finalizó el procedimiento, sin observarse complicaciones inmediatas durante el mismo. Se hizo un seguimiento clínico posterior con las escalas anteriormente mencionadas a los 7 días, 1, 3 y 6 meses. En 95 pacientes (93%) se observó una mejora significativa de los síntomas y se suspendió o se redujo la medicación oral, mientras que en 6 pacientes existió una mejoría parcial de los síntomas al mes, pero hubo una recaída a los 3 meses. En estos casos se debió reiniciar el tratamiento con AINES, manteniéndose a 4 pacientes dentro de la categoría del IDO anterior (aunque con una disminución de al menos 2 puntos en el score numérico del dolor). Sólo un paciente no presentó mejoría de la sintomatología durante el seguimiento y tuvo reaparición de los síntomas habituales a los 7 días, por lo que se debió reprogramar una segunda infiltración. Conclusión: En nuestra experiencia el bloqueo nervioso lumbar selectivo bajo control tomográfico, utilizando esteroides y anestésicos locales, resultó un procedimiento efectivo en el control del dolor con un bajo índice de complicaciones. Abstract in english Objectives: To present our experience with minimally invasive treatment of low back pain and sciatica with the computed tomography-guided percutaneous injection of steroids and local anaesthetics. Materials and methods: From August 2011 to June 2012, 102 patients underwent selective computed tomogra [...] phy-guided foraminal block for low back pain and sciatica treatment. Sixtyfi ve patients received foraminal infi ltration (64%), 29 epidural infi ltration (28%), and 8 (8%) were subject to combined procedures. All procedures were performed on an outpatient basis with local anaesthetic, with no immediate complications. All patients received oral NSAIDs (non-steroidal anti-infl ammatory drugs) prior to the procedure. A numeric scale of pain and the Oswestry index (IDO) was employed to measure local pain and limb disability. All patients showed at least 7 points in the initial evaluation. Results: All the patients showed a significant reduction in pain by the end of procedure. A clinical follow-up was made after 7 days, 1, 3, and 6 months after the treatment using the previously mentioned scales. Ninety-fi ve patients (93%) showed a signifi cant improvement in their symptoms, with suspension or decrease in oral medication. Six patients showed only a partial reduction of symptoms during the follow-up after one month, with a recurrence of symptoms after 3 months and restarted oral treatment. Four of these patients remained in the same IDO category with at least a 2 point decrease in the pain scale. Only one patient showed no improvement in symptoms during follow-up with a recurrence of symptoms 7 days after procedure, and for whom a second procedure was reprogrammed. Conclusion: In our experience CT-guided percutaneous lumbar selective nerve block using steroids and local anaesthetics, is an effective method of pain control with a very low incidence of complications.

  6. Comparison of three obturation techniques with regard to bacterial leakage

    Scientific Electronic Library Online (English)

    Cleber Keiti, Nabeshima; Guilherme Henrique Rosa, Martins; Mário Francisco de Pasquali, Leonardo; Regina Célia Furukava, Shin; Silvana, Cai; Manoel Eduardo de Lima, Machado.

    2013-09-01

    Full Text Available AIM: To compare bacterial leakage in root canals obturated with the modified single-cone, lateral condensation, and continuous wave of condensation techniques. METHODS: Distobuccal root canals of maxillary molars were shaped up to ProTaper F2 and obturated with modified singlecone, lateral condensat [...] ion or continuous wave of condensation technique. Two-chamber bacterial model using Enterococcus faecalis was employed for bacterial leakage evaluation for 30 days. The chi-square test was applied to evaluate differences between turbid and non-turbid samples, and the Kruskal-Wallis test was used for evaluating the time necessary for microleakage. A significance level of 5% was set for all analyses. RESULTS: The modified single-cone technique showed leakage in 73.3% of samples, lateral condensation in 66.6%, and continuous wave of condensation in 53.3%, but there were no significant differences among the groups (p>0.05). CONCLUSIONS: It can be concluded that the modified single-cone technique shows similar sealing efficacy to that of lateral condensation and continuous wave of condensation technique.

  7. Effect of apically separated rotary instruments on bacterial leakage of obturated root canals using resilon.

    Science.gov (United States)

    Mohammadi, Zahed; Mashouf, Rasoul Yousefi; Jafarzadeh, Hamid; Heydari, Ali; Shalavi, Sousan

    2015-03-01

    The purpose of this study was to determine the effect of a separated rotary instrument on the time required for bacterial penetration of obturated root canals using Resilon. Eighty-four extracted human maxillary premolars with single canals were used in this study. Group 1 consisted of teeth obturated with gutta-percha and AH-26 sealer (n=15); Group 2 consisted of teeth obturated similarly to Group 1 but without a separated file; Group 3 consisted of teeth obturated with Resilon and Epiphany sealer (n=15); and Group 4 consisted of teeth obturated similarly to Group 3 but without a separated file. Six teeth were used as positive controls, and six teeth were used as negative controls for each experimental group. Negative controls were obturated similarly to experimental teeth. On the other hand, positive controls were obturated with gutta-percha or Resilon without sealer. A suspension of Enterococcus faecalis was placed in the access chamber daily, and penetration was determined when turbidity was noted in the culture broth during a three-month period. No significant difference between experimental groups was observed. However, differences between experimental groups and control groups were statistically significant. PMID:25928974

  8. É realmente necessário o uso do estimulador de nervo periférico no bloqueio do nervo femoral? ¿Es realmente necesario el uso del estimulador de nervio periférico en el bloqueo del nervio femoral? Peripheral nerve stimulator for femoral nerve block. Is it really necessary?

    Directory of Open Access Journals (Sweden)

    Karl Otto Geier

    2003-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Vários são os métodos de localização do nervo femoral no espaço perivascular na região inguinal sendo o mais comum o do estimulador de nervo periférico. O objetivo deste estudo foi o de avaliar a necessidade do bloqueio do nervo femoral com o método do estimulador de nervo periférico, comparando-o com o método da perda de resistência tanto pela técnica de injeção única como pela técnica com catéteres. MÉTODO: Foram realizados 60 bloqueios do nervo femoral divididos em quatro grupos homogêneos (GA, GB, GC e GD. Trinta bloqueios representaram dois grupos pela técnica de injeção única, quinze com agulha descartável 21G (GA e quinze com agulha isolada adaptada ao estimulador de nervo periférico (GC e os restantes trinta bloqueios divididos em quinze bloqueios com cateter venoso (GB e quinze com cateter longo Contiplex® (GD. Todos os bloqueios do nervo femoral foram realizados no espaço perivascular inguinal. O espaço perifemoral foi identificado após a segunda perda de resistência ao ar (fascia ilíaca (GA e GC, e com 0,3 a 0,4 mA com o estimulador de nervo periférico (GB e GD. Foram avaliados os seguintes parâmetros: tempo para a realização do bloqueio; presença ou ausência de parestesias ou disestesias; dificuldade de punção e falhas. RESULTADOS: Não foram relatadas parestesias nem disestesias. Duas falhas resultaram no grupo A (p JUSTIFICATIVA Y OBJETIVOS: Varios son los métodos de localización del nervio femoral en el espacio perivascular en la región inguinal siendo el más común el del estimulador de nervio periférico. El objetivo de este estudio fue el de evaluar la necesidad del bloqueo del nervio femoral con el método del estimulador del nervio periférico, comparándose con el método de la pérdida de resistencia tanto por la técnica de inyección única como por la técnica con catéteres. MÉTODO: Fueron realizados sesenta bloqueos del nervio femoral divididos en cuatro grupos homogéneos (GA, GB, GC y GD. Treinta bloqueos representaron dos grupos por la técnica de inyección única, quince con aguja desechable 21G (GA y quince con aguja aislada adaptada al estimulador de nervio periférico (GC y los restantes treinta bloqueos divididos en quince bloqueos con catéter venoso (GB y quince con catéter largo Contiplex® (GD. Todos los bloqueos del nervio femoral fueron realizados en el espacio perivascular inguinal. El espacio perifemoral fue identificado después de la segunda pérdida de resistencia al aire (fascia ilíaca (GA y GC, y con 0,3 a 0,4 mA con el estimulador de nervio periférico (GB y GD. Fueron evaluados los siguientes parámetros: tiempo para la realización del bloqueo; tiempo de duración del bloqueo; si hubo o no parestesias o disestesias; se hubo o no dificultad de punción y fallas. RESULTADOS: No fueron relatadas parestesias ni disestesias. Dos fallas resultaron en el grupo A (p BACKGROUND AND OBJECTIVES: There are several methods to locate the femoral nerve in the perivascular inguinal space, being the most common the use of a peripheral nerve stimulator. This study aimed at evaluating femoral nerve block performed with peripheral nerve stimulator as compared to the loss of resistance to air technique, both by single injection or with catheter insertion. METHODS: Sixty patients undergoing femoral nerve blocks were divided in four homogeneous groups (GA, GB, GC, GD. Thirty blocks were performed with single injection technique: 15 with disposable 21G needle (GA and 15 with insulated needle adapted to the peripheral nerve stimulator (GC. The remaining 30 blocks were divided in 15 blocks performed with intravenous catheter (GB and 15 with long Contiplex® catheter (GD. All femoral nerve blocks were performed in the perivascular inguinal space. Perifemoral space was identified after the second loss of resistance to air (iliac fascia, GA and GC, and with 0.3 to 0.4 mA stimuli from peripheral nerve stimulator (GB and GD. The following parameters were evaluated: time to blockade performance, presence or absence of paresthesias or disesthesias, puncture difficulties and failures. RESULTS: There were no paresthesias or disesthesias. There have been two failures (p < 0.26 in the same GA patient, and two puncture difficulties due to recent and multiple blocks on the same site. There have been no significant efficacy differences between loss of resistance and peripheral nerve stimulator methods. Time for peripheral nerve stimulator block was longer (p < 0.001. CONCLUSIONS: Whereas the peripheral nerve stimulator is more widely used in the inguinal region, our study has shown that the loss of resistance to air technique is an effective and feasible alternative.

  9. Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine in inferior alveolar nerve block during surgical extraction of impacted lower third molars

    Scientific Electronic Library Online (English)

    Alejandro, Sierra Rebolledo; Esther, Delgado Molina; Leonardo, Berini Aytés; Cosme, Gay Escoda.

    2007-03-01

    Full Text Available Objetivo: Valorar y comparar la eficacia anestésica de la Articaína al 4% respecto a la Lidocaína al 2%, ambas con una concentración de 1:100.000 de epinefrina en el bloqueo troncal del nervio alveolar inferior durante la extracción quirúrgica de terceros molares inferiores incluidos. Diseño del est [...] udio: Se realizó un ensayo clínico aleatorio a doble ciego en una muestra de 30 pacientes programados para las extracciones quirúrgicas bilaterales de terceros molares inferiores simétricos en el Servicio de Cirugía Bucal del Máster de Cirugía e Implantología Bucal de la Universidad de Barcelona. Previo consentimiento del paciente, dos operadores efectuaron las intervenciones quirúrgicas de forma extemporánea, utilizando como anestésico local la Articaína al 4% o la Lidocaína al 2 % con la misma concentración de vasoconstrictor (epinefrina 1:100.000). Las variables estudiadas para cada anestésico fueron: tiempo de latencia (o de inicio del efecto anestésico), duración del efecto anestésico, cantidad de solución anestésica utilizada y la necesidad de reanestesiar la zona operatoria. Se utilizó una escala analógica visual para valorar la cantidad de dolor experimentado durante el acto quirúrgico y, así, evaluar subjetivamente la profundidad anestésica de las dos soluciones. Resultados: Se observaron diferencias estadísticamente significativas (p= .003) en cuanto a la duración del efecto anestésico, que fue mayor para la artcaína al 4% (220,8 minutos), respecto a la lidocaína al 2% (168,20 minutos). En las variables tiempo de latencia, cantidad de solución anestésica utilizada y necesidad de reanestesiar el campo operatorio se evidenciaron diferencias clínicas a favor de la articaína, aunque estas diferencias no fueron estadísticamente significativas. La valoración cualitativa de los anestésicos mediante la escala analógica visual mostró similitud en el dolor experimentado por los pacientes con ambos anestésicos. Conclusiones: De acuerdo con los resultados obtenidos se puede afirmar que la articaína al 4% muestra mejores características clínicas que la lidocaína al 2%, especialmente en cuanto al tiempo de latencia y duración del efecto anestésico. Sin embargo, no hubieron diferencias estadísticamente significativas que confirmen la superioridad de una solución respecto a la otra, al valorar la eficacia anestésica. Abstract in english Background: A comparative study is made of the anesthetic efficacy of 4% articaine versus 2% lidocaine, both with epinephrine 1:100,000, in truncal block of the inferior alveolar nerve during the surgical extraction of impacted lower third molars. Study design: A randomized double-blind clinical tri [...] al was conducted of 30 patients programmed for the bilateral surgical extraction of symmetrical lower third molars in the context of the Master of Oral Surgery and Implantology (University of Barcelona, Barcelona, Spain). Following the obtainment of informed consent, two operators performed surgery on an extemporaneous basis, using as local anesthetic 4% articaine or 2% lidocaine with the same concentration of vasoconstrictor (epinephrine 1:100,000). The study variables for each anesthetic were: latency (time to action) and duration of anesthetic effect, the amount of anesthetic solution used, and the need of re-anesthetize the surgical zone. A visual analog scale was used to assess pain during surgery, and thus subjectively evaluate the anesthetic efficacy of the two solutions. Results: Statistically significant differences (p = 0.003) were observed in the mean duration of anesthetic effect (220.86 min. for 4% articaine vs. 168.20 min. for 2% lidocaine). Latency, the amount of anesthetic solution and the need to re-anesthetize the surgical field showed clinical differences in favor of articaine, though statistical significance was not reached. The pain scores indicated similar anesthetic efficacy with both solutions. Conclusions: The results obtained suggest that 4% articaine offers better clinical performance than 2

  10. Surgical anatomy of the retroperitoneal spaces, Part IV: retroperitoneal nerves.

    Science.gov (United States)

    Mirilas, Petros; Skandalakis, John E

    2010-03-01

    We present surgicoanatomical topographic relations of nerves and plexuses in the retroperitoneal space: 1) six named parietal nerves, branches of the lumbar plexus: iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, obturator, femoral. 2) The sacral plexus is formed by the lumbosacral trunk, ventral rami of S1-S3, and part of S4; the remainder of S4 joining the coccygeal plexus. From this plexus originate the superior gluteal nerve, which passes backward through the greater sciatic foramen above the piriformis muscle; the inferior gluteal nerve also courses through the greater sciatic foramen, but below the piriformis; 3) sympathetic trunks: right and left lumbar sympathetic trunks, which comprise four interconnected ganglia, and the pelvic chains; 4) greater, lesser, and least thoracic splanchnic nerves (sympathetic), which pass the diaphragm and join celiac ganglia; 5) four lumbar splanchnic nerves (sympathetic), which arise from lumbar sympathetic ganglia; 6) pelvic splanchnic nerves (nervi erigentes), providing parasympathetic innervation to the descending colon and pelvic splanchna; and 7) autonomic (prevertebral) plexuses, formed by the vagus nerves, splanchnic nerves, and ganglia (celiac, superior mesenteric, aorticorenal). They include sympathetic, parasympathetic, and sensory (mainly pain) fibers. The autonomic plexuses comprise named parts: aortic, superior mesenteric, inferior mesenteric, superior hypogastric, and inferior hypogastric (hypogastric nerves). PMID:20349652

  11. Bloqueos nerviosos periféricos de la extremidad inferior para analgesia postoperatoria y tratamiento del dolor crónico Lower limb continuous peripheral nerve blocks for postoperative analgesia and chronic pain

    Directory of Open Access Journals (Sweden)

    V. Domingo

    2004-05-01

    Full Text Available Existe un interés creciente por la realización de los bloqueos de nervio periférico (BNP debido a sus potenciales beneficios como los concernientes a las interacciones de los fármacos anticoagulantes y los bloqueos neuroaxiales. Los BNP de la extremidad inferior, y sobre todo, los bloqueos periféricos del nervio ciático son el pariente pobre de las técnicas de anestesia regional y, en general, son poco conocidos y por tanto poco utilizados. En este artículo se realiza una revisión de los bloqueos del plexo lumbosacro, realizando especial énfasis en los bloqueos continuos mediante catéteres para analgesia postoperatoria y para el tratamiento del dolor crónico. La utilización de anestésicos locales de larga duración de acción, asociada a un escaso bloqueo motor, como es el caso de la ropivacaína, nos permite combinar técnicas de punción única para conseguir una adecuada analgesia intraoperatoria, con las técnicas de perfusión continua para analgesia postoperatoria. Es necesario un conocimiento anatómico preciso, así como de los territorios cutáneos de inervación de las ramas del plexo lumbosacro, para la realización de estas técnicas de bloqueo. La introducción de diferentes técnicas de imagen, fundamentalmente la ultrasonografía, para la localización de las estructuras nerviosas, facilita la realización de estos bloqueos y disminuye el riesgo de lesiones de los órganos adyacentes. La realización de los bloqueos continuos de nervio periférico ofrece el beneficio de una analgesia postoperatoria prolongada, con menores efectos adversos, mayor grado de satisfacción del paciente, y una recuperación funcional más rápida después de la cirugía.There is increasing interest in peripheral nerve blocks (PNB because of potential benefits relative to interactions of anticoagulants and central neuraxial techniques. Among all the regional anesthesia procedures, PNB of the lower limb, and specially sciatic nerve block, are the less known and rarely used. In this paper, we summarize the recent advances in lumbosacral plexus block, with special remark on continuous catheter blocks for postoperative analgesia and chronic pain treatment. The use of long action local anes-thetics combined with a weak motor block, like ropivacaine, permits the combination of a single skin injection technique to achieve an adequate intraoperative analgesia with continuous infusion ones for postoperative analgesia. A detailed knowledge of anatomy as well as cutaneous nerve distribution is needed for the performance of these techniques. The introduction of several image-based techniques, principally ultrasound imaging, may improve the accuracy of nerve localization and needle placement. It also can help to prevent accidental puncture to vessels and other neighbouring structures. Continuous plexus and peripheral nerve blocks offer the potential benefits of prolonged analgesia with fewer side effects, greater patient satisfaction, and faster functional recovery after surgery.

  12. An apparatus for obturating leaky tubes in heat exchangers

    International Nuclear Information System (INIS)

    This apparatus is characterized in that it comprises a sleeve capable of being sealingly fixed in an orifice provided in the exchanger upper wall, a vertical column provided at its lower end with a variable length arm at right angle thereto, the free end of said arm being integral with a unit carrying a deformable capsule with a vertical axis, capable of being introduced into one of the tubes and of obturating same through deformation, means integral with the unit for introducing the deformation of the capsule, means for dissociating said capsule from the unit, means for causing the arm to rotate about the vertical axis of the column, means for applying a vertical translation to the arm and means for changing the arm length. This can be applied to the heat-exchangers of fast nuclear reactors

  13. Comparative evaluation of sealing ability of different obturation materials

    Directory of Open Access Journals (Sweden)

    Melih Irena

    2010-01-01

    Full Text Available Introduction Root canal filling materials are intended to prevent microleakage and passing of microorganisms and their toxins along the root canal space and into the periradicular tissues. Objective Objective of this in vitro study was to evaluate and compare apical leakage of root canals obturated using a modified warm vertical condensation technique and different materials. Methods Sixty-five extracted single-root teeth were prepared according to the crown-down/ step-back technique. Each canal was rinsed with 3% NaOCl during and after the preparation. The teeth were divided into 3 groups. Every group was obturated by the same technique, but with different materials: RealSeal system (SybronEndo, gutta-percha with AH Plus (Dentsply Maillefer and gutta-percha with Acroseal sealer (Septodont. The remaining 20 teeth were in the control group. The teeth were immersed in 1% methylene blue for 72 hours. After that period, the roots were split longitudinally, and dye penetration was measured using a stereomicroscope. Results Dye penetration occurred in all groups. The least dye penetration occurred in the RealSeal group (0.33}0.29 mm, while the highest dye penetration occurred in the Acroseal group (1.11}0.52 mm. According to the Student's t-test, Acroseal showed significantly more leakage (p<0.001 than RealSeal and AH Plus materials. The microleakage of RealSeal system was not significantly different (p>0.05 from that of AH Plus sealer with gutta-percha. Conclusion The results suggested that new material Resilon (RealSeal and conventional combination AH Plus with gutta-percha had the least apical dye penetration and provided the best sealing.

  14. Stress analysis in oral obturator prostheses, part II: photoelastic imaging

    Science.gov (United States)

    Pesqueira, Aldiéris Alves; Goiato, Marcelo Coelho; da Silva, Emily Vivianne Freitas; Haddad, Marcela Filié; Moreno, Amália; Zahoui, Abbas; dos Santos, Daniela Micheline

    2014-06-01

    In part I of the study, two attachment systems [O-ring; bar-clip (BC)] were used, and the system with three individualized O-rings provided the lowest stress on the implants and the support tissues. Therefore, the aim of this study was to assess the stress distribution, through the photoelastic method, on implant-retained palatal obturator prostheses associated with different attachment systems: BOC-splinted implants with a bar connected to two centrally placed O-rings, and BOD-splinted implants with a BC connected to two distally placed O-rings (cantilever). One photoelastic model of the maxilla with oral-sinus-nasal communication with three parallel implants was fabricated. Afterward, two implant-retained palatal obturator prostheses with the two attachment systems described above were constructed. Each assembly was positioned in a circular polariscope and a 100-N axial load was applied in three different regions with implants by using a universal testing machine. The results were obtained through photograph record analysis of stress. The BOD system exhibited the highest stress concentration, followed by the BOC system. The O-ring, centrally placed on the bar, allows higher mobility of the prostheses and homogeneously distributes the stress to the region of the alveolar ridge and implants. It can be concluded that the use of implants with O-rings, isolated or connected with a bar, to rehabilitate maxillectomized patients allows higher prosthesis mobility and homogeneously distributes the stress to the alveolar ridge region, which may result in greater chewing stress distribution to implants and bone tissue. The clinical implication of the augmented bone support loss after maxillectomy is the increase of stress in the attachment systems and, consequently, a higher tendency for displacement of the prosthesis.

  15. Bilateral Obturator Hernia Diagnosed by Computed Tomography: A Case Report with Review of the Literature

    International Nuclear Information System (INIS)

    Obturator hernia is a rare form of abdominal hernia and a diagnostic challenge. It is commonly seen in elderly thin females. Its diagnosis is often delayed with resultant increased morbidity and mortality due to bowel ischemia/gangrene. It is mistakenly diagnosed as femoral or inguinal hernia on USG. Computed tomography is diagnostic and is a valuable tool for preoperative diagnosis. This report presents a case of 70-year-old thin female presenting with intestinal obstruction due to left sided obstructed obturator hernia. USG showed small bowel obstruction and an obstructed left sided femoral hernia. CT scan of abdomen and pelvis with inguinal and upper thigh region disclosed left sided obturator hernia. It also detected clinically occult right sided obturator hernia. Early diagnosis and surgical treatment contribute greatly in reducing the morbidity and mortality rate

  16. An Alternative Approach to Combine Orbital Prosthesis and Obturator: A Case Report

    OpenAIRE

    Soganci, Gokce; Yalug, Suat; Kocacikli, Mustafa

    2011-01-01

    This report describes a different approach for diminishing the movements of orbital prosthesis during mimic movements and chewing function. Mechanical devices such as magnets are used to enhance the retention in case lack of the implants. However rigid fixation of obturator and orbital prosthesis can result in movements of the orbital prosthesis during mastication. In this case obturator and orbital prosthesis are combined by magnets. However this combination is not rigid because of an active...

  17. An in vitro comparative evaluation of fracture resistance of endodontically treated teeth obturated with different materials

    OpenAIRE

    Chadha, Rupali; Taneja, Sonali; Kumar, Mohit; Sharma, Mohit

    2010-01-01

    The aim of this study was to evaluate the in vitro effect of various obturating materials on fracture resistance of root canal treated teeth. Sixty freshly extracted human mandibular premolars were used. After standardizing the length to 13 mm, the teeth were biomechanically prepared and divided into four groups based on type of obturating materials used. Teeth were embedded in acrylic resin and fracture strength was measured using a universal testing machine. Data obtained was evaluated stat...

  18. Biocompatibility of root canal obturation materials implanted in rats muscular tissue

    OpenAIRE

    Karadži? Branislav 1; Vujaškovi? Mirjana

    2009-01-01

    The purpose of this study was to investigate the biocompatibility of different dental materials for teeth root canal obturation, implanted in rat muscular tissue, by analyzing the type of muscular tissue inflammatory reaction level. In the preparation of Wistar rats M. biceps femoris, three different materials for root canal obturation were implanted: Sealapex (Kerr, Romulus, USA), AH-26 (DE Trey, Zurich, Switzerland) and Spongio cement material based on polymethil metacrylate - PMMA (Tomi?, ...

  19. Comparison of Vertical Forces during Root Canal Filling with Three Different Obturation Techniques

    OpenAIRE

    Katalini?, Ivan; Baraba, Anja; Glavi?i?, Snježana; Šegovi?, Sanja; Ani?, Ivica; Mileti?, Ivana

    2013-01-01

    The aim of this study was to examine and compare vertical forces exerted during root canal obturation with the cold lateral condensation technique, Thermafil technique and ProTaper guttapercha. Fourty-five single-rooted permanent teeth were used in the study. All specimens were instrumented using the ProTaper rotating technique and were randomly divided into three experimental groups (n=15 per group). In the first group, root canals were obturated using the cold lateral condensation technique...

  20. Sealing ability of a novel hydrophilic vs. conventional hydrophobic obturation systems: A bacterial leakage study

    Directory of Open Access Journals (Sweden)

    Vibha Hegde

    2015-01-01

    Full Text Available Aim: Comparative assessment of apical sealing ability of a novel Smart-Seal System, Resilon, and conventional Gutta-Percha system using a bacterial leakage model. Materials and Methods: Seventy freshly extracted human single rooted teeth with fully formed apices were randomly divided into three groups (20 each and two control groups (5 positive and 5 negative. Teeth were de-coronated, and roots were standardized to a working length of 16 mm. Root canal preparation was done with rotary pro-taper file system in all groups. Group A was obturated using Smart-Seal system (Hydrophilic, Group B using Resilon/Epiphany system (Hydrophilic, and Group C using Gutta-Percha (GP/AH plus system (Hydrophobic in a single cone technique. Using Enterococcus faecalis, a split chamber bacterial leakage model was developed to evaluate the sealing ability of three obturation systems. Samples will be monitored every 24 hours for 60 days. Results: All three groups have shown leakage. Novel Smart-Seal System and Resilon have shown similar results and relatively lesser samples leaked in comparison to GP obturations at the end of the observation period. There was no significant difference amongst Resilon and Smart-Seal System (P > 0.05 but there was a significant difference amongst them when compared to GP obturations (P < 0.05. Conclusion: Hydrophilic obturations of the root canal shows a better resistance to bacterial leakage as compared to hydrophobic obturations.

  1. Eficacia y seguridad del bloqueo del nervio safeno guiado por ultrasonido en pacientes con dolor crónico de rodilla / Efficacy and safety of ultrasound-guided saphenous nerve block in patients with chronic knee pain

    Scientific Electronic Library Online (English)

    Mario Andrés, Arcila Lotero; Roberto, Rivera Díaz; María Adelaida, Mejía Aguilar; Santiago, Jaramillo Jaramillo.

    2014-07-01

    Full Text Available Introducción: La osteoartritis de rodilla es una causa común de consulta en el mundo. Muchos pacientes con síntomas leves responden a los tratamientos conservadores, y otros requieren de tratamiento intervencionista, como bloqueos de nervios periféricos. Objetivo: Determinar la eficacia clínica y la [...] seguridad del manejo intervencionista con bloqueo del nervio safeno guiado por ultrasonografía en pacientes con dolor crónico de rodilla. Materiales y métodos: Estudio de tipo descriptivo retrospectivo en pacientes con enfermedad dolorosa crónica de rodilla que recibieron tratamiento intervencionista guiado por ultrasonografía en una clínica de dolor del país entre los meses de septiembre de 2011 y junio de 2012, para determinar su eficacia clínica y su seguridad. Se obtuvieron datos de todos los pacientes antes del procedimiento, a los 2 días, un mes y 3 meses después. La intensidad de dolor se midió con la escala visual analógica. Resultados: Se realizaron 25 bloqueos del nervio safeno. El 68% de los pacientes presentaron alivio del dolor a los 2 días. El 56 y el 40% presentaron alivio al mes y a los 3 meses de realizado el procedimiento, respectivamente, con una diferencia estadísticamente significativa (p Abstract in english Introduction: Knee osteoarthritis is a common cause for consultation around the world. Many patients with mild symptoms respond to conservative treatment, while others require interventional therapy including peripheral nerve blocks. Objective: To establish the clinical efficacy and safety of interv [...] entional management with ultrasound-guided saphenous nerve block in patients with chronic keen pain. Materials and methods: Descriptive, retrospective trial in chronic keen pain patients who underwent ultrasound-guided interventional therapy at the pain clinic in the country, between September 2011 and June 2012, to determine the clinical efficacy and safety of the procedure. Data were obtained from all patients prior to the procedure, and then at two days, one month and three months later. The pain intensity was measured using the visual analog scale. Results: 25 saphenous nerve blocks were performed. 68% of the patients experienced pain relief within two days. 56% and 40% exhibited relief one and three months after the procedure, respectively, with a statistically significant difference (p

  2. Construction of a maxillary prosthesis with a hollow obturator by the balloon technique and a case report.

    Science.gov (United States)

    Hayashi, J; Nishiyama, M; Miyake, M; Kudo, I; Nakazawa, K

    1989-12-01

    The authors devised a new method for making a maxillary prosthesis with a hollow obturator, which was named the Balloon Technique. This new technique has a number of advantages over the conventional method in that it not only facilitates the molding of a soft plastic hollow obturator in a single process, but also simplifies the trial fitting of the completed obturator. Furthermore, it makes possible firm adhesion of the hollow obturator and the denture base by the hot-melt method while the denture base resin is cured. Finally, the completed maxillary prosthesis is extremely light. PMID:2695602

  3. Terminal nerve: cranial nerve zero

    Directory of Open Access Journals (Sweden)

    Jorge Eduardo Duque Parra

    2006-12-01

    Full Text Available It has been stated, in different types of texts, that there are only twelve pairs of cranial nerves. Such texts exclude the existence of another cranial pair, the terminal nerve or even cranial zero. This paper considers the mentioned nerve like a cranial pair, specifying both its connections and its functional role in the migration of liberating neurons of the gonadotropic hormone (Gn RH. In this paper is also stated the hypothesis of the phylogenetic existence of a cerebral sector and a common nerve that integrates the terminal nerve with the olfactory nerves and the vomeronasals nerves which seem to carry out the odors detection function as well as in the food search, pheromone detection and nasal vascular regulation.

  4. Bloqueos de nervio periférico para el dolor posoperatorio de artroscopia de cadera / Peripheral nerve block for the postoperative pain relief after arthroscopy of the hip

    Scientific Electronic Library Online (English)

    Jorge Jaime, Márquez Arábia; Carlos Eduardo, Restrepo Garcés; William Henry, Márquez Arábia.

    2013-04-01

    Full Text Available Introducción: el tratamiento del dolor posoperatorio de la artroscopia de cadera es un reto y no se conocen estudios relacionados con su tratamiento basado en bloqueos regionales. Objetivo: Determinar el comportamiento del dolor posoperatorio y la satisfacción de los pacientes tratados por artroscop [...] ia de cadera con bloqueo femoral, bloqueo del plexo lumbar o infiltración intraarticular. Métodos: Se revisaron prospectivamente todos los registros anestésicos de 61 pacientes que requirieron artroscopia de cadera bajo anestesia general utilizando bloqueo femoral con 0,3 mL/kg de levobupivacaína al 0,375 %, bloqueo del plexo lumbar con 0,4 mL/kg de levobupivacaína al 0,375 % o infiltración intraarticular con 20 mL de bupivacaína al 0,5 %. Se revisaron los datos de dolor posoperatorio evaluados con escala visual análoga a los 15, 30, 60 y 120 minutos y a las 24 horas; la satisfacción del paciente en el momento del alta hospitalaria y a las 24 horas, el bloqueo motor y sensitivo y la necesidad de morfina en el posoperatorio. Resultados: El grupo tratado con infiltración intraarticular presentó los niveles de dolor más altos en casi todos los momentos evaluados. Comparado con el bloqueo del plexo lumbar, más pacientes del grupo bloqueo femoral presentaron niveles mayores de dolor en casi todos los momentos. De los pacientes del grupo tratado con infiltración intraarticular 55 % recibieron morfina en algún momento del posoperatorio, así como 28,5 % del grupo bloqueo femoral y 15 % del grupo bloqueo del plexo lumbar. El nivel de satisfacción de los pacientes fue alto y similar en los tres grupos. Conclusión: La analgesia posoperatoria para artroscopia de cadera fue mejor con bloqueo del plexo lumbar comparado con el bloqueo femoral o la infiltración intraarticular. Abstract in english Background: The treatment of postoperative pain after arthroscopy of the hip is a challenge and there are no known studies related to its treatment which have been based on regional block. Objectives:To determine the behaviour of postoperative pain and the satisfaction of the patients who have been [...] treated with arthroscopy of the hip with femoral block, lumbar plexus block or intra-articular infiltration. Methods:All the anaesthetic records of 61 patients that required arthroscopy of the hip under general anaesthesia using femoral block with 0,3 mL/kg of Levobupivacaine 0,375 %, lumbar plexus block with 0,4 mL/kg of Levobupivacaine 0,375 % or intra-articular infiltration with 20 mL of Bupivacaine 0,5 % were checked. The data about postoperative pain which had been assessed with visual analogous scale at the 15, 30, 60 and 120 minutes and at the 24 hours, the satisfaction of the patients at the moment of the discharge from hospital at the 24 hours, the sensitive and motor block and the need to use Morphine in the postoperative phase were also checked. Results:The group of patients that were treated with intra-articular infiltration presented the highest levels of pain in almost all evaluated moments. As compared with the lumbar plexus block, more patients that underwent femoral block presented higher levels of pain in almost all moments. Out of the patients in the group that was treated with intra-articular infiltration, the 55 % received Morphine at any postoperative moment as well as the 28,5 % treated with femoral block and the 15 % who underwent lumbar plexus block. The level of patients´ satisfaction was high and similar in the three groups. Conclusions:Postoperative analgesia for arthroscopy of the hip was better with lumbar plexus block as compared with femoral block or intra-articular infiltration.

  5. The spinal nerves that constitute the lumbosacral plexus and their distribution in the chinchilla

    Directory of Open Access Journals (Sweden)

    M. A. Martinez-Pereira

    2011-04-01

    Full Text Available In this study, the spinal nerves that constitute the lumbosacral plexus (plexus lumbosacrales (LSP and its distribution in Chinchilla lanigera were investigated. Ten chinchillas (6 males and 4 females were used in this research. The spinal nerves that constitute the LSP were dissected and the distribution of pelvic limb nerves originating from the plexus was examined. The iliohypogastric nerve arose from L1 and L2,, giving rise to the cranial and caudal nerves, and the ilioinguinal nerve arose from L3. The other branch of L3 gave rise to the genitofemoral nerve and 1 branch from L4 gave rise to the lateral cutaneous femoral nerve. The trunk formed by the union of L4–5 divided into medial (femoral nerve and lateral branches (obturator nerve. It was found that the LSP was formed by all the ventral branches of L4 at L6 and S1 at S3. At the caudal part of the plexus, a thick branch, the ischiadic plexus, was formed by contributions from L5–6 and S1. This root gave rise to the nerve branches which were disseminated to the posterior limb (cranial and caudal gluteal nerves, caudal cutaneous femoral nerve and ischiadic nerve. The ischiadic nerve divided into the caudal cutaneous surae, lateral cutaneous surae, common fibular and tibial nerve. The pudendal nerve arose from S1–2 and the other branch of S2 and S3 formed the rectal caudal nerve. The results showed that the origins and distribution of spinal nerves that constitute the LSP of chinchillas were similar to those of a few rodents and other mammals.

  6. The spinal nerves that constitute the lumbosacral plexus and their distribution in the chinchilla

    Scientific Electronic Library Online (English)

    M A, Martinez-Pereira; E M, Rickes.

    Full Text Available In this study, the spinal nerves that constitute the lumbosacral plexus (plexus lumbosacrales) (LSP) and its distribution in Chinchilla lanigera were investigated. Ten chinchillas (6 males and 4 females) were used in this research. The spinal nerves that constitute the LSP were dissected and the dis [...] tribution of pelvic limb nerves originating from the plexus was examined. The iliohypogastric nerve arose from L1 and L2, giving rise to the cranial and caudal nerves, and the ilioinguinal nerve arose from L3. The other branch of L3 gave rise to the genitofemoral nerve and 1 branch from L4 gave rise to the lateral cutaneous femoral nerve. The trunk formed by the union of L4-5 divided into medial (femoral nerve) and lateral branches (obturator nerve). It was found that the LSP was formed by all the ventral branches of L4 at L6 and S1 at S3. At the caudal part of the plexus, a thick branch, the ischiadic plexus, was formed by contributions from L5-6 and S1. This root gave rise to the nerve branches which were disseminated to the posterior limb (cranial and caudal gluteal nerves, caudal cutaneous femoral nerve and ischiadic nerve). The ischiadic nerve divided into the caudal cutaneous surae, lateral cutaneous surae, common fibular and tibial nerve. The pudendal nerve arose from S1-2 and the other branch of S2 and S3 formed the rectal caudal nerve. The results showed that the origins and distribution of spinal nerves that constitute the LSP of chinchillas were similar to those of a few rodents and other mammals.

  7. Reducing the risk of nerve injury during Bernese periacetabular osteotomy: a cadaveric study.

    Science.gov (United States)

    Kalhor, M; Gharehdaghi, J; Schoeniger, R; Ganz, R

    2015-05-01

    The modified Smith-Petersen and Kocher-Langenbeck approaches were used to expose the lateral cutaneous nerve of the thigh and the femoral, obturator and sciatic nerves in order to study the risk of injury to these structures during the dissection, osteotomy, and acetabular reorientation stages of a Bernese peri-acetabular osteotomy. Injury of the lateral cutaneous nerve of thigh was less likely to occur if an osteotomy of the anterior superior iliac spine had been carried out before exposing the hip. The obturator nerve was likely to be injured during unprotected osteotomy of the pubis if the far cortex was penetrated by > 5 mm. This could be avoided by inclining the osteotome 45° medially and performing the osteotomy at least 2 cm medial to the iliopectineal eminence. The sciatic nerve could be injured during the first and last stages of the osteotomy if the osteotome perforated the lateral cortex of ischium and the ilio-ischial junction by > 10 mm. The femoral nerve could be stretched or entrapped during osteotomy of the pubis if there was significant rotational or linear displacement of the acetabulum. Anterior or medial displacement of Bernese peri-acetabular osteotomy. PMID:25922457

  8. Critérios de avaliação do bloqueio anestésico 3 em 1: É comum o envolvimento do nervo obturador? Criterios de evaluación del bloqueo anestésico 3 en 1: ¿Es común el envolvimiento del nervio obturador? Evaluation criteria for 3-in-1 anesthetic block: Is the involvement of the obturator nerve common?

    OpenAIRE

    Karl Otto Geier

    2003-01-01

    JUSTIFICATIVA E OBJETIVOS: No bloqueio 3:1 é controvertida a participação do nervo obturador. Intervenções cirúrgicas de superfície na face medial da coxa incidem sobre os dermátomos dos nervos femoral e obturador, de limites imprecisos, sobrepostos ou mesmo ausentes. A correlação entre o desfecho clínico com outros meios de diagnóstico podem ser conclusivos sobre o acometimento do nervo obturador. CONTEÚDO: Comumente o desfecho de um bloqueio regional é pesquisado mais pela insensibilidade d...

  9. Anatomical basis for sciatic nerve block at the knee level / Bases anatómicas para el bloqueo anestésico del nervio isquiático al nivel de la rodilla / Bases anatômicas para o bloqueio anestésico do nervo isquiático no nível do joelho

    Scientific Electronic Library Online (English)

    Fabiano Timbó, Barbosa; Tatiana Rosa Bezerra Wanderley, Barbosa; Rafael Martins da, Cunha; Amanda Karine Barros, Rodrigues; Fernando Wagner da Silva, Ramos; Célio Fernando de, Sousa-Rodrigues.

    2015-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Recentemente a feitura de bloqueio do nervo isquiático tem sido revista devido ao potencial benéfico para analgesia pós-operatória e satisfação dos pacientes após o advento da ultrassonografia. O objetivo deste estudo foi descrever as relações anatômicas do nervo isquiáti [...] co na fossa poplítea para determinar a distância ideal em que a agulha deve ser posicionada para a feitura do bloqueio anestésico do nervo isquiático anterior a sua bifurcação em nervo tibial e fibular comum. MÉTODO: O trabalho foi feito por meio de dissecção de fossa poplítea de cadáveres humanos, fixados em formol a 10%, provenientes do Laboratório de Anatomia Humana dos departamentos de Morfologia da Universidade Federal de Alagoas e da Universidade de Ciências da Saúde de Alagoas. Obteve-se acesso ao nervo isquiático. RESULTADOS: Foram analisadas 44 fossas poplíteas. Observou-se a bifurcação do nervo isquiático em relação ao ápice da fossa. Houve bifurcação em 67,96% abaixo do ápice, 15,90% acima do ápice, 11,36% próxima ao ápice e 4,78% na região glútea. CONCLUSÕES: A bifurcação do nervo isquiático em seus ramos ocorre em vários níveis e a chance de se obter sucesso quando a agulha é usada entre 5 e 7 cm acima da fossa poplítea é de 95,22%. Abstract in spanish JUSTIFICACIÓN Y OBJETIVOS: Recientemente la realización de bloqueo del nervio isquiático ha sido nuevamente analizada debido al potencial beneficioso para la analgesia postoperatoria y por la satisfacción de los pacientes después del advenimiento de la ecografía. El objetivo de este estudio fue des [...] cribir las relaciones anatómicas del nervio isquiático en la fosa poplítea para determinar la distancia ideal en que la aguja debe ser posicionada para la realización del bloqueo anestésico del nervio isquiático anterior a su bifurcación en el nervio tibial y fibular común. MÉTODO: El trabajo se hizo por medio de la disección de la fosa poplítea de cadáveres humanos, empapados en formol al 10%, provenientes del Laboratorio de Anatomía Humana de los departamentos de Morfología de la Universidad Federal de Alagoas y de la Universidad de Ciencias de la Salud de Alagoas. Se obtuvo el acceso al nervio isquiático. RESULTADOS: Fueron analizadas 44 fosas poplíteas. Se observó la bifurcación del nervio isquiático con relación al ápice de la fosa. Hubo una bifurcación en un 67,96% por debajo del ápice, un 15,90% por encima del ápice, un 11,36% cercana al ápice y un 4,78% en la región glútea. CONCLUSIONES: La bifurcación del nervio isquiático en sus ramas se da en varios niveles y la probabilidad de que se obtenga éxito cuando la aguja se usa entre 5 y 7 cm por encima de la fosa poplítea es de un 95,22%. Abstract in english BACKGROUND AND OBJECTIVES: Recently, administration of sciatic nerve block has been revised due to the potential benefit for postoperative analgesia and patient satisfaction after the advent of ultrasound. The aim of this study was to describe the anatomical relations of the sciatic nerve in the po [...] pliteal fossa to determine the optimal distance the needle must be positioned in order to realize the sciatic nerve block anterior to its bifurcation into the tibial and common fibular nerve. METHOD: The study was conducted by dissection of human cadavers' popliteal fossa, fixed in 10% formalin, from the Laboratory of Human Anatomy and Morphology Departments of the Universidade Federal de Alagoas and Universidade de Ciências da Saúde de Alagoas. Access to the sciatic nerve was obtained. RESULTS: 44 popliteal fossa were analyzed. The bifurcation of the sciatic nerve in relation to the apex of the fossa was observed. There was bifurcation in: 67.96% below the apex, 15.90% above the apex, 11.36% near the apex, and 4.78% in the gluteal region. CONCLUSIONS: The sciatic nerve bifurcation to its branches occurs at various levels, and the chance to succeed when the needle is placed between 5 and 7 cm above the popliteal is 95.22%.

  10. Reducing the length of hospital stay after total knee arthroplasty: influence of femoral and sciatic nerve block / Redução do tempo de internação após artroplastia total do joelho – Influência do bloqueio do nervo femoral e do nervo ciático

    Scientific Electronic Library Online (English)

    Lúcio Honório de, Carvalho Júnior; Eduardo Frois, Temponi; Vinícius Oliveira, Paganini; Lincoln Paiva, Costa; Luiz Fernando Machado, Soares; Matheus Braga Jacques, Gonçalves.

    2015-02-01

    Full Text Available Objetivo: avaliar a mudança no tempo de permanência hospitalar (PH) no pós-operatório de artroplastia total do joelho (ATJ) após a utilização do bloqueio dos nervos femoral e ciático. Métodos: os prontuários de 287 pacientes foram avaliados, levando-se em consideração o número de horas de internaçã [...] o, o percentual e o motivo de reinternação em 30 dias, bem como as complicações associadas, sendo divididos em dois grupos de acordo com a permanência ou não no centro de terapia intensiva (CTI). Durante os anos de 2009 e 2010, a anestesia utilizada para a realização dos procedimentos foi a raquianestesia isolada. A partir de 2011, o bloqueio dos nervos femoral e ciático foi introduzido. Resultados: no período entre 2009 e 2012, o tempo médio de PH variou entre 74 horas, em 2009, e 75,2 horas, em 2010. A PH média em 2011 foi de 56,52 horas e de 53,72 horas em 2012, no grupo de pacientes que não permaneceram no CTI no pós-operatório. No mesmo período, no grupo que precisou de internação no CTI, a PH média foi de 138,7 horas em 2009; 90,25 horas em 2010; 79,8 horas em 2011 e 52,91 horas em 2012. Em 2009 e 2010, a taxa de reinternação foi de 0%, e em 2011 e 2012, 3,44% e 1%, respectivamente. Conclusão: de acordo com este estudo, a utilização do bloqueio dos nervos femoral e ciático após a ATJ permitiu a redução significativa da PH. Abstract in english Objective: the aim of this study is to evaluate the change in length of hospital stay postoperatively for Total Knee Arthroplasty after using femoral and sciatic nerve block. Materials and methods: the medical records of 287 patients were evaluated, taking into account the number of hours of admiss [...] ion, the percentage and the reason for re-hospitalization within 30 days, as well as associated complications. All patients were divided into two groups according or not to whether they were admitted to ICU or not. During the years 2009 and 2010, isolated spinal anesthesia was the method used in the procedure. From 2011 on, femoral and sciatic nerve blocking was introduced. Results: between the years 2009 and 2012, the average length of stay ranged from 74 hours in 2009 to 75.2 hours in 2010. The average length of stay in 2011 was 56.52 hours and 53.72 hours in 2012, all in the group of patients who did not remain in the ICU postoperatively. In the same period, among those in the group that needed ICU admission, the average length of stay was 138.7 hours in 2009, 90.25 hours in 2010, 79.8 hours in 2011, and 52.91 hours in 2012. During 2009 and 2010, the rate of re-hospitalization was 0%, while in 2011 and 2012, were 3.44% and 1%, respectively. Conclusion: according to this study, the use of femoral and sciatic nerve blocking after total knee arthroplasty allowed significant reduction in hospital stay.

  11. Controle da dor pós-operatória da artroplastia total do joelho: é necessário associar o bloqueio do nervo isquiático ao bloqueio do nervo femoral? Control del dolor postoperatorio de la artroplastia total de la rodilla: ¿es necesario asociar el bloqueo del nervio isquiático al bloqueo del nervio femoral? Control of postoperative pain following total knee arthroplasty: is it necessary to associate sciatic nerve block to femoral nerve block?

    Directory of Open Access Journals (Sweden)

    Affonso H. Zugliani

    2007-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A artroplastia total do joelho (ATJ promove grande trauma tecidual, produzindo intensa dor no pós-operatório. A analgesia pós-operatória de boa qualidade é fundamental, devendo-se considerar que a mobilização articular precoce é um importante aspecto para obtenção de bons resultados. Há controvérsias na literatura sobre a eficácia do bloqueio isolado do nervo femoral. O objetivo deste estudo foi avaliar a analgesia pós-operatória com a associação do bloqueio dos nervos isquiático e femoral. MÉTODO: Foram estudados 17 pacientes submetidos à ATJ sob raquianestesia, divididos em dois grupos: A e B. No Grupo A (n = 9 foi realizado bloqueio do nervo femoral e no Grupo B (n = 8, bloqueio dos nervos femoral e isquiático. Os bloqueios foram realizados no pós-operatório imediato utilizando-se 20 mL de ropivacaína a 0,5% em cada um. A dor foi aferida nas primeiras 24 horas pela Escala Analógica Visual e escala verbal. Foi observado o tempo decorrido entre os bloqueios e a primeira queixa de dor (M1. RESULTADOS: A mediana do tempo de analgesia (M1 no Grupo A foi de 110 min. e no Grupo B de 1.285 min. (p = 0,0001. Não foram observadas complicações atribuíveis às técnicas utilizadas. CONCLUSÃO: O bloqueio do nervo isquiático, quando associado ao bloqueio do nervo femoral, nas condições deste estudo, melhorou de maneira significativa a qualidade da analgesia pós-operatória da ATJ.JUSTIFICATIVA Y OBJETIVOS: La artroplastia total de la rodilla (ATR promueve gran trauma del tejido produciendo un intenso dolor en el postoperatorio. La analgesia de postoperatorio de buena calidad es fundamental, debiendo considerar que la movilización articular precoz es un importante aspecto para la obtención de buenos resultados. Existen controversias en la literatura sobre la eficacia del bloqueo aislado del nervio femoral. El objetivo de este estudio fue evaluar la analgesia en postoperatorio con la asociación del bloqueo de los nervios isquiático y femoral. MÉTODO: Fueron estudiados 17 pacientes sometidos a ATR bajo raquianestesia, divididos en dos grupos: A y B. En el Grupo A (n = 9 fue realizado bloqueo del nervio femoral y en el Grupo B (n = 8 bloqueo de los nervios femoral e isquiático. Los bloqueos fueron realizados en el postoperatorio inmediato utilizando 20 mL de ropivacaína a 0,5% en cada uno. El dolor se comprobó en las primeras 24 horas a través de la Escala Analógica Visual y escala verbal. Fue observado el tiempo transcurrido entre los bloqueos y el primer quejido de dolor (M1. RESULTADOS: La mediana del tiempo de analgesia (M1 en el Grupo A fue de 110 min y en el Grupo B de 1.285 min (p = 0,0001. No fueron observadas complicaciones atribuibles a las técnicas utilizadas. CONCLUSIONES: El bloqueo del nervio isquiático, cuando se asocia al bloqueo del nervio femoral, e las condiciones de este estudio, mejoró de manera significativa la calidad de la analgesia en postoperatorio de la ATR.BACKGROUND AND OBJECTIVES: Total knee arthroplasty (TKA causes severe tissue trauma, leading to severe postoperative pain. Good postoperative analgesia is fundamental and one should consider that early mobilization of the joint is an important aspect to obtain good results. There is a controversy in the literature on the efficacy of isolated femoral nerve block. The objective of this study was to evaluate postoperative analgesia with the association of sciatic and femoral nerve block. METHODS: Seventeen patients undergoing TKA under spinal anesthesia were divided in two groups: A and B. In Group A (n = 9, femoral nerve block was performed, while in Group B (n = 8, femoral and sciatic nerve block were done. The blockades were done in the immediate postoperative period with 20 mL of 0.5% of ropivacaine. Pain was evaluated in the first 24 hours using the Visual Analog Scale and the verbal scale. The length of time between the nerve block and the first complaint of pain (M1 was also evaluated. RESULTS: The median of the duration of analgesia (M1 in Group A was 110 min

  12. Controle da dor pós-operatória da artroplastia total do joelho: é necessário associar o bloqueio do nervo isquiático ao bloqueio do nervo femoral? / Control of postoperative pain following total knee arthroplasty: is it necessary to associate sciatic nerve block to femoral nerve block? / Control del dolor postoperatorio de la artroplastia total de la rodilla: ¿es necesario asociar el bloqueo del nervio isquiático al bloqueo del nervio femoral?

    Scientific Electronic Library Online (English)

    Affonso H., Zugliani; Nubia, Verçosa; José Luiz Gomes do, Amaral; Louis, Barrucand; Cátia, Salgado; Márcia Borges Hage, Karam.

    2007-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A artroplastia total do joelho (ATJ) promove grande trauma tecidual, produzindo intensa dor no pós-operatório. A analgesia pós-operatória de boa qualidade é fundamental, devendo-se considerar que a mobilização articular precoce é um importante aspecto para obtenção de bons [...] resultados. Há controvérsias na literatura sobre a eficácia do bloqueio isolado do nervo femoral. O objetivo deste estudo foi avaliar a analgesia pós-operatória com a associação do bloqueio dos nervos isquiático e femoral. MÉTODO: Foram estudados 17 pacientes submetidos à ATJ sob raquianestesia, divididos em dois grupos: A e B. No Grupo A (n = 9) foi realizado bloqueio do nervo femoral e no Grupo B (n = 8), bloqueio dos nervos femoral e isquiático. Os bloqueios foram realizados no pós-operatório imediato utilizando-se 20 mL de ropivacaína a 0,5% em cada um. A dor foi aferida nas primeiras 24 horas pela Escala Analógica Visual e escala verbal. Foi observado o tempo decorrido entre os bloqueios e a primeira queixa de dor (M1). RESULTADOS: A mediana do tempo de analgesia (M1) no Grupo A foi de 110 min. e no Grupo B de 1.285 min. (p = 0,0001). Não foram observadas complicações atribuíveis às técnicas utilizadas. CONCLUSÃO: O bloqueio do nervo isquiático, quando associado ao bloqueio do nervo femoral, nas condições deste estudo, melhorou de maneira significativa a qualidade da analgesia pós-operatória da ATJ. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: La artroplastia total de la rodilla (ATR) promueve gran trauma del tejido produciendo un intenso dolor en el postoperatorio. La analgesia de postoperatorio de buena calidad es fundamental, debiendo considerar que la movilización articular precoz es un importante aspecto pa [...] ra la obtención de buenos resultados. Existen controversias en la literatura sobre la eficacia del bloqueo aislado del nervio femoral. El objetivo de este estudio fue evaluar la analgesia en postoperatorio con la asociación del bloqueo de los nervios isquiático y femoral. MÉTODO: Fueron estudiados 17 pacientes sometidos a ATR bajo raquianestesia, divididos en dos grupos: A y B. En el Grupo A (n = 9) fue realizado bloqueo del nervio femoral y en el Grupo B (n = 8) bloqueo de los nervios femoral e isquiático. Los bloqueos fueron realizados en el postoperatorio inmediato utilizando 20 mL de ropivacaína a 0,5% en cada uno. El dolor se comprobó en las primeras 24 horas a través de la Escala Analógica Visual y escala verbal. Fue observado el tiempo transcurrido entre los bloqueos y el primer quejido de dolor (M1). RESULTADOS: La mediana del tiempo de analgesia (M1) en el Grupo A fue de 110 min y en el Grupo B de 1.285 min (p = 0,0001). No fueron observadas complicaciones atribuibles a las técnicas utilizadas. CONCLUSIONES: El bloqueo del nervio isquiático, cuando se asocia al bloqueo del nervio femoral, e las condiciones de este estudio, mejoró de manera significativa la calidad de la analgesia en postoperatorio de la ATR. Abstract in english BACKGROUND AND OBJECTIVES: Total knee arthroplasty (TKA) causes severe tissue trauma, leading to severe postoperative pain. Good postoperative analgesia is fundamental and one should consider that early mobilization of the joint is an important aspect to obtain good results. There is a controversy i [...] n the literature on the efficacy of isolated femoral nerve block. The objective of this study was to evaluate postoperative analgesia with the association of sciatic and femoral nerve block. METHODS: Seventeen patients undergoing TKA under spinal anesthesia were divided in two groups: A and B. In Group A (n = 9), femoral nerve block was performed, while in Group B (n = 8), femoral and sciatic nerve block were done. The blockades were done in the immediate postoperative period with 20 mL of 0.5% of ropivacaine. Pain was evaluated in the first 24 hours using the Visual Analog Scale and the verbal scale. The length of time between the nerve block and the first complaint of pain (M1) was also evaluate

  13. Obturator or "lateral" bypass in the management of infected vascular prostheses at the groin

    Directory of Open Access Journals (Sweden)

    Davidović Lazar B.

    2002-01-01

    Full Text Available The infection of the previously implanted vascular graft at the groin, is associated with great mortality and morbidity rate [1]. The authors present a retrospective study in which they analyzed management of infected vascular prostheses at the groin, using obturator bypass in 26 cases, and "lateral" bypass in 15 cases. The indications for obturator bypass reconstructions included: 20 infections of aorto-femoral grafts, two infected pse udoaneurysms in the groin after RTA of the superficial femoral artery, and 4 infections of iliac-femoral grafts. The indications for lateral bypass reconstructions were: infections after aorto-femoral reconstructions - 8 cases; infection after femora-popliteal reconstructions - 4 cases; infection after iliac-femoral reconstruction - 2 patients, and one infected pseudoaneurysm in the groin after RTA of the superficial femoral artery. In 3 subjects obturator bypass was performed using extraperitoneal approach while in other 23 patients transperitoneal approach was done by donor's artery. The obturator bypass was performed using a PTFE graft in 3 cases and Dacron graft in 23. The donor's artery used for obturator bypass was a noninfected proximal part of aortofemoral graft in 20 cases, and iliac artery in 6 patients. The superfical femoral artery was recipient artery for obturator bypass in 3 cases, deep femoral artery in one case, and above the knee popliteal artery in 22 cases (Figure 1. In two patients transperitoenal approach to donors artery for "lateral" bypass has been used, and in 13 cases extraperitoneal. The proximal noninfected part of aorto femoral graft was used as a donor's artery for lateral bypass in 8 patients, while common iliac artery in 7 subjects. In 5 cases recon structions were performed using PTFE grafts, in 3 using autologous saphenous vein grafts, and in 7 using Dacron grafts. The recipient artery for "lateral" bypass was deep femoral in 8 cases, superficial femoral in three patients and above the knee popliteal artery in 4 subjects. After both types of reconstruction, extirpation of infected grafts from the groin was performed (Figure 2. The control examination was performed using physical and Doppler ultrasonographic examinations, one, 3, 6, 12 months, and then every year after the operation. In cases with suspected graft infection or thrombosis, control angography was also performed. One intraoperative perforation of the urinary bladder has been done accidentally during obturator bypass reconstruction. The mean follow-up period for patients with obturator bypasses was 2.3 years, while 2.1 years for patients with "lateral" bypasses. Comparing with "lateral" bypass, obturator bypass showed statistically significant lower (p < 0.05 30- day mortality and early graft infection rate, as well as statistically significant better early and total limb salvage rate. There were no statistically significant differences (p > 0.05 between obturator and "lateral" bypass procedures having in mind, late graft infection rate, as well as early and late graft patency (Figures 3 and 4. In cases with infected vascular prostheses in the groin, the authors recommend obturator bypass comparing with "lateral" bypass.

  14. Bilateral high division of sciatic nerve

    Directory of Open Access Journals (Sweden)

    K. Shwetha

    2014-08-01

    Full Text Available Sciatic nerve is the thickest nerve in the body formed by the sacral plexus from L4 to S3 in the lesser pelvis. It emerges through the greater sciatic foramen below the piriformis and enter the gluteal region. Then the nerve passes on the back of the thigh and at the level of superior angle of popliteal fossa it terminates by dividing into tibial and common peroneal nerve. The knowledge of anatomical variations in the division of nerve is important for various surgical and anaesthetic procedures. During routine dissection in the department of anatomy, Mysore Medical College and Research Institute, Mysore, a rare bilateral high division of sciatic nerve was observed in a female cadaver aged about 40 years. In the present case there was bilateral high division of sciatic nerve. The nerve was seen dividing into two branches before it emerges through the greater sciatic foramen. The tibial nerve was entering the gluteal region below the piriformis muscle and common peroneal nerve was entering by piercing the piriformis. The knowledge of this variation is important as the nerve may get compressed with surrounding anatomical structures resulting in non discogenic sciatica. The awareness of variations is important for surgeons during various procedures like fracture, posterior dislocation of hip joint and hip joint replacement. The anatomical variations are important during deep intramuscular injections in gluteal region and also for anaesthetists during sciatic nerve block. [Int J Res Med Sci 2014; 2(4.000: 1785-1787

  15. Apical leakage of obturated canals prepared by Er:YAG laser.

    Science.gov (United States)

    Kimura, Y; Yonaga, K; Yokoyama, K; Matsuoka, E; Sakai, K; Matsumoto, K

    2001-09-01

    The present study evaluates the degree of apical leakage in vitro after root canal preparation using Er:YAG laser irradiation followed by obturation. Twenty-four single-rooted teeth were divided into 2 groups of 12. One group served as a control and these root canals were conventionally prepared up to a #50K file. The other group was prepared by Er:YAG laser irradiation at parameters of 2 Hz and 170 to 230 mJ/pulse. After obturation the teeth were immersed in a vacuum flask containing 0.6% rhodamine for 48 h, longitudinally bisected, and observed by stereoscopy and scanning electron microscopy. The degree of apical leakage from an apical stop was measured and statistical analysis was performed. The degree of apical leakage from the teeth prepared by laser was not significantly less than that from control teeth (p > 0.01). Morphological findings showed that contact between the root canal walls and obturated materials was hermetic in both groups, but canal walls prepared by laser were rough and irregular. These results show that root canal preparation by laser does not affect apical leakage after obturation compared with leakage in canals prepared using the conventional method. PMID:11556559

  16. Filling of simulated lateral canals using different obturation techniques: analysis through IDA digital radiograph system

    Directory of Open Access Journals (Sweden)

    Clarissa Teles Rodrigues

    2012-09-01

    Full Text Available Introduction: Lateral canals are part of the root canal system and may be related to periodontal-endodontic diseases. The filling techniques that employ thermoplasticized gutta-percha have demonstrated better results in filling lateral canals. Objective: The aim of this study was to evaluate, through digital radiographs, three techniques of root canal obturation (Lateral Condensation, Obtura II System, Tagger’s Hybrid regarding to the ability of filling artificial lateral canals. Material and methods: 30 extracted human lower premolars were used in this study. The crowns were removed and artificial laterals canals were prepared on the coronal, medium and apical thirds of the roots by using a reamer made of a K 10 file. The root canals were instrumented and obturated by the following techniques: Lateral Condensation, Obtura II System, and Tagger’s Hybrid. The teeth were radiographed with IDA digital radiograph system and the filling of the lateral canals was evaluated by scores for further statistical analysis. Results: No significant difference was found in the filling of lateral canals between Lateral Condensation and Obtura II, but a significant difference was found among these two and Tagger’s Hybrid technique. Conclusion: Tagger’s Hybrid technique promoted the highest numbers of obturated lateral canals. In the three groups, the root thirds presenting greater number of filled lateral canals were coronal and middle, regardless of the obturation technique employed.

  17. Application of palatal RB obturator in babies with isolated palatal cleft

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    Radojičić Julija

    2009-01-01

    Full Text Available Background. Isolated cleft of secondary palate has a specific clinical picture due to a wide communication between the mouth and nose cavity. As a consequence of that, babies born with this malformation are often subject to infections of the upper bronchial tubes, middle ear, speech disorders, and certainly the most difficult existential problem they face at the very beginning of their lives, the impossibility of suckling (breast feeding. Such babies have to be fed with gastric probe. The difficulties in their nutrition have often been described in literature, yet a singular attitude toward early orthodontic therapy has not been adopted still. The aim of the paper was to describe a design and application of obturator immediately after the birth of a baby with isolated palatal cleft, and the role in feeding. Case report. We presented a female neonate, born on 27th December 2007, with a wide fissure in the shape of the letter U over the entire secondary palate. The baby was referred to the Stomatology Clinic due to nutrition impossibility. To avoid feeding with gastric probe, the formation of RB obturator was performed (artificial palate. Hereby, the procedure of obturator making with an explanation of its function is presented. Conclusion. The application of RB obturator and the necessary education of parents have a major role in shortening the time of breast feeding and increasing the amount of food intake and, thus, for the normal growth and development of newborn infants with isolated palate cleft.

  18. Neuromodulation of the Suprascapular Nerve.

    Science.gov (United States)

    Kurt, Erkan; van Eijk, Tess; Henssen, Dylan; Arnts, Inge; Steegers, Monique

    2016-01-01

    Chronic intractable shoulder pain (CISP) is defined as shoulder pain which is present for longer than 6 months and does not respond to standard treatments like medication, physical therapy, rehabilitation, selective nerve blocks and local infiltrations, or orthopedic procedures. The etiology of CISP may be very diverse, varying from many orthopedic conditions to non-orthopedic conditions. The fact that the suprascapular nerve is one of the most important nerves supplying the shoulder region makes this nerve an interesting target in treating patients suffering shoulder pain. Invasive treatment options are peripheral nerve blocks, temporary electrical stimulation, and neurostimulation. To our best knowledge, thus far there are only a few reports describing the technique of permanent neurostimulation of the suprascapular nerve. In this article we present a patient suffering shoulder pain after she underwent surgery for cervical stenosis. After a step by step treatment protocol was done, we finally offered her trial stimulation of the suprascapular nerve. A single quad lead was implanted via a posterior approach under fluoroscopic and ultrasound guidance. Two weeks after successful stimulation, we implanted a permanent neuromodulation system. Permanent neurostimulation of the suprascapular nerve and its end branches may be a new interesting target in treating patients suffering shoulder pain due to various etiologies. In our patient the follow-up period is 9 months with an excellent result in pain relief, we observed no complications thus far, especially no dislocation or breakage of the lead. In this report, literature on this subject is reviewed, and our technique is well documented with additional anatomical illustrations. PMID:26752491

  19. Cutaneous Sensory Block Area, Muscle-Relaxing Effect, and Block Duration of the Transversus Abdominis Plane Block

    DEFF Research Database (Denmark)

    Støving, Kion; Rothe, Christian; Rosenstock, Charlotte V; Aasvang, Eske K; Lundstrøm, Lars H; Lange, Kai H W

    2015-01-01

    BACKGROUND AND OBJECTIVES: The transversus abdominis plane (TAP) block is a widely used nerve block. However, basic block characteristics are poorly described. The purpose of this study was to assess the cutaneous sensory block area, muscle-relaxing effect, and block duration. METHODS: Sixteen healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 9...

  20. Bloqueio seletivo dos nervos supraescapular e axilar promove analgesia satisfatória e menor grau de bloqueio motor: comparação com o bloqueio interescalênico El bloqueo selectivo de los nervios supraescapular y axilar promueve una analgesia satisfactoria y un menor grado de bloqueo motor: comparación con el bloqueo interescalénico Selective suprascapular and axillary nerve block provides adequate analgesia and minimal motor block: comparison with interscalene block

    Directory of Open Access Journals (Sweden)

    Patrícia Falcão Pitombo

    2013-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVO: Cirurgias artroscópicas do ombro cursam com intensa dor pós-operatória. Diversas técnicas analgésicas têm sido preconizadas. O objetivo deste estudo foi comparar o bloqueio dos nervos supraescapular e axilar nas cirurgias artroscópicas de ombro com a abordagem interescalênica do plexo braquial. MÉTODO: Sessenta e oito pacientes foram alocados em dois grupos de 34, de acordo com a técnica utilizada: grupo interescalênico (GI e grupo seletivo (GS, sendo ambas as abordagens realizadas com neuroestimulador. No GI, após resposta motora adequada foram injetados 30 mL de levopubivacaína em excesso enantiomérico de 50% a 0,33% com adrenalina 1:200.000. No GS, após resposta motora do nervo supraescapular e axilar, foram injetados 15 mL da mesma substância em cada nervo. Em seguida, realizada anestesia geral. Variáveis avaliadas: tempo para realização dos bloqueios, analgesia, consumo de opioide, bloqueio motor, estabilidade cardiocirculatória, satisfação e aceitabilidade pelo paciente. RESULTADOS: Tempo para execução do bloqueio interescalênico foi significativamente menor que para realização do bloqueio seletivo. Analgesia foi significativamente maior no pós-operatório imediato no GI e no pós-operatório tardio no GS. Consumo de morfina foi significativamente maior na primeira hora no GS. Bloqueio motor foi significativamente menor no GS. Estabilidade cardiocirculatória, satisfação e aceitabilidade da técnica pelo paciente não diferiram entre os grupos. Ocorreu uma falha no GI e duas no GS. CONCLUSÕES: Ambas as técnicas são seguras, eficazes com mesmo grau de satisfação e aceitabilidade. O bloqueio seletivo de ambos os nervos apresentou analgesia satisfatória, com a vantagem de proporcionar bloqueio motor restrito ao ombro.JUSTIFICATIVA Y OBJETIVOS: Las cirugías artroscópicas del hombro cursan con un intenso dolor postoperatorio. Diversas técnicas analgésicas han sido preconizadas. El objetivo de este estudio fue comparar el bloqueo de los nervios supraescapular y axilar en las cirugías artroscópicas de hombro con el abordaje interescalénico del plexo braquial. MÉTODO: Sesenta y ocho pacientes fueron ubicados en dos grupos de 34, de acuerdo con la técnica utilizada: grupo Interescalénico (GI y grupo selectivo (GS, siendo ambos abordajes realizados con neuroestimulador. En el GI, y después de la respuesta motora adecuada, se inyectaron 30 mL de levopubivacaina en exceso enantiomérico de un 50% al 0,33% con adrenalina 1:200.000. En el GS, y después de la respuesta motora del nervio supraescapular y axilar, se inyectaron 15 mL de la misma sustancia en cada nervio. Enseguida se realizó la anestesia general. Las variables que se evaluaron fueron: tiempo para la realización de los bloqueos, analgesia, consumo de opioide, bloqueo motor, estabilidad cardiocirculatoria, satisfacción y aceptabilidad por parte del paciente. RESULTADOS: El tiempo para la ejecución del bloqueo interescalénico fue significativamente menor que para la realización del bloqueo selectivo. La analgesia fue significativamente mayor en el postoperatorio inmediato en el GI y en el postoperatorio tardío en el GS. El consumo de morfina fue significativamente mayor en la primera hora en el GS. El bloqueo motor fue significativamente menor en el GS. La estabilidad cardiocirculatoria, satisfacción y aceptabilidad de la técnica por el paciente no fueron diferentes entre los grupos. Ocurrió un fallo en el GI y dos en el GS. CONCLUSIONES: Ambas técnicas son seguras y eficaces con el mismo grado de satisfacción y de aceptabilidad. El bloqueo selectivo de ambos nervios presentó una analgesia satisfactoria, con la ventaja de proporcionar un bloqueo motor restringido al hombro.BACKGROUND AND OBJECTIVE: Shoulder arthroscopic surgeries evolve with intense postoperative pain. Several analgesic techniques have been advocated. The aim of this study was to compare suprascapular and axillary nerve blocks in shoulder arthroscopy using the interscalene approach to brachial ple

  1. Bloqueio seletivo dos nervos supraescapular e axilar promove analgesia satisfatória e menor grau de bloqueio motor: comparação com o bloqueio interescalênico / Selective suprascapular and axillary nerve block provides adequate analgesia and minimal motor block: comparison with interscalene block / El bloqueo selectivo de los nervios supraescapular y axilar promueve una analgesia satisfactoria y un menor grado de bloqueo motor: comparación con el bloqueo interescalénico

    Scientific Electronic Library Online (English)

    Patrícia Falcão, Pitombo; Rogério Meira, Barros; Marcos Almeida, Matos; Norma Sueli Pinheiro, Módolo.

    2013-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVO: Cirurgias artroscópicas do ombro cursam com intensa dor pós-operatória. Diversas técnicas analgésicas têm sido preconizadas. O objetivo deste estudo foi comparar o bloqueio dos nervos supraescapular e axilar nas cirurgias artroscópicas de ombro com a abordagem interescalêni [...] ca do plexo braquial. MÉTODO: Sessenta e oito pacientes foram alocados em dois grupos de 34, de acordo com a técnica utilizada: grupo interescalênico (GI) e grupo seletivo (GS), sendo ambas as abordagens realizadas com neuroestimulador. No GI, após resposta motora adequada foram injetados 30 mL de levopubivacaína em excesso enantiomérico de 50% a 0,33% com adrenalina 1:200.000. No GS, após resposta motora do nervo supraescapular e axilar, foram injetados 15 mL da mesma substância em cada nervo. Em seguida, realizada anestesia geral. Variáveis avaliadas: tempo para realização dos bloqueios, analgesia, consumo de opioide, bloqueio motor, estabilidade cardiocirculatória, satisfação e aceitabilidade pelo paciente. RESULTADOS: Tempo para execução do bloqueio interescalênico foi significativamente menor que para realização do bloqueio seletivo. Analgesia foi significativamente maior no pós-operatório imediato no GI e no pós-operatório tardio no GS. Consumo de morfina foi significativamente maior na primeira hora no GS. Bloqueio motor foi significativamente menor no GS. Estabilidade cardiocirculatória, satisfação e aceitabilidade da técnica pelo paciente não diferiram entre os grupos. Ocorreu uma falha no GI e duas no GS. CONCLUSÕES: Ambas as técnicas são seguras, eficazes com mesmo grau de satisfação e aceitabilidade. O bloqueio seletivo de ambos os nervos apresentou analgesia satisfatória, com a vantagem de proporcionar bloqueio motor restrito ao ombro. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: Las cirugías artroscópicas del hombro cursan con un intenso dolor postoperatorio. Diversas técnicas analgésicas han sido preconizadas. El objetivo de este estudio fue comparar el bloqueo de los nervios supraescapular y axilar en las cirugías artroscópicas de hombro con el [...] abordaje interescalénico del plexo braquial. MÉTODO: Sesenta y ocho pacientes fueron ubicados en dos grupos de 34, de acuerdo con la técnica utilizada: grupo Interescalénico (GI) y grupo selectivo (GS), siendo ambos abordajes realizados con neuroestimulador. En el GI, y después de la respuesta motora adecuada, se inyectaron 30 mL de levopubivacaina en exceso enantiomérico de un 50% al 0,33% con adrenalina 1:200.000. En el GS, y después de la respuesta motora del nervio supraescapular y axilar, se inyectaron 15 mL de la misma sustancia en cada nervio. Enseguida se realizó la anestesia general. Las variables que se evaluaron fueron: tiempo para la realización de los bloqueos, analgesia, consumo de opioide, bloqueo motor, estabilidad cardiocirculatoria, satisfacción y aceptabilidad por parte del paciente. RESULTADOS: El tiempo para la ejecución del bloqueo interescalénico fue significativamente menor que para la realización del bloqueo selectivo. La analgesia fue significativamente mayor en el postoperatorio inmediato en el GI y en el postoperatorio tardío en el GS. El consumo de morfina fue significativamente mayor en la primera hora en el GS. El bloqueo motor fue significativamente menor en el GS. La estabilidad cardiocirculatoria, satisfacción y aceptabilidad de la técnica por el paciente no fueron diferentes entre los grupos. Ocurrió un fallo en el GI y dos en el GS. CONCLUSIONES: Ambas técnicas son seguras y eficaces con el mismo grado de satisfacción y de aceptabilidad. El bloqueo selectivo de ambos nervios presentó una analgesia satisfactoria, con la ventaja de proporcionar un bloqueo motor restringido al hombro. Abstract in english BACKGROUND AND OBJECTIVE: Shoulder arthroscopic surgeries evolve with intense postoperative pain. Several analgesic techniques have been advocated. The aim of this study was to compare suprascapular and axillary nerve blocks in shoulder

  2. Analgesia pós-operatória em correção cirúrgica de pé torto congênito: comparação entre bloqueio nervoso periférico e bloqueio peridural caudal Analgesia postoperatoria en corrección quirúrgica de pie jorobado congénito: comparación entre bloqueo nervioso periférico y bloqueo epidural caudal Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block

    Directory of Open Access Journals (Sweden)

    Monica Rossi Rodrigues

    2009-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O procedimento de correção de pé torto congênito (PTC cursa com dor pós-operatória intensa. A técnica mais utilizada em crianças é a peridural caudal associada à anestesia geral. Tem como limitação a curta duração da analgesia pós-operatória. Os bloqueios de nervos periféricos têm sido apontados como procedimentos com baixa incidência de complicações e tempo prolongado de analgesia. O objetivo do estudo foi comparar o tempo de analgesia dos bloqueios nervosos periféricos e bloqueio caudal e o consumo de morfina nas primeiras 24 horas após a correção de PTC em crianças. MÉTODO: Estudo randômico, encoberto, em crianças submetidas à intervenção cirúrgica para liberação póstero-medial de PTC, alocadas em 4 grupos conforme a técnica anestésica: Caudal (ACa; Bloqueios isquiático e femoral (IF; Bloqueios isquiático e safeno (IS; Bloqueio isquiático e anestesia local (IL, associados à anestesia geral. Nas primeiras 24 horas os pacientes receberam dipirona e paracetamol via oral e foram avaliados por anestesiologista que desconhecia a técnica empregada. Conforme escores da escala CHIPPS (Children's and infants postoperative pain scale era administrada morfina via oral (0,19 mg.kg-1 por dia. RESULTADOS: Foram estudadas 118 crianças distribuídas nos grupos ACa (30, IF (32, IS (28 IL (28. O tempo médio entre o bloqueio e a primeira dose de morfina foi 6,16 horas no grupo ACa, 7,05 horas no IF, 7,58 horas no IS e 8,18 horas no IL. O consumo de morfina foi 0,3 mg.kg-1 por dia nos quatro grupos. Não houve diferença significativa entre os grupos. CONCLUSÕES: Os bloqueios nervosos periféricos não promoveram maior tempo de analgesia, tampouco redução no consumo de morfina nas primeiras 24 horas em crianças submetidas à correção de PTC quando comparados ao bloqueio peridural caudal.JUSTIFICATIVA Y OBJETIVOS: El procedimiento de corrección de pie jorobado congénito (PJC, debuta con dolor postoperatorio intenso. La técnica más utilizada en niños es la epidural caudal asociada a la anestesia general. Posee la limitante de una corta duración de la analgesia postoperatoria. Los bloqueos de nervios periféricos han sido indicados como procedimientos con una baja incidencia de complicaciones y un tiempo prolongado de analgesia. El objetivo del estudio actual, fue comparar el tiempo de analgesia de los bloqueos nerviosos periféricos y del bloqueo caudal y el consumo de morfina, en las primeras 24 horas después de la corrección de PJC en niños. MÉTODO: Estudio randómico doble ciego, en niños sometidos a la intervención quirúrgica para liberación posteromedial de PJC, ubicadas en cuatro grupos conforme a la técnica anestésica: caudal (ACa; bloqueos isquiático y femoral (IF; bloqueos isquiático y safeno (IS; bloqueo isquiático y anestesia local (IL, asociados a la anestesia general. En las primeras 24 horas, los pacientes recibieron dipirona y paracetamol vía oral y fueron evaluados por un anestesiólogo que no conocía la técnica usada. Conforme a las puntuaciones de la escala CHIPPS (Children's and infants postoperative pain scale, se administraba morfina vía oral (0,19 mg.kg-1 por día. RESULTADOS: Fueron estudiados 118 niños distribuidos en los grupos ACa (30, IF (32, IS (28 IL (28. El tiempo promedio entre el bloqueo y la primera dosis de morfina fue de 6,16 horas en el grupo ACa, 7,05 horas en el IF, 7,58 horas en el IS y 8,18 horas en el IL. El consumo de morfina fue de 0,3 mg.kg-1 por día en los cuatro grupos. No hubo diferencia significativa entre los grupos. CONCLUSIONES: Los bloqueos nerviosos periféricos no promovieron un tiempo más elevado de analgesia, ni tampoco una reducción en el consumo de morfina en las primeras 24 horas, en niños sometidos a la corrección de PJC cuando se les comparó con el bloqueo epidural caudal.BACKGROUND AND OBJECTIVES: Correction of congenital clubfoot (CCF is associated with severe postoperative pain. Caudal epidural block associated with general anesthesia is the anesthetic technique used more often in children, but it is limited by the short duration of the postoperative analgesia. Peripheral nerve blocks are associated with a low incidence of complications and prolonged analgesia. The objective of this study was to compare the duration of analgesia in peripheral nerve blocks and caudal block, as well as morphine consumption in the first 24 hours after correction of CCF in children. METHODS: This is a randomized, double-blind study with children undergoing surgeries for posteromedial release of CCF, who were divided in four groups according to the anesthetic technique: caudal (ACa, sciatic and femoral block (IF, sciatic and saphenous block (IS, and sciatic block and local anesthesia (IL, associated with general anesthesia. In the first 24 hours, patients received oral dypirone and acetaminophen, and they were evaluated by anesthesiologists who were unaware of the technique used. Oral morphine (0.19 mg.kg¹ per day was administered according to the scores of the CHIPPS (Children's and infants' postoperative pain scale scale. RESULTS: One hundred and eighteen children separated into four groups: ACa (30, IF (32, IS (28, and IL (28 participated in this study. The mean time between the blockade and the first dose of morphine was 6.16 hours in group ACa, 7.05 hours in group IF, 7.58 in IS, and 8.18 hours in IL. Morphine consumption was 0.3 mg.kg-1 per day in all four groups. Significant differences were not observed among the groups. CONCLUSIONS: peripheral nerve blocks did not promote longer lasting analgesia or a decrease in morphine consumption in the first 24 hours in children undergoing CCF correction when compared to caudal epidural block.

  3. Comparative Evaluation of Sealing Ability of Three Newer Root Canal Obturating Materials Guttaflow, Resilon and Thermafil: An In Vitro Study

    OpenAIRE

    H Bhandi, Shilpa; T.S., Subhash

    2013-01-01

    Introduction: Microleakage continues to be a main reason for failure of root canal treatment where the challenge has been to achieve an adequate seal between the internal structure and the main obturating material. The objective of this study is to compare the sealing ability of 3 newer obturating materials GuttaFlow, Resilon/Epiphany system (RES) and Thermafil, using silver nitrate dye and observing under stereomicroscope.

  4. Effect of Lidocaine Chloride on Group A Nerve Fibers Function

    OpenAIRE

    Jelena Scekic; Mara Drecun; Slavica Vujisic

    2010-01-01

    Local anesthetics, such as lidocaine chloride delay or inhibit the occurrence and transmission of impulses along the excitable tissue membranes, but there is not enough information about their effects on types of nerve fibers within the whole nerve. The aim of the study was to determine the function parameters and examine the degree of blocking for each fiber type in group A of isolated frog sciatic nerves in relation to lidocaine chloride concentration. Thirty frog sciatic nerves, divided in...

  5. Eficacia y seguridad del bloqueo de nervio supraescapular guiado por ultrasonido en pacientes con dolor crónico de hombro / Efficacy and safety of ultrasound-guided suprascapular nerve block in patients with chronic shoulder pain

    Scientific Electronic Library Online (English)

    Mario Andrés, Arcila Lotero; Roberto Cario, Rivera Díaz; Daniel, Campuzano Escobar; María Adelaida, Mejía Aguilar; Sandra Milena, Martínez Ramírez.

    2013-06-01

    Full Text Available Introducción: El síndrome de hombro doloroso es una de las patologías más comunes de dolor crónico de origen osteomuscular. Y es frecuente encontrar pacientes sin mejoría con el tratamiento conservador con terapia física y fármacos, e incluso fallo en el manejo quirúrgico. El bloqueo supraescapular [...] guiado por ultrasonido es una alternativa cuando la terapia de base no funciona. Objetivo: Determinar la eficacia clínica y la seguridad del manejo intervencionista con bloqueo del nervio supraescapular guiado por ultrasonografía en pacientes con dolor crónico de hombro. Materiales y métodos: Se realizó un estudio de tipo descriptivo, prospectivo, de seguimiento a una cohorte de 46 pacientes con enfermedad dolorosa crónica de hombro que recibieron tratamiento intervencionista guiado por ultrasonografía en el Instituto Colombiano del Dolor entre los meses de octubre de 2011 y mayo de 2012, para determinar su eficacia y seguridad. Se obtuvieron datos antes del procedimiento, a los 2 días y un mes después. La intensidad de dolor se midió con la escala visual analógica (EVA). Resultados: Se realizaron 46 bloqueos. El 78,3% de los pacientes presentaron una disminución del dolor de al menos el 50% a los 2 días y el 47,8% al mes, con una diferencia estadísticamente significativa (p Abstract in english Introduction: The painful shoulder syndrome is one of the most common chronic pain conditions of muscle-skeletal origin. It is frequent to find patients who do not improve with conservative treatment based on medications and physical therapy, or even with surgical management. Ultrasound-guided supra [...] scapular blockade is another option when basic therapy does not work. Objective: To determine the clinical efficacy and safety of interventional management with ultrasound-guided suprascapular nerve block in patients with chronic shoulder pain. Materials and methods: A descriptive, prospective, follow-up study was conducted in a cohort of 46 patients with chronic shoulder pain disorder who received interventional treatment under ultrasound guidance at the Colombian Pain Institute between October 2011 and May 2012, with the objective of determining efficacy and safety of the procedure. Data were gathered before the procedure, and then two days later and one month after the procedure. Pain intensity was measured using the visual analogue scale (VAS). Results: Forty-six blocks were performed. Overall, 78.3% of the patients experienced at least 50% reduction of pain two days later, and 47.8% had pain relief after one month, with a statistically significant difference (p

  6. Hermetizing ability of the new obturating material for root canals «Real Seal» with «Resilon» technology

    Directory of Open Access Journals (Sweden)

    Makedonova Y.A.

    2012-03-01

    Full Text Available Simple, reliable and predictable obturation of root canals side by side with their cleaning and forming is an essential part of the endodontic treatment. The aim of this research is investigation of obturation density of root canals. Canals filled by means of lateral condensation of the new obturative system «Real Seal/Resilon» and by means of traditional method of canals obturation with the help of gutta-percha and sealer АН-plus. The results of the research proved a ligher hermetizing ability of the new experimental material «Real Seal» in comparison with obturation by means of gutta-percha pins. The obtained data reflects an objective picture and can be applied as a unique quality monitoring obturation of root canals.

  7. Efficacy of Two Rotary NiTi Instruments in Removal of Resilon/Epiphany Obturants

    OpenAIRE

    Pooneh Mohebbi

    2012-01-01

    Introduction: The success of endodontic retreatment is related to the complete removal of the obturation material from the root canal system. The aim of this study was to evaluate the efficacy of Mtwo R and ProTaper retreatment files in removing the Resilon/Epiphany system with or without chloroform during retreatment. Materials and Methods: Sixty distal roots of first mandibular molars were prepared and laterally condensed with Resilon/Epiphany, then divided into four groups (15 each for ret...

  8. Silicone obturators and the bacterial flora in symptomatic nasal septal perforations

    OpenAIRE

    Hulterström, Anna Karin

    2012-01-01

    Background A perforation in the nasal septum can cause symptoms such as bleeding, obstruction, crusts and pain, and can be a challenge to treat. Surgery is the treatment of choice, but disease, size of the perforation, or the patient’s wish may contradict surgery. A custom-made silicone obturator is a successful treatment option, but little is known how this treatment affects the microbial flora. The purposes of this thesis were (i) to investigate the microbial flora around symptomatic nasal ...

  9. An In-Vitro Evaluation and Comparison of Apical Sealing Ability of Three Different Obturation Technique - Lateral Condensation, Obtura II, and Thermafil

    OpenAIRE

    Emmanuel, Samson; Shantaram, Kulkarni; Sushil, Kumar C; Manoj, Likhitkar

    2013-01-01

    Introduction: Success of non-surgical root canal treatment is predicted by meticulous cleaning and shaping of the root canal system, three-dimensional obturation and a well-fitting "leakage-free" coronal restoration. The techniques of obturation that are available have their own relative position in the historical development of filling techniques. Over the years, pitfalls with one technique have often led to the development of newer methods of obturation, along with the recognition that no o...

  10. What Are Nerve Blocks for Headache?

    Science.gov (United States)

    ... at the Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY. Matthew S. Robbins, MD, ... is an assistant professor of neurology at the Albert Einstein College of Medicine, and the current chair of ...

  11. Flank hernia secondary to phenol nerve block.

    LENUS (Irish Health Repository)

    Al-Hilli, Z

    2010-09-01

    The management of patients with chronic pain is challenging. The aim of treatment is alleviation of symptoms in an attempt to increase functional capacity. Interventional procedures, such as chemical neurolysis are adopted when other techniques fail to provide adequate pain control.

  12. Sabots, Obturator and Gas-In-Launch Tube Techniques for Heat Flux Models in Ballistic Ranges

    Science.gov (United States)

    Bogdanoff, David W.; Wilder, Michael C.

    2013-01-01

    For thermal protection system (heat shield) design for space vehicle entry into earth and other planetary atmospheres, it is essential to know the augmentation of the heat flux due to vehicle surface roughness. At the NASA Ames Hypervelocity Free Flight Aerodynamic Facility (HFFAF) ballistic range, a campaign of heat flux studies on rough models, using infrared camera techniques, has been initiated. Several phenomena can interfere with obtaining good heat flux data when using this measuring technique. These include leakage of the hot drive gas in the gun barrel through joints in the sabot (model carrier) to create spurious thermal imprints on the model forebody, deposition of sabot material on the model forebody, thereby changing the thermal properties of the model surface and unknown in-barrel heating of the model. This report presents developments in launch techniques to greatly reduce or eliminate these problems. The techniques include the use of obturator cups behind the launch package, enclosed versus open front sabot designs and the use of hydrogen gas in the launch tube. Attention also had to be paid to the problem of the obturator drafting behind the model and impacting the model. Of the techniques presented, the obturator cups and hydrogen in the launch tube were successful when properly implemented

  13. FABRICATION OF A HOLLOW BULB OBTURATOR FOR A HEMI- MAXILLECTOMY DEFECT: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Mukesh

    2014-05-01

    Full Text Available Benign or malignant tumors of mouth and oropharyngeal region often result in the maxillofacial defects. The acquired maxillectomy defects results in the impairment of speech, mastication, swallowing and facial esthetics. The Prosthodontist plays a significant role in the rehabilitation of the acquired maxillectomy defects with the special emphasis to the reduction of the weight of the prosthesis and thereby enhancing the retention and stability. The weight of the obturator can cause a dislodging force. It must therefore be as light as possible. A suitable technique of fabrication should be selected to achieve this. This case report describes the fabrication of a hollow bulb obturator for a hemi- maxillectomy patient (Aramany’s class 1 defect who had undergone wide excision and alveolar resection squeal of management of adenoid cystic carcinoma of the right palate. This article describes the step by step clinical and laboratory procedure involved in the rehabilitation of a hemimaxillectoy dentate patients using obturator lined with soft liner to restore the functions such as esthetics, mastication, deglutition and speech

  14. Preparation of feeding obturators for infants with cleft lip and palate.

    Science.gov (United States)

    Osuji, O O

    1995-01-01

    Clefts of the lip and palate are the commonest congenital craniofacial malformations in children. Sucking is impaired in infants born with complete clefts of the lip and palate. Feeding obturators improve feeding thereby contributing to weight gain and a thriving state of health, a prerequisite for surgical repair of the defects. A pediatric dentist may be required to fabricate the obturator. A method for constructing the appliance is presented. The severity of the clefts varies so much that stock trays are not always useful for the impression of the infant's maxillary arch. A preliminary impression is taken by introducing a thermoplastic impression material with the index and middle fingers as the tray. A model is produced from which a custom tray is constructed. The final maxillary impression is taken using an irreversible hydrocolloid with the child in an upright position. An obturator is constructed on the stone model by sprinkling soft autopolymerizing acrylic resin on the palate extending well into the mucobuccal fold area. The cured appliance is trimmed and polished prior to insertion. PMID:8611491

  15. Efficacy of ProTaper Retreatment System in Root Canals Obturated with Gutta-Percha Using Two Different Sealers and GuttaFlow

    OpenAIRE

    Jaya Siotia; Shashi Rashmi Acharya; Sunil Kumar Gupta

    2011-01-01

    Objective. To compare the efficacy of ProTaper retreatment files in removing three different obturating materials. Study Design. Forty-five human, single-rooted premolars were divided into three experimental groups. Group 1 was obturated with gutta-percha and AH Plus sealer, Group 2 was obturated with gutta-percha and zinc oxide eugenol sealer, and Group 3 was obturated with GuttaFlow. Retreatment was done using the ProTaper universal rotary retreatment files. Root halves were visualized usin...

  16. The binding of tetrodotoxin to nerve membranes

    Science.gov (United States)

    Keynes, R. D.; Ritchie, J. M.; Rojas, E.

    1971-01-01

    1. The% reduction in size of the externally recorded action potential produced by concentrations of tetrodotoxin (TTX) in the range 6-300 nM was determined for the small non-myelinated fibres of the rabbit cervical vagus nerve and of the walking leg nerves of crab and lobster. The concentration of TTX for 50% reduction was around 80 nM for rabbit vagus and 14 nM for crab nerve. 2. Bio-assay procedures were devised to measure the amount of TTX taken up by a nerve when it was exposed to a very small volume of a solution whose TTX content was just great enough to produce 100% block of conduction. The extracellular space of each nerve was determined with [14C]sugar so that an allowance could be made for extracellular dilution. 3. The TTX binding by rabbit, crab and lobster nerve was respectively 0·064, 0·053 and 0·036 p-mole/mg wet weight of nerve. 4. The binding of saxitoxin was measured in rabbit vagus nerve, and found to be much the same as that of TTX. 5. Control experiments on rabbit sciatic nerve, where the area of excitable membrane was much smaller, showed that there was relatively little unspecific binding of TTX. 6. In view of the evidence presented here and elsewhere that the blocking of sodium conductance by TTX involves the attachment of only one TTX molecule at each sodium site, and that unspecific binding of TTX does not cause serious errors, these results suggest that in 1 ?m2 of nerve membrane the number of sodium sites is 75 for rabbit, 49 for crab, and 36 for lobster nerve. PMID:5575342

  17. Bloqueio do nervo frênico após realização de bloqueio do plexo braquial pela via interescalênica: relato de caso A bloqueo del nervio frénico después de la realización de bloqueo del plexo braquial por la vía interescalénica: relato de caso Phrenic nerve block after interscalene brachial plexus block: case report

    Directory of Open Access Journals (Sweden)

    Luis Henrique Cangiani

    2008-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Bloqueio do nervo frênico é um evento adverso do bloqueio do plexo braquial; entretanto, na sua maioria, sem repercussões clínicas importantes. O objetivo deste relato foi apresentar um caso em que ocorreu bloqueio do nervo frênico, com comprometimento ventilatório, em paciente com insuficiência renal crônica submetido a instalação de fístula arteriovenosa extensa, sob bloqueio do plexo braquial pela via perivascular interescalênica. RELATO DO CASO: Paciente do sexo masculino, 50 anos, tabagista, portador de insuficiência renal crônica em regime de hemodiálise, hipertensão arterial, hepatite C, diabetes mellitus, doença pulmonar obstrutiva crônica, a ser submetido à instalação de fístula arteriovenosa extensa no membro superior direito sob bloqueio de plexo braquial pela via interescalênica. O plexo braquial foi localizado com utilização do estimulador de nervo periférico. Foram injetados 35 mL de uma solução de anestésico local, constituída de uma mistura de lidocaína a 2% com epinefrina a 1:200.000 e ropivacaína a 0,75% em partes iguais. Ao final da injeção o paciente apresentava-se lúcido, porém com dispnéia e predomínio de incursão respiratória intercostal ipsilateral ao bloqueio. Não havia murmúrio vesicular na base do hemitórax direito. A SpO2 manteve-se em 95%, com cateter nasal de oxigênio. Não foi necessária instalação de métodos de auxílio ventilatório invasivo. Radiografia do tórax revelou que o hemidiafragma direito ocupava o 5° espaço intercostal. O quadro clínico foi revertido em três horas. CONCLUSÕES: O caso mostrou que houve paralisia total do nervo frênico com sintomas respiratórios. Apesar de não ter sido necessária terapêutica invasiva para o tratamento, fica o alerta para a restrição da indicação da técnica nesses casos.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del nervio frénico es un evento adverso del bloqueo del plexo braquial, sin embargo, en su mayoría, sin repercusiones clínicas importantes. El objetivo de este relato fue presentar un caso en que ocurrió bloqueo del nervio frénico, con comprometimiento ventilatorio en paciente con insuficiencia renal crónica, sometido a la instalación de fístula arterio-venosa extensa, bajo bloqueo del plexo braquial por la vía perivascular interescalénica. RELATO DEL CASO: Paciente del sexo masculino, 50 años, tabaquista, portador de insuficiencia renal crónica en régimen de hemodiálisis, hipertensión arterial, hepatitis C, diabetes melito, enfermedad pulmonar obstructiva crónica, sometido a la instalación de fístula arterio-venosa extensa en el miembro superior derecho bajo bloqueo de plexo braquial por la vía interescalénica. El plexo braquial fue localizado con la utilización del estimulador de nervio periférico. Se inyectaron 35 mL de una solución de anestésico local constituida de una mezcla de lidocaína a 2% con epinefrina a 1:200.000 y ropivacaína a 0,75% en partes iguales. Al final de la inyección el paciente estaba lúcido, pero sin embargo con disnea y predominio de incursión respiratoria intercostal ipsilateral al bloqueo. No había murmullo vesicular en la base del hemitórax derecho. La SpO2 se mantuvo en un 95%, con catéter nasal de oxígeno. No fue necesaria la instalación de métodos de auxilio ventilatorio invasivo. La radiografía del tórax reveló que el hemidiafragma derecho ocupaba el 5° espacio intercostal. El cuadro clínico se revirtió en tres horas. CONCLUSIONES: El caso mostró que hubo parálisis total del nervio frénico con síntomas respiratorios. A pesar de no haber sido necesaria la terapéutica invasiva para el tratamiento, queda el aviso aquí para la restricción de la indicación de la técnica en esos casos.BACKGROUND AND OBJECTIVES: Phrenic nerve block is a common adverse event of brachial plexus block. However, in most cases it does not have any important clinical repercussion. The objective of this work was to report a case with phrenic nerve block with respiratory repercus

  18. Neuromodulation of the suprascapular nerve.

    Science.gov (United States)

    Elahi, Foad; Reddy, Chandan G

    2014-01-01

    The shoulder joint is an enarthrodial or ball-and-socket joint. A complex network of anatomic structures endows the human shoulder with tremendous mobility, greater than any other joint in the body. Many pathologies can been found in those patients with chronic shoulder pain. The painful limitation of shoulder motion affects hand and arm motion as well; therefore, it significantly influences work performance and everyday activities as well as the quality of life. Therefore, the treatment of patients with chronic shoulder pain has major social and health economic implications. In this article we present a patient with a complex history of shoulder pathology including 7 surgeries that left the patient with chronic debilitating shoulder pain. She was suffering from chronic pain and limited mobility of the shoulder joint due to adhesive shoulder capsulitis. She was treated with a multimodality approach with the goals of increasing shoulder range of motion and decreasing her pain. This did not provide significant improvement. The suprascapular nerve supplies motor and sensory innervation to the shoulder, and can be easily accessible in the supraspinatus fossa. A suprascapular nerve block dramatically decreased her pain. This clinical observation along with confirmatory nerve block play an important role during the decision-making process for a trial period of electrical neuromodulation. She was followed for 3 months after the permanent implantation of a suprascapular nerve stimulator. Her pain and shoulder range of motion in all planes improved dramatically. Peripheral nerve stimulation (PNS) of the suprascapular nerve, in addition to multimodality pain management, is one approach to the difficult task of treating adhesive capsulitis with accompanying pain and the inability to move the shoulder. We conducted a literature review on PubMed and found no case describing a similar patient to our knowledge. PMID:25415792

  19. Relationship Between Volume of Pterygopalatine Fossa and Block Anesthesia of Maxillary Nerve: A Pilot Study / Relación entre el Volumen de la Fosa Pterigopalatina y la Anestesia Troncular del Nervio Maxilar: Un Estudio Piloto

    Scientific Electronic Library Online (English)

    Pedro, Aravena Torres; Nicole, Cresp Sinning; Katherine, Büchner Sagredo; Carlos, Muñoz Rocha; Ricardo, Cartes-Velásquez.

    2011-09-01

    Full Text Available El bloqueo troncular del nervio maxilar (BTNM) se logra depositando anestesia vía canal palatino mayor en la fosa pterigopalatina. Los autores difieren en la cantidad de anestesia a depositar y la tasa de complicaciones asociadas (diplopía y hematomas). Coronado et al. (2008) midió el volumen de la [...] fosa pterigopalatina encontrando un promedio de 1,2ml, sugiriendo dicha cantidad de anestesia para el BTNM. El objetivo del presente trabajo es comparar la eficacia de dosis bajas de 1,2ml (DB) versus dosis tradicional de 1,8ml (DT) de anestesia para el BTNM y sus efectos adversos. Se realizó un estudio clínico cuasiexperimental de carácter exploratorio, participaron 82 pacientes donde la técnica anestésica estaba indicada para un procedimiento de exodoncia, los que fueron aleatorizados en los grupos DB y DT, administrándoles lidocaína al 2% con 1:50.000 de epinefrina. Se registraron variables demográficas (sexo y edad), clínicas (pieza a extraer y dosis administrada) y anatómicas (índices facial superior y craneal). El éxito anestésico (EA) se definió como la posibilidad de realizar la exodoncia con nulo o mínimo dolor, medido con escala visual análoga (EVA). En el análisis estadístico se utilizaron los tests de chi cuadrado y t de student (p Abstract in english Block anesthesia of maxillary nerve 9BAMN) is achieved by depositing anesthesia through greater palatine canal into the pterygopalatine fossa. Authors differ in the amount of anesthesia to be administered and the rate of complications (diplopia and hematomas), Coronado et al., (2008), measured the s [...] ize of the pterygopalatine fossa finding an average of 1.2 ml, suggesting that amount of anesthesia for BAMN. The aim of this study is to compare the effectiveness of low doses of 1.2 ml (LD)versus traditional dose of 1.8 m. (TD) of anesthesia for BAMN and its adverse effects. A quasi experimental exploratory clinical study was performed involving 82 patients where the anesthetic technique was suitable for tooth extraction procedure; patients were randomized in LD and TD groups, 2% lidocaine with 1:50.000 epinephrine was used. Demographic (sex and age), clinical (tooth for extraction and anesthetic dose) as well as anatomical variables (upper facial and cranial index) were recorded. The anesthetic success (AS) was defined as the possibility to perform the tooth extraction with no pain or minimal pain as measured by visual analogue scale (VAS). For statistical analysis chi-square and t test (p

  20. SCIATIC NERVE AND ITS VARIATIONS: AN ANATOMICAL STUDY

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    Anbumani T.L

    2015-06-01

    Full Text Available Background and aims: The Sciatic nerve is the widest nerve of the body, consists of two components namely tibial and common peroneal components, derived from the lumbosacral plexus from the ventral rami of L4 to S3 spinal nerves. The Sciatic nerve usually enters the gluteal region under the piriformis muscle. The purpose of this study is to identify the variations in the course and branching pattern of the sciatic nerve and its relation to the piriformis muscle which may lead to various clinical manifestations like non-discogenic sciatica. Materials and methods: 50 gluteal regions and posterior compartment of thigh from 25 formalin fixed adult cadavers are used for this study, of which one is a female cadaver. Gluteal regions and the posterior aspect of thigh on both sides are dissected to expose the sciatic nerve. Variations in the sciatic nerve and their relationship to piriformis muscle are observed. Results: 41 gluteal regions and posterior compartments of thigh (82% showed normal anatomy of sciatic nerve and also piriformis muscle. 9 regions (18% showed variations in the sciatic nerve, of which 5 regions (10% showed variation of sciatic nerve in relation to piriformis muscle. Other details are explained further in the article. Conclusion: A proper knowledge about the variations of sciatic nerve, its relation to piriformis muscle is must for medical professionals during posterior hip surgeries, sciatic nerve decompression, total hip replacement, sciatic nerve injury during deep intramuscular gluteal injections, failed sciatic nerve block during anaesthetic procedures etc.

  1. Nerve conduction velocity

    Science.gov (United States)

    ... strong the impulse is. You should feel no pain once the test is finished. Often, the nerve ... systemic amyloidosis Sensorimotor polyneuropathy Tibial nerve dysfunction Ulnar nerve dysfunction Any peripheral neuropathy can cause abnormal results. Damage to the ...

  2. Cervical Radiculopathy (Pinched Nerve)

    Science.gov (United States)

    ... by reducing swelling and inflammation around the nerve. • Steroid injection. In this procedure, steroids are injected near the ... nerve injection), or into the facet joint. Although steroid injections do not relieve the pressure on the nerve ...

  3. Clinical and radiographic evaluation of zinc oxide with aloe vera as an obturating material in pulpectomy: An in vivo study

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    Abhishek Khairwa

    2014-01-01

    Full Text Available Background: Pulp therapy for pulpally involved primary teeth continues to be a challenge to clinicians. One of the major areas of continued research is in the area of finding obturating materials to suit the specific properties of these teeth. Zinc oxide eugenol is used frequently in pulpectomy for the obturation of the primary teeth. Aims: To evaluate clinically and radiographically a mixture of zinc oxide eugenol and aloe vera as an obturating material. Materials and Methods: A total of 50 children, aged between 4 and 9 years, who were screened for unilateral or bilateral carious deciduous molars were studied. Out of these, 15 children were randomly selected for endodontic treatment. Obturation was done with a mixture of zinc oxide powder and aloe vera gel. Clinical and radiographic evaluation was done after 7 days, 1 month, 3 months, 6 months, and 9 months. The data were statistically analyzed. Results and Conclusion: Endodontic treatment using a mixture of zinc oxide powder and aloe vera gel in primary teeth has shown good clinical and radiographic success. A detailed observational study with longer follow-up will highlight the benefits of aloe vera in primary teeth as an obturating medium.

  4. Ischemic and reperfusion injury of rat peripheral nerve

    International Nuclear Information System (INIS)

    A rat model of severe nerve ischemia was used to study the effects of ischemia and reperfusion on nerve conduction, blood flow, and the integrity of the blood-nerve barrier. Conduction failure was consistently found in the sciatic-tibial nerve during 1- and 3-hr ischemic periods. Recovery of the compound muscle action potential was prompt and complete upon reperfusion following 1 hr of ischemia. However, after 3 hr of ischemia, recovery in the proximal portion of the sciatic nerve was 14C]sucrose following 1 hr of ischemia but was significantly impaired after 3 hr of ischemia. The permeability-surface area product was consistently greater following 1 hr of reperfusion than during the immediate reperfusion period. These data indicate that severe ischemia of peripheral nerve results in reperfusion injury, conduction block, and blood-nerve barrier disruption. Microvascular events, which may occur during reperfusion, may be important in amplifying the nerve fiber damage that began during ischemia

  5. Nervio Femoral Accesorio: Una Variación del Plexo Lumbar / Accessory Femoral Nerve: a Variation of Lumbar Plexus

    Scientific Electronic Library Online (English)

    E, Olave; J. J, Cabezas; A, Soto; O, Binvignat.

    2013-12-01

    Full Text Available Variaciones en el origen de los ramos del plexo lumbar son observadas comúnmente durante las disecciones. Entre ellas se pueden mencionar: ausencia del nervio iliohipogástrico, presencia de un nervio obturador accesorio, bifurcación del nervio femoral, entre otras, destacándose la presencia de un ne [...] rvio accesorio del nervio femoral. Durante una disección de rutina, en un cadáver fijado en formaldehido 10%, de un individuo adulto, Chileno, de sexo masculino, se observó la presencia unilateral de este nervio femoral accesorio originado del ramo anterior del nervio femoral, el cual estaba formado por dos ramos, describiendo sus características de origen, trayecto y distribución. Las variaciones anatómicas del plexo lumbar deben ser consideradas en el momento de efectuar cirugías en la región, evitando daños al nervio mencionado u otros, durante la disección quirúrgica. Abstract in english Variations in the origin of the branches of the lumbar plexus are commonly observed during dissections. Among them may be mentioned: absence of iliohypogastric nerve, the presence of an accessory obturator nerve, femoral nerve bifurcation, highlighting the presence of a accessory femoral nerve. Duri [...] ng routine dissection in a cadaver fixed in 10% formaldehyde, an adult individual, Chilean, male, unilateral accessory femoral nerve was observed, originating from the anterior branch of femoral nerve, which consisted of two branches.The characteristics of origin, course and distribution are described. Anatomical variations of the lumbar plexus must always be considered at the time of surgery in the mentioned sector avoiding nerve damage, during surgical dissection.

  6. Comparison of ProTaper and Mtwo retreatment systems in the removal of resin-based root canal obturation materials during retreatment.

    Science.gov (United States)

    Iriboz, Emre; Sazak Öveço?lu, Hesna

    2014-04-01

    To evaluate the effectiveness of the ProTaper and Mtwo retreatment systems for removal of resin-based obturation techniques during retreatment. A total of 160 maxillary anterior teeth were enlarged to size 30 using ProTaper and Mtwo rotary instruments. Teeth were randomly divided into eight groups. Resilon?+?Epiphany, gutta-percha?+?Epiphany, gutta-percha?+?AH Plus and gutta-percha?+?Kerr Pulp Canal Sealer (PCS) combinations were used for obturation. ProTaper and Mtwo retreatment files were used for removal of root canal treatments. After clearing the roots, the teeth were split vertically into halves, and the cleanliness of the canal walls was determined by scanning electron microscopy. Specimens obturated with gutta-percha and Kerr PCS displayed significantly more remnant obturation material than did specimens filled with resin-based obturation materials. Teeth prepared with Mtwo instruments contained significantly more remnant filling material than did teeth prepared with ProTaper. ProTaper files were significantly faster than Mtwo instruments in terms of the mean time of retreatment and time required to reach working length. The Resilon?+?Epiphany and AH Plus?+?gutta-percha obturation materials were removed more easily than were the Epiphany?+?gutta-percha and Kerr PCS?+?gutta-percha obturation materials. Although ProTaper retreatment files worked faster than did Mtwo retreatment files in terms of removing root canal obturation materials, both retreatment systems are effective, reliable and fast. PMID:24697958

  7. Evaluation of three instrumentation techniques at the precision of apical stop and apical sealing of obturation

    Directory of Open Access Journals (Sweden)

    Özgür Genç

    2011-08-01

    Full Text Available OBJECTIVE: The aim of this study was to investigate the ability of two NiTi rotary apical preparation techniques used with an electronic apex locator-integrated endodontic motor and a manual technique to create an apical stop at a predetermined level (0.5 mm short of the apical foramen in teeth with disrupted apical constriction, and to evaluate microleakage following obturation in such prepared teeth. MATERIAL AND METHODS: 85 intact human mandibular permanent incisors with single root canal were accessed and the apical constriction was disrupted using a #25 K-file. The teeth were embedded in alginate and instrumented to #40 using rotary Lightspeed or S-Apex techniques or stainless-steel K-files. Distance between the apical foramen and the created apical stop was measured to an accuracy of 0.01 mm. In another set of instrumented teeth, root canals were obturated using gutta-percha and sealer, and leakage was tested at 1 week and 3 months using a fluid filtration device. RESULTS: All techniques performed slightly short of the predetermined level. Closest preparation to the predetermined level was with the manual technique and the farthest was with S-Apex. A significant difference was found between the performances of these two techniques (p<0.05. Lightspeed ranked in between. Leakage was similar for all techniques at either period. However, all groups leaked significantly more at 3 months compared to 1 week (p<0.05. CONCLUSIONS: Despite statistically significant differences found among the techniques, deviations from the predetermined level were small and clinically acceptable for all techniques. Leakage following obturation was comparable in all groups.

  8. Coronal and apical leakage analysis of two different root canal obturation systems

    OpenAIRE

    Patricia Gimenez Oddoni; Isabel Mello; Jeffrey Martin Coil; João Humberto Antoniazzi

    2008-01-01

    This study compared the coronal and apical leakage of AH Plus with gutta-percha to that of Epiphany with Resilon. Twenty-four single rooted teeth were instrumented and divided into 2 groups according to the solutions for smear layer removal and the obturation materials employed: Group A - 17% EDTA-T and AH Plus with gutta-percha; Group B - primer and Epiphany with Resilon. The Group B specimens were light-cured in the coronal area for 20 s. The external root surfaces were covered with a doubl...

  9. Interim obturator in an infant with Treacher Collins syndrome: Review and chairside modification in impression making

    Directory of Open Access Journals (Sweden)

    Sudhir Bhandari

    2011-01-01

    Full Text Available Treacher Collins syndrome has been described as a syndrome involving 1st and 2nd branchial arches, affecting various organs in the craniofacial region. Affected infants report with nasal regurgitation and minimal dietary intake due to cleft palate, consequently show delayed and retarded growth. The situation is further complicated when the repair of the palatal defect is postponed due to delayed milestones. At this juncture, it is of paramount importance to intervene prosthetically and close the defect with the aid of an interim obturator. Herein we describe a simple, yet successful, chairside approach to make an impression of an infant without the aid of any kind of anesthesia.

  10. Rehabilitation of patient with acquired maxillary defect, using a closed hollow bulb obturator

    Directory of Open Access Journals (Sweden)

    Abhilasha S Bhasin

    2011-01-01

    Full Text Available Palliative care means providing support and care for patients with life-threatening or debilitating illness so that they can live their life as comfortably as possible. The fact that cure is no longer a reality does not mean that care cannot be made available. Partial maxillectomy defect presents a prosthodontic challenge in terms of re-establishing oronasal separation. Such defect has direct effect on cosmetic, function and psychology of the patient. This article describes step by step clinical and laboratory procedures involved in the rehabilitation of a hemimaxillectomy patient, using a definitive closed hollow bulb obturator, which improved his physical, emotional, functional, social and spiritual needs.

  11. Classical Fourier analysis applied to a simple out-line: the bovine obturator foramen.

    OpenAIRE

    Kucherova, Irina; Parés Casanova, Pere-Miquel

    2012-01-01

    The purpose of this article it to pre-sent a procedure of shape charac-terisation using the classical Fourier analysis combined with image tech-niques. It was applied to the outline of the obturator foramen of the bo-vine pelvis. This outline was ex-tracted and characterised by an ordered series of harmonics, each harmonic being described by four coefficients. Step by step recon-structions of outlines using an in-creasing number of harmonics were then performed. Although the first seven harmo...

  12. The Effect of Two Post-Space Preparation Techniques on the Seal of Resilon and Gutta-Percha Obturation Materials

    OpenAIRE

    Kazem Ashofteh Yazdi; Hasan Razmi; Sholeh Ghabraei; Noushin Shokouhinejad; Marzieh Aligholi; Saeed Rahmani

    2010-01-01

    INTRODUCTION: The aim of this study was to compare the effect of post space preparation with Gates Glidden drills or hand files on the sealing ability of gutta-percha or Resilon obturation materials. MATERIALS AND METHODS: One-hundred and four single-rooted human teeth were instrumented and divided into four experimental groups (n=21 each) and two groups of positive and negative control (n=10). Forty-two roots of experimental groups were obturated with gutta-percha and Dorifill sealer; and 42...

  13. Monoblock Obturation Technique for Non-Vital Immature Permanent Maxillary Incisors Using Mineral Trioxide Aggregate: Results from Case Series

    International Nuclear Information System (INIS)

    Ten patients presented with non-vital immature teeth for root canal treatment. In all these cases the pre-operative clinical examination revealed apical periodontitis with a buccal sinus tract of endodontic origin. These cases were treated by a mineral trioxide aggregate (MTA) monoblock obturation technique. Follow-up evaluations were performed at 1 - 2 years after treatment. Eight out of 10 cases were associated with periradicular healing at follow-up evaluation. Mineral trioxide aggregate Monoblock obturation technique appears to be a valid material to obtain periradicular healing in teeth with open apices and necrotic pulps. (author)

  14. Peripheral nerve injuries in the athlete.

    Science.gov (United States)

    Feinberg, J H; Nadler, S F; Krivickas, L S

    1997-12-01

    Peripheral nerves are susceptible to injury in the athlete because of the excessive physiological demands that are made on both the neurological structures and the soft tissues that protect them. The common mechanisms of injury are compression, traction, ischaemia and laceration. Seddon's original classification system for nerve injuries based on neurophysiological changes is the most widely used. Grade 1 nerve injury is a neuropraxic condition, grade 2 is axonal degeneration and grade 3 is nerve transection. Peripheral nerve injuries are more common in the upper extremities than the lower extremities, tend to be sport specific, and often have a biomechanical component. While the more acute and catastrophic neurological injuries are usually obvious, many remain subclinical and are not recognised before neurological damage is permanent. Early detection allows initiation of a proper rehabilitation programme and modification of biomechanics before the nerve injury becomes irreversible. Recognition of nerve injuries requires an understanding of peripheral neuroanatomy, knowledge of common sites of nerve injury and an awareness of the types of peripheral nerve injuries that are common and unique to each sport. The electrodiagnostic exam, usually referred to as the 'EMG', consists of nerve conduction studies and the needle electrode examination. It is used to determine the site and degree of neurological injury and to predict outcome. It should be performed by a neurologist or physiatrist (physician specialising in physical medicine and rehabilitation), trained and skilled in this procedure. Timing is essential if the study is to provide maximal information. Findings such as decreased recruitment after injury and conduction block at the site of injury may be apparent immediately after injury but other findings such as abnormal spontaneous activity may take several weeks to develop. The electrodiagnostic test assists with both diagnosis of the injury and in predicting outcome. Proximal nerve injuries have a poorer prognosis for neurological recovery. The most common peripheral nerve injury in the athlete is the burner syndrome. Though primarily a football injury, burners have been reported in wrestling, hockey, basketball and weight-lifting as a result of acute head, neck and/or shoulder trauma. Most burners are self-limiting, but they occasionally produce permanent neurological deficits. The axillary nerve is commonly injured with shoulder dislocations but is also susceptible to injury by direct compression. The sciatic and common peroneal nerves can be injured by trauma. The suprascapular, musculocutaneous, ulnar, median and tibial nerves are susceptible to entrapment. The long thoracic and femoral nerves can be injured by severe traction. PMID:9421863

  15. Relationship Between Volume of Pterygopalatine Fossa and Block Anesthesia of Maxillary Nerve: A Pilot Study Relación entre el Volumen de la Fosa Pterigopalatina y la Anestesia Troncular del Nervio Maxilar: Un Estudio Piloto

    Directory of Open Access Journals (Sweden)

    Pedro Aravena Torres

    2011-09-01

    Full Text Available Block anesthesia of maxillary nerve 9BAMN is achieved by depositing anesthesia through greater palatine canal into the pterygopalatine fossa. Authors differ in the amount of anesthesia to be administered and the rate of complications (diplopia and hematomas, Coronado et al., (2008, measured the size of the pterygopalatine fossa finding an average of 1.2 ml, suggesting that amount of anesthesia for BAMN. The aim of this study is to compare the effectiveness of low doses of 1.2 ml (LDversus traditional dose of 1.8 m. (TD of anesthesia for BAMN and its adverse effects. A quasi experimental exploratory clinical study was performed involving 82 patients where the anesthetic technique was suitable for tooth extraction procedure; patients were randomized in LD and TD groups, 2% lidocaine with 1:50.000 epinephrine was used. Demographic (sex and age, clinical (tooth for extraction and anesthetic dose as well as anatomical variables (upper facial and cranial index were recorded. The anesthetic success (AS was defined as the possibility to perform the tooth extraction with no pain or minimal pain as measured by visual analogue scale (VAS. For statistical analysis chi-square and t test (p El bloqueo troncular del nervio maxilar (BTNM se logra depositando anestesia vía canal palatino mayor en la fosa pterigopalatina. Los autores difieren en la cantidad de anestesia a depositar y la tasa de complicaciones asociadas (diplopía y hematomas. Coronado et al. (2008 midió el volumen de la fosa pterigopalatina encontrando un promedio de 1,2ml, sugiriendo dicha cantidad de anestesia para el BTNM. El objetivo del presente trabajo es comparar la eficacia de dosis bajas de 1,2ml (DB versus dosis tradicional de 1,8ml (DT de anestesia para el BTNM y sus efectos adversos. Se realizó un estudio clínico cuasiexperimental de carácter exploratorio, participaron 82 pacientes donde la técnica anestésica estaba indicada para un procedimiento de exodoncia, los que fueron aleatorizados en los grupos DB y DT, administrándoles lidocaína al 2% con 1:50.000 de epinefrina. Se registraron variables demográficas (sexo y edad, clínicas (pieza a extraer y dosis administrada y anatómicas (índices facial superior y craneal. El éxito anestésico (EA se definió como la posibilidad de realizar la exodoncia con nulo o mínimo dolor, medido con escala visual análoga (EVA. En el análisis estadístico se utilizaron los tests de chi cuadrado y t de student (p<0,05. Los resultados muestran que el dolor y el EA en el grupo DB fueron de 2,93 y 61,67% y en el DT de 3,09 y 59,09% respectivamente, hubo 6 casos de diplopía sin diferencias estadísticamente significativas entre ambos grupos.

  16. Synovial sarcoma of nerve

    OpenAIRE

    Scheithauer, BW; Amrami, KK; Folpe, AL; Silva, AI; Edgar, MA; Woodruff, JM; Levi, AD; Spinner, RJ

    2011-01-01

    Tumors of peripheral nerve are largely neuroectodermal in nature and derived from 2 elements of nerve, Schwann or perineurial cells. In contrast, mesenchymal tumors affecting peripheral nerve are rare and are derived mainly from epineurial connective tissue. The spectrum of the latter is broad and includes lipoma, vascular neoplasms, hematopoietic tumors, and even meningioma. Of malignant peripheral nerve neoplasms, the vast majority are primary peripheral nerve sheath tumors. Malignancies of...

  17. Photoelastic analysis to compare implant-retained and conventional obturator dentures

    Science.gov (United States)

    Goiato, Marcelo Coelho; Prado Ribeiro, Paula do; Pellizzer, Eduardo Piza; Pesqueira, Aldiéris Alves; Haddad, Marcela Filiè; dos Santos, Daniela Micheline; Moreno, Amália

    2012-06-01

    The use of photoelastic analysis contributes to the rehabilitation of patients with oral-sinus-nasal sequelae, which in turn affect important functions such as chewing, swallowing, and speech. The prosthetic rehabilitation with implant-retained dentures is a suitable treatment option. The purpose of this study was to verify, by using a photoelastic analysis, the stress distribution in implant-retained palatal obturator dentures (relined or not) associated with different attachment systems (O-ring, bar-clip, and bar-clip associated with distally placed O-rings). Two photoelastic models were obtained from an experimental maxillary cast presenting an oral-nasal communication. One model had two 13-mm length implants placed on the left region. A total of eight colorless maxillary obturators were fabricated and subsequently four of them were relined with soft silicone soft, and three had attachment systems associated. The assembly (model/attachment system/prosthesis) was positioned in a circular polariscope and a 100-N load was applied at 10 mm/s. The results showed that the denture relining influenced the distribution and amount of stress on the models. The O-ring group displayed the lowest stress levels, followed by bar-clip system associated with distally placed O-rings and bar-clip groups.

  18. Application of microcomputed tomography for quantitative analysis of dental root canal obturations

    Directory of Open Access Journals (Sweden)

    Anna Kierklo

    2014-03-01

    Full Text Available Introduction: The aim of the study was to apply microcomputed tomography to quantitative evaluation of voids and to test any specific location of voids in tooth’s root canal obturations. Materials and Methods: Twenty root canals were prepared and obturated with gutta-percha and Tubli-Seal sealer using the thermoplastic compaction method (System B + Obtura II. Roots were scanned and three-dimensional visualization was obtained. The volume and Feret’s diameter of I-voids (at the filling/dentine interface and S-voids (surrounded by filling material were measured. Results: The results revealed that none of the scanned root canal fillings were void-free. For I-voids, the volume fraction was significantly larger, but their number was lower (P = 0.0007, than for S-voids. Both types of voids occurred in characteristic regions (P < 0.001. I-voids occurred mainly in the apical third, while S-voids in the coronal third of the canal filling. Conclusions: Within the limitations of this study, our results indicate that microtomography, with proposed semi-automatic algorithm, is a useful tools for three-dimensional quantitative evaluation of dental root canal fillings. In canals filled with thermoplastic gutta-percha and Tubli-Seal, voids at the interface between the filling and canal dentine deserve special attention due to of their periapical location, which might promote apical microleakage. Further studies might help to elucidate the clinical relevance of these results.

  19. Evaluation of three instrumentation techniques at the precision of apical stop and apical sealing of obturation

    Scientific Electronic Library Online (English)

    Özgür, Genç; Tayfun, Alaçam; Guven, Kayaoglu.

    2011-08-01

    Full Text Available OBJECTIVE: The aim of this study was to investigate the ability of two NiTi rotary apical preparation techniques used with an electronic apex locator-integrated endodontic motor and a manual technique to create an apical stop at a predetermined level (0.5 mm short of the apical foramen) in teeth wit [...] h disrupted apical constriction, and to evaluate microleakage following obturation in such prepared teeth. MATERIAL AND METHODS: 85 intact human mandibular permanent incisors with single root canal were accessed and the apical constriction was disrupted using a #25 K-file. The teeth were embedded in alginate and instrumented to #40 using rotary Lightspeed or S-Apex techniques or stainless-steel K-files. Distance between the apical foramen and the created apical stop was measured to an accuracy of 0.01 mm. In another set of instrumented teeth, root canals were obturated using gutta-percha and sealer, and leakage was tested at 1 week and 3 months using a fluid filtration device. RESULTS: All techniques performed slightly short of the predetermined level. Closest preparation to the predetermined level was with the manual technique and the farthest was with S-Apex. A significant difference was found between the performances of these two techniques (p

  20. Application of microcomputed tomography for quantitative analysis of dental root canal obturations

    Directory of Open Access Journals (Sweden)

    Małgorzata Jaworska

    2014-03-01

    Full Text Available Introduction: The aim of the study was to apply microcomputed tomography to quantitative evaluation of voids and to test any specific location of voids in tooth’s root canal obturations. Materials and Methods: Twenty root canals were prepared and obturated with gutta-percha and Tubli-Seal sealer using the thermoplastic compaction method (System B + Obtura II. Roots were scanned and three-dimensional visualization was obtained. The volume and Feret’s diameter of I-voids (at the filling/dentine interface and S-voids (surrounded by filling material were measured. Results: The results revealed that none of the scanned root canal fillings were void-free. For I-voids, the volume fraction was significantly larger, but their number was lower (P = 0.0007, than for S-voids. Both types of voids occurred in characteristic regions (P < 0.001. I-voids occurred mainly in the apical third, while S-voids in the coronal third of the canal filling. Conclusions: Within the limitations of this study, our results indicate that microtomography, with proposed semi-automatic algorithm, is a useful tools for three-dimensional quantitative evaluation of dental root canal fillings. In canals filled with thermoplastic gutta-percha and Tubli-Seal, voids at the interface between the filling and canal dentine deserve special attention due to of their periapical location, which might promote apical microleakage. Further studies might help to elucidate the clinical relevance of these results.

  1. Bilateral variant of sciatic nerve exhibiting intra-pelvic division

    Directory of Open Access Journals (Sweden)

    Rejeena P Raj, Kunjumon PC, More Anju B

    2014-04-01

    Full Text Available Context (background: In case of high division of the sciatic nerve in the pelvis its, common peroneal component may pierce the Piriformis muscle. This anatomical variant can explain many clinical findings. Aims: Its objective is to report a case of high division of the sciatic nerve in order to contribute towards better anatomical understanding of the gluteal region. Methods and Material: Routine undergraduate dissection of a male cadaver revealed bilateral variation in sciatic nerve. Results: Sciatic nerve is dividing into tibial and common peroneal components in the pelvis. Common peroneal component is piercing through the piriformis muscle. Tibial component is emerging between piriformis and superior gemelli muscle. Conclusions: Sciatic nerve variation can lead to a Piriformis muscle syndrome, inadvertent injury during operations in the gluteal region, failure of sciatic nerve block and/or sciatic neuropathy. The differences in routes of these two nerve components can explain them.

  2. Comparison of apical leakage in root canals obturated with various gutta percha techniques using a dye vacuum tracing method.

    Science.gov (United States)

    Dalat, D M; Spångberg, L S

    1994-07-01

    In this study, residual apical microlumina remaining after obturation with five different gutta-percha obturation methods were traced with an efficient vacuum method. Seventy-nine human maxillary anterior teeth were instrumented and divided into five groups. The groups were obturated with single-cone techniques, lateral condensation, vertical condensation, Thermafil, and Ultrafil techniques. All specimens were immersed in a vacuum flask containing 2% methylene blue dye solution. The air was evacuated with a vacuum pump to an absolute pressure of 75 torr for 30 min. The roots were sectioned longitudinally and the linear extent of dye penetration was measured. Group mean linear dye penetration values were: single-cone technique, 1.55 +/- 0.95 mm; lateral condensation, 2.25 +/- 1.46 mm; vertical condensation, 2.61 +/- 2.61 mm; Thermafil 1.41 +/- 1.16 mm; and Ultrafil 3.51 +/- 4.70 mm. There were no statistically significant differences between the gutta-percha obturation methods. The clinical implications of these findings are discussed. PMID:7996091

  3. Influence of the spatulation of two zinc oxide-eugenol-based sealers on the obturation of lateral canals

    Directory of Open Access Journals (Sweden)

    Pécora Jesus Djalma

    2002-01-01

    Full Text Available The objective of this research was to evaluate, in vitro, the importance of the correct manipulation of endodontic sealers, correlating it with flow rate and with the consequent obturation of root canals. Twenty-four human canines were prepared, 1 mm from the apex, with K-files up to size 50, by means of the step-back technique. Six lateral canals were then drilled in each tooth, with size 10 file fixed to a low-speed handpiece. The teeth were randomly divided into 4 groups, and root canals were obturated either with the EndométhasoneÒ sealer or Grossman sealer, prepared at ideal or incorrect clinical consistency. After obturation by means of the lateral condensation technique, the teeth were radiographed and evaluated as to the number of sealed lateral canals. Statistical analysis revealed significant differences (p < 0.001 between the tested sealers, and indicated the higher capacity of the well-manipulated Grossman sealer to fill lateral canals. It can be concluded that the flow rate of a sealer and its correct manipulation are very important for the satisfactory obturation of lateral canals.

  4. Microleakage of Single-Cone Gutta-Percha Obturation Technique in Combination with Different Types of Sealers

    Science.gov (United States)

    Sadr, Saeedeh; Golmoradizadeh, Ali; Raoof, Maryam; Tabanfar, Mohammad Javad

    2015-01-01

    Introduction: Various materials and methods have been recommended for successful root canal obturation. The aim of this experimental in vitro study was to compare the sealing ability of three root canal sealers AH-26, glass ionomer cement (GIC) and zinc oxide eugenol (ZOE) in single gutta-percha obturating system. Methods and Materials: Seventy extracted single-rooted human teeth were decoronated. The teeth were randomly divided into 3 experimental groups (n=20) and 2 positive and negative control groups. After root canal preparation, canals were obturated with single-cone method using either AH-26, GIC and ZOE. The leakage was evaluated using the dye penetration method. The samples were sectioned to evaluate the linear leakage using a stereomicroscope. The data were analyzed using the One-way ANOVA test. Results: All the specimens in the positive control group showed evidence of leakage. In the experimental groups, the lowest leakage scores were observed in the AH-26 group (P<0.05). However, there were no statistically significant differences between GIC and ZOE samples (P=0.676). Conclusion: AH-26 showed a superior seal and less microleakage compared to the two other materials in single gutta-percha obturating system. PMID:26213544

  5. Rock blocks

    OpenAIRE

    Turner, W

    2007-01-01

    Consider representation theory associated to symmetric groups, or to Hecke algebras in type A, or to q-Schur algebras, or to finite general linear groups in non-describing characteristic. Rock blocks are certain combinatorially defined blocks appearing in such a representation theory, first observed by R. Rouquier. Rock blocks are much more symmetric than general blocks, and every block is derived equivalent to a Rock block. Motivated by a theorem of J. Chuang and R. Kessar ...

  6. Bloqueio do nervo frênico após realização de bloqueio do plexo braquial pela via interescalênica: relato de caso / Phrenic nerve block after interscalene brachial plexus block: case report / A bloqueo del nervio frénico después de la realización de bloqueo del plexo braquial por la vía interescalénica: relato de caso

    Scientific Electronic Library Online (English)

    Luis Henrique, Cangiani; Luis Augusto Edwards, Rezende; Armando, Giancoli Neto.

    2008-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Bloqueio do nervo frênico é um evento adverso do bloqueio do plexo braquial; entretanto, na sua maioria, sem repercussões clínicas importantes. O objetivo deste relato foi apresentar um caso em que ocorreu bloqueio do nervo frênico, com comprometimento ventilatório, em pac [...] iente com insuficiência renal crônica submetido a instalação de fístula arteriovenosa extensa, sob bloqueio do plexo braquial pela via perivascular interescalênica. RELATO DO CASO: Paciente do sexo masculino, 50 anos, tabagista, portador de insuficiência renal crônica em regime de hemodiálise, hipertensão arterial, hepatite C, diabetes mellitus, doença pulmonar obstrutiva crônica, a ser submetido à instalação de fístula arteriovenosa extensa no membro superior direito sob bloqueio de plexo braquial pela via interescalênica. O plexo braquial foi localizado com utilização do estimulador de nervo periférico. Foram injetados 35 mL de uma solução de anestésico local, constituída de uma mistura de lidocaína a 2% com epinefrina a 1:200.000 e ropivacaína a 0,75% em partes iguais. Ao final da injeção o paciente apresentava-se lúcido, porém com dispnéia e predomínio de incursão respiratória intercostal ipsilateral ao bloqueio. Não havia murmúrio vesicular na base do hemitórax direito. A SpO2 manteve-se em 95%, com cateter nasal de oxigênio. Não foi necessária instalação de métodos de auxílio ventilatório invasivo. Radiografia do tórax revelou que o hemidiafragma direito ocupava o 5° espaço intercostal. O quadro clínico foi revertido em três horas. CONCLUSÕES: O caso mostrou que houve paralisia total do nervo frênico com sintomas respiratórios. Apesar de não ter sido necessária terapêutica invasiva para o tratamento, fica o alerta para a restrição da indicação da técnica nesses casos. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El bloqueo del nervio frénico es un evento adverso del bloqueo del plexo braquial, sin embargo, en su mayoría, sin repercusiones clínicas importantes. El objetivo de este relato fue presentar un caso en que ocurrió bloqueo del nervio frénico, con comprometimiento ventilato [...] rio en paciente con insuficiencia renal crónica, sometido a la instalación de fístula arterio-venosa extensa, bajo bloqueo del plexo braquial por la vía perivascular interescalénica. RELATO DEL CASO: Paciente del sexo masculino, 50 años, tabaquista, portador de insuficiencia renal crónica en régimen de hemodiálisis, hipertensión arterial, hepatitis C, diabetes melito, enfermedad pulmonar obstructiva crónica, sometido a la instalación de fístula arterio-venosa extensa en el miembro superior derecho bajo bloqueo de plexo braquial por la vía interescalénica. El plexo braquial fue localizado con la utilización del estimulador de nervio periférico. Se inyectaron 35 mL de una solución de anestésico local constituida de una mezcla de lidocaína a 2% con epinefrina a 1:200.000 y ropivacaína a 0,75% en partes iguales. Al final de la inyección el paciente estaba lúcido, pero sin embargo con disnea y predominio de incursión respiratoria intercostal ipsilateral al bloqueo. No había murmullo vesicular en la base del hemitórax derecho. La SpO2 se mantuvo en un 95%, con catéter nasal de oxígeno. No fue necesaria la instalación de métodos de auxilio ventilatorio invasivo. La radiografía del tórax reveló que el hemidiafragma derecho ocupaba el 5° espacio intercostal. El cuadro clínico se revirtió en tres horas. CONCLUSIONES: El caso mostró que hubo parálisis total del nervio frénico con síntomas respiratorios. A pesar de no haber sido necesaria la terapéutica invasiva para el tratamiento, queda el aviso aquí para la restricción de la indicación de la técnica en esos casos. Abstract in english BACKGROUND AND OBJECTIVES: Phrenic nerve block is a common adverse event of brachial plexus block. However, in most cases it does not have any important clinical repercussion. The objective of this work was to report a case

  7. Nerve injury locations during retropubic sling procedures.

    Science.gov (United States)

    Fisher, Hilaire W; Lotze, Peter M

    2011-04-01

    The risk of persistent pain following a retropubic sling is rare (1%). Nerve injuries have been suspected as a cause of persistent postoperative pain. We present two cases of postoperative pain thought to be secondary to injury or mechanical distortion of two different pelvic nerves. Visual exam, cystoscopy, and MRI studies demonstrated no abnormal findings. Manual examination produced site-specific tenderness thought to be associated with a specific nerve distribution. Each patient's pain was first relieved with a local anesthetic block at the site of the pain. One patient required surgical excision of the mesh, and the second patient only required conservative management. Both patients' pain completely resolved. Based on these and other reported cases, along with cadaveric dissections, we hypothesize that retropubic slings can potentially injure the pudendal, ilioinguinal, and iliohypogastric nerve branches. PMID:21060989

  8. Avaliação da dor pós-operatória e alta hospitalar com bloqueio dos nervos ilioinguinal e ílio-hipogástrico durante herniorrafia inguinal realizada com raquianestesia: estudo prospectivo / Assessment of postoperative pain and hospital discharge after inguinal and iliohypogastric nerve block for inguinal hernia repair under spinal anesthesia: a prospective study

    Scientific Electronic Library Online (English)

    Guilherme de Castro, Santos; Gisela Magalhães, Braga; Fábio Lopes, Queiroz; Túlio Pinho, Navarro; Renato Santiago, Gomez.

    2011-10-01

    Full Text Available OBJETIVO: Comparar a qualidade da analgesia (intensidade da dor e consumo de analgésicos) e o tempo de alta hospitalar dos pacientes que receberam ou não bloqueio ilioinguinal (II) e ílio- hipogástrico (IH) pós-incisão associado à infiltração da ferida operatória com ropivacaína 0,75% em cirurgia de [...] herniorrafia inguinal, sob raquianestesia. MÉTODOS: Foi realizado estudo prospectivo, aleatório, duplo-cego com 34 pacientes submetidos à herniorrafia inguinal. Eles foram divididos em dois grupos: controle (C) e bloqueio II e IH (B). O grupo C (n = 17) recebeu raquianestesia com 15 mg de bupivacaína 0,5% hiperbárica e o grupo B (n = 17) recebeu raquianestesia com 15 mg de bupivacaína 0,5% hiperbárica em associação com bloqueio II e IH (10 mL de ropivacaína 0,75%) e infiltração da ferida cirúrgica (10 mL de ropivacaína 0,75%). Foram registrados os dados antropométricos, intensidade da dor pela escala analógica visual (EAV) e número de doses de analgésicos (dipirona, cetorolaco e nalbufina) no pós-operatório imediato, assim como o tempo de alta hospitalar. RESULTADOS: A EAV em repouso três horas após o término do procedimento e o tempo de hospitalização foram significativamente menores no grupo B em comparação com o grupo C (p Abstract in english OBJECTIVE: This study was designed to evaluate analgesia (pain intensity and analgesic consumption) and the time of discharge of patients who underwent ilioinguinal (II) and iliohypogastric (IH) nerve block associated with wound infiltration with 0.75% ropivacaine, or not, after inguinal hernia repa [...] ir surgery under spinal anesthesia. METHODS: This was a prospective, randomized, double-blind study with 34 patients undergoing inguinal hernia repair. Patients were divided into two groups: control (C) and II and IH nerve block (B). Group C (n = 17) received spinal anesthesia with 15 mg hyperbaric 0.5% bupivacaine and Group B (n = 17) received spinal anesthesia with 15 mg hyperbaric 0.5% bupivacaine associated with II and IH nerve block (10 mL of 0.75% ropivacaine) and surgical wound infiltration (10 mL of 0.75% ropivacaine). The following data were analyzed: demographic data, pain intensity according to the visual analog scale (VAS), and number of doses of analgesics (dipyrone, ketorolac and nalbuphine) in the immediate postoperative period, as well as at the time of hospital discharge. RESULTS: The VAS at rest was significantly lower in Group B compared with Group C (p

  9. Root canal obturation by hybrid technique of thermomechanical gutta-percha compaction

    Directory of Open Access Journals (Sweden)

    Ili? Dragan

    2004-01-01

    Full Text Available The purpose of the study was to present and discuss the thermomechanical hybrid technique in root canal obturation and investigate the efficiency of apical hermeticity. The hybrid obturation technique is well explained and performed through the lexan models and extracted teeth in aim of better visualisation and comprehension as suggested by the author Tagger and McSpadden’s articles. The technique consisted of lateral condensation of gutta-percha that was followed by thermomechanical compaction of the same mass using Ni-Ti flexible compactor. Firstly the master gutta-percha cone had to be adapted and then the master machine compactor selected for setting inside the canal. Upon laterally arranging gutta-percha cones, the master compactor was inserted between canal wall and gutta-percha. The master compactor was rotated for 5-6 seconds to creat heat to soften the cones to merge themselves and fill the first half of the canal. The bigger compactor served to fill the rest of the canal adding more gutta-percha cones. In comparison to the single cone and simple manual compaction techniques the hybrid technique is less time consuming more efficient in homogenicity and apical leakage. Considering the many device-consuming techniques the hybrid one is simpler to perform and cheaper as well. Precaution is to be taken when treating curved and narrow canals where much patience is needed due to possible compactor breakage and root fracture. It can be concluded that this hybrid technique is preferable particularly in cases of relatively straight canals with preserved apical foramen when time is to be saved for the radiographic and prosthetics procedure that has to be done during the same visit, which is very often convenient for patient and therapist.

  10. The Physics of Nerves

    CERN Document Server

    Heimburg, Thomas

    2010-01-01

    The accepted model for nerve pulse propagation in biological membranes seems insufficient. It is restricted to dissipative electrical phenomena and considers nerve pulses exclusively as a microscopic phenomenon. A simple thermodynamic model that is based on the macroscopic properties of membranes allows explaining more features of nerve pulse propagation including the phenomenon of anesthesia that has so far remained unexplained.

  11. [Who is responsible for the postoperative nerve injury? Anesthesia? Orthopedics? Trauma?].

    Science.gov (United States)

    Kelsaka, Ebru; Güldo?u?, Fuat; Erdo?an, Murat; Zengin, Eyüp Ca?atay

    2014-01-01

    In the pathogenesis of peripheral nerve injury, mechanical as well as vascular pressure, and chemical reasons play a role. In the applications of peripheral nerve block, there can be mechanical injury due to the type of needle and intrafascicular injections. In humerus fractures, nerve injury can be seen due to the surgical retractions and close proximity of the nerves with the bone. In addition, trauma may be the reason for posttraumatic nerve injury. In this presentation, we discussed the causes of postoperative nerve damage, which is seen after the operation of the distal humerus fracture. PMID:25205414

  12. Unusual Communications between the Cutaneous Branches of Ulnar Nerve in the Palm

    OpenAIRE

    Sirasanagandla, Srinivasa Rao; Padavinangady, Abhinitha; Nayak, Satheesha B.; Jetti, Raghu

    2015-01-01

    Variations of dorsal and volar digital cutaneous branches of ulnar nerve are of tremendous clinical importance for successful regional nerve blocks, skin flaps, carpal tunnel release and placement of electrodes for electrophysiological studies. With the aforementioned clinical implications it is worth to report the variations of cutaneous branches of ulnar nerve. In the current case, we have encountered a rare variation (Kaplan`s anastomosis) of ulnar nerve, in the right upper limb. We have n...

  13. Features and Principles the Spread of Local Anesthetic Blockade of the Sciatic Nerve at Depends on the Amount of Anesthetic

    OpenAIRE

    Piacherski Valery; Marachkou Aliaksei

    2014-01-01

    Aim: To study the features of local anesthetic solution spreading during sciatic nerve block in dependence on the anesthetic solution volume. Material and Methods: One hundred and sixty nine cases of sciatic nerve blocks done under ultrasonic visualization control were analyzed. Sciatic nerve blocks were performed by lidocaine in volumes 30; 25; 20; 15; 12.5; 10; 7.5; 6.5; 5; 4.5 ml. The cross-section area, equal to local anesthetic spreading, was determined; the extension...

  14. An in Vitro Comparison of Apical Microleakage in Two Obturation Techniques: Lateral Condensation and One-Step

    Directory of Open Access Journals (Sweden)

    AR - Farhad

    2006-01-01

    Full Text Available Introduction: For a successful root canal treatment, canal must be obturated apically, coronally and laterally to prevent microleakage and canal reinfection. Cold lateral condensation is the most popular method of canal obturation; an easy method with a controlled filling. Cold lateral technique disadvantages are presence of void, possible vertical root fracture, and absence of a homogenous and condensed filling. In some techniques like One-step, heat is used to soften gutta-percha for better adaptation to canal walls. The purpose of this study was to compare of the apical microleakage in roots obturated with One-step and lateral condensation techniques.Methods and materials: In this in invitro study ninety extracted human maxillary central incisors, canines, and mandibular premolar (single rooted teeth were instrumented to a size 40 file and step back flaring was performed to a size 80 file. Apical patency was ensured in all teeth. The teeth were divided into two experimental groups of 40 each and two positive and negative control groups. In the first experimental group, the roots were obturated with lateral condensation gutta-percha technique and AH26 as a sealer. In the second experimental group, the roots were obturated with One-step technique and AH26 according to the instruction of manufacturer. All roots were placed in humidor with 100% humidity and incubated at 37ºc for 3 days to allow the sealer to set. After achieving coronal seal, the roots were coated with two layers of fingernail polish and one layer of stickywax except for the apical 2-3mm and then placed into India ink and incubated at 37ºc for 72h. The roots were removed from the dye, fractured longitudinally and liner dye penetration was measured.Results: The mean apical dye penetration in laterally condensed technique and One –step technique were 3.60±2.03 mm and 4.00±2.23 mm respectively. Dye penetration in negative control group was zero, and in the positive control group dye pentrated through all the canal system. Statistical analysis of the results did not show significant difference between two groups.Conclusion: Although there was no statistical difference in the sealing ability of laterally condensed and One-step techniques, further in vivo and in vitro studies are needed to prove the clinical abilities of One-step technique.Key words: Apical microleakage, Obturation, Lateral Condensation, One-step

  15. Avaliação da dor pós-operatória e alta hospitalar com bloqueio dos nervos ilioinguinal e ílio-hipogástrico durante herniorrafia inguinal realizada com raquianestesia: estudo prospectivo Assessment of postoperative pain and hospital discharge after inguinal and iliohypogastric nerve block for inguinal hernia repair under spinal anesthesia: a prospective study

    Directory of Open Access Journals (Sweden)

    Guilherme de Castro Santos

    2011-10-01

    Full Text Available OBJETIVO: Comparar a qualidade da analgesia (intensidade da dor e consumo de analgésicos e o tempo de alta hospitalar dos pacientes que receberam ou não bloqueio ilioinguinal (II e ílio- hipogástrico (IH pós-incisão associado à infiltração da ferida operatória com ropivacaína 0,75% em cirurgia de herniorrafia inguinal, sob raquianestesia. MÉTODOS: Foi realizado estudo prospectivo, aleatório, duplo-cego com 34 pacientes submetidos à herniorrafia inguinal. Eles foram divididos em dois grupos: controle (C e bloqueio II e IH (B. O grupo C (n = 17 recebeu raquianestesia com 15 mg de bupivacaína 0,5% hiperbárica e o grupo B (n = 17 recebeu raquianestesia com 15 mg de bupivacaína 0,5% hiperbárica em associação com bloqueio II e IH (10 mL de ropivacaína 0,75% e infiltração da ferida cirúrgica (10 mL de ropivacaína 0,75%. Foram registrados os dados antropométricos, intensidade da dor pela escala analógica visual (EAV e número de doses de analgésicos (dipirona, cetorolaco e nalbufina no pós-operatório imediato, assim como o tempo de alta hospitalar. RESULTADOS: A EAV em repouso três horas após o término do procedimento e o tempo de hospitalização foram significativamente menores no grupo B em comparação com o grupo C (p OBJECTIVE: This study was designed to evaluate analgesia (pain intensity and analgesic consumption and the time of discharge of patients who underwent ilioinguinal (II and iliohypogastric (IH nerve block associated with wound infiltration with 0.75% ropivacaine, or not, after inguinal hernia repair surgery under spinal anesthesia. METHODS: This was a prospective, randomized, double-blind study with 34 patients undergoing inguinal hernia repair. Patients were divided into two groups: control (C and II and IH nerve block (B. Group C (n = 17 received spinal anesthesia with 15 mg hyperbaric 0.5% bupivacaine and Group B (n = 17 received spinal anesthesia with 15 mg hyperbaric 0.5% bupivacaine associated with II and IH nerve block (10 mL of 0.75% ropivacaine and surgical wound infiltration (10 mL of 0.75% ropivacaine. The following data were analyzed: demographic data, pain intensity according to the visual analog scale (VAS, and number of doses of analgesics (dipyrone, ketorolac and nalbuphine in the immediate postoperative period, as well as at the time of hospital discharge. RESULTS: The VAS at rest was significantly lower in Group B compared with Group C (p < 0.05, three hours after the procedure, with no differences on VAS during movement in all postoperative periods. The number of doses of analgesics during the postoperative period was similar in both groups, but patients in Group B were discharged earlier than in Group C. CONCLUSION: II and IH nerve block associated with surgical wound infiltration with 0.75% ropivacaine provides better postoperative analgesia and early hospital discharge in patients undergoing inguinal hernia repair under spinal anesthesia.

  16. Optic nerve oxygenation

    DEFF Research Database (Denmark)

    Stefánsson, Einar; Pedersen, Daniella Bach; Jensen, Peter Koch; la Cour, Morten; Kiilgaard, Jens Folke; Bang, Kurt; Eysteinsson, Thor

    2005-01-01

    glaucoma patients is six times higher at a perfusion pressure of 30 mmHg, which corresponds to a level where the optic nerve is hypoxic in experimental animals, as compared to perfusion pressure levels above 50 mmHg where the optic nerve is normoxic. Medical intervention can affect optic nerve oxygen......The oxygen tension of the optic nerve is regulated by the intraocular pressure and systemic blood pressure, the resistance in the blood vessels and oxygen consumption of the tissue. The oxygen tension is autoregulated and moderate changes in intraocular pressure or blood pressure do not affect the...... optic nerve oxygen tension. If the intraocular pressure is increased above 40 mmHg or the ocular perfusion pressure decreased below 50 mmHg the autoregulation is overwhelmed and the optic nerve becomes hypoxic. A disturbance in oxidative metabolism in the cytochromes of the optic nerve can be seen at...

  17. Nerve conduction and excitability studies in peripheral nerve disorders

    DEFF Research Database (Denmark)

    Krarup, Christian; Moldovan, Mihai

    2009-01-01

    PURPOSE OF REVIEW: The review is aimed at providing information about the role of nerve excitability studies in peripheral nerve disorders. It has been known for many years that the insight into peripheral nerve pathophysiology provided by conventional nerve conduction studies is limited. Nerve excitability studies are relatively novel but are acquiring an increasingly important role in the study of peripheral nerves. RECENT FINDINGS: By measuring responses in nerve that are related to nodal fun...

  18. Additional Nerve Supply of Gluteus Maximus by Common Peroneal Nerve

    OpenAIRE

    Khayati Sant Ram,; Anjali Aggarwal,; Tulika Gupta; Richa Gupta,; Daisy Sahini

    2015-01-01

    During routine dissection, variation of sciatic nerve was discovered bilaterally. Sciatic nerve emerged from the pelvis through greater sciatic foramen. On both sides, it divided into common peroneal nerve and tibial nerve. Common peroneal nerve pierced the piriformis muscle with resultant splitting of the muscle into two parts. Tibial nerve emerged at the lower border of muscle, thus two divisions of sciatic nerve were separated by the inferior belly of the piriformis muscle. On the left sid...

  19. Epidural block

    Science.gov (United States)

    An epidural block is a numbing medicine given by injection (shot) in the back. It numbs or causes a loss of ... the pain of contractions during childbirth. An epidural block may also be used to reduce pain during ...

  20. Penetration of a resin-based filling material into lateral root canals and quality of obturation by different techniques

    Scientific Electronic Library Online (English)

    André Luiz da Costa, MICHELOTTO; Cacio, MOURA-NETTO; Angela Toshie, ARAKI; Eduardo, AKISUE; Gilson Blitzkow, SYDNEY.

    Full Text Available The aim of this study was to evaluate the penetration of a resin/polyester polymer-based material (Resilon Real Seal; SybronEndo Corp., Orange, USA) into simulated lateral canals, and the quality of obturations by different techniques. A total of 30 standardized simulated canals were divided into th [...] ree groups according to the technique of obturation used: MS (McSpadden), SB (SystemB/Obtura II), and LC (Lateral Condensation). To analyze the penetration of the filling material, the simulated canals were digitalized and the images were analyzed using the Leica QWIN Pro v2.3 software. The data of the middle and apical thirds were separately submitted to analysis of variance (ANOVA), followed by the Tukey’s test for the comparison of the techniques. Results showed a significant difference (p

  1. Population Blocks.

    Science.gov (United States)

    Smith, Martin H.

    1992-01-01

    Describes an educational game called "Population Blocks" that is designed to illustrate the concept of exponential growth of the human population and some potential effects of overpopulation. The game material consists of wooden blocks; 18 blocks are painted green (representing land), 7 are painted blue (representing water); and the remaining…

  2. Population Blocks.

    Science.gov (United States)

    Smith, Martin H.

    1992-01-01

    Describes an educational game called "Population Blocks" that is designed to illustrate the concept of exponential growth of the human population and some potential effects of overpopulation. The game material consists of wooden blocks; 18 blocks are painted green (representing land), 7 are painted blue (representing water); and the remaining…

  3. Comparative evaluation of continuous intercostal nerve block or epidural analgesia on the rate of respiratory complications, intensive care unit, and hospital stay following traumatic rib fractures: a retrospective review

    Science.gov (United States)

    Britt, Todd; Sturm, Ryan; Ricardi, Rick; Labond, Virginia

    2015-01-01

    Background Thoracic trauma accounts for 10%–15% of all trauma admissions. Rib fractures are the most common injury following blunt thoracic trauma. Epidural analgesia improves patient outcomes but is not without problems. The use of continuous intercostal nerve blockade (CINB) may offer superior pain control with fewer side effects. This study’s objective was to compare the rate of pulmonary complications when traumatic rib fractures were treated with CINB vs epidurals. Methods A hospital trauma registry provided retrospective data from 2008 to 2013 for patients with 2 or more traumatic rib fractures. All subjects were admitted and were treated with either an epidural or a subcutaneously placed catheter for continuous intercostal nerve blockade. Our primary outcome was a composite of either pneumonia or respiratory failure. Secondary outcomes included total hospital days, total ICU days, and days on the ventilator. Results 12.5% (N=8) of the CINB group developed pneumonia or had respiratory failure compared to 16.3% (N=7) in the epidural group. No statistical difference (P=0.58) in the incidence of pneumonia or vent dependent respiratory failure was observed. There was a significant reduction (P=0.05) in hospital days from 9.72 (SD 9.98) in the epidural compared to 6.98 (SD 4.67) in the CINB group. The rest of our secondary outcomes showed no significant difference. Conclusion This study did not show a difference in the rate of pneumonia or ventilator-dependent respiratory failure in the CINB vs epidural groups. It was not sufficiently powered. Our data supports a reduction in hospital days when CINB is used vs epidural. CINB may have advantages over epidurals such as fewer complications, fewer contraindications, and a shorter time to placement. Further studies are needed to confirm these statements. PMID:26604819

  4. A Comparative Study of the Microleakage of Resilon/Epiphany and Gutta-Percha/AH-Plus Obturating Systems

    OpenAIRE

    Elmakki Fathia; Neamat Hassan Abu-bakr; Ibrahim Yahia

    2012-01-01

    Introduction: The aim of the present study was to investigate and compare the apical sealing ability of Resilon/Epiphany-filled root canals with those that were obturated with gutta-percha/AH-Plus endodontic sealer. Materials and Methods: A total of 60 extracted human single-rooted teeth were selected; 25 teeth for the two test groups and five for each control group. After conducting conventional endodontic treatment, the teeth were immersed in physiologic saline solution for thirty days, and...

  5. Pregnancy after tension-free vaginal mesh (anterior Prolift) and concomitant tension-free vaginal tape-obturator procedure

    OpenAIRE

    Jia Wang; Yi Dai; Yi Luo; Xiao Luo; Li Xiao Wan; Chao Han Zhang; Yin Xiu Xia; Hong Shen

    2011-01-01

    Objective. Treatment of anterior vaginal wall prolapse and stress urinary incontinence (SUI) with transobturator tension-free vaginal mesh (anterior Prolift) and concomitant tension-free vaginal tape-obturator (TVT-O) has been proved feasible, safe and effective. However, there is little known about the influence of pregnancy on women who have had such procedures before pregnancy. Design and methods. A 32-year-old woman (gravid 1, para 1) with two years history of SUI and nine months history ...

  6. Imaging the trigeminal nerve

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Alexandra [Radiology Department, Instituto Portugues de Oncologia Francisco Gentil, Centro de Lisboa, Rua Prof. Lima Basto, 1093, Lisboa (Portugal)], E-mail: borgalexandra@gmail.com; Casselman, Jan [Department of Radiology, A. Z. St Jan Brugge and A. Z. St Augustinus Antwerpen Hospitals (Belgium)

    2010-05-15

    Of all cranial nerves, the trigeminal nerve is the largest and the most widely distributed in the supra-hyoid neck. It provides sensory input from the face and motor innervation to the muscles of mastication. In order to adequately image the full course of the trigeminal nerve and its main branches a detailed knowledge of neuroanatomy and imaging technique is required. Although the main trunk of the trigeminal nerve is consistently seen on conventional brain studies, high-resolution tailored imaging is mandatory to depict smaller nerve branches and subtle pathologic processes. Increasing developments in imaging technique made possible isotropic sub-milimetric images and curved reconstructions of cranial nerves and their branches and led to an increasing recognition of symptomatic trigeminal neuropathies. Whereas MRI has a higher diagnostic yield in patients with trigeminal neuropathy, CT is still required to demonstrate the bony anatomy of the skull base and is the modality of choice in the context of traumatic injury to the nerve. Imaging of the trigeminal nerve is particularly cumbersome as its long course from the brainstem nuclei to the peripheral branches and its rich anastomotic network impede, in most cases, a topographic approach. Therefore, except in cases of classic trigeminal neuralgia, in which imaging studies can be tailored to the root entry zone, the full course of the trigeminal nerve has to be imaged. This article provides an update in the most recent advances on MR imaging technique and a segmental imaging approach to the most common pathologic processes affecting the trigeminal nerve.

  7. Imaging the trigeminal nerve

    International Nuclear Information System (INIS)

    Of all cranial nerves, the trigeminal nerve is the largest and the most widely distributed in the supra-hyoid neck. It provides sensory input from the face and motor innervation to the muscles of mastication. In order to adequately image the full course of the trigeminal nerve and its main branches a detailed knowledge of neuroanatomy and imaging technique is required. Although the main trunk of the trigeminal nerve is consistently seen on conventional brain studies, high-resolution tailored imaging is mandatory to depict smaller nerve branches and subtle pathologic processes. Increasing developments in imaging technique made possible isotropic sub-milimetric images and curved reconstructions of cranial nerves and their branches and led to an increasing recognition of symptomatic trigeminal neuropathies. Whereas MRI has a higher diagnostic yield in patients with trigeminal neuropathy, CT is still required to demonstrate the bony anatomy of the skull base and is the modality of choice in the context of traumatic injury to the nerve. Imaging of the trigeminal nerve is particularly cumbersome as its long course from the brainstem nuclei to the peripheral branches and its rich anastomotic network impede, in most cases, a topographic approach. Therefore, except in cases of classic trigeminal neuralgia, in which imaging studies can be tailored to the root entry zone, the full course of the trigeminal nerve has to be imaged. This article provides an update in the most recent advances on MR imaging technique and a segmental imaging approach to the most common pathologic processes affecting the trigeminal nerve.

  8. [Limit of root canal obturation by gutta percha compaction technique in single rooted teeth. Clinical data apropos of 168 canals].

    Science.gov (United States)

    Gaye, F; Mbaye, M; Toure, B; Dieng, O; Diallo, B

    2002-03-01

    After the introduction of the lateral compactage of gutta percha in endodontic clinic of OdontoStomatology Institute of Dakar in 1995; the immediate evaluation of the quality and the limit of the canal obturation due to a prospective study on 157 monoradicular teeth so be 168 canals (11 supplementary canals) has shown that 75% of canals are of type I of Vertucci and that the apical limit of security is reached within 80.25% of cases. The manual step back canal preparation (79.17%) and the technique of canal obturation by lateral compactage of gutta percha [(64.88%); Apical limit of security: 59.52%] permit to obtain a densities (95.83%) and homogeneous (79.57%) canal obturation. The indication of gutta percha compactage on monoradicular teeth (hermetic and tridimensional root canal filling) must avail to apical curved roots of lateral incisive, the use of adapted instruments in case of canines (31 mm) and apical stop cone on necrotic pulp teeth. PMID:12061241

  9. Conduction Block in PMP22 Deficiency

    OpenAIRE

    Bai, Yunhong; Zhang, Xuebao; Katona, Istvan; Saporta, Mario Andre; Shy, Michael E; O’Malley, Heather A.; Isom, Lori L.; Suter, Ueli; LI, JUN

    2010-01-01

    Patients with PMP22 deficiency present with focal sensory and motor deficits when peripheral nerves are stressed by mechanical force. It has been hypothesized that these focal deficits are due to mechanically induced conduction block (CB). To test this hypothesis, we induced 60-70% CB (defined by electrophysiological criteria) by nerve compression in an authentic mouse model of HNPP with an inactivation of one of the two pmp22 alleles (pmp22+/?). Induction time for the CB was significantly sh...

  10. Raquianestesia com morfina versus raquianestesia sem morfina associada a bloqueio do nervo pudendo: avaliação da analgesia e complicações em hemorroidectomias Spinal anesthesia with morphine versus spinal anesthesia without morphine associated to pudendal nerve block: evaluation of the analgesia and complications in hemorrhoidectomy

    Directory of Open Access Journals (Sweden)

    Carlos Henrique Marques dos Santos

    2009-03-01

    Full Text Available INTRODUÇÃO: Recentemente, alguns autores têm relatado que o bloqueio do nervo pudendo com uso de ropivacaína proporciona boa analgesia pós-operatória. Assim, considerou-se de interesse a comparação de dois métodos anestésicos verificando a analgesia pós-operatória e as complicações. OBJETIVO: Comparar duas técnicas anestésicas (raquianestesia com morfina versus raquianestesia sem morfina associada com bloqueio do nervo pudendo para hemorroidectomia quanto à analgesia pósoperatória e complicações. MATERIAIS E MÉTODOS: Foram estudados 40 pacientes provenientes do ambulatório de Coloproctologia do Hospital Regional de Mato Grosso do Sul no período de março a outubro de 2008. Todos os pacientes foram randomizados por sorteio imediatamente antes de se iniciar a intervenção cirúrgica e foram distribuídos em dois grupos: Grupo 1: 20 pacientes submetidos à raquianestesia com morfina com 0,15µg associado com bupivacaína hiperbárica 10mg; - Grupo 2: 20 pacientes submetidos à raquianestesia com bupivacaína pesada 10mg associado ao bloqueio do nervo pudendo bilateral com agulha para raquianestesia 27G utilizando ropivacaína 10mg/ml diluída em 10ml de água destilada. RESULTADOS: Avaliou-se 40 pacientes, sendo 21 do sexo feminino. A idade média foi de 52 anos, variando de 21 a 72 anos. Apenas no grupo 1 observou-se complicações, sendo a principal prurido, seguida de retenção urinária e cefaléia. Após 6 horas da cirurgia, a média do nível de dor foi 1,55 no grupo 1 e 1,4 no grupo 2. Após 12 horas da cirurgia as médias foram 1,75 e 0,15 nos grupos 1 e 2, respectivamente. CONCLUSÃO: A hemorroidectomia realizada com associação de raquianestesia sem morfina e bloqueio do nervo pudendo utilizando ropivacaína proporcionou melhor efeito analgésico no período de 12 horas após a cirurgia e não apresentou complicações nesta casuística, mostrando-se superior à raquianestesia com morfina.INTRODUCTION: Recently, some authors have reported that the pudendal nerve block using ropivacaine provides good postoperative analgesia. Thus, we consider of interest to compare two anesthetic methods checking postoperative analgesia and adverse effects. OBJECTIVE: To compare two anesthetic techniques (spinal anesthesia with morphine versus spinal anesthesia without morphine associated with pudendal nerve block for hemorrhoidectomy in relation to postoperative analgesia and adverse effects. MATERIALS AND METHODS: We studied 40 patients from Hospital Regional de Mato Grosso do Sul among March to October of 2008. All patients were randomized by lot immediately before surgery, distributed in two groups: Group 1: 20 patients undergoing spinal anesthesia with morphine 0.15µg associated with hyperbaric bupivacaine 10mg; - Group 2: 20 patients undergoing spinal anesthesia with heavy bupivacaine 10mg associated with bilateral pudendal nerve block with ropivacaine 10mg/ml diluted in 10ml of distilled water. RESULTS: Most patients were female (N = 21. The average age was 52 years, ranging from 21 to 72 years. The group 1 presented a higher prevalence of adverse effects (62.5%. Among the adverse effects of group 1 was higher prevalence of itch, urinary retention and migraine. Most patients who reported pain in the postoperative range from group 1 was male and prevailing in the first 12 hours, with the average level of pain of 1.55. In group 2 the pain was observed in equal proportion in both sexes and in the first six hours, with the average level of pain of 1.75. CONCLUSION: The hemorrhoidectomy accomplished with spinal anesthesia without morphine and blockade of the pudendal nerve using ropivacaine provided better analgesic effect in the period of 12 hours after the surgery and it didn't present complications in this casuistry, being shown superior to the spinal anesthesia with morphine.

  11. Raquianestesia com morfina versus raquianestesia sem morfina associada a bloqueio do nervo pudendo: avaliação da analgesia e complicações em hemorroidectomias / Spinal anesthesia with morphine versus spinal anesthesia without morphine associated to pudendal nerve block: evaluation of the analgesia and complications in hemorrhoidectomy

    Scientific Electronic Library Online (English)

    Carlos Henrique Marques dos, Santos; Fábio Tacla, Saad; Robson Luiz Silveira, Jará; Magali da Silva Sanches, Machado.

    2009-03-01

    Full Text Available INTRODUÇÃO: Recentemente, alguns autores têm relatado que o bloqueio do nervo pudendo com uso de ropivacaína proporciona boa analgesia pós-operatória. Assim, considerou-se de interesse a comparação de dois métodos anestésicos verificando a analgesia pós-operatória e as complicações. OBJETIVO: Compar [...] ar duas técnicas anestésicas (raquianestesia com morfina versus raquianestesia sem morfina associada com bloqueio do nervo pudendo) para hemorroidectomia quanto à analgesia pósoperatória e complicações. MATERIAIS E MÉTODOS: Foram estudados 40 pacientes provenientes do ambulatório de Coloproctologia do Hospital Regional de Mato Grosso do Sul no período de março a outubro de 2008. Todos os pacientes foram randomizados por sorteio imediatamente antes de se iniciar a intervenção cirúrgica e foram distribuídos em dois grupos: Grupo 1: 20 pacientes submetidos à raquianestesia com morfina com 0,15µg associado com bupivacaína hiperbárica 10mg; - Grupo 2: 20 pacientes submetidos à raquianestesia com bupivacaína pesada 10mg associado ao bloqueio do nervo pudendo bilateral com agulha para raquianestesia 27G utilizando ropivacaína 10mg/ml diluída em 10ml de água destilada. RESULTADOS: Avaliou-se 40 pacientes, sendo 21 do sexo feminino. A idade média foi de 52 anos, variando de 21 a 72 anos. Apenas no grupo 1 observou-se complicações, sendo a principal prurido, seguida de retenção urinária e cefaléia. Após 6 horas da cirurgia, a média do nível de dor foi 1,55 no grupo 1 e 1,4 no grupo 2. Após 12 horas da cirurgia as médias foram 1,75 e 0,15 nos grupos 1 e 2, respectivamente. CONCLUSÃO: A hemorroidectomia realizada com associação de raquianestesia sem morfina e bloqueio do nervo pudendo utilizando ropivacaína proporcionou melhor efeito analgésico no período de 12 horas após a cirurgia e não apresentou complicações nesta casuística, mostrando-se superior à raquianestesia com morfina. Abstract in english INTRODUCTION: Recently, some authors have reported that the pudendal nerve block using ropivacaine provides good postoperative analgesia. Thus, we consider of interest to compare two anesthetic methods checking postoperative analgesia and adverse effects. OBJECTIVE: To compare two anesthetic techniq [...] ues (spinal anesthesia with morphine versus spinal anesthesia without morphine associated with pudendal nerve block) for hemorrhoidectomy in relation to postoperative analgesia and adverse effects. MATERIALS AND METHODS: We studied 40 patients from Hospital Regional de Mato Grosso do Sul among March to October of 2008. All patients were randomized by lot immediately before surgery, distributed in two groups: Group 1: 20 patients undergoing spinal anesthesia with morphine 0.15µg associated with hyperbaric bupivacaine 10mg; - Group 2: 20 patients undergoing spinal anesthesia with heavy bupivacaine 10mg associated with bilateral pudendal nerve block with ropivacaine 10mg/ml diluted in 10ml of distilled water. RESULTS: Most patients were female (N = 21). The average age was 52 years, ranging from 21 to 72 years. The group 1 presented a higher prevalence of adverse effects (62.5%). Among the adverse effects of group 1 was higher prevalence of itch, urinary retention and migraine. Most patients who reported pain in the postoperative range from group 1 was male and prevailing in the first 12 hours, with the average level of pain of 1.55. In group 2 the pain was observed in equal proportion in both sexes and in the first six hours, with the average level of pain of 1.75. CONCLUSION: The hemorrhoidectomy accomplished with spinal anesthesia without morphine and blockade of the pudendal nerve using ropivacaine provided better analgesic effect in the period of 12 hours after the surgery and it didn't present complications in this casuistry, being shown superior to the spinal anesthesia with morphine.

  12. Facial Nerve Neuroma Management

    OpenAIRE

    Weber, Peter C.; Osguthorpe, J. David

    1998-01-01

    Three facial nerve neuromas were identified in the academic year 1994-1995. Each case illustrates different management dilemmas. One patient with a grade III facial nerve palsy had a small geniculate ganglion neuroma with the dilemma of decompression versus resection clear nerve section margins. The second patient underwent facial neuroma resection with cable graft reconstruction, but the permanent sections were positive. The last patient had a massive neuroma in which grafting versus other f...

  13. Vagus Nerve Stimulation

    OpenAIRE

    Howland, Robert H.

    2014-01-01

    The vagus nerve is a major component of the autonomic nervous system, has an important role in the regulation of metabolic homeostasis, and plays a key role in the neuroendocrine-immune axis to maintain homeostasis through its afferent and efferent pathways. Vagus nerve stimulation (VNS) refers to any technique that stimulates the vagus nerve, including manual or electrical stimulation. Left cervical VNS is an approved therapy for refractory epilepsy and for treatment resistant depression. Ri...

  14. Readiness for surgery after axillary block

    DEFF Research Database (Denmark)

    Koscielniak-Nielsen, Z J; Stens-Pedersen, H L; Lippert, F K

    1997-01-01

    We have assessed prospectively the time to readiness for surgery following axillary block (sum of block performance and latency times) in 80 patients. The brachial plexus was identified using a nerve stimulator, and anaesthetized with 45 mL of mepivacaine 1% with adrenaline 5 micrograms mL-1. In...... 10 min. Patchy analgesia was supplemented after electrolocating the unblocked nerves after 20, 30 or 40 min. The patient was pronounced ready for surgery when analgesia was present in all areas to be operated upon, which always included the three nerves to the hand. The single injection technique......%, respectively), P <0.0001. As a result, readiness for surgery was achieved faster in group 2 (25 min), than in group 1 (38.5 min), P <0.0001. After supplementation, block effectiveness was 100% in group 1 and 98% in group 2 (NS). The frequency of adverse effects (vessel puncture or paraesthesia) was similar in...

  15. The influence of obturation technique on sealer thickness and depth of sealer penetration into dentinal tubules evaluated by computer-aided digital analysis.

    Science.gov (United States)

    Ravindranath, Mithun; Neelakantan, Prasanna; Karpagavinayagam, Kumaraguru; Subba Rao, C V

    2011-01-01

    The aim of this study was to determine sealer penetration into dentinal tubules and sealer thickness with different obturation materials and techniques, with the null hypothesis that sealer cement thickness and dentinal tubule penetration was not affected by obturation technique. This study used 180 freshly extracted human mandibular premolars. Samples were obturated using the lateral condensation technique with either gutta-percha (Group 1) or Resilon (Group 2), using AH Plus (subgroup A) or Epiphany (subgroup B) as a sealer. Other samples were obturated with One-Step Obturator (Group 3) using AH Plus or Epiphany sealer. The sealer thickness and sealer penetration into dentinal tubules was evaluated using stereomicroscopy and analysis of digital images using AutoCAD software at 5.0 mm, 3.0 mm, and 1.0 mm from the apex. The mean value of sealer thickness for Group 3 was significantly lower than the mean values of the other groups. There was no significant difference in the mean values between subgroups A and B for Group 1 or Group 3, whereas for Group 2, the mean value in subgroup A was significantly higher than the mean value in subgroup B. The greatest average frequency of the penetration of sealer cement was found at the 5.0 mm level, followed by the 3.0 mm level, which, in turn, was greater than at the 1.0 mm level. The thickness of the sealer cement is dependent on the obturation technique employed, while the penetration of the sealer into the dentinal tubules is independent of the obturation technique. PMID:22313823

  16. Mineral trioxide aggregate for obturation of maxillary central incisors with necrotic pulp and open apices.

    Science.gov (United States)

    Erdem, Arzu Pinar; Sepet, Elif

    2008-10-01

    There are few reports on treatment of necrotic pulps with mineral trioxide aggregate (MTA) for apexification. Five immature teeth with necrotic pulps were treated with the use of an apical plug of MTA for apexification. All teeth were central incisors that had premature interruption of root development caused by a previous trauma. According to the treatment protocol, the root canals were rinsed with 5% NaOCl; then calcium hydroxide paste was placed in the canals for 1-6 weeks. The apical portion of the canals were filled with MTA. The rest of the canals were obturated with lateral condensation of the gutta-percha applied with a canal sealer. At 6 months, 1 year and 2 year follow-up periods the clinical and radiographic appearance of the teeth showed the resolution of the periapical lesions and continued root end development in all except in the one case in which the MTA was extruded out the apex. MTA can be considered a very effective option for apexification with the advantage of reduced treatment time, good sealing ability and high biocompatibility. PMID:18557748

  17. Coronal and apical leakage analysis of two different root canal obturation systems

    Scientific Electronic Library Online (English)

    Patricia Gimenez, Oddoni; Isabel, Mello; Jeffrey Martin, Coil; João Humberto, Antoniazzi.

    2008-09-01

    Full Text Available This study compared the coronal and apical leakage of AH Plus with gutta-percha to that of Epiphany with Resilon. Twenty-four single rooted teeth were instrumented and divided into 2 groups according to the solutions for smear layer removal and the obturation materials employed: Group A - 17% EDTA-T [...] and AH Plus with gutta-percha; Group B - primer and Epiphany with Resilon. The Group B specimens were light-cured in the coronal area for 20 s. The external root surfaces were covered with a double layer of ethyl cyanoacrylate, except for the apical foramen and the cavity access. The teeth were immersed in 0.5% methylene blue for 48 h. The specimens were rinsed, dried and axially split for dye penetration measurement with the ImageLab 2.3 software. The t-test showed no significant differences for coronal leakage between the groups, but there were significant differences for apical leakage between the groups (P

  18. Efficacy of Two Rotary NiTi Instruments in Removal of Resilon/Epiphany Obturants

    Directory of Open Access Journals (Sweden)

    Pooneh Mohebbi

    2012-10-01

    Full Text Available Introduction: The success of endodontic retreatment is related to the complete removal of the obturation material from the root canal system. The aim of this study was to evaluate the efficacy of Mtwo R and ProTaper retreatment files in removing the Resilon/Epiphany system with or without chloroform during retreatment. Materials and Methods: Sixty distal roots of first mandibular molars were prepared and laterally condensed with Resilon/Epiphany, then divided into four groups (15 each for retreatment: 1 Mtwo R/solvent; 2 Mtwo R; 3 ProTaper D/solvent; and 4 ProTaper D. The cleanliness of the canal walls was evaluated using radiography; a stereomicroscope and SEM. Data were subjected to ANOVA and Student’s t-test. Results: Neither rotary system performed better than the other when considering the whole root canal, with or without solvent. In the apical portion, ProTaper/solvent showed the best result (P<0.05. Conclusion: In Resilon/Epiphany retreatment cases, ProTaper/solvent was better in the apical portion; however when considering the whole canal, Mtwo R and the ProTaper D series had the same performance.

  19. Coronal and apical leakage analysis of two different root canal obturation systems

    Directory of Open Access Journals (Sweden)

    Patricia Gimenez Oddoni

    2008-09-01

    Full Text Available This study compared the coronal and apical leakage of AH Plus with gutta-percha to that of Epiphany with Resilon. Twenty-four single rooted teeth were instrumented and divided into 2 groups according to the solutions for smear layer removal and the obturation materials employed: Group A - 17% EDTA-T and AH Plus with gutta-percha; Group B - primer and Epiphany with Resilon. The Group B specimens were light-cured in the coronal area for 20 s. The external root surfaces were covered with a double layer of ethyl cyanoacrylate, except for the apical foramen and the cavity access. The teeth were immersed in 0.5% methylene blue for 48 h. The specimens were rinsed, dried and axially split for dye penetration measurement with the ImageLab 2.3 software. The t-test showed no significant differences for coronal leakage between the groups, but there were significant differences for apical leakage between the groups (P < 0.05. AH Plus with gutta-percha and Epiphany with Resilon provided the same coronal seal, whereas Epiphany with Resilon provided the best apical seal.

  20. Sealing ability of three hydrophilic single-cone obturation systems: An in vitroglucose leakage study

    Directory of Open Access Journals (Sweden)

    Vibha Hegde

    2015-01-01

    Full Text Available Aim: The aim of this study is to compare the corono-apical sealing ability of three single-cone obturation systems using a glucose leakage model. Materials and Methods: A total of 90 freshly extracted human maxillary single-rooted teeth was selected, and their crowns were cut. The root canal of each sample was instrumented using a rotary crown down technique and then divided into four experimental (n = 20 each and two control groups (n = 5 each. Samples in the experimental groups were filled as follows: Group 1, cold lateral condensation using gutta-percha/AH Plus; group 2, single-cone C-points/smart-paste bio-sealer; group 3, single-cone bio-ceramic (BC impregnated gutta-percha/endo-sequence BC sealer; group 4, single-cone Resilon/RealSeal SE after 7 days, the sealing ability of root canal fillings was tested at different time intervals using glucose leakage model. Glucose leakage values were measured using a spectrophotometer and statistically analyzed. Results: The four experimental groups presented significantly different glucose leakage values at all test periods (P < 0.05. At the end of the observation period, the cumulative glucose leakage values of groups 2 and 3 were significantly lower than those of groups 1 and 4 (P < 0.05. Conclusion: C-points/smart-paste Bio and BC impregnated gutta-percha/endo-sequence BC sealer combinations provided the superior sealing ability over the lateral condensation technique.

  1. Use of Postoperative Palatal Obturator After Total Palatal Reconstruction With Radial Forearm Fasciocutaneous Free Flap.

    Science.gov (United States)

    Jeong, Euicheol C; Jung, Young Ho; Shin, Jin-yong

    2015-07-01

    A 67-year-old-male patient visited our hospital for a mass on the soft palate of approximately 5.0 × 6.0? cm in size. He was diagnosed with adenoid cystic carcinoma and reconstruction after total palate resection was planned. After ablative surgery, a radial forearm free flap procedure was successfully performed to cover the hard and soft palates. However, wound disruption occurred twice during the postoperative period. When a palate defect is reconstructed using a soft tissue free flap, flap drooping by gravitation and the flap itself can generate irregularity in the lower contour of the palate and, in the long-term, insufficiencies of velopharyngeal function, speech, and mastication. To complement such functional and aesthetic problems caused by flap drooping, conventional prosthetics and new operative techniques have been discussed. However, overcoming wound disruption caused by flap drooping in the acute postoperative period has not been discussed. In this case, the temporary use of a palatal obturator during the postoperative period was beneficial after soft tissue reconstruction of the palate. PMID:26114541

  2. Sealing ability of three hydrophilic single-cone obturation systems: An in vitro glucose leakage study

    Science.gov (United States)

    Hegde, Vibha; Arora, Shashank

    2015-01-01

    Aim: The aim of this study is to compare the corono-apical sealing ability of three single-cone obturation systems using a glucose leakage model. Materials and Methods: A total of 90 freshly extracted human maxillary single-rooted teeth was selected, and their crowns were cut. The root canal of each sample was instrumented using a rotary crown down technique and then divided into four experimental (n = 20 each) and two control groups (n = 5 each). Samples in the experimental groups were filled as follows: Group 1, cold lateral condensation using gutta-percha/AH Plus; group 2, single-cone C-points/smart-paste bio-sealer; group 3, single-cone bio-ceramic (BC) impregnated gutta-percha/endo-sequence BC sealer; group 4, single-cone Resilon/RealSeal SE after 7 days, the sealing ability of root canal fillings was tested at different time intervals using glucose leakage model. Glucose leakage values were measured using a spectrophotometer and statistically analyzed. Results: The four experimental groups presented significantly different glucose leakage values at all test periods (P sealer combinations provided the superior sealing ability over the lateral condensation technique. PMID:25821383

  3. Microscopic analysis of the quality of obturation and physical properties of MTA Fillapex.

    Science.gov (United States)

    Amoroso-Silva, Pablo Andrés; Guimarães, Bruno Martini; Marciano, Marina Angélica; Duarte, Marco Antonio Hungaro; Cavenago, Bruno Cavalini; Ordinola-Zapata, Ronald; Almeida, Marcela Milanezi de; Moraes, Ivaldo Gomes de

    2014-12-01

    This study analyzed the quality of obturation and physical properties of MTA Fillapex and AH Plus sealer. A sample of 30 human maxillary central incisors were instrumented with Protaper until a F5 (50/05) file. Both sealers were mixed with Rhodamine-B dye to allow visualization on a confocal laser-scanning microscope (CLSM). Next, the canals were filled using the single cone technique. After setting, all samples were sectioned at 2, 4, and 6 mm from the apex. CLSM was used to analyze the gaps and sealer penetration into the dentinal tubules. All samples were scanned 10 µm below the dentin surface and images were recorded at 100× magnification using the fluorescent mode. Additionally, the solubility, flowability and setting time of the sealers were evaluated. All the measured quantities of the examined materials were evaluated for significant differences by means of statistical analysis. The CLSM analysis of the MTA Fillapex showed the highest percentage of gaps at all sections (P = 0.0001). Physical tests revealed adequate properties for both sealers except for a higher solubility of the MTA Fillapex (P = 0.0001). The MTA Fillapex presented flowability and intratubular penetration similar to the AH Plus. Nevertheless, the MTA Fillapex sealer presented a higher solubility and considerable quantity of gaps between the sealer/dentin interface in relation to the AH Plus sealer. Clinicians must take into consideration, the quality of endodontic sealers as it is essential in the outcome of the root canal filling. PMID:25209870

  4. Variations of the sciatic nerve and its relation with the piriformis muscle in South Indian population

    Directory of Open Access Journals (Sweden)

    Sushma R. Kotian

    2015-09-01

    Conclusion: Although the variations of the sciatic nerve are common and are already reported, the present study indicates some additional findings not reported previously and further stresses on its applied significance. These variations are important for surgeons, as this is an area of frequent surgical manipulation, nerve injury during deep intramuscular injections, sciatic nerve block etc. They may lead to in-advertent injury during operations, piriformis syndrome, non-discogenic sciatica, muscle atrophy, failure of sciatic nerve block and many other complications. [J Exp Integr Med 2015; 5(3.000: 144-148

  5. [Sciatic nerve intraneural perineurioma].

    Science.gov (United States)

    Bonhomme, Benjamin; Poussange, Nicolas; Le Collen, Philippe; Fabre, Thierry; Vital, Anne; Lepreux, Sébastien

    2015-12-01

    Intraneural perineurioma is a benign tumor developed from the perineurium and responsible for localized nerve hypertrophy. This uncommon tumor is characterized by a proliferation of perineural cells with a "pseudo-onion bulb" pattern. We report a sciatic nerve intraneural perineurioma in a 39-year-old patient. PMID:26586011

  6. Efficacy of ProTaper Retreatment System in Root Canals Obturated with Gutta-Percha Using Two Different Sealers and GuttaFlow.

    Science.gov (United States)

    Siotia, Jaya; Acharya, Shashi Rashmi; Gupta, Sunil Kumar

    2011-01-01

    Objective. To compare the efficacy of ProTaper retreatment files in removing three different obturating materials. Study Design. Forty-five human, single-rooted premolars were divided into three experimental groups. Group 1 was obturated with gutta-percha and AH Plus sealer, Group 2 was obturated with gutta-percha and zinc oxide eugenol sealer, and Group 3 was obturated with GuttaFlow. Retreatment was done using the ProTaper universal rotary retreatment files. Root halves were visualized using magnifying loops at 3X magnification and optical stereomicroscope at 10X magnification. Images were analyzed using AutoCAD 2004 software to calculate area of the remaining debris in the canal. For statistical analysis were used variance test and ANOVA. Results. Total debris/canal area ratio between the three groups showed a statistically significant difference (P < 0.001). Conclusion. ProTaper retreatment system did not produce completely clean canals in any of the groups. However, it had the best efficacy towards removing silicon based obturating material GuttaFlow. PMID:22114598

  7. Interventional multispectral photoacoustic imaging with a clinical ultrasound probe for discriminating nerves and tendons: an ex vivo pilot study

    Science.gov (United States)

    Mari, Jean Martial; Xia, Wenfeng; West, Simeon J.; Desjardins, Adrien E.

    2015-11-01

    Accurate and efficient identification of nerves is an essential component of peripheral nerve blocks. While ultrasound (US) imaging is increasingly used as a guidance modality, it often provides insufficient contrast for identifying nerves from surrounding tissues such as tendons. Electrical nerve stimulators can be used in conjunction with US imaging for discriminating nerves from surrounding tissues, but they are insufficient to reliably prevent neural punctures, so that alternative methods are highly desirable. In this study, an interventional multispectral photoacoustic (PA) imaging system was used to directly compare the signal amplitudes and spectra acquired from nerves and tendons ex vivo, for the first time. The results indicate that the system can provide significantly higher image contrast for discriminating nerves and tendons than that provided by US imaging. As such, photoacoustic imaging could be valuable as an adjunct to US for guiding peripheral nerve blocks.

  8. An in vitro comparison of bond strengths of Gutta-percha/AH Plus, Resilon/Epiphany self-etch and EndoREZ obturation system to intraradicular dentin using a push-out test design

    Directory of Open Access Journals (Sweden)

    A Sanjana Patil

    2013-01-01

    Conclusion: The adhesiveness quality to root dentin promoted by newer methacrylate resin-based obturation systems like Resilon/Epihany SE and EndoREZ is compromised even when teeth with simple anatomic features were obturated under well-monitored laboratory conditions.

  9. Optic nerve sheath meningocele

    Directory of Open Access Journals (Sweden)

    Juan Carlos Mesa-Gutiérrez

    2008-10-01

    Full Text Available Juan Carlos Mesa-Gutiérrez, Silvia Muñoz Quiñones, Jorge Arruga GinebredaDepartment of Ophthalmology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainAbstract: A 53-year-old man presented with a 5-month history of visual loss in his left eye. Visual acuity could be corrected to 20/20 with an increased hyperopic correction. Dilated funduscopy showed faint choroidal folds and elevation of the left optic disc. The coronal view of T2-weighted magnetic resonance imaging demonstrated a fluid-filled dilated sheath surrounding normal optic nerves. General physical examination and cerebrospinal fluid analysis were normal. The subject was diagnosed as having dural ectasia of the optic nerve sheath and followed a course of acetazolamide 250 mg twice daily for three months, and displayed good anatomical and functional results during a 2-year follow-up period. Despite the fact that several authors have recommended an optic nerve decompression, most of the patients follow a benign clinical course. The role of corticosteroids is not described in the literature. Raised levels of proteins in the cerebrospinal fluid in the perioptic subarachnoidal space could be a determining factor. On the basis of an osmotic gradient between the cerebral subarachnoid space and perioptic subarachnoid space, carbonic anhydrase inhibitors could be beneficial. In contrast to other reports, we believe that surgical intervention could be reserved for patients with rapid or progressive optic nerve dysfunction.Keywords: optic nerve, perineural subaracnoid space, optic nerve meningocoele, optic nerve tumors

  10. Lesão do músculo obturador externo em atletas de futebol profissional / Injury of the external obturator muscle in professional soccer athletes

    Scientific Electronic Library Online (English)

    Henrique Gonçalves, Valente; Felipe Osório, Marques; Luciano Da Silva De, Souza; Roberto Trápaga, Abib; Daniel Cury, Ribeiro.

    2011-02-01

    Full Text Available Diversos estudos têm analisado os diferentes tipos de lesões que acometem o jogador de futebol. Nota-se, no entanto, que nenhum cita a lesão do músculo obturador externo. Na medida em que este é um músculo pequeno e monoarticular, sua incidência provavelmente é baixa e pouco documentada na literatur [...] a. Sendo assim, o objetivo deste estudo é apresentar quatro casos de estiramentos do obturador externo em uma equipe profissional de futebol no ano de 2006. Os dados foram coletados a partir de um programa de armazenamento denominado Sistema de Preparação Desportiva que fornece dados referentes ao nome, diagnóstico, mecanismo de trauma, história clínica, tempo de afastamento e evolução. Todos os atletas que apresentaram imagem de ressonância nuclear magnética compatível com ruptura do obturador externo foram inclusos no estudo. Quatro lesões por estiramento do músculo obturador externo foram encontradas, de um total de 28 lesões por estiramento muscular durante o ano de 2006. Todos os atletas apresentavam dor difusa na região do quadril durante os movimentos de rotação lateral e medial do quadril. O mecanismo de trauma predominante foi o movimento de rotação lateral do tronco sobre o fêmur em cadeia cinética fechada. Concluímos que a lesão do obturador externo pode ser confundida com uma lesão dos músculos adutores do quadril, devido à localização da dor relatada pelo indivíduo. A avaliação clínica deve basear-se no relato do atleta e na realização dos testes funcionais, principalmente para os músculos rotadores do quadril. O exame de ressonância nuclear magnética foi fundamental para localizar, classificar e avaliar a extensão da lesão neste estudo Abstract in english Several studies have investigated different injuries that occur among soccer players. However, it has been noticed that none has mentioned injury to the external obturator muscle. As a small and monoarticulated muscle, its incidence is probably low and barely documented in the literature. Therefore, [...] the aim of this study is to present four external obturator muscle strain cases in a professional soccer team in 2008. The data was collected from a database using the software Sistema de Preparação Desportiva which provides data such as name, diagnosis, trauma mechanism, clinical history, time away from training and progress. All athletes who undertook Magnetic Resonance Imaging (MRI) of the external obturator muscle and presented rupture of the external obturator muscle were included in the study. Four external obturator muscle strain injuries were identified from a total of twenty-eight muscle strains during the year of 2006. All athletes presented diffuse pain on the hip for medial and lateral rotation of the joint. The predominant injury mechanism was lateral rotation of the trunk over the femur on closed kinetic chain. It was concluded that external obturator muscle strain injuries can be mistaken for those related to the hip adductor muscles due to the reported pain area. Clinical examination should be based on the athletes' report and functional tests, mainly for the hip rotator muscles. The MRI scan was essential to the location, classification and evaluation of the injury size.

  11. Suprascapular nerve entrapment.

    Science.gov (United States)

    Corò, L; Azuelos, A; Alexandre, A

    2005-01-01

    It is important to be aware of neuropathy involving the suprascapular nerve. While direct trauma to the suprascapular nerve is the usual cause (direct blow to the base of the neck or posterior shoulder, shoulder dislocation or fracture), the problem may result from overuse injuries (such as repetitive tennis serving or spiking of a volley ball), excessive horizontal adduction, weight lifting, backpacking or no apparent reason. These last three years we have operated 8 cases of suprascapular nerve neurolysis at the level of suprascapular incision, and section of the transverse scapular ligament through the back supraspinal approach. PMID:15830964

  12. Comparación entre la técnica de multi-inyección y la inyección única con localización del nervio mediano en el bloqueo infraclavicular para cirugía del miembro superior Multi-injection vs. single injection technique with localization of the medial nerve for infraclavicular block for upper limb surgery

    Directory of Open Access Journals (Sweden)

    Reinaldo Grueso Angulo

    2010-04-01

    Full Text Available Introducción. El propósito de este experimento clínico aleatorizado controlado y ciego para el observador es comparar la efectividad del bloqueo del Plexo braquial por la via infraclavicular guiado por neuroestimulador luego de usar dos técnicas diferentes: la técnica de inyección múltiple con localización de tres cordones diferentes y la técnica de inyección única con localización del cordón medial. Métodos. Doscientos sesenta (260 pacientes programados para cirugía de miembro superior con Anestesia regional fueron asignados de manera aleatoria en dos grupos: inyección múltiple IM (129 o inyección única IU (128. El desenlace primario que se evaluó fue la efectividad del bloqueo, entendida como la ausencia de de sedación fuera de unos límites establecidos o la necesidad de administrar anestesia general. Otros desenlaces evaluados fueron la satisfacción de los pacientes y la presencia de efectos secundarios. Resultados. Los grupos fueron comparables en sus características de base. El tiempo de colocación del bloqueo fue de 9,6 minutos (±5,9 en IU vs. 10,4 minutos (±3,8 en IM, el cual no fue clínicamente diferente. El desenlace primario mostro 7 fallas de 129 pacientes (5,43 % en IM, mientras que en IU fueron 27 fallas de 128 pacientes analizados (21,09 %. Esta diferencia entre las dos técnicas da como resultado un RR: 3,89 con un IC (1,76 - 8,6 con una pIntroduction. The purpose of this, randomized, controlled, observer-blind clinical trial, was to compare the efficacy of the neurostimulator-guided infraclavicular block of the brachial plexus, using two different techniques: multiple injection with localization of three different cords and the single injection technique with localization of the medial cord. Methods. Two hundred and sixty (260 patients scheduled for upper limb surgery under Regional anesthesia were randomly distributed into two groups: multiple injection (MI (129 or single injection (SI (128. The primary outcome assessed was the efficacy of the block, meaning the absence of sedation beyond some established margins or the need to administer general anesthesia. Other outcomes measured were patient satisfaction and the presence of side effects. Results. Both groups had comparable baseline characteristics. The time for administering the block was 9,6 minutes (±5,9 for SI vs. 10,4 minutes (±3,8 for MI, which was not clinically different. The primary outcome showed 7 failures in 129 MI patients (5,43 % and 27 (21,09 % of the SI 128 patients studied. This difference between the two techniques results in a RR of 3,89 with a CI (1,76 - 8,6 and p< 0,0002. Conclusions. In a significant sample of patients and within a controlled environment, the effectiveness of the brachial plexus block using the conventional multiple injections technique with peripheral nerve stimulator was superior to stimulator-guided peripheral nerve single injection technique with localization of the medial cord.

  13. Comparative evaluation of a novel smart-seal obturating system and its homogeneity of using cone beam computed tomography: In vitro simulated lateral canal study

    Directory of Open Access Journals (Sweden)

    Shashank Arora

    2014-01-01

    Full Text Available Aim: The aim was to evaluate and compare a novel polyamide polymer based obturating system and Gutta-percha and sealer in filling simulated lateral canals and their homogeneity when used for obturating the root canals. Materials and Methods: A total of 60 freshly extracted human single rooted teeth with fully formed apices were selected for this study. Teeth were de-coronated, and roots were standardized to a working length of 15 mm. Root canal preparation was carried out with rotary Protaper file system in all groups. The specimens were then randomly divided into three groups A, B, and C (n = 20. Ten samples from each group were decalcified and simulated lateral canals were made at 2, 4, and 6 mm from the root apex. Remaining ten samples from each group were maintained calcified. Group A was obturated with SmartSeal system (Prosmart-DRFP Ltd., Stamford, UK. Group B was obturated with sectional backfill method. Group C was obutrated with cold lateral compaction method (control. Decalcified samples from the respective groups were analyzed with digital radiography and photography and the measurement of the linear extension and area of lateral canal filling was done using UTHSCSA (UTHSCSA Image Tool for Windows version 3.0, San Antonio, TX, USA software. Calcified samples were subjected to cone beam computed tomography image analysis sectioned axially. Results: Group A 92.46 ± 19.45 showed greatest extent of filling in lateral canals and denser homogeneity of oburation, followed by Group B 78.43 ± 26.45 and Group C 52.12 ± 36.67. Conclusions: Polyamide polymer obturation proved to have greater efficiency when compared with Gutta-percha system, when used for obturation with regards to adaptation of the sealer and penetration into the simulated lateral canals.

  14. Uso de obturadores en cirugía oral y maxilofacial: Presentación de cinco casos clínicos / Use of obturators in oral and maxillofacial surgery: A report of five cases

    Scientific Electronic Library Online (English)

    R.T., Velázquez-Cayón; R., Flores-Ruiz; D., Torres-Lagares; S., González-Guerrero; D., González-Padilla; J.L., Gutiérrez-Perez.

    2011-03-01

    Full Text Available Los defectos creados en el maxilar, principalmente tras cirugía resectiva de tumores malignos, traumatismo o defectos congénitos, deben ser corregidos con el fin de recuperar los consecuentes déficits en el habla, la deglución, la masticación y la estética. Para ello contamos con dos amplias posibil [...] idades: reconstrucción quirúrgica o colocación de un obturador protésico maxilar. En este artículo llevamos a cabo una revisión de la literatura reciente y clásica sobre obturadores palatinos, ilustrándola mediante 5 casos clínicos con esta opción terapéutica. Hemos encontrado descritas una amplia variedad de modificaciones para los distintos tipos de obturadores, como la fabricación de aletas nasales, colocación de obturadores de forma inmediata tras la cirugía, el hecho de ahuecar el aditamento obturador, etc. En nuestra práctica hemos observado una serie de ventajas en la colocación de este tipo de prótesis de forma posquirúrgica diferida y en estrecha colaboración con su médico responsable. Abstract in english Defects created in the maxillary bone, principally after surgical resection of malignant tumors, trauma or congenital defects, must be corrected to eliminate the resulting speech, swallowing, and chewing defects and restore the cosmetic appearance. Two major options available are surgical reconstruc [...] tion or the placement of a maxillary obturator prosthesis. The recent and classic literature on palatal obturators is reviewed and five clinical cases treated with a palatal obturator are reported. A large variety of modifications have been reported for different types of obturators, such as nasal wings, immediate postoperative obturator prosthesis placement, etc. In the authors' experience, deferred postoperative obturator placement in close collaboration with the responsible doctor has advantages.

  15. An In Vitro Comparative Study of the Adaptation and Sealing Ability of Two Carrier-Based Root Canal Obturators

    OpenAIRE

    Ahmed Alkahtani; Sara Al-Subait; Sukumaran Anil

    2013-01-01

    The study was done to assess the sealing ability and adaptation of RealSeal 1, and to compare it with Thermafil. 65 single-rooted extracted teeth were selected and root canal treatment was performed. Root canals were obturated with RealSeal 1 or Thermafil. A double chamber bacterial leakage model using E. faecalis was developed to assess the sealing ability. Samples were monitored daily for 60 days. After the bacterial leakage test, samples were embedded in resin and sectioned horizontally at...

  16. Use of an obturator with nCPAP in a premature infant with a cleft lip and palate.

    Science.gov (United States)

    Pesun, Igor J; Minski, John; Narvey, Michael; Pantel, Cynthia; Swain, Vanessa

    2015-05-01

    Premature infants have underdeveloped lungs and their care involves the use of nasal continuous positive airway pressure (nCPAP). For an adequate amount of oxygen to enter the lungs, the palate needs to be intact. Premature infants with a cleft lip and palate remain intubated for extended periods of time with the risks inherent in long-term intubation because of the inability to maintain nCPAP. This paper describes the fabrication of a custom-designed obturator attached to nCPAP variable flow generator tubing for a premature infant with a unilateral cleft lip and palate. PMID:25794910

  17. Peripheral Nerve Disorders

    Science.gov (United States)

    ... after an injury. Some people are born with peripheral nerve disorders. Symptoms often start gradually, and then get worse. They include Numbness Pain Burning or tingling Muscle weakness Sensitivity to touch ...

  18. Facial nerve pathology

    International Nuclear Information System (INIS)

    This paper reports MR imaging and CT used in 13 cases of facial neuromas and eight simulating lesions. On MR imaging, facial neuromas has long T1 and long T2 characteristics. In a 4-year-old girl with congenital facial palsy, CT and MR imaging demonstrated a facial neuroma involving the entire intratemporal segment of the facial nerve, including massive involvement of the greater superficial petrosal nerve extending into the vidian canal. A primary chemodectoma of the facial nerve (enhanced after administration of gadolinium) was identical to the facial neuroma on CT scans and MR images. Perineural metastatic lesions could not be differentiated from facial neuromas. Isolated granulomas of the facial nerve had CT findings similar to those of a facial neuroma

  19. Lymphoma Nerve Infiltration

    Directory of Open Access Journals (Sweden)

    Baehring JM

    2014-01-01

    Full Text Available Neurolymphomatosis (NL denotes the invasion of cranial nerves, nerve roots, plexus, or nerves by Non-Hodgkin lymphoma (NHL or leukaemia. This occurs in the absence (primary NL or presence (primary NL of systemic NHL. Clinical patterns include a painful polyneuropathy or polyradiculopathy, cranial neuropathy, painless polyneuropathy, and peripheral mononeuropathy. Integration of clinical information, imaging findings, as well as histopathologic examination of involved nerves or non-neural tissue, and cerebrospinal fluid analysis are needed to establish the diagnosis. Timely recognition of the disease and its exact neuroanatomical extent is the basis for successful therapy using systemic chemotherapy and localized irradiation of bulky disease sites. More complex regimens are required when cerebrospinal fluid and systemic disease sites are affected.

  20. Diabetic Nerve Problems

    Science.gov (United States)

    ... at the wrong times. This damage is called diabetic neuropathy. Over half of people with diabetes get ... you change positions quickly Your doctor will diagnose diabetic neuropathy with a physical exam and nerve tests. ...

  1. Degenerative Nerve Diseases

    Science.gov (United States)

    ... such as alcoholism, a tumor, or a stroke. Other causes may include toxins, chemicals, and viruses. Sometimes the cause is not known. Degenerative nerve diseases include Alzheimer's disease Amyotrophic lateral sclerosis Friedreich's ataxia Huntington's disease ...

  2. Anatomy of the extraneural blood supply to the intracranial oculomotor nerve.

    OpenAIRE

    Cahill, M; J. Bannigan; EUSTACE, P.

    1996-01-01

    AIMS: An anatomical study was undertaken to determine the extraneural blood supply to the intracranial oculomotor nerve. METHODS: Human tissue blocks containing brainstem, cranial nerves II-VI, body of sphenoid, and associated cavernous sinuses were obtained, injected with contrast material, and dissected using a stereoscopic microscope. RESULTS: Eleven oculomotor nerves were dissected, the intracranial part being divided into proximal, middle, and distal (intracavernous) parts. The proximal ...

  3. Optic nerve oxygen tension

    DEFF Research Database (Denmark)

    la Cour, M; Kiilgaard, Jens Folke; Eysteinsson, T; Wiencke, A K; Bang, K; Dollerup, J; Jensen, P K; Stefánsson, E

    2000-01-01

    To investigate the influence of acute changes in intraocular pressure on the oxygen tension in the vicinity of the optic nerve head under control conditions and after intravenous administration of 500 mg of the carbonic anhydrase inhibitor dorzolamide.......To investigate the influence of acute changes in intraocular pressure on the oxygen tension in the vicinity of the optic nerve head under control conditions and after intravenous administration of 500 mg of the carbonic anhydrase inhibitor dorzolamide....

  4. Optic nerve aspergillosis.

    Science.gov (United States)

    Yuan, Lisi; Prayson, Richard A

    2015-07-01

    We report a 55-year-old woman with optic nerve Aspergillosis. Aspergillus is an ubiquitous airborne saprophytic fungus. Inhaled Aspergillus conidia are normally eliminated in the immunocompetent host by innate immune mechanisms; however, in immunosuppressed patients, they can cause disease. The woman had a past medical history of hypertension and migraines. She presented 1 year prior to death with a new onset headache behind the left eye and later developed blurred vision and scotoma. A left temporal artery biopsy was negative for giant cell arteritis. One month prior to the current admission, she had an MRI showing optic nerve thickening with no other findings. Because of the visual loss and a positive antinuclear antibody test, she was given a trial of high dose steroids and while it significantly improved her headache, her vision did not improve. At autopsy, the left optic nerve at the level of the cavernous sinus and extending into the optic chiasm was enlarged in diameter and there was a 1.3 cm firm nodule surrounding the left optic nerve. Histologically, an abscess surrounded and involved the left optic nerve. Acute angle branching, angioinvasive fungal hyphae were identified on Grocott's methenamine silver stained sections, consistent with Aspergillus spp. No gross or microscopic evidence of systemic vasculitis or infection was identified in the body. The literature on optic nerve Aspergillosis is reviewed. PMID:25861888

  5. Unusual Communications between the Cutaneous Branches of Ulnar Nerve in the Palm.

    Science.gov (United States)

    Sirasanagandla, Srinivasa Rao; Padavinangady, Abhinitha; Nayak, Satheesha B; Jetti, Raghu

    2015-03-01

    Variations of dorsal and volar digital cutaneous branches of ulnar nerve are of tremendous clinical importance for successful regional nerve blocks, skin flaps, carpal tunnel release and placement of electrodes for electrophysiological studies. With the aforementioned clinical implications it is worth to report the variations of cutaneous branches of ulnar nerve. In the current case, we have encountered a rare variation (Kaplan`s anastomosis) of ulnar nerve, in the right upper limb. We have noticed that the dorsal cutaneous branch of ulnar nerve divided into three branches, the lateral two branches supplied the skin of the medial one and half fingers of the dorsum of hand. The medial branch established communications with the superficial branches of ulnar nerve and distributed to the skin of the one and half fingers of the volar aspect of hand. The possible outcome of this communications is discussed. Course and distribution of ulnar nerve on the contralateral side was found to be normal. PMID:25954612

  6. High-resolution measurement of electrically-evoked vagus nerve activity in the anesthetized dog

    Science.gov (United States)

    Yoo, Paul B.; Lubock, Nathan B.; Hincapie, Juan G.; Ruble, Stephen B.; Hamann, Jason J.; Grill, Warren M.

    2013-04-01

    Objective. Not fully understanding the type of axons activated during vagus nerve stimulation (VNS) is one of several factors that limit the clinical efficacy of VNS therapies. The main goal of this study was to characterize the electrical recruitment of both myelinated and unmyelinated fibers within the cervical vagus nerve. Approach. In anesthetized dogs, recording nerve cuff electrodes were implanted on the vagus nerve following surgical excision of the epineurium. Both the vagal electroneurogram (ENG) and laryngeal muscle activity were recorded in response to stimulation of the right vagus nerve. Main results. Desheathing the nerve significantly increased the signal-to-noise ratio of the ENG by 1.2 to 9.9 dB, depending on the nerve fiber type. Repeated VNS following nerve transection or neuromuscular block (1) enabled the characterization of A-fibers, two sub-types of B-fibers, and unmyelinated C-fibers, (2) confirmed the absence of stimulation-evoked reflex compound nerve action potentials in both the ipsilateral and contralateral vagus nerves, and (3) provided evidence of stimulus spillover into muscle tissue surrounding the stimulating electrode. Significance. Given the anatomical similarities between the canine and human vagus nerves, the results of this study provide a template for better understanding the nerve fiber recruitment patterns associated with VNS therapies.

  7. An in vitro comparative study of the adaptation and sealing ability of two carrier-based root canal obturators.

    Science.gov (United States)

    Alkahtani, Ahmed; Al-Subait, Sara; Anil, Sukumaran

    2013-01-01

    The study was done to assess the sealing ability and adaptation of RealSeal 1, and to compare it with Thermafil. 65 single-rooted extracted teeth were selected and root canal treatment was performed. Root canals were obturated with RealSeal 1 or Thermafil. A double chamber bacterial leakage model using E. faecalis was developed to assess the sealing ability. Samples were monitored daily for 60 days. After the bacterial leakage test, samples were embedded in resin and sectioned horizontally at 2 and 4?mm from the apical foramen. Specimens were examined under scanning electron microscope and digitally photographed. AutoCAD software was used to measure the gap between the canal surface and obturation material. Results were statistically analyzed using nonparametric Kaplan-Meier survival analysis for the bacterial leakage and t-test to compare the means of gap in RealSeal 1 and Thermafil at 2 and 4?mm. There was no significant difference between the RealSeal 1 and Thermafil with respect to leakage over time. At 2?mm and 4?mm, RealSeal 1 had significantly more gaps than Thermafil. From the observations it can be concluded that RealSeal 1 and Thermafil have comparable performance in terms of adaptation and sealing ability. PMID:23710141

  8. Bloqueio dos nervos ilioinguinal e ílio-hipogástrico com dexcetoprofeno intravenoso melhora a analgesia após histerectomia abdominal / Ilioinguinal-iliohypogastric nerve block with intravenous dexketoprofen improves postoperative analgesia in abdominal hysterectomies / Bloqueo de los nervios ilioinguinal e ilio-hipogástrico con dexketoprofeno intravenoso mejora la analgesia después de la histerectomía abdominal

    Scientific Electronic Library Online (English)

    Evren, Yucel; Iclal Ozdemir, Kol; Cevdet, Duger; Kenan, Kaygusuz; Sinan, Gursoy; Caner, Mimaroglu.

    2013-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVO: O objetivo deste estudo foi avaliar os efeitos da aplicação intravenosa(IV) de dexcetoprofeno trometamol em bloqueio dos nervos ilioinguinal e ílio-hipogástrico na qualidade analgésica e no consumo de morfina após histerectomia abdominal total. MÉTODO: Estudo clínico contro [...] lado e randomizado conduzido com 61 pacientes. O estudo foi feito em sala de operação, sala de recuperação pós-anestésica e ambulatório. Os 61 pacientes foram randomicamente alocados em três grupos: grupo controle (Grupo C), grupo bloqueio (Grupo B) e grupo bloqueio com dexcetoprofeno (Grupo BD). Antes da incisão cirúrgica feita após a indução da anestesia, fizemos o bloqueio dos nervos ilioinguinal e ilio-hipogástrico (Grupo C recebeu solução salina e grupos B e BD receberam levobupivacaína). Em contraste com os grupos C e B, o Grupo BD recebeu dexcetoprofeno. Administramos morfina a todos os pacientes para analgesia, com o uso do método de analgesia controlada pelo paciente (ACP) durante o pós-operatório de 24 horas. Registramos os escores para dor pela escala visual analógica (EVA), os índices de satisfação, o consumo de morfina e os efeitos colaterais durante o pós-operatório de 24 horas. RESULTADOS: Os escores EVA do Grupo BD foram menores do que os dos grupos C e B no pós-operatório (p Abstract in spanish JUSTIFICATIVA Y OBJETIVO: El objetivo de este estudio fue evaluar los efectos de la aplicación intravenosa (IV) del dexketoprofeno trometamol en el bloqueo de los nervios ilioinguinal e Ilio-hipogástrico en la calidad analgésica y en el consumo de morfina después de la histerectomía abdominal total. [...] MÉTODO: Estudio clínico controlado y aleatorio llevado a cabo con 61 pacientes. El estudio se hizo en un quirófano, en la sala de recuperación postanestésica y en el ambulatorio. Los 61 pacientes fueron aleatoriamente divididos en tres grupos: grupo control (Grupo C), grupo bloqueo (Grupo B) y grupo bloqueo con dexketoprofeno (Grupo BD). Antes de la incisión quirúrgica hecha después de la inducción de la anestesia, hicimos el bloqueo de los nervios ilioinguinal e ilio-hipogástrico (Grupo C recibió solución salina y grupos B y BD recibieron levobupivacaína). En contraste con los grupos C y B, el Grupo BD recibió dexketoprofeno. Administramos morfina a todos los pacientes para la analgesia con el uso del método ACP durante el postoperatorio de 24 horas. Registramos las puntuaciones EVA, los índices de satisfacción, el consumo de morfina y los efectos colaterales durante el postoperatorio de 24 horas. RESULTADOS: Los puntuaciones EVA del Grupo BD fueron menores que las de los grupos C y B en el postoperatorio (p Abstract in english BACKGROUND AND OBJECTIVE: In this study, our aim was to evaluate the effects of intravenous dexketoprofen trometamol with ilioinguinal and iliohypogastric nerve block on analgesic quality and morphine consumption after total abdominal hysterectomy operations. METHODS: We conducted this randomized co [...] ntrolled clinical study on 61 patients. The study was conducted in the operation room, post-anesthesia care unit, and inpatient clinic. We randomly grouped the 61 patients into control group (group C), block group (group B) and dexketoprofen-block group (group DB). Before the skin incision performed after anesthesia induction, we performed ilioinguinal iliohypogastric block (group C given saline and group P and DB given levobupivacaine). In contrast to group C and B, group DB was given dexketoprofen. We administered morphine analgesia to all patients by patient-controlled analgesia (PCA) during the postoperative 24 hours. We recorded Visual Analogue Scale (VAS), satisfaction scores, morphine consumption and side effects during postoperative 24 hours. RESULTS: We found the DB group's VAS scores to be lower than the control group and block group's (p

  9. Spinal blocks.

    Science.gov (United States)

    Kokki, Hannu

    2012-01-01

    Every anesthetist should have the expertise to perform lumbar puncture that is the prerequisite to induce spinal anesthesia. Spinal anesthesia is easy and effective technique: small amount of local anesthetic injected in the lumbar cerebrospinal fluid provides highly effective anesthesia, analgesia, and sympathetic and motor block in the lower part of the body. The main limitation of spinal anesthesia is a variable and relatively short duration of the block with a single-injection of local anesthetic. With appropriate use of adjuvant or combining spinal anesthesia with epidural anesthesia, the analgesic action can be controlled in case of early recovery of initial block or in patients with prolonged procedures. Contraindications are rare. Bleeding disorders and any major dysfunction in coagulation system are rare in children, but spinal anesthesia should not be used in children with local infection or increased intracranial pressure. Children with spinal anesthesia may develop the same adverse effects as has been reported in adults, but in contrast to adults, cardiovascular deterioration is uncommon in children even with high blocks. Most children having surgery with spinal anesthesia need sedation, and in these cases, close monitoring of sufficient respiratory function and protective airway reflexes is necessary. Postdural puncture headache and transient neurological symptoms have been reported also in pediatric patients, and thus, guardians should be provided instructions for follow-up and contact information if symptoms appear or persist after discharge. Epidural blood patch is effective treatment for prolonged, severe headache, and nonopioid analgesic is often sufficient for transient neurological symptoms. PMID:21899656

  10. Eficácia de duas técnicas de obturação em cavidades experimentais de reabsorção radicular interna / Efficacy of two obturation techniques in experimental internal root resorption cavities

    Scientific Electronic Library Online (English)

    Tiago André Fontoura de, Melo; Gustavo Golgo, Kunert; Mireli Belizario da, Silva; Mariella Falci, Cabeda.

    2014-12-01

    Full Text Available Introdução: O preenchimento com material endodôntico obturador em dentes com reabsorção radicular interna é extremamente difícil. Objetivo: Avaliar a eficácia de duas técnicas de obturação no preenchimento de cavidades experimentais de reabsorção interna. Material e método: Vinte incisivos cent [...] rais superiores artificiais, com a presença de uma cavidade simulada padronizada de reabsorção no terço médio do canal radicular, foram utilizados. Após o preparo endodôntico dos dentes, os mesmos foram randomicamente divididos em dois grupos (n=10), de acordo com a técnica de obturação empregada: híbrida de Tagger ou com auxílio do sistema ultrassônico. A verificação da obturação endodôntica, junto à cavidade de reabsorção interna, foi feita por meio da tomada radiográfica com dois tipos de incidência: mesiodistal e vestibulolingual. Para a análise da área de obturação, foi empregado o programa Image Tool®. Os dados obtidos da obturação foram submetidos à análise estatística por meio do Teste t de Student, com nível de significância de 5%. Resultado: Não houve diferença estatística entre as técnicas de obturação testadas. Apenas pôde-se observar diferença significativa nos dentes obturados com auxílio do ultrassom, quando se comparou a incidência radiográfica realizada no sentido mesiodistal com a vestibulolingual. Conclusão: As duas técnicas de obturação testadas foram similares no preenchimento da cavidade de reabsorção interna. Abstract in english Introduction: The filling with obturation endodontic material in teeth with internal root resorption is extremely difficult. Objective: To evaluate the efficacy of two obturation techniques in the filling of experimental internal resorption cavities. Material and method: Twenty maxillary centra [...] l incisors artificial, with the presence of a standardized simulated resorption cavity in the middle third of the root canal were used. After endodontic treatment of teeth, they were randomly divided into two groups (n=10), according to the obturation technique used: hybrid Tagger or with the aid of the ultrasonic system. Verification of endodontic obturation, with the cavity internal resorption, was taken by radiography with two types of incidence: mesiodistal and buccolingual. For the analysis of area closures, we used the Image Tool® program. The data of the filling were subjected to statistical analysis using Student's t test, with significance level of 5%. Result: There was no statistical difference between the tested obturation techniques. As one can observe a significant difference in teeth obturated with the aid of ultrasound, when compared to the radiograph performed in mesiodistal with buccolingual. Conclusion: The two obturation techniques tested were similar to fill the cavity of internal resorption.

  11. Nodopathies of the peripheral nerve: an emerging concept.

    Science.gov (United States)

    Uncini, Antonino; Kuwabara, Satoshi

    2015-11-01

    Peripheral nerve diseases are traditionally classified as demyelinating or axonal. It has been recently proposed that microstructural changes restricted to the nodal/paranodal region may be the key to understanding the pathophysiology of antiganglioside antibody mediated neuropathies. We reviewed neuropathies with different aetiologies (dysimmune, inflammatory, ischaemic, nutritional, toxic) in which evidence from nerve conductions, excitability studies, pathology and animal models, indicate the involvement of the nodal region in the pathogenesis. For these neuropathies, the classification in demyelinating and axonal is inadequate or even misleading, we therefore propose a new category of nodopathy that has the following features: (1) it is characterised by a pathophysiological continuum from transitory nerve conduction block to axonal degeneration; (2) the conduction block may be due to paranodal myelin detachment, node lengthening, dysfunction or disruption of Na(+) channels, altered homeostasis of water and ions, or abnormal polarisation of the axolemma; (3) the conduction block may be promptly reversible without development of excessive temporal dispersion; (4) axonal degeneration, depending on the specific disorder and its severity, eventually follows the conduction block. The term nodopathy focuses to the site of primary nerve injury, avoids confusion with segmental demyelinating neuropathies and circumvents the apparent paradox that something axonal may be reversible and have a good prognosis. PMID:25699569

  12. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... in the United States have some form of epilepsy. You are about to see a vagus nerve ... the implantation of a vagus nerve stimulator for epilepsy. My name is Dr. Stephanie Einhaus and I ...

  13. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... emailed in previously was do small electrical appliances, cellular phones, or metal detectors affect vagus nerve stimulation? The ... been asked does vagus nerve stimulator therapy cause sleep disturbances? The answer to that question is no, ...

  14. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... dissect down to the vagus nerve and wrap these electrodes around the nerve and then connect them ... the trachea and we’re dissecting down between these two to what’s called the carotid sheath. The ...

  15. Ultrasound-Guided Ankle Blocks: A Review of Current Practices.

    Science.gov (United States)

    Falyar, Christian R

    2015-10-01

    Ankle blocks are routinely indicated for surgical anesthesia and postoperative analgesia of procedures involving the foot. Traditionally, ankle blocks have been performed by relying on landmark identification of nerves. The literature regarding the performance and efficacy of ankle blocks is inconsistent. This can be attributed to several variables, such as provider technique, differences in patient populations, and the type and volume of local anesthetics administered. As with other peripheral nerve blocks originally performed using landmark technique, ultrasound imaging is now being incorporated into these procedures. Ultrasound guidance provides the anesthetist with several advantages over landmark techniques. The ability to identify peripheral nerves, view needle movements in real-time, and observe the spread of local anesthetic has been shown to result in greater block efficacy, even with reduced volumes of local anesthetic. Additionally, ultrasound imaging gives the provider the option to perform regional anesthesia in specific patient populations not considered possible when using landmark technique. Despite the limited literature on ultrasound-guided ankle blocks, outcome metrics seem to be consistent with those of other peripheral nerve blocks performed using this technology. PMID:26638458

  16. High division of sciatic nerve

    OpenAIRE

    Tripti Shrivastava; Lalit Garg; Mishra, B. K.; Neeta Chhabra

    2014-01-01

    Background: The Sciatic nerve is the largest and thickest nerve in the human body with a long course in the inferior extremity. It divides into tibial and common peroneal nerves which can occur at any level from the sacral plexus to the inferior part of the popliteal space. Sciatic nerve variations are relatively common. These variations may contribute to clinical conditions ex sciatica, coccygodynia and piriformis syndrome and have important clinical implications in anaesthesiology, neurolog...

  17. Types of Heart Block

    Science.gov (United States)

    ... from the NHLBI on Twitter. Types of Heart Block Some people are born with heart block (congenital), ... congenital and acquired heart block. First-Degree Heart Block In first-degree heart block, the heart's electrical ...

  18. The level of the sciatic nerve division and its relations to the piriform muscle

    Directory of Open Access Journals (Sweden)

    Ugrenović Slađana Z.

    2005-01-01

    Full Text Available Background. The sciatic nerve, as the terminal branch of the sacral plexus, leaves the pelvis through the greater sciatic foramen beneath the piriform muscle. Afterwards, it separates into the tibial and the common peroneal nerve, most frequently at the level of the upper angle of the popliteal fossa. Higher level of the sciatic nerve division is a relatively frequent phenomenom and it may be the cause of an incomplete block of the sciatic nerve during the popliteal block anesthesia. There is a possibility of different anatomic relations between the sciatic nerve or its terminal branches and the piriform muscle (piriformis syndrome. The aim of this research was to investigate the level of the sciatic nerve division and its relations to the piriform muscle. It was performed on 100 human fetuses (200 lower extremities which were in various gestational periods and of various sex, using microdissection method. Characteristic cases were photographed. Results. Sciatic nerve separated into the tibial and common peroneal nerve in popliteal fossa in 72.5% of the cases (bilaterally in the 66% of the cases. In the remainder of the cases the sciatic nerve division was high (27.5% of the cases in the posteror femoral or in the gluteal region. Sciatic nerve left the pelvis through the infrapiriform foramen in 192 lower extremities (96% of the cases, while in 8 lower extremities (4% of the cases the variable relations between sciatic nerve and piriform muscle were detected. The common peroneal nerve penetrated the piriform muscle and left the pelvis in 5 lower extremities (2.5% of the cases and the tibial nerve in those cases left the pelvis through the infrapiriform foramen. In 3 lower extremities (1.5% of the cases common peroneal nerve left the pelvis through suprapiriform, and the tibial nerve through the infrapiriform foramen. The high terminal division of sciatic nerve (detected in 1/3 of the cases, must be kept in mind during the performing of popliteal block anesthesia. Conclusion. Although very rare, anatomical abnormalities of common peroneal nerve in regard to piriform muscle are still possible.

  19. Post stimulus effects of high frequency biphasic electrical current on a fibre's conductibility in isolated frog nerves

    Science.gov (United States)

    Liu, Hailong; Zhu, Linlin; Sheng, Shulei; Sun, Lifei; Zhou, Hongmin; Tang, Hong; Qiu, Tianshuang

    2013-06-01

    Objective. High frequency biphasic (HFB) electrical currents are widely used in nerve blocking studies. Their safety margins largely remain unknown and need to be investigated. Approach. This study, exploring the post stimulus effects of HFB electrical currents on a nerve's conductibility, was performed on bullfrog sciatic nerves. Both compound action potentials (CAPs) and differential CAPs (DCAPs, i.e. control CAPs subtracted by CAPs following HFB currents) were obtained, and N1 and N2 components, which were the first and second upward components of DCAPs, were used for analyses of the effects introduced by HFB electrical stimulation. Main results. First, HFB currents of 10 kHz at a completely blocking threshold were applied for 5 s. The maximum amplitudes and conducting velocities of the CAPs were significantly (P nerve's conductibility, exhibited two distinct phases: a fast one lasting several seconds and a slow one lasting longer than 5 min. Further tests showed a linear relationship between the HFB stimulation durations and recovering periods of N1 amplitudes. Supra-threshold blocking did not cause higher N1 amplitudes. Significance. This study indicates that HFB electrical currents lead to long lasting post stimulus reduction of a nerve's conductibility, which might relate to potential nerve injuries. A possible mechanism, focusing on changes in intracellular and periaxonal ionic concentrations, was proposed to underlie the reduction of the nerve's conductibility and potential nerve injuries. Greater caution and stimulation protocols with greater safety margins should be explored when utilizing HFB electrical current to block nerve conductions.

  20. Nerve conduction and excitability studies in peripheral nerve disorders

    DEFF Research Database (Denmark)

    Krarup, Christian; Moldovan, Mihai

    2009-01-01

    PURPOSE OF REVIEW: The review is aimed at providing information about the role of nerve excitability studies in peripheral nerve disorders. It has been known for many years that the insight into peripheral nerve pathophysiology provided by conventional nerve conduction studies is limited. Nerve....... Studies of different metabolic neuropathies have assessed the influence of uremia, diabetes and ischemia, and the use of these methods in toxic neuropathies has allowed pinpointing damaging factors. Various mutations in ion channels associated with central nervous system disorders have been shown to have...

  1. Optic nerve oxygen tension

    DEFF Research Database (Denmark)

    Kiilgaard, Jens Folke; Pedersen, D B; Eysteinsson, T; la Cour, M; Bang, K; Jensen, P K; Stefánsson, E

    2004-01-01

    The authors have previously reported that carbonic anhydrase inhibitors such as acetazolamide and dorzolamide raise optic nerve oxygen tension (ONPO(2)) in pigs. The purpose of the present study was to investigate whether timolol, which belongs to another group of glaucoma drugs called beta blockers, has a similar effect. In addition, the effect of dorzolamide and timolol in combination was studied.

  2. Variant anatomy of sciatic nerve in a black Kenyan population.

    Science.gov (United States)

    Ogeng'o, J A; El-Busaidy, H; Mwika, P M; Khanbhai, M M; Munguti, J

    2011-08-01

    Knowledge of variant anatomy of the sciatic nerve is important in avoiding inadvertent injury during operations in the gluteal region and interpreting nondiscogenic sciatica. This variant anatomy may cause piriformis syndrome and failure of sciatic nerve block. The variations differ between populations but data from Africans is scarce. This study, therefore, investigated variations of sciatic nerve in a black Kenyan population. One hundred and sixty-four sciatic nerves from 82 cadavers of black Kenyans were exposed by dissection at the Department of Human Anatomy, University of Nairobi, Kenya. The level of bifurcation, relationship to piriformis, and topographic relations between the branches were studied. The results were analysed by SPSS version 16.0 and are presented by macrographs. In 33 (20.1%) cases division occurred in the pelvis, while in 131 (79.9%) it occurred outside the pelvis. A single trunk sciatic nerve exited below the piriformis muscle in 131 (79.9%) cases. In cases of pelvic division, the tibial nerve was always infrapiriformic, while the common peroneal nerve passed below piriformis in 16 (9.8%) cases, pierced the piriformis in 13 (7.9%), and passed above it in 4 (2.4%). For those in which division was extrapelvic, 110 (67.1%) were in the popliteal fossa, 17 (10.4%) in the middle third of the thigh, and 4 (2.4%) in the gluteal region. Where the division was pelvic, in 19 (11.6%) cases they continued separately, in 8 (4.9%) the two nerves reunited, and in 6 (3.7%) they were connected by a communicating nerve. The sciatic nerve in the Kenyan population varies from the classical description in over 30% of cases, with many high divisions, low incidence of piriformic course of common peroneal nerve, reunion, and unusual connection between common peroneal and tibial nerves. These variations may complicate surgery and interpretation of sciatic neuropathy. Preoperative nerve imaging and extra operative diligence in the gluteal region and the back of the thigh are recommended. PMID:21866528

  3. Role of dexamethasone in brachial plexus block

    International Nuclear Information System (INIS)

    To evaluate the effect of dexamethasone added to (lignocaine) on the onset and duration of axillary brachial plexus block. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital Rawalpindi, from September 2009 to March 2010. Patients and Methods: A total of 100 patients, who were scheduled for elective hand and forearm surgery under axillary brachial plexus block, were randomly allocated to group A in which patients received 40 ml 1.5% lidocaine with 2 ml of isotonic saline (0.9%) and group B in which patients received 40 ml 1.5% lidocaine with 2 ml of dexamethasone (8 mg). Nerve stimulator with insulated needle for multiple stimulations technique was used to locate the brachial plexus nerves. After the injection onset of action and duration of sensory blockade of brachial plexus were recorded at 5 minutes and 15 minutes interval. Results: Group A showed the onset of action of 21.64 ± 2.30 min and in group B it was 15.42 ± 1.44 min (p< 0.001). Duration of nerve block was 115.08 ± 10.92 min in group A and 265.42 ± 16.56 min in group B (p < 0.001). Conclusion: The addition of dexamethasone to 1.5% lignocaine solution in axillary brachial plexus block prolongs the duration of sensory blockade significantly. (author)

  4. The Effect of Two Post-Space Preparation Techniques on the Seal of Resilon and Gutta-Percha Obturation Materials

    Directory of Open Access Journals (Sweden)

    Kazem Ashofteh Yazdi,

    2010-06-01

    Full Text Available INTRODUCTION: The aim of this study was to compare the effect of post space preparation with Gates Glidden drills or hand files on the sealing ability of gutta-percha or Resilon obturation materials. MATERIALS AND METHODS: One-hundred and four single-rooted human teeth were instrumented and divided into four experimental groups (n=21 each and two groups of positive and negative control (n=10. Forty-two roots of experimental groups were obturated with gutta-percha and Dorifill sealer; and 42 roots with Resilon/Epiphany self-etch using lateral compaction technique. Each gutta-percha or Resilon group was divided into two subgroups (n=21 and post-space prepared with either Gates Glidden drills or hand files and chloroform. After post space preparation, 5 mm of apical gutta-percha or Resilon was left intact. The whole system was sterilized with gamma-rays. Saliva leakage was tested using a split-chamber model. Specimens were monitored every 24 hours for 30 days. The data were analyzed using log-rank test and Cox regression analysis. RESULTS: There were no significant differences between the sealing ability of gutta-percha and Resilon. Furthermore, no significant difference was found between two different methods of post space preparation (P>0.05. CONCLUSION: Under the limitations of this ex vivo study, there were no significant differences between the sealing ability of Resilon and gutta-percha after post space preparation using Gates Glidden drills or hand files with the aid of chloroform.

  5. Evaluation of Coronal Leakage Following Different Obturation Techniques and in-vitro Evalution Using Methylene Blue Dye Preparation

    Science.gov (United States)

    Mathur, Rachit; Sharma, Medhavi; Sharma, Deepak; Raisingani, Deepak; Vishnoi, Suchita; Singhal, Deepika

    2015-01-01

    Introduction Coronal and apical leakage still remains one of the most important cause for endodontic failure in spite of the presence of advanced endodontic materials. The cause may attribute to different filling techniques, physical and chemical properties of sealers and presence or absence of smear layer assessment of coronal or apical leakage is used as a research method to compare the sealing ability of different techniques and endodontic materials. Aim To compare the coronal bacterial leakage using methylene blue in four different obturation techniques after protaper hand instrumentation. Materials and Methods Ninety extracted single-rooted teeth were instrumented to an apical preparation size F3 Protaper hand files. Twenty teeth were randomly obturated with lateral compaction, 20 with vertical compaction, 20 with combination of vertical and lateral compaction and 20 with Thermafil. Ten teeth were used for positive and negative controls (five teeth in each group). Teeth were kept in 100% humidity for 90 days, and then subjected coronally to Proteus vulgaris for 21 days to assess bacterial leakage. After bacterial challenge, methylene blue was placed coronally for another 21 days, and then scoring was done according to depth of dye leakage. Chi-square test was done for statistical analysis. Results Leakage as observed with combination of vertical and lateral compaction was significantly less than vertical compaction, lateral compaction and thermafil carriers during bacterial challenge. However, when dye was used it also showed statistically significant results with thermafil carriers showing the least leakage in comparison to vertical condensation, lateral condensation and combined groups. Conclusion The study concludes that two different methods i.e. bacterial and dye leakage revealed considerable variation on the same substrate Thus, due to the presence of variability among the results obtained by two different analytical methods used in the present study, the study emphasizes the need for standardization of methods as the lack of standardization hinders the comparison of different endodontic filling techniques. PMID:26813402

  6. Pathology of the vestibulocochlear nerve

    International Nuclear Information System (INIS)

    There is a large scala of pathology affecting the vestibulocochlear nerve. Magnetic resonance imaging is the method of choice for the investigation of pathology of the vestibulocochlear nerve. Congenital pathology mainly consists of agenesis or hypoplasia of the vestibulocochlear nerve. Tumoral pathology affecting the vestibulocochlear nerve is most frequently located in the internal auditory canal or cerebellopontine angle. Schwannoma of the vestibulocochlear nerve is the most frequently found tumoral lesion followed by meningeoma, arachnoid cyst and epidermoid cyst. The most frequently encountered pathologies as well as some more rare entities are discussed in this chapter.

  7. Pathology of the vestibulocochlear nerve

    Energy Technology Data Exchange (ETDEWEB)

    De Foer, Bert [Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: bert.defoer@GZA.be; Kenis, Christoph [Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: christophkenis@hotmail.com; Van Melkebeke, Deborah [Department of Neurology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: Deborah.vanmelkebeke@Ugent.be; Vercruysse, Jean-Philippe [University Department of ENT, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: jphver@yahoo.com; Somers, Thomas [University Department of ENT, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: Thomas.somers@GZA.be; Pouillon, Marc [Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: marc.pouillon@GZA.be; Offeciers, Erwin [University Department of ENT, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: Erwin.offeciers@GZA.be; Casselman, Jan W. [Department of Radiology, AZ Sint-Jan AV Hospital, Ruddershove 10, Bruges (Belgium); Consultant Radiologist, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium); Academic Consultent, University of Ghent (Belgium)], E-mail: jan.casselman@azbrugge.be

    2010-05-15

    There is a large scala of pathology affecting the vestibulocochlear nerve. Magnetic resonance imaging is the method of choice for the investigation of pathology of the vestibulocochlear nerve. Congenital pathology mainly consists of agenesis or hypoplasia of the vestibulocochlear nerve. Tumoral pathology affecting the vestibulocochlear nerve is most frequently located in the internal auditory canal or cerebellopontine angle. Schwannoma of the vestibulocochlear nerve is the most frequently found tumoral lesion followed by meningeoma, arachnoid cyst and epidermoid cyst. The most frequently encountered pathologies as well as some more rare entities are discussed in this chapter.

  8. Blocked strainers

    International Nuclear Information System (INIS)

    Thermal insulation was the cause of the blockages that shut down five BWRs in Sweden. The main culprit was mineral wool installed when the plants started up. Physical degradation of the wool over the lifetime of the plant meant it could easily be washed out of place during a loss of coolant accident and could quickly block strainers in the emergency core cooling systems. The five BWRs are almost all back on line, equipped with larger strainers and faster backwashing capability. But the incident prompted more detailed investigation into how materials in the containment would behave during an accident. One material that caused particular concern is Caposil, a material often used to insulate the reactor vessel. Composed of natural calcium, aluminium silicates and cellulose fibres, in the event of a LOCA Caposil becomes particularly hazardous. Under high pressure, or when brought into contact with high pressure water and steam, Caposil fragments into 1 cm clumps, free fibres, and ''fines''. It is these fines which cause major problems and can block a strainer extremely quickly. The successful testing of a high performance water filter which can handle Caposil is described. (4 figures) (Author)

  9. Effect of Lidocaine Chloride on Group A Nerve Fibers Function

    Directory of Open Access Journals (Sweden)

    Jelena Scekic

    2010-12-01

    Full Text Available Local anesthetics, such as lidocaine chloride delay or inhibit the occurrence and transmission of impulses along the excitable tissue membranes, but there is not enough information about their effects on types of nerve fibers within the whole nerve. The aim of the study was to determine the function parameters and examine the degree of blocking for each fiber type in group A of isolated frog sciatic nerves in relation to lidocaine chloride concentration. Thirty frog sciatic nerves, divided into three groups of 10, were examined. The nerves were incubated in Ringer solution (2.0 mmol/l calcium solution for 2 hours and control measurements were made. The nerves were put then in the following lidocaine chloride solutions: group I: 0.5 mmol/l, group II: 1.0 mmol/l and group III: 2.0 mmol/l. Experimental measurements were performed during incubation each minute until response disappearance. The compound action potential was induced by single electrical stimulus and the parameters were measured using the digital oscilloscope. The obtained data were statistically analyzed using the GraphPad Prism 5.0. Conduction velocitities for the respective types of fiber were: A? = 18.61±1.44 m/s; A? = 14.26±1.28 m/s; A? = 10.82±1.06 m/s; and A? = 6.51±0.51 m/s. The lowest percentage of blocked fiber type was for A?, and the highest for A? in relation to all three concentrations of lidocaine chloride (p?0.05. Increasing concentrations of lidocaine chloride solution increased the proportion of blocked fibers for each type of group A fibers (p?0.05. For A? fibers decrease of amplitude compared to the decrease of conduction velocity was greater (p?0.05. All group A fibers were sensitive to the effects of lidocaine chloride, but the most sensitive were A? fibers.

  10. Spinal myoclonus following a peripheral nerve injury: a case report

    Directory of Open Access Journals (Sweden)

    Erkol Gokhan

    2008-08-01

    Full Text Available Abstract Spinal myoclonus is a rare disorder characterized by myoclonic movements in muscles that originate from several segments of the spinal cord and usually associated with laminectomy, spinal cord injury, post-operative, lumbosacral radiculopathy, spinal extradural block, myelopathy due to demyelination, cervical spondylosis and many other diseases. On rare occasions, it can originate from the peripheral nerve lesions and be mistaken for peripheral myoclonus. Careful history taking and electrophysiological evaluation is important in differential diagnosis. The aim of this report is to evaluate the clinical and electrophysiological characteristics and treatment results of a case with spinal myoclonus following a peripheral nerve injury without any structural lesion.

  11. Postoperative rehabilitation in patients with peripherial nerves injury

    Directory of Open Access Journals (Sweden)

    ?irovi? Dragana

    2003-01-01

    Full Text Available Injuries of extremities can be followed by various neuromuscular complications. Injury of peripheral nerves directly depended on the topographic localization of injury (fractures, cuts, contusions. The neuromuscular complications were diagnosed and under follow-up, based on clinical, x-ray, neurologic and neurophysiological findings. The timing of physical treatment and assessment of the necessary neurosurgical intervention depended on the obtained findings. After surgeries, we continued to apply physical treatment and rehabilitation. The aim of the paper was to assess the significance of proper timing for surgery and adequate postoperative rehabilitation, as well as treatment results, depending on the extent of peripheral nerve injury. Material and methods: Based on the study condocted in the period from 2000-2002, most surgeries were done on the ulnar nerve (4 pts, median nerve (4 pts, radial nerve (3 pts, peroneal nerve (2 pts and plexus brachialis (3 pts. Paresis and peripheral nerve paralysis, associated with sensibility disorders, predominated in clinical features. In most patients surgery was done during the first 3 - 6 months after injury. In early postoperative treatment positioning of extremities with electrotherapy were most often used in early postoperative treatment, Bioptron and dosed kinesitherapy. Depending on the neurophysiological findings, in later treatment stage we included electrostimulation, thermotherapy, kinesitherapy and working therapy, with the necessary application of static and dynamic orthroses. Study results showed that the success of treatment depended on the extent of injury, i.e. whether suture of liberalization of the nerve had been done, on the adequate timing of surgery, as well as on the adequate timing and application of physical therapy and rehabilitation. More rapid and complete functional recovery was achieved if the interval between injury and surgery was shorter, as well as physical therapy was applied early. Based on the analysis of the achieved results, we concluded that peripheral nerve lesions after fractures and contusions had better prognosis in relation to isolated sections of peripheral nerves, having in mind that these were mostly conductive block transfer and nerve stretching lesion, which do not leave sequelae after completed treatment After neurorrhaphies and applied therapy, motor and sensitive deficit mostly depended on good timing of surgery and continual physiatric treatment. It is also important to point out the significance of team-work among neurosurgeon, neurologist and physiatrist necessary in early detection and successful treatment of numerous sequelae and invalidity in patients with peripheral nerve lesions.

  12. Traumatic third nerve palsy.

    OpenAIRE

    Elston, J S

    1984-01-01

    Twenty patients with a traumatic third nerve palsy had sustained a closed head injury with prolonged loss of consciousness in a high-speed deceleration accident. Sixteen were male, and the average age was 25 years. Seven had skull or facial fractures, 15 damage to the anterior visual pathways, and 16 other permanent neurological damage. Nineteen developed the misdirection/regeneration syndrome. Thirteen had strabismus surgery, and an area of binocular single vision was enlarged or achieved in...

  13. [Suprascapular nerve entrapment].

    Science.gov (United States)

    Fansa, H; Schneider, W

    2003-03-01

    Isolated compression of the suprascapular nerve is a rare entity, that is seldom considered in differential diagnosis of shoulder pain. Usually atrophy of supraspinatus and infraspinatus muscles is present, resulting in weakened abduction and external rotation of the shoulder. Mostly the patients do not note the paresis, but complain about a dull and burning pain over the dorsal shoulder region. In a proximal lesion (at level of the superior transverse scapular ligament) electromyography reveals changes in both muscles, while in a distal lesion (spinoglenoidal notch) only the infraspinatus shows a pathology. From 1996 to 2001 we diagnosed an isolated suprascapular entrapment in nine patients. Seven patients were operated: The ligament was removed and the nerve was neurolysed. The average age was 36 years. All patients showed pathological findings in electrophysiological and clinical examination. Five patients had an atrophy of both scapula muscles, two showed only infraspinatus muscle atrophy (one with a ganglion in the distal course of the nerve). Six patients were followed up. All showed an improvement. Pain disappeared and all patients were able to return to work and sport activities. Electrophysiological examination one year after operation revealed normal nerve conduction velocity. The number of motor units, however, showed a reduction by half compared to the healthy side. Lesions without history of trauma are usually caused by repetitive motion or posture. Weight lifting, volley ball and tennis promote the entrapment. Rarely a lesion (either idiopathic or due to external compression) is described for patients who underwent surgery. Patients with a ganglion or a defined cause of compression should be operated, patients who present without a distinct reason for compression should firstly be treated conservatively. Physiotherapy, antiphlogistic medication and avoiding of the pain triggering motion can improve the symptoms. However, if muscle atrophy is evident, an operation is indicated from our experience. PMID:12874724

  14. Optic nerve hypoplasia

    OpenAIRE

    Kaur, Savleen; Jain, Sparshi; Sodhi, Harsimrat B. S.; Rastogi, Anju; Kamlesh,

    2013-01-01

    Optic nerve hypoplasia (ONH) is a congenital anomaly of the optic disc that might result in moderate to severe vision loss in children. With a vast number of cases now being reported, the rarity of ONH is obviously now refuted. The major aspects of ophthalmic evaluation of an infant with possible ONH are visual assessment, fundus examination, and visual electrophysiology. Characteristically, the disc is small, there is a peripapillary double-ring sign, vascular tortuosity, and thinning of the...

  15. Cranial Nerve II: Vision

    OpenAIRE

    Gillig, Paulette Marie; Sanders, Richard D

    2009-01-01

    This article contains a brief review of the anatomy of the visual system, a survey of diseases of the retina, optic nerve and lesions of the optic chiasm, and other visual field defects of special interest to the psychiatrist. It also includes a presentation of the corticothalamic mechanisms, differential diagnosis, and various manifestations of visual illusions, and simple and complex visual hallucinations, as well as the differential diagnoses of these various visual phenomena.

  16. Estudo comparativo do bloqueio combinado femoral-isquiático, por punção em sítio único, com anestesia subaracnóidea para cirurgia unilateral do membro inferior / Comparative study between combined sciatic-femoral nerve block, via a single skin injection, and spinal block anesthesia for unilateral surgery of the lower limb / Estudio comparativo del bloqueo combinado femoral-isquiático por punción en sitio único, con anestesia subaracnoidea para cirugías unilateral del miembro inferior

    Scientific Electronic Library Online (English)

    Luiz Eduardo, Imbelloni; Gustavo Volpato Passarini de, Rezende; Eliana Marisa, Ganem; José Antonio, Cordeiro.

    2010-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A raquianestesia unilateral pode apresentar vantagens em pacientes ambulatoriais. O objetivo deste trabalho foi comparar a raquianestesia unilateral com o bloqueio combinado femoral-isquiático em cirurgias ortopédicas unilaterais e ambulatoriais. MÉTODO: Sessenta pacientes [...] foram aleatoriamente separados em dois grupos para receber 6 mg de bupivacaína hiperbárica ou hipobárica (grupo RQ) em decúbito lateral esquerdo ou 800 mg de lidocaína 1,6% com epinefrina nos nervos femoral e isquiático (grupo CFI) em decúbito dorsal. O bloqueio dos nervos foi realizado com agulha de 150 mm conectada a um neuroestimulador e inserida no ponto médio entre as duas abordagens clássicas, sendo injetados 15 mL no nervo femoral e 35 mL no nervo isquiático. Avaliados o tempo para realização dos bloqueios e sua duração. Vinte minutos após, os pacientes foram avaliados em relação aos bloqueios sensitivo e motor. RESULTADOS: O tempo para a realização da raquianestesia foi significativamente menor do que o bloqueio combinado femoral-isquiático. O bloqueio unilateral foi obtido em 90% dos pacientes no grupo RQ e 100% no grupo CFI. O tempo para recuperação do bloqueio sensitivo e motor foi significativamente maior no grupo CFI. Não houve bradicardia ou hipotensão. CONCLUSÕES: Este estudo conclui que é tecnicamente fácil realizar bloqueio anterior combinado femoral-isquiático e pode ser uma alternativa para o bloqueio unilateral do membro inferior. A raquianestesia unilateral com baixas doses de bupivacaína resultou em menor tempo para realização, menor número de tentativas e recuperação mais precoce do bloqueio combinado femoral-isquiático, porém com mesma efetividade. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: La raquianestesia unilateral puede presentar ventajas en pacientes ambulatoriales. El objetivo de este trabajo fue comparar la raquianestesia unilateral con el bloqueo combinado femoral-isquiático en cirugías ortopédicas unilaterales y ambulatoriales. MÉTODO: Sesenta pacie [...] ntes fueron separados aleatoriamente en dos grupos de 30 para recibir 6 mg de bupivacaína hiperbárica o hipobárica (grupo RQ), en decúbito lateral izquierdo u 800 mg de lidocaína 1,6% con epinefrina en los nervios femoral e isquiático (grupo CFI), en decúbito dorsal. El bloqueo de los nervios fue realizado con una aguja de 150 mm conectada a un neuroestimulador e insertada en el punto medio entre las dos incisiones clásicas. Se inyectaron 15 mL en el nervio femoral y 35 mL en el nervio isquiático. Fue mensurado el tiempo para la realización de los bloqueos y su duración. Veinte minutos después, los pacientes fueron evaluados con relación a los bloqueos sensitivo y motor. RESULTADOS: El tiempo para la realización de la raquianestesia fue significativamente menor que el bloqueo combinado femoral-isquiático. El bloqueo unilateral se obtuvo en un 90% de los pacientes en el grupo RQ y en un 100% en el grupo CFI. El tiempo para la recuperación del bloqueo sensitivo y motor fue significativamente mayor en el grupo CFI. No hubo bradicardia o hipotensión. CONCLUSIONES: Por medio de este estudio, se llega a la conclusión de que es técnicamente fácil realizar el bloqueo anterior combinado femoral-isquiático y de que ese puede ser una alternativa para el bloqueo unilateral del miembro inferior. La raquianestesia unilateral con bajas dosis de bupivacaína, mostró un menor tiempo para la realización, un menor número de intentos y una recuperación más rápida del bloqueo combinado femoral-isquiático. Sin embargo, la efectividad fue la misma. Abstract in english BACKGROUND AND OBJECTIVES: Unilateral spinal anesthesia has advantages when used in outpatient basis. The objective of the present study was to compare unilateral spinal anesthesia with combined sciatic-femoral nerve block in unilateral orthopedic surgeries in outpatients. METHODS: Sixty patients we [...] re randomly divided into two groups of 30 patients to receive 6 mg of hyperbaric or hypobaric bup

  17. Anaesthetic Management of a Patient with Thyrotoxicosis for Nonthyroid Surgery with Peripheral Nerve Blockade

    Science.gov (United States)

    Buget, Mehmet I.; Sencan, Bilge; Varansu, Giray; Kucukay, Suleyman

    2016-01-01

    Thyrotoxicosis is a hypermetabolic condition caused by an elevation in thyroid hormone levels. The disorder has a variety of causes, manifestations, and therapies. Several clinical features of thyrotoxicosis are due to sympathetic stimulation with increased beta-adrenoreceptor upregulation and sensitization to catecholamine. Anaesthetic management of thyrotoxicosis patients using neuraxial block has been described in literature; however, to our knowledge, there are no reports of peripheral nerve block utilization. Here, we report on the anaesthetic management of a patient with thyroiditis-associated thyrotoxicosis undergoing emergency surgery via a femoral and sciatic nerve block.

  18. Optic nerve hypoplasia

    Directory of Open Access Journals (Sweden)

    Savleen Kaur

    2013-01-01

    Full Text Available Optic nerve hypoplasia (ONH is a congenital anomaly of the optic disc that might result in moderate to severe vision loss in children. With a vast number of cases now being reported, the rarity of ONH is obviously now refuted. The major aspects of ophthalmic evaluation of an infant with possible ONH are visual assessment, fundus examination, and visual electrophysiology. Characteristically, the disc is small, there is a peripapillary double-ring sign, vascular tortuosity, and thinning of the nerve fiber layer. A patient with ONH should be assessed for presence of neurologic, radiologic, and endocrine associations. There may be maternal associations like premature births, fetal alcohol syndrome, maternal diabetes. Systemic associations in the child include endocrine abnormalities, developmental delay, cerebral palsy, and seizures. Besides the hypoplastic optic nerve and chiasm, neuroimaging shows abnormalities in ventricles or white- or gray-matter development, septo-optic dysplasia, hydrocephalus, and corpus callosum abnormalities. There is a greater incidence of clinical neurologic abnormalities in patients with bilateral ONH (65% than patients with unilateral ONH. We present a review on the available literature on the same to urge caution in our clinical practice when dealing with patients with ONH. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, endocrinology consultation with or without genetic testing are helpful in the diagnosis and management of ONH. (Method of search: MEDLINE, PUBMED.

  19. Peripheral nerve hyperexcitability syndromes.

    Science.gov (United States)

    Küçükali, Cem Ismail; Kürtüncü, Murat; Akçay, Halil ?brahim; Tüzün, Erdem; Öge, Ali Emre

    2015-01-01

    Peripheral nerve hyperexcitability (PNH) syndromes can be subclassified as primary and secondary. The main primary PNH syndromes are neuromyotonia, cramp-fasciculation syndrome (CFS), and Morvan's syndrome, which cause widespread symptoms and signs without the association of an evident peripheral nerve disease. Their major symptoms are muscle twitching and stiffness, which differ only in severity between neuromyotonia and CFS. Cramps, pseudomyotonia, hyperhidrosis, and some other autonomic abnormalities, as well as mild positive sensory phenomena, can be seen in several patients. Symptoms reflecting the involvement of the central nervous system occur in Morvan's syndrome. Secondary PNH syndromes are generally seen in patients with focal or diffuse diseases affecting the peripheral nervous system. The PNH-related symptoms and signs are generally found incidentally during clinical or electrodiagnostic examinations. The electrophysiological findings that are very useful in the diagnosis of PNH are myokymic and neuromyotonic discharges in needle electromyography along with some additional indicators of increased nerve fiber excitability. Based on clinicopathological and etiological associations, PNH syndromes can also be classified as immune mediated, genetic, and those caused by other miscellaneous factors. There has been an increasing awareness on the role of voltage-gated potassium channel complex autoimmunity in primary PNH pathogenesis. Then again, a long list of toxic compounds and genetic factors has also been implicated in development of PNH. The management of primary PNH syndromes comprises symptomatic treatment with anticonvulsant drugs, immune modulation if necessary, and treatment of possible associated dysimmune and/or malignant conditions. PMID:25719304

  20. Optic nerve hypoplasia.

    Science.gov (United States)

    Kaur, Savleen; Jain, Sparshi; Sodhi, Harsimrat B S; Rastogi, Anju; Kamlesh

    2013-05-01

    Optic nerve hypoplasia (ONH) is a congenital anomaly of the optic disc that might result in moderate to severe vision loss in children. With a vast number of cases now being reported, the rarity of ONH is obviously now refuted. The major aspects of ophthalmic evaluation of an infant with possible ONH are visual assessment, fundus examination, and visual electrophysiology. Characteristically, the disc is small, there is a peripapillary double-ring sign, vascular tortuosity, and thinning of the nerve fiber layer. A patient with ONH should be assessed for presence of neurologic, radiologic, and endocrine associations. There may be maternal associations like premature births, fetal alcohol syndrome, maternal diabetes. Systemic associations in the child include endocrine abnormalities, developmental delay, cerebral palsy, and seizures. Besides the hypoplastic optic nerve and chiasm, neuroimaging shows abnormalities in ventricles or white- or gray-matter development, septo-optic dysplasia, hydrocephalus, and corpus callosum abnormalities. There is a greater incidence of clinical neurologic abnormalities in patients with bilateral ONH (65%) than patients with unilateral ONH. We present a review on the available literature on the same to urge caution in our clinical practice when dealing with patients with ONH. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, endocrinology consultation with or without genetic testing are helpful in the diagnosis and management of ONH. (Method of search: MEDLINE, PUBMED). PMID:24082663

  1. Analysis of Block OMP using Block RIP

    CERN Document Server

    Wang, Jun; Zhang, Hao; Wang, Xiqin

    2011-01-01

    Orthogonal matching pursuit (OMP) is a canonical greedy algorithm for sparse signal reconstruction. When the signal of interest is block sparse, i.e., it has nonzero coefficients occurring in clusters, the block version of OMP algorithm (i.e., Block OMP) outperforms the conventional OMP. In this paper, we demonstrate that a new notion of block restricted isometry property (Block RIP), which is less stringent than standard restricted isometry property (RIP), can be used for a very straightforward analysis of Block OMP. It is demonstrated that Block OMP can exactly recover any block K-sparse signal in no more than K steps if the Block RIP of order K+1 with a sufficiently small isometry constant is satisfied. Using this result it can be proved that Block OMP can yield better reconstruction properties than the conventional OMP when the signal is block sparse.

  2. Limitations of Conduits in Peripheral Nerve Repairs

    OpenAIRE

    Moore, Amy M.; Kasukurthi, Rahul; Magill, Christina K.; Farhadi, H. Francis; Borschel, Gregory H; Mackinnon, Susan E.

    2009-01-01

    Nerve conduits have emerged as alternatives to autologous nerve grafts, but their use in large-diameter nerve deficits remains untested. We report four patients who underwent repair of large-diameter nerves using absorbable nerve conduits and discuss the failed clinical outcomes. The reported cases demonstrate the importance of evaluating the length, diameter, and function of nerves undergoing conduit repair. In large-diameter nerves, the use of conduits should be carefully considered.

  3. conduction blockade of the rat sciatic nerve

    Directory of Open Access Journals (Sweden)

    L. Leitao

    2009-08-01

    Full Text Available Newly synthesized chiral xanthone derivatives (CXD from L-Valinol (XEVOL, L-Leucinol (XEL and S-(--?-4- dimethylbenzylamine (XEA are structurally very similar to local anaesthetics [1,2], to which they might share common molecular targets regarding their activity in the nervous system (e.g. anti-epileptic and anti- depressant potential. This prompted us to investigate whether these compounds exhibit anaesthetic-like properties at the neuronal cell level, focusing on their ability to block the rat sciatic nerve conduction [3]. Nerve conduction blockade might result from a selective interference with Na+ ionic currents or from a non-selective modification of membrane stabilizing properties. Thus, we also evaluated the ability of xanthone derivatives to prevent hypotonic haemolysis [4], given that erythrocytes are non-excitable cells that are devoid of voltage- gated Na+ channels.Xanthone derivatives (XEVOL, XEA and XEL and the core nucleus, CMX, were about equipotent regarding blockade of the rat sciatic nerve conduction, when these compounds were applied in the low micromolar concentration range (0.100-3 ?M. However, at this concentration range, xanthone derivatives had little or no protective effect against hypotonic haemolysis; protection of hypotonic haemolysis was observed only when XEVOL, XEL and CMX were used in higher micromolar (30-100 ?M concentrations. It is worth noting that XEA (100 ?M was virtually devoid of the anti-haemolytic effect. Data suggest that nerve conduction blockade caused by newly synthesized xanthone derivatives might result predominantly from an action on Na+ ionic currents. This effect can be dissociated from their ability to stabilize cell membranes, which only became apparent upon increasing the concentration of the xanthone derivatives to the high micromolar range.This work was supported by FCT (I&D, nº226/2003; I&D, nº4040/2007, FEDER, POCI, U. Porto, and Caixa Geral de Depósitos.

  4. Vertiginous Syndrome Associated with Incorrect Anesthesia Technique to Block the Maxillary Nerve via the Greater Palatine Canal: Case Report and Anatomic Correlation with Cadaveric Parts / Síndrome Vertiginoso Asociado a Técnica Anestésica Incorrecta para Bloquear el Nervio Maxilar vía Canal Palatino Mayor: Reporte de Caso y Correlación Anatómica en Piezas Cadavéricas

    Scientific Electronic Library Online (English)

    Reinaldo, Soto; Felipe, Cáceres; Jorge, Lankin.

    2014-09-01

    Full Text Available La técnica anestésica vía canal palatino mayor tiene como objetivo abordar al nervio maxilar en la fosa pterigopalatina, anestesiando un gran territorio, incluyendo la pulpa y periodonto de la hemiarcada correspondiente. Después de haber aplicado esta técnica en una paciente y no obteniendo el resul [...] tado esperado, esta comenzó a experimentar vértigo, náuseas, sensación de líquido en el oído y vómitos. Fue evaluada en el servicio de urgencias del Hospital Parroquial de San Bernardo y en una Clínica Privada, sin lograr un diagnóstico preciso y realizando solo un tratamiento sintomático. Al día siguiente fue dada de alta con baja sintomatología, la cual desapareció totalmente durante el día. Se propone la hipótesis de una difusión del anestésico hacia el oído medio e interno mediante el tubo auditivo. Esto explicaría por un lado la sintomatología vestibular y por otro la ausencia de anestesia en los dientes y territorios esperados. Además se realizó una correlación anatómica en cadáveres, utilizando 8 hemicabezas conservadas y siguiendo el posible trayecto de la aguja desde la mucosa palatina hasta el orificio faríngeo de la tuba auditiva. Se concluyó que el síndrome vertiginoso experimentado por la paciente se pudo deber a una técnica fallida al nervio maxilar vía canal palatino mayor con ingreso de la aguja al tubo auditivo, difundiendo el anestésico hacia el oído medio. Abstract in english The anesthetic technique through the greater palatine canal seeks to block the maxillary nerve in the pterygopalatine fossa and anesthetize a large area, including the pulp and periodontium of the arch in question. After applying this technique in a patient, it failed to obtain the expected result. [...] The patient began to experience dizziness, nausea, vomiting and the sensation of fluid in the ear. She was evaluated in both the emergency room of the Hospital Parroquial de San Bernardo and at a private clinic without accurate diagnosis. Only symptomatic treatment was provided. The next day she was discharged with reduced symptoms, which disappeared completely during the day. We propose the hypothesis of a diffusion of the anesthetic solution into the middle and inner ear through the auditory tube. This diffusion would explain the vestibular symptoms and the absence of anesthesia in the expected areas. We carried out an anatomic correlation in cadavers, following the path of a needle from the palatal mucosa to the pharyngeal opening of auditory tube. We conclude that the vertiginous syndrome could be due to an incorrect application of the technique, with the needle entering the auditory tube and spreading the anesthetic solution into the middle ear.

  5. Repair of sciatic nerve defects using tissue engineered nerves

    OpenAIRE

    Zhang, Caishun; Lv, Gang

    2013-01-01

    In this study, we constructed tissue-engineered nerves with acellular nerve allografts in Sprague-Dawley rats, which were prepared using chemical detergents-enzymatic digestion and mechanical methods, in combination with bone marrow mesenchymal stem cells of Wistar rats cultured in vitro, to repair 15 mm sciatic bone defects in Wistar rats. At postoperative 12 weeks, electrophysiological detection results showed that the conduction velocity of regenerated nerve after repair with tissue-engine...

  6. Evaluation of the influence of smear layer removal on the sealing ability of two different obturation techniques

    Directory of Open Access Journals (Sweden)

    Kerem Engin Akpınar

    2011-01-01

    Full Text Available

    Purpose: This study investigates the effects of Nd:YAG laser irradiation and 17% EDTA irrigation on apical seals with clearing technique, when used prior to two root canal filling techniques.

    Material and Methods: Sixty freshly extracted human mandibular premolar and canine teeth, each with one root canal, were instrumented with Protaper rotary nickel-titanium instruments and then randomly divided into six groups according to the final irrigation solutions and Nd:YAG laser irradiation for smear layer removal and obturation techniques employed: Group I: 2.5% sodium hypochlorite (NaOCl and cold lateral condensation technique, Group II: 17% EDTA and cold lateral condensation technique, Group III: Nd:YAG laser and cold lateral condensation technique, Group IV: 2.5% NaOCl and thermoplasticised injectable gutta-percha technique (Dia-Gun system, Group V: 17% EDTA and Dia-Gun system, Group VI: Nd:YAG laser and Dia-Gun system. After obturation, the root surfaces were coated with a double layer of nail varnish, with the exception of the apical 2 mm, and placed in indian ink for 7 days. All samples were rendered transparent to measure the maximum linear dye penetration.

    Results: Group 1 showed significantly greater dye leakage compared with groups 5 and 6 (P<0.05. However, no significant difference was found between other groups (P>0.05. Canals obturated with Dia-Gun system showed less mean dye leakage than canals obturated with lateral condensation. Groups, finally irrigated with 17%EDTA and irradiated with Nd:YAG laser, were showed lower mean dye leakage than control groups for both obturation techniques.

    Conclusion: Under in vitro conditions, we found that smear layer removal improved the ability of the filling materials to prevent the fluid movement. Also, Dia-Gun system showed less apical leakage than cold lateral condensation technique in the presence or absence of the smear layer.

    Keywords: Apical leakage, Dia-Gun, EDTA, Nd:YAG laser, clearing technique

  7. What Causes Heart Block?

    Science.gov (United States)

    ... from the NHLBI on Twitter. What Causes Heart Block? Heart block has many causes. Some people are ... develop it during their lifetimes (acquired). Congenital Heart Block One form of congenital heart block occurs in ...

  8. Nilpotent extensions of blocks

    OpenAIRE

    Puig, Lluis

    2010-01-01

    There are normal sub-blocks of nilpotent blocks which are NOT nilpotent or, equivalently, nilpotent extensions of non-nilpotent blocks. In this paper we determine the source algebra structure of the non-nilpotent blocks involved in these situations. Actually, we introduce a new type of blocks - called the inertial blocks - which include the nilpotent blocks and is closed by taking normal sub-blocks.

  9. Hand function after nerve repair.

    OpenAIRE

    Lundborg, Göran; Rosén, Birgitta

    2007-01-01

    Treatment of injuries to major nerve trunks in the hand and upper extremity remains a major and challenging reconstructive problem. Such injuries may cause long-lasting disabilities in terms of lost fine sensory and motor functions. Nowadays there is no surgical repair technique that can ensure recovery of tactile discrimination in the hand of an adult patient following nerve repair while very young individuals usually regain a complete recovery of functional sensibility. Post-traumatic nerve...

  10. Ultrasound-guided single-penetration dual-injection block for leg and foot surgery

    DEFF Research Database (Denmark)

    Børglum, Jens; Johansen, Karina; Christensen, Karen Margrethe; Lenz, Katja; Bendtsen, Thomas F; Tanggaard, Katrine; Christensen, Anders F; Moriggl, Bernhard; Jensen, Kenneth

    2014-01-01

    We describe a new approach to blocking the sciatic and saphenous nerves in the proximal thigh (level of the lesser trochanter or immediately below) using a single-penetration dual-injection (SPEDI) technique. The popliteal-sciatic approach necessitates repositioning of the leg exposing the...... popliteal fossa and an extra injection for the saphenous nerve (SAN) block at the midthigh level. We introduce an alternative, effective, and possibly faster method....

  11. Study of Variations in the Divisions, Course and Termination of the Sciatic Nerve

    Directory of Open Access Journals (Sweden)

    B. N. Umarji

    2013-01-01

    Full Text Available Background: The sciatic nerve is the large stand thickest branch of lumbosacral plexus. It has a long course in the pelvic cavity and in the lower extremity. It separates into its two branches, the tibial and common peroneal nerves outside the pelvis. But the division can occur at any level from the sacral plexus to the inferior part of the popliteal fossa. These anatomical variations in division may cause nerve compression resulting in sciatica, piriformis syndrome, and coccygodynia. Aim: The aim of this study is to observe the variations in division of sciatic nerve as compared to known facts. Methods: The study was performed on cadavers. The inferior extremities of 45 cadavers were examined and variations of division of sciatic nerve were noted and classified. Results: The highest incidence of sciatic nerve variation was observed in its termination. In 11.11% of cases the sciatic nerve was found to be divided in the gluteal region. In 11.11%specimens, the common peroneal nerve pierced the piriformis muscle. Conclusion: The higher division of sciatic nerve can result in the involvement of only one out of the two divisions for the sciatic neuropathy. It is important to consider the higher divisions while performing opliteal block anaesthesia.

  12. Brief reports: a clinical evaluation of block characteristics using one milliliter 2% lidocaine in ultrasound-guided axillary brachial plexus block.

    LENUS (Irish Health Repository)

    O'Donnell, Brian

    2010-09-01

    We report onset and duration of ultrasound-guided axillary brachial plexus block using 1 mL of 2% lidocaine with 1:200,000 epinephrine per nerve (total local anesthetic volume 4 mL). Block performance time, block onset time, duration of surgery, and block duration were measured. Seventeen consecutive patients were recruited. The mean (SD) block performance and onset times were 271 (67.9) seconds and 9.7 (3.7) minutes, respectively. Block duration was 160.8 (30.7) minutes. All operations were performed using regional anesthesia alone. The duration of anesthesia obtained is sufficient for most ambulatory hand surgery.

  13. Sealing ability of three materials in the orifice of root canal systems obturated with gutta-percha.

    Science.gov (United States)

    Jenkins, Stephen; Kulild, James; Williams, Karen; Lyons, William; Lee, Charles

    2006-03-01

    There were 130 single roots randomly assigned to one of 12 experimental or two control groups. Forty specimens each were sealed with 1, 2, 3, or 4 mm of Cavit, ProRoot MTA, or Tetric. After creation of a uniform orifice diameter, the smear layer was removed and the canal systems obturated using warm lateral compaction of gutta-percha (GP). GP was removed to the experimental depth, experimental materials placed in the orifice, and roots submerged in India ink in a vacuum flask. Specimens were demineralized and leakage measured using a 10x stereomicroscope and graded for depth of leakage by one calibrated, blinded rater. There was no significant interaction (p > 0.05) between test materials and orifice depths, nor main effect of orifice depth (p > 0.05). However, there was a statistically significant main effect of test materials with Tetric demonstrating a significantly better seal than Pro Root or Cavit (p < 0.0001) irrespective of orifice depth. PMID:16500232

  14. TopSeal-Dentine Interface After two Obturation Techniques: Lateral Condensation and Thermoplastified/Thermosoftened Technique. A SEM Study

    Directory of Open Access Journals (Sweden)

    Bennys Guzmán de Sousa

    2010-06-01

    Full Text Available  Background: Vertical condensation (VC endodontic systems have improved results of endodontic treatment when compared to lateral condensation (LC. They improve the diffusion and adaptability of the sealer cement (SC and the gutta-percha (GP, in order to obtain a hermetic sealing and ensure the lack of cracks in the sealer material-dentine interface. However, it has not been established whether the application of heat may or not alter the sealer cement-dentine interface (SCDI. Objective: Compare the SCDI at different distances from the root apex, when using two obturation techniques, vertical (TopSeal® and lateral. Methods: An in vitro experimental study with scanning electron microscopy (SEM was carried out. Canals of 40 recently extracted single-root premolars were endodontically prepared with the same instrumentation technique. 20 of them were sealed with LC and TopSeal® and the other 20 were sealed with VC and TopSeal®. The specimens were then cut at 1 mm, 4 mm, and 8 mm from the root apex and observed under SEM. Results: Statistically significant differences were observed in the SCDI of teeth sealed with VC compared to those sealed with LC (pConclusions: The thermoplastified/thermosoftened technique reduces the SCDI when compared to the LC technique. However, the former showed a thicker cement layer on the 1 mm measures, which may have significant clinic implications.

  15. A Comparative Study of the Microleakage of Resilon/Epiphany and Gutta-Percha/AH-Plus Obturating Systems

    Directory of Open Access Journals (Sweden)

    Elmakki Fathia

    2012-07-01

    Full Text Available Introduction: The aim of the present study was to investigate and compare the apical sealing ability of Resilon/Epiphany-filled root canals with those that were obturated with gutta-percha/AH-Plus endodontic sealer. Materials and Methods: A total of 60 extracted human single-rooted teeth were selected; 25 teeth for the two test groups and five for each control group. After conducting conventional endodontic treatment, the teeth were immersed in physiologic saline solution for thirty days, and subsequently sealed and stored in methylene blue dye solution for seven days. The teeth were sectioned to evaluate the linear apical leakage using a stereoscopic microscope. The data were statistically analyzed by non-parametric Kruskal-Wallis and Mann-Whitney U tests. Results: The results showed significant differences between the two groups of endodontic sealers (P<0.001. Conclusion: Within the limitation of the present in vitro study, Resilon/Epiphany sealer had better apical sealing ability than gutta-percha/AH-Plus sealer.

  16. Functions of the Renal Nerves.

    Science.gov (United States)

    Koepke, John P.; DiBona, Gerald F.

    1985-01-01

    Discusses renal neuroanatomy, renal vasculature, renal tubules, renin secretion, renorenal reflexes, and hypertension as related to renal nerve functions. Indicates that high intensitites of renal nerve stimulation have produced alterations in several renal functions. (A chart with various stimulations and resultant renal functions and 10-item,…

  17. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... That’s what the vagus nerve is. It’s a big nerve in the neck and it delivers impulses ... treat them as early as possible. There’s a big trend in the United States to do that. ...

  18. Ulnar nerve entrapment neuropathy due to extraneural ganglia at the elbow: A case report

    OpenAIRE

    Özgür TA?KAPILIO?LU; Ahmet BEKAR; M. Erim KÜR?AT; Yalçinkaya, Ulviye

    2005-01-01

    --------------------------------------------------------------------------------A rare case of ulnar nerve entrapment due to extraneural ganglion at the elbow is presented. A 64-year old right-handed man presented with a 6 months history of pain in his right elbow, progressive numbness, tingling, atrophy and weakness in his right hand. Electrophysiological studies demonstrated a severe conduction block affecting the ulnar nerve in the retrotrochlear groove but without any sign of major axonal...

  19. Ultrasound-Guided Infraorbital Nerve Pulsed Radiofrequency Treatment for Intractable Postherpetic Neuralgia - A Case Report -

    OpenAIRE

    Lim, Seung Mo; Park, Hae Lang; Moon, Hyong Yong; Kang, Kyung Ho; Kang, Hyun; Baek, Chong Hwa; Jung, Yong Hun; Kim, Jin Yun; Koo, Gill Hoi; Shin, Hwa Yong

    2013-01-01

    A 60-year-old man presented with pain on the left cheek and lateral nose. The patient had been diagnosed with facial herpes zoster in the left V2 area 6 months previously. Medical treatment was prescribed for 6 months but it had little effect. We blocked the left infraorbital nerve under ultrasound guidance, but pain relief was short term. Therefore, we performed pulsed radiofrequency treatment on the left infraorbital nerve under ultrasound guidance. Six months after the procedure, the reduc...

  20. Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space.

    Science.gov (United States)

    Hernando, Moisés Fernández; Cerezal, Luis; Pérez-Carro, Luis; Abascal, Faustino; Canga, Ana

    2015-07-01

    Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included "piriformis syndrome," a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. The concept of fibrous bands playing a role in causing symptoms related to sciatic nerve mobility and entrapment represents a radical change in the current diagnosis of and therapeutic approach to DGS. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. A broad spectrum of known pathologies may be located nonspecifically in the subgluteal space and can therefore also trigger DGS. These can be classified as traumatic, iatrogenic, inflammatory/infectious, vascular, gynecologic and tumors/pseudo-tumors. Because of the ever-increasing use of advanced magnetic resonance neurography (MRN) techniques and the excellent outcomes of the new endoscopic treatment, radiologists must be aware of the anatomy and pathologic conditions of this space. MR imaging is the diagnostic procedure of choice for assessing DGS and may substantially influence the management of these patients. The infiltration test not only has a high diagnostic but also a therapeutic value. This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments, with emphasis on MR imaging and endoscopic correlation. PMID:25739706

  1. Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space

    Energy Technology Data Exchange (ETDEWEB)

    Hernando, Moises Fernandez; Cerezal, Luis; Perez-Carro, Luis; Abascal, Faustino; Canga, Ana [Diagnostico Medico Cantabria (DMC), Department of Radiology, Santander, Cantabria (Spain); Valdecilla University Hospital, Orthopedic Surgery Department Clinica Mompia (L.P.C.), Santander, Cantabria (Spain); Valdecilla University Hospital, Department of Radiology, Santander, Cantabria (Spain)

    2015-03-05

    Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included ''piriformis syndrome,'' a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. The concept of fibrous bands playing a role in causing symptoms related to sciatic nerve mobility and entrapment represents a radical change in the current diagnosis of and therapeutic approach to DGS. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. A broad spectrum of known pathologies may be located nonspecifically in the subgluteal space and can therefore also trigger DGS. These can be classified as traumatic, iatrogenic, inflammatory/infectious, vascular, gynecologic and tumors/pseudo-tumors. Because of the ever-increasing use of advanced magnetic resonance neurography (MRN) techniques and the excellent outcomes of the new endoscopic treatment, radiologists must be aware of the anatomy and pathologic conditions of this space. MR imaging is the diagnostic procedure of choice for assessing DGS and may substantially influence the management of these patients. The infiltration test not only has a high diagnostic but also a therapeutic value. This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments, with emphasis on MR imaging and endoscopic correlation. (orig.)

  2. Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space

    International Nuclear Information System (INIS)

    Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included ''piriformis syndrome,'' a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. The concept of fibrous bands playing a role in causing symptoms related to sciatic nerve mobility and entrapment represents a radical change in the current diagnosis of and therapeutic approach to DGS. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. A broad spectrum of known pathologies may be located nonspecifically in the subgluteal space and can therefore also trigger DGS. These can be classified as traumatic, iatrogenic, inflammatory/infectious, vascular, gynecologic and tumors/pseudo-tumors. Because of the ever-increasing use of advanced magnetic resonance neurography (MRN) techniques and the excellent outcomes of the new endoscopic treatment, radiologists must be aware of the anatomy and pathologic conditions of this space. MR imaging is the diagnostic procedure of choice for assessing DGS and may substantially influence the management of these patients. The infiltration test not only has a high diagnostic but also a therapeutic value. This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments, with emphasis on MR imaging and endoscopic correlation. (orig.)

  3. Block Tensor Unfoldings

    OpenAIRE

    Ragnarsson, Stefan; Van Loan, Charles F.

    2011-01-01

    Within the field of numerical multilinear algebra, block tensors are increasingly important. Accordingly, it is appropriate to develop an infrastructure that supports reasoning about block tensor computation. In this paper we establish concise notation that is suitable for the analysis and development of block tensor algorithms, prove several useful block tensor identities, and make precise the notion of a block tensor unfolding.

  4. Elimination of microwave effects on the vitality of nerves after blockage of active transport

    Energy Technology Data Exchange (ETDEWEB)

    McRee, D.I.; Wachtel, H.

    1986-12-01

    We have previously reported that exposure to microwave fields (a specific absorption rate of 10 W/kg at 2.45-GHz continuous wave) would consistently lower the survival time of isolated frog sciatic nerves stimulated at high repetition rates (50 pulse pairs per second, ppps). The time course of the loss of excitability of the exposed nerve (as compared to its unexposed contralateral mate) is reminiscent of that seen when the active transport of sodium (Na) and potassium (K) is blocked by certain agents--such as the cardiac glycoside ouabain. To assess the role that these microwaves may have in interfering with or counteracting active transport, we performed a series of experiments in which the active Na-K pump was substantially blocked by ouabain prior to microwave exposure. The paired nerves were soaked for 5 min in a high concentration (10(-3) g/liter) of ouabain to achieve the fastest and most complete blockage of the Na-K pump prior to stimulation at 50 ppps. The ''rundown time course'' was, as expected, accelerated in all ouabain-treated nerves, but the microwave-exposed nerves showed no additional shortening of survival time. The experiments were repeated at a slower stimulation rate (5 ppps) so that the survival time of the nerves more closely approximated that of nerves not treated with ouabain (1 to 2 h versus 30 min or less for ouabain-treated nerves stimulated at 50 ppps). Results of these lower stimulation rates also showed that there was no significant difference in the survival time of ouabain-treated exposed and control nerves. These results lend support to the view that the relative loss of excitability in microwave-exposed nerves is related to an interference with or counteraction of the Na-K pump.

  5. Bloqueio dos nervos femoral e isquiático guiados por ultrassom em paciente anticoagulado: case reports Bloqueo de los nervios femoral e isquiático guiados por ultrasonido en paciente anticoagulado Ultrasound-guided femoral and sciatic nerve blocks in an anticoagulated patient: relato de casos

    Directory of Open Access Journals (Sweden)

    Leonardo Henrique Cunha Ferraro

    2010-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O uso de ultrassom para guiar a punção em bloqueios de nervos periféricos tem-se tornado cada vez mais frequente. Com a menor probabilidade de promover lesões vasculares, o ultrassom torna-se uma ferramenta interessante na realização de bloqueios periféricos, especialmente nos pacientes em uso de anticoagulantes ou com distúrbios da coagulação. O objetivo foi relatar dois casos em que se realizaram os bloqueios isquiático e femoral guiados por ultrassom em pacientes anticoagulados. RELATO DOS CASOS: No primeiro caso, a cirurgia realizada consistiu na amputação de antepé esquerdo devido a necrose e sinais de infecção e, no segundo caso, em limpeza cirúrgica de joelho esquerdo. Os pacientes apr esentavam distúrbios de coagulação com atividade de protrombina e tempo de tromboplastina ativado acima dos valores da normalidade. Ambos os pacientes foram submetidos a bloqueio femoral e isquiático guiados por ultrassom, evoluindo sem alteração motora ou sensitiva nos territórios desses nervos e sem hematoma no local da punção. CONCLUSÕES: A anticoagulação impõe certas restrições à aplicação das técnicas anestésicas regionais clássicas. Com o avanço dos equipamentos e métodos de ultrassom, hoje é possível identificar com alta precisão estruturas vasculares e neurais. Isso possibilita que a punção guiada por ultrassom seja mais precisa, tanto para atingir a área de interesse como para minimizar os riscos de lesão vascular acidental. Até o presente, não se recomenda a realização de bloqueio periférico em pacientes anticoagulados ou portadores de coagulopatias. Entretanto, considerando que há poucos relatos sobre bloqueios regionais com ultrassom em situações de coagulopatias, a segurança de tal técnica nessas condições ainda não foi estabelecida.JUSTIFICATIVA Y OBJETIVOS: El uso del ultrasonido para guiar la punción en bloqueos de nervios periféricos se ha convertido cada vez más en una práctica frecuente. Con la menor probabilidad de promover lesiones vasculares, el ultrasonido se convierte en un instrumento interesante en la realización de bloqueos periféricos, especialmente en los pacientes que usan anticoagulantes o con disturbios de la coagulación. El objetivo de este estudio fue relatar dos casos en que se realizaron los bloqueos isquiático y femoral guiados por ultrasonido en pacientes anticoagulados. RELATO DE LOS CASOS: En el primer caso, la cirugía realizada consistió en la amputación del pie anterior izquierdo en función de una necrosis y de señales de infección. El segundo caso, fue una limpieza quirúrgica de la rodilla izquierda. Los pacientes presentaron disturbios de coagulación con una actividad de protrombina y tiempo de tromboplastina activado por encima de los valores normales. Los dos pacientes se sometieron al bloqueo femoral e isquiático guiado por ultrasonido, evolucionando sin alteración motora o sensitiva en los territorios de esos nervios y sin hematoma en la región local de la punción. CONCLUSIONES: La anticoagulación impone ciertas restricciones a la aplicación de las técnicas anestésicas regionales clásicas. Con el avance de los equipos y métodos de ultrasonido, hoy por hoy se puede identificar con alta precisión las estructuras vasculares y neurales. Eso posibilita que la punción guiada por ultrasonido sea más exacta, tanto para alcanzar el área de interés como para minimizar los riesgos de lesión vascular accidental. Hasta el presente momento, no se recomienda la realización de bloqueo periférico en pacientes anticoagulados o portadores de coagulopatías. Sin embargo, considerando que existen pocos relatos sobre bloqueos regionales con ultrasonido en situaciones de coagulopatías, la seguridad de tal técnica en esas condiciones todavía no se ha establecido.BACKGROUND AND OBJECTIVES: The use of the ultrasound to guide the puncture in peripheral nerve blocks has become increasingly more frequent. With the lower probability of promoting vascular damage the ultrasou

  6. Bloqueio dos nervos femoral e isquiático guiados por ultrassom em paciente anticoagulado: case reports / Ultrasound-guided femoral and sciatic nerve blocks in an anticoagulated patient: relato de casos / Bloqueo de los nervios femoral e isquiático guiados por ultrasonido en paciente anticoagulado

    Scientific Electronic Library Online (English)

    Leonardo Henrique Cunha, Ferraro; Maria Angela, Tardelli; Américo Masafuni, Yamashita; José Daniel Braz, Cardone; Juliana Midori, Kishi.

    2010-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O uso de ultrassom para guiar a punção em bloqueios de nervos periféricos tem-se tornado cada vez mais frequente. Com a menor probabilidade de promover lesões vasculares, o ultrassom torna-se uma ferramenta interessante na realização de bloqueios periféricos, especialmente [...] nos pacientes em uso de anticoagulantes ou com distúrbios da coagulação. O objetivo foi relatar dois casos em que se realizaram os bloqueios isquiático e femoral guiados por ultrassom em pacientes anticoagulados. RELATO DOS CASOS: No primeiro caso, a cirurgia realizada consistiu na amputação de antepé esquerdo devido a necrose e sinais de infecção e, no segundo caso, em limpeza cirúrgica de joelho esquerdo. Os pacientes apr esentavam distúrbios de coagulação com atividade de protrombina e tempo de tromboplastina ativado acima dos valores da normalidade. Ambos os pacientes foram submetidos a bloqueio femoral e isquiático guiados por ultrassom, evoluindo sem alteração motora ou sensitiva nos territórios desses nervos e sem hematoma no local da punção. CONCLUSÕES: A anticoagulação impõe certas restrições à aplicação das técnicas anestésicas regionais clássicas. Com o avanço dos equipamentos e métodos de ultrassom, hoje é possível identificar com alta precisão estruturas vasculares e neurais. Isso possibilita que a punção guiada por ultrassom seja mais precisa, tanto para atingir a área de interesse como para minimizar os riscos de lesão vascular acidental. Até o presente, não se recomenda a realização de bloqueio periférico em pacientes anticoagulados ou portadores de coagulopatias. Entretanto, considerando que há poucos relatos sobre bloqueios regionais com ultrassom em situações de coagulopatias, a segurança de tal técnica nessas condições ainda não foi estabelecida. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El uso del ultrasonido para guiar la punción en bloqueos de nervios periféricos se ha convertido cada vez más en una práctica frecuente. Con la menor probabilidad de promover lesiones vasculares, el ultrasonido se convierte en un instrumento interesante en la realización d [...] e bloqueos periféricos, especialmente en los pacientes que usan anticoagulantes o con disturbios de la coagulación. El objetivo de este estudio fue relatar dos casos en que se realizaron los bloqueos isquiático y femoral guiados por ultrasonido en pacientes anticoagulados. RELATO DE LOS CASOS: En el primer caso, la cirugía realizada consistió en la amputación del pie anterior izquierdo en función de una necrosis y de señales de infección. El segundo caso, fue una limpieza quirúrgica de la rodilla izquierda. Los pacientes presentaron disturbios de coagulación con una actividad de protrombina y tiempo de tromboplastina activado por encima de los valores normales. Los dos pacientes se sometieron al bloqueo femoral e isquiático guiado por ultrasonido, evolucionando sin alteración motora o sensitiva en los territorios de esos nervios y sin hematoma en la región local de la punción. CONCLUSIONES: La anticoagulación impone ciertas restricciones a la aplicación de las técnicas anestésicas regionales clásicas. Con el avance de los equipos y métodos de ultrasonido, hoy por hoy se puede identificar con alta precisión las estructuras vasculares y neurales. Eso posibilita que la punción guiada por ultrasonido sea más exacta, tanto para alcanzar el área de interés como para minimizar los riesgos de lesión vascular accidental. Hasta el presente momento, no se recomienda la realización de bloqueo periférico en pacientes anticoagulados o portadores de coagulopatías. Sin embargo, considerando que existen pocos relatos sobre bloqueos regionales con ultrasonido en situaciones de coagulopatías, la seguridad de tal técnica en esas condiciones todavía no se ha establecido. Abstract in english BACKGROUND AND OBJECTIVES: The use of the ultrasound to guide the puncture in peripheral nerve blocks has become increasingly more frequent. With the lowe

  7. Residual Antimicrobial Activity of MTAD® in Human Dentin After Obturation with Gutta-Percha/AH26 and Resilon/RealSeal SE at Different Time Intervals; An Ex Vivo Study

    Science.gov (United States)

    Bolhari, Behnam; Bahador, Abbas; Assadian, Hadi; Dehghan, Somayyeh

    2014-01-01

    Objectives: To eliminate microorganisms that are responsible for pulpal and periapical infections and to prevent reinfection of the root canal system an effective chemomechanical preparation by irrigants with sustained antimicrobial activity is beneficial. Hereby, we evaluated the residual antibacterial activity of MTAD after canal obturation at different time intervals. Materials and Methods: A total of 120 human single-canalled anterior teeth were selected. The root canals were instrumented to a standardized apical size. Among all, 90 teeth received final irrigation with MTAD and were divided into three groups according to their obturation materials; i.e. gutta-percha/AH26, Resilon/RealSeal SE and positive controls. All these groups were divided into three 1-, 3- and 6-week time interval subgroups. Thirty teeth as negative control had no final irrigation with MTAD, but were obturated with gutta-percha/AH26 or Resilon/RealSealSE. Dentin powder was prepared after 1, 3 and 6 weeks. Dentin powder was exposed to Enterococcus faecalis for 24h and then cultured. Colony Forming Unit (CFU) was counted. Results: Residual antimicrobial activity of MTAD in the teeth obturated with guttapercha/AH26 was significantly higher than the teeth obturated with Resilon/RealSeal SE (pEpiphany SE significantly decreased antimicrobial activity of MTAD at all time points. PMID:24910674

  8. Living with Heart Block

    Science.gov (United States)

    ... from the NHLBI on Twitter. Living With Heart Block First-degree heart block may not cause any symptoms or require treatment. ... shown that people who have first-degree heart block might be at higher risk for atrial fibrillation ( ...

  9. Ultrasound guided supraclavicular block.

    LENUS (Irish Health Repository)

    Hanumanthaiah, Deepak

    2013-09-01

    Ultrasound guided regional anaesthesia is becoming increasingly popular. The supraclavicular block has been transformed by ultrasound guidance into a potentially safe superficial block. We reviewed the techniques of performing supraclavicular block with special focus on ultrasound guidance.

  10. Nanofibrous nerve conduits for repair of 30-mm-long sciatic nerve defects

    OpenAIRE

    Biazar, Esmaeil; Keshel, Saeed Heidari; Pouya, Majid; Rad, Hadi; Nava, Melody Omrani; Azarbakhsh, Mohammad; Hooshmand, Shirin

    2013-01-01

    It has been confirmed that nanofibrous poly(3-hydroxybutyrate-co-3-hydroxyvalerate) nerve conduit can promote peripheral nerve regeneration in rats. However, its efficiency in repair of over 30-mm-long sciatic nerve defects needs to be assessed. In this study, we used a nanofibrous poly(3-hydroxybutyrate-co-3-hydroxyvalerate) nerve conduit to bridge a 30-mm-long gap in the rat sciatic nerve. At 4 months after nerve conduit implantation, regenerated nerves were cally observed and histologicall...

  11. Isolated Ocular Motor Nerve Palsies.

    Science.gov (United States)

    Kung, Nathan H; Van Stavern, Gregory P

    2015-10-01

    An isolated ocular motor nerve palsy is defined as dysfunction of a single ocular motor nerve (oculomotor, trochlear, or abducens) with no associated or localizing neurologic signs or symptoms. When occurring in patients aged 50 or older, the most common cause is microvascular ischemia, but serious etiologies such as aneurysm, malignancy, and giant cell arteritis should always be considered. In this article, the authors review the clinical approach, anatomy, and differential diagnosis of each isolated ocular motor nerve palsy and discuss the clinical characteristics, pathophysiology, and treatment of microvascular ischemia. PMID:26444399

  12. Schwannomatosis of the sciatic nerve

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Tetsuji; Maruyama, Shigeki; Mizuno, Kosaku [Dept. of Orthopaedic Surgery, Kobe University School of Medicine (Japan)

    2001-02-01

    A 52-year-old woman with schwannomatosis in the left sciatic nerve is presented. The patient had no stigmata of neurofibromatosis (NF) type 1 or 2. Cutaneous or spinal schwannomas were not detected. Magnetic resonance (MR) imaging of the sciatic nerve revealed more than 15 tumors along the course of the nerve. Histological examination revealed schwannomas consisting of Antoni A and B areas. Immunohistochemical study showed most cells reacting intensely for S-100 protein. The patient underwent conservative follow-up treatment due to the minimal symptoms. The relationship of the disease with NF-2 and plexiform schwannoma is discussed. (orig.)

  13. Schwannomatosis of the sciatic nerve

    International Nuclear Information System (INIS)

    A 52-year-old woman with schwannomatosis in the left sciatic nerve is presented. The patient had no stigmata of neurofibromatosis (NF) type 1 or 2. Cutaneous or spinal schwannomas were not detected. Magnetic resonance (MR) imaging of the sciatic nerve revealed more than 15 tumors along the course of the nerve. Histological examination revealed schwannomas consisting of Antoni A and B areas. Immunohistochemical study showed most cells reacting intensely for S-100 protein. The patient underwent conservative follow-up treatment due to the minimal symptoms. The relationship of the disease with NF-2 and plexiform schwannoma is discussed. (orig.)

  14. Simulação de bloqueios periféricos guiados por ultra-som: curva de aprendizado dos residentes de anestesiologia do CET-SMA/HSL Simulacro de bloqueos periféricos guiados por ultrasonido: curva de aprendizaje de los residentes de anestesiología del CET-SMA/HSL Simulation of ultrasound-guided peripheral nerve block: learning curve of CET-SMA/HSL anesthesiology residents

    Directory of Open Access Journals (Sweden)

    Marilia Bonifácio Baranauskas

    2008-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A técnica de ultra-som tem sido cada vez mais utilizada para a realização de bloqueios de nervos periféricos. Existem poucos relatos na literatura que analisam a curva de aprendizado da técnica de ultra-som. O objetivo do estudo foi avaliar a curva de aprendizado dos residentes de Anestesiologia do CET-SMA/HSL em bloqueios periféricos guiados por ultra-som por meio de modelo experimental de gelatina. MÉTODO: Foi desenvolvido modelo experimental com cuba preenchida de gelatina e azeitona submersa. Nove residentes foram distribuídos aleatoriamente em três grupos (G1, G2 e G3 compostos, cada um, de um R1, um R2 e um R3. Os três grupos receberam explanação teórica. O G1 recebeu duas horas de treinamento prático, o G2 uma hora e o G3 não treinou. Na seqüência, os participantes foram solicitados a posicionar a agulha no ponto médio da parede da azeitona, próximo ao transdutor e reposicionar a agulha entre a azeitona e o fundo da cuba, simulando a injeção perineural do anestésico. Foram avaliadas a velocidade e eficácia das tarefas, além das falhas técnicas. RESULTADOS: O G1 apresentou média de tempo para realização das tarefas de 37,63 segundos, sem falhas técnicas; no G2 observou-se média de 64,40 segundos, ocorrendo duas falhas técnicas e o G3 apresentou média de 93,83 segundos, com 12 falhas técnicas. CONCLUSÕES: O estudo permite concluir que o maior tempo de treinamento em modelo experimental de bloqueios periféricos guiados por ultra-som melhorou a curva de aprendizado na simulação da técnica.JUSTIFICATIVA Y OBJETIVOS: La técnica de ultrasonido ha sido cada vez más utilizada para la realización de bloqueos de nervios periféricos. Existen pocos relatos en la literatura que analizan la curva de aprendizaje de la técnica de ultrasonido. El objetivo del estudio fue evaluar la curva de aprendizaje de los residentes de Anestesiología del CET-SMA/HSL en bloqueos periféricos guiados por ultrasonido a través de modelo experimental de gelatina. MÉTODO: Fue desarrollado un modelo experimental con un recipiente lleno de gelatina y aceituna sumergida. Nueve residentes se distribuyeron aleatoriamente en tres grupos (G1, G2, G3 compuestos cada uno, por un R1, un R2 y un R3. Los tres grupos recibieron una explicación teórica. El G1 recibió dos horas de entrenamiento práctico, el G2 una hora y el G3 no fue entrenado. Acto seguido, se les solicitó a los participantes que pusiesen la aguja en el punto medio de la pared de la aceituna, cerca del transductor y reposicionar la aguja entre la aceituna y el fondo del recipiente, simulando la inyección perineural del anestésico. Se evaluaron la velocidad y la eficacia de las tareas, además de las fallas técnicas. RESULTADOS: El G1 presentó un promedio de tiempo para la realización de las tareas de 37,63 segundos, sin fallas técnicas; en el G2 se observó un promedio de 64,40 segundos, ocurriendo dos fallas técnicas y el G3 presentó un promedio de 93,83 segundos, con doce fallas técnicas. CONCLUSIONES: El estudio permite concluir que el mayor tiempo de entrenamiento en un modelo experimental de bloqueos periféricos guiados por ultrasonido mejoró la curva de aprendizaje en el simulacro de la técnica.BACKGROUND AND OBJECTIVES: The use of ultrasound imaging in peripheral nerve block has been increasing. However, there are few reports in the literature on the learning curve of the ultrasound technique. The objective of this report was to evaluate the learning curve of CET-SMA/HSL Anesthesiology residents of ultrasound-guided peripheral block using an experimental agar model. METHODS: An experimental model was developed by filling a bowl with agar and olives. Nine residents were randomly divided in three groups (G1, G2, and G3, each one with a R1, a R2, and a R3. All three groups received theoretical explanation. G1 also had two hours of practical training, G2 had one hour, and G3 had no training. Residents were then asked to place a needle at the middle of the olive wall, near the transducer

  15. Assessment of Median Nerve Mobility by Ultrasound Dynamic Imaging for Diagnosing Carpal Tunnel Syndrome

    Science.gov (United States)

    Kuo, Tai-Tzung; Lee, Ming-Ru; Liao, Yin-Yin; Chen, Jiann-Perng; Hsu, Yen-Wei; Yeh, Chih-Kuang

    2016-01-01

    Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy and is characterized by median nerve entrapment at the wrist and the resulting median nerve dysfunction. CTS is diagnosed clinically as the gold standard and confirmed with nerve conduction studies (NCS). Complementing NCS, ultrasound imaging could provide additional anatomical information on pathological and motion changes of the median nerve. The purpose of this study was to estimate the transverse sliding patterns of the median nerve during finger movements by analyzing ultrasound dynamic images to distinguish between normal subjects and CTS patients. Transverse ultrasound images were acquired, and a speckle-tracking algorithm was used to determine the lateral displacements of the median nerve in radial-ulnar plane in B-mode images utilizing the multilevel block-sum pyramid algorithm and averaging. All of the averaged lateral displacements at separate acquisition times within a single flexion–extension cycle were accumulated to obtain the cumulative lateral displacements, which were curve-fitted with a second-order polynomial function. The fitted curve was regarded as the transverse sliding pattern of the median nerve. The R2 value, curvature, and amplitude of the fitted curves were computed to evaluate the goodness, variation and maximum value of the fit, respectively. Box plots, the receiver operating characteristic (ROC) curve, and a fuzzy c-means clustering algorithm were utilized for statistical analysis. The transverse sliding of the median nerve during finger movements was greater and had a steeper fitted curve in the normal subjects than in the patients with mild or severe CTS. The temporal changes in transverse sliding of the median nerve within the carpal tunnel were found to be correlated with the presence of CTS and its severity. The representative transverse sliding patterns of the median nerve during finger movements were demonstrated to be useful for quantitatively estimating median nerve dysfunction in CTS patients. PMID:26764488

  16. Stability of Doxycycline Absorbed on Root Canal Dentin After Obturation with Gutta-Percha/AH26 and Resilon/RealSeal at Different Time Intervals

    Directory of Open Access Journals (Sweden)

    Behnam Bolhari

    2013-01-01

    Full Text Available Objective: Eradication of microorganisms present in the root canal system is paramount for the successful outcome of root canal therapy. The purpose of this study was to compare the of doxycycline absorbed from MTAD into root canal dentin after obturation with gutta-percha/AH26 and Resilon/RealSeal at different time intervals.Materials and Methods: Fifty-one extracted human teeth were instrumented. Thirty samples were obturated with either gutta-percha/AH26 or Resilon/self-etch RealSeal after final irrigation with MTAD. Fifteen samples were kept unobturated (positive control; six samples were obturated with either gutta-percha/AH26 or Resilon/self-etch RealSeal without MTAD irrigation (negative control.After aging for 1, 3 or 6 weeks, dentin debri were collected, the Doxycycline compound was extracted and its amount was quantified using high performance liquid chromatography. The statistical significance of the change in Doxycycline concentrations was tested with two-way ANOVA.Results: The mean concentration of Doxycycline in dentin for one, three and six-week guttapercha/AH26 samples was 1.8±0.36, 1.22±0.22 and 0.67±0.11 respectively, whereas these concentrations in Resilon/RealSeal samples were 1.60±0.26, 0.80±0.14 and 0.59±0.01 respectively. Regarding the positive control group, these concentrations were 2.09±0.11, 1.54±0.12 and 0.72±0.07 respectively for 1, 3 and 6-week intervals. No Doxycycline was detected in negative control groups. The Doxycycline concentrations showed a significant difference forobturating materials (p=0.008. These concentrations were higher in the gutta-percha/AH26 samples than Resilon/RealSeal samples in each time interval.Conclusion: The remaining amount of Doxycycline bonded to dentin was higher when root canals were obturated with gutta-percha/AH26 compared to Resilon/RealSeal. The stability of Doxycycline showed a time dependent decrease.

  17. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... vagus nerve stimulation is its lack of side effects. Patients who are getting this are patients who ... in contradistinction to medication, there are no side effects that are cognitive. A lot of the epilepsy ...

  18. GRP nerves in pig antrum

    DEFF Research Database (Denmark)

    Holst, J J; Poulsen, Steen Seier

    We extracted gastrin-releasing peptide (GRP) and its C-terminal decapeptide corresponding to 6.4 and 6.8 pmol/g from pig antrum mucosa. By immunohistochemistry GRP was localized to mucosal, submucosal, and myenteric nerve fibers. A few nerve cell bodies were also identified. Using isolated perfused...... pig antrum with intact vagal innervation, we found concomitant, atropine-resistant release of GRP and gastrin during electrical stimulation of the vagal nerves. Intra-arterial GRP at 10(-11)-10(-10) mol/l caused up to fivefold, dose-dependent increases in gastrin secretion; higher doses were less...... response to GRP and abolished the effect of vagal stimulation. The available evidence strongly suggests that GRP nerves are responsible for the stimulatory vagal effects on gastrin secretion in the pig....

  19. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... Soccer is really not a contact sport. The only thing we’d probably really restrict is football. ... vagus nerve stimulation help prevent seizures? We would only do it in a patient who is having ...

  20. Imaging of the facial nerve

    Energy Technology Data Exchange (ETDEWEB)

    Veillon, F. [Service de Radiologie I, Hopital de Hautepierre, 67098 Strasbourg Cedex (France)], E-mail: Francis.Veillon@chru-strasbourg.fr; Ramos-Taboada, L.; Abu-Eid, M. [Service de Radiologie I, Hopital de Hautepierre, 67098 Strasbourg Cedex (France); Charpiot, A. [Service d' ORL, Hopital de Hautepierre, 67098 Strasbourg Cedex (France); Riehm, S. [Service de Radiologie I, Hopital de Hautepierre, 67098 Strasbourg Cedex (France)

    2010-05-15

    The facial nerve is responsible for the motor innervation of the face. It has a visceral motor function (lacrimal, submandibular, sublingual glands and secretion of the nose); it conveys a great part of the taste fibers, participates to the general sensory of the auricle (skin of the concha) and the wall of the external auditory meatus. The facial mimic, production of tears, nasal flow and salivation all depend on the facial nerve. In order to image the facial nerve it is mandatory to be knowledgeable about its normal anatomy including the course of its efferent and afferent fibers and about relevant technical considerations regarding CT and MR to be able to achieve high-resolution images of the nerve.

  1. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... the electrodes, so when the patient turns their head, it will not pull on the nerve. So ... is the one that goes closest to the head and that is the one that’s furthest away ...

  2. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... us. One of the questions was does the implant have to be replaced after a period of ... tests when someone has a vagus nerve stimulator implant? That’s also a very good question. The answer ...

  3. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... about to see a vagus nerve stimulation, a safe and effective treatment for children with uncontrollable seizures ... device has proven to be very reliable and safe. Again, there’s been over 4,800 children implanted ...

  4. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... and his parents also recognize some spells during sleep at night, where he probably has some seizures ... been asked does vagus nerve stimulator therapy cause sleep disturbances? The answer to that question is no, ...

  5. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... watching a live surgical procedure performed on a young child for the implantation of a vagus nerve ... here, surgical tech. Nicki Friedman. This is a young 9-year-old who has a history of ...

  6. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... hazards of other kinds of medical treatment or tests when someone has a vagus nerve stimulator implant? ... close, we’re going to perform a computer test on it to make sure the connection is ...

  7. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... under the age of 12. One of the benefits of this type of therapy is that the ... back and forth to program the device. Another benefit of vagus nerve stimulation is its lack of ...

  8. Experimental nerve regeneration. A review.

    Science.gov (United States)

    Wong, B J; Mattox, D E

    1991-06-01

    The aim of peripheral nerve repair is to restore motor and sensory function, which requires more than just 10-0 sutures and a good microscope. The past decade has seen an explosion in the understanding of how nerves grow, and this information is being used to develop better treatments for nerve injuries. In the future, treatment will not be limited to the operating room, because postoperative adjuvant therapies will become increasingly more important in the management of nerve repairs. At the same time, advancement in manufacturing techniques, a better understanding of biomaterials, and the use of the laser will replace the time-honored techniques of surgical repair in many clinical settings. PMID:1762787

  9. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available VAGUS NERVE STIMULATOR IMPLANTATION LEBONHEUR CHILDREN’S MEDICAL CENTER, MEMPHIS, TN Broadcast October 28, 2004 NARRATOR Approximately 1% of children in the United States have some form of epilepsy. You ...

  10. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... States have some form of epilepsy. You are about to see a vagus nerve stimulation, a safe ... under the skin for the stimulator, which is about the same size as a pacemaker for the ...

  11. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available VAGUS NERVE STIMULATOR IMPLANTATION LEBONHEUR CHILDREN’S MEDICAL CENTER, MEMPHIS, TN Broadcast October 28, 2004 NARRATOR Approximately 1% of children in the United States have some form of ...

  12. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... this is we now have long-term outcome data for patients with vagus nerve stimulators, that have ... currently having. Some patients don’t have as big an effect. It is extraordinarily rare to make ...

  13. Vagal nerve stimulator: Evolving trends

    OpenAIRE

    Ogbonnaya, Sunny; Kaliaperumal, Chandrasekaran

    2013-01-01

    Over three decades ago, it was found that intermittent electrical stimulation from the vagus nerve produces inhibition of neural processes, which can alter brain activity and terminate seizures. This paved way for the concept of vagal nerve stimulator (VNS). We describe the evolution of the VNS and its use in different fields of medicine. We also review the literature focusing on the mechanism of action of VNS producing desired effects in different conditions. PUBMED and EMBASE search was per...

  14. Biochemical engineering nerve conduits using peptide amphiphiles.

    OpenAIRE

    A Tan; Rajadas, J.; Seifalian, A M

    2012-01-01

    Peripheral nerve injury is a debilitating condition. The gold standard for treatment is surgery, requiring an autologous nerve graft. Grafts are harvested from another part of the body (a secondary site) to treat the affected primary area. However, autologous nerve graft harvesting is not without risks, with associated problems including injury to the secondary site. Research into biomaterials has engendered the use of bioartificial nerve conduits as an alternative to autologous nerve grafts....

  15. Unilateral traumatic oculomotor nerve paralysis

    International Nuclear Information System (INIS)

    The present authors report a case of unilateral traumatic oculomotor nerve paralysis which shows interesting CT findings which suggest its mechanism. A 60-year-old woman was admitted to our hospital with a cerebral concussion soon after a traffic accident. A CT scan was performed soon after admission. A high-density spot was noted at the medial aspect of the left cerebral peduncle, where the oculomotor nerve emerged from the midbrain, and an irregular, slender, high-density area was delineated in the right dorsolateral surface of the midbrain. Although the right hemiparesis had already improved by the next morning, the function of the left oculomotor nerve has been completely disturbed for the three months since the injury. In our case, it is speculated that an avulsion of the left oculomotor nerve rootlet occurred at the time of impact as the mechanism of the oculomotor nerve paralysis. A CT taken soon after the head injury showed a high-density spot; this was considered to be a hemorrhage occurring because of the avulsion of the nerve rootlet at the medial surface of the cerebral peduncle. (J.P.N.)

  16. Nanotechnology for peripheral nerve regeneration

    Directory of Open Access Journals (Sweden)

    E. Biazar

    2010-08-01

    Full Text Available Peripheral nerve injuries (PNI can lead to lifetime loss of function and disfigurement. Different methods such as conventional allograft procedures and using of biological tubes have problems for damaged peripheral nerves reconstruction. Designed scaffolds with natural and synthetic materials are now widely used in the reconstruction of damaged tissues. Utilization of absorbable and non-absorbable synthetic and natural polymers with unique characteristics can be an appropriate solution to repair damaged nerve tissues. Polymeric nanofibrous scaffolds with properties similar to neural structure can be more effective in the reconstruction process. Better cell adhesion and migration, more guiding of axons and structural features such as porosity provide clearer role of nanofibers for the restoration of neural tissues. In this paper, basic concepts of peripheral nerve injury, types of  artificial and natural guides and  the methods to improve the performance of tubes like orientation, nanotechnology applications for nerve reconstruction, fiber and nanofibers, electrospinning methods and their application in the peripheral nerve reconstruction have been reviewed.

  17. Neuromechanical assessment of lidocaine test block in spastic lower limbs.

    Science.gov (United States)

    Buffenoir, Kévin; Decq, Philippe; Lambertz, Daniel; Perot, Chantal

    2013-11-01

    The objective of this study was to quantify in spastic lower limbs the changes in reflex EMGs and in ankle stiffness after a lidocaine block of the soleus nerve to better understand physiological effects of lidocaine. Twenty patients were prospectively included and assessed before and after lidocaine block of the soleus nerve. We studied clinical and neuromechanical parameters of the triceps surae, including quantification of the maximum Hoffmann's reflex (Hmax) and tendinous reflex (T) normalized to the maximum direct motor response (Mmax), and passive ankle stiffness assessed by sinusoidal length perturbations. All patients whatever the aetiology of spasticity were improved in clinical parameters of spasticity after the block (62% reduction of the Ashworth score, 85% reduction of stretch reflex scores, increased score on the Physicians' Rating Scale). All patients presented a reduction of the Hmax-Mmax ratio (mean reduction of 67%) and the T-Mmax ratio (82%). Ankle stiffness was decreased by an average of 23%. Measured stiffness was correlated with the Ashworth score and the T-Mmax ratio. Relatively greater change in the T reflex than in the H reflex suggests that lidocaine block reduces hyperreflexia not only by interfering with generation of afferent volleys in the injected nerve, but also probably by altering generation of the volleys at the level of muscle spindles in the affected spastic muscles, presumably by blocking the transmission along gamma-efferent fibers. PMID:24053519

  18. Effective dermatomal blockade after subcostal transversus abdominis plane block

    DEFF Research Database (Denmark)

    Mitchell, Anja Ulrike; Torup, Henrik

    2012-01-01

    The ultrasound-guided transversus abdominis plane (TAP) block is used to treat postoperative pain after abdominal surgery. Abdominal wall sensory nerves are anaesthetised by injecting local anaesthetics into the neurofascial plane between the internal oblique and the transversus abdominis muscles. Sensory assessment of a TAP block may guide the decision on the extent of the block. The purpose of this study was to investigate if the dermatomal extent of sensory blockade after injection of 20 ml 0.5% ropivacaine bilaterally into the TAP can be assessed using cold and pinprick sensation.

  19. Is pulmonary function affected by bilateral dual transversus abdominis plane block? A randomized, placebo-controlled, double-blind, crossover pilot study in healthy male volunteers

    DEFF Research Database (Denmark)

    Petersen, Maria; Elers, Jimmi

    2011-01-01

    : Transversus abdominis plane (TAP) blocks have been shown to reduce postoperative pain after various abdominal surgical procedures in several studies. The motor nerves of the abdominal wall are located in the same plane as the sensory nerves affected by the TAP block. The aim of this study was to examine whether the application of an ultrasound-guided TAP block would affect the muscles of the anterior abdominal wall with respect to their function as accessory respiratory muscles and hence pulmonary function.

  20. Toward Fuzzy block theory

    CERN Document Server

    Owladeghaffari, H

    2008-01-01

    This study, fundamentals of fuzzy block theory, and its application in assessment of stability in underground openings, has surveyed. Using fuzzy topics and inserting them in to key block theory, in two ways, fundamentals of fuzzy block theory has been presented. In indirect combining, by coupling of adaptive Neuro Fuzzy Inference System (NFIS) and classic block theory, we could extract possible damage parts around a tunnel. In direct solution, some principles of block theory, by means of different fuzzy facets theory, were rewritten.

  1. Testing block subdivision algorithms on block designs

    Science.gov (United States)

    Wiseman, Natalie; Patterson, Zachary

    2016-01-01

    Integrated land use-transportation models predict future transportation demand taking into account how households and firms arrange themselves partly as a function of the transportation system. Recent integrated models require parcels as inputs and produce household and employment predictions at the parcel scale. Block subdivision algorithms automatically generate parcel patterns within blocks. Evaluating block subdivision algorithms is done by way of generating parcels and comparing them to those in a parcel database. Three block subdivision algorithms are evaluated on how closely they reproduce parcels of different block types found in a parcel database from Montreal, Canada. While the authors who developed each of the algorithms have evaluated them, they have used their own metrics and block types to evaluate their own algorithms. This makes it difficult to compare their strengths and weaknesses. The contribution of this paper is in resolving this difficulty with the aim of finding a better algorithm suited to subdividing each block type. The proposed hypothesis is that given the different approaches that block subdivision algorithms take, it's likely that different algorithms are better adapted to subdividing different block types. To test this, a standardized block type classification is used that consists of mutually exclusive and comprehensive categories. A statistical method is used for finding a better algorithm and the probability it will perform well for a given block type. Results suggest the oriented bounding box algorithm performs better for warped non-uniform sites, as well as gridiron and fragmented uniform sites. It also produces more similar parcel areas and widths. The Generalized Parcel Divider 1 algorithm performs better for gridiron non-uniform sites. The Straight Skeleton algorithm performs better for loop and lollipop networks as well as fragmented non-uniform and warped uniform sites. It also produces more similar parcel shapes and patterns.

  2. Comparison of nerve graft integration after segmentar resection versus epineural burying in crushed rat sciatic nerves

    Directory of Open Access Journals (Sweden)

    Cunha Marco Túlio Rodrigues da

    1997-01-01

    Full Text Available The aim of the present paper is to compare and correlate the take of nerve segments in a severely crushed nerve. Forty adult Wistar rats had their right sciatic nerve by a "Péan-Murphy" forceps for 40 minutes. In Group 1 (n=20, a segmentar serection in the crushed sciatic nerve was made. A sural nerve segment from the opposite hindpaw was placed in the gap. In Group 2 (n=20, a lontudinal insision in the epineurium of the lesioned sciatic nerve was made. A sural nerve segment was buried underneath the epineurium. The crushed sciatic nerves undergone Wallerian degeneration and endoneurial fibrosis. Sciatic nerves from Group 2 had significant better histological aspects than those from Group 1. Sural nerve grafts presented better degrees of regeneration than crushed sciatic nerves. Sural nerve grafts from Group 2 (burying method integrated as well as those from Group 1 (segmentar resection.

  3. Study of Sural Nerve Complex in Human Cadavers

    OpenAIRE

    Seema, S. R.

    2013-01-01

    Aim. The sural nerve complex (SNC) consists of four named components: medial sural cutaneous nerve (MSCN), lateral sural cutaneous nerve (LSCN), peroneal communicating nerve (PCN), and sural nerve (SN). The formation and distribution of the sural nerve vary in different individuals. SN is universally recognized by surgeons as a site for harvesting an autologous nerve graft. The nerve is widely used for electrophysiological studies. Hence the study of sural nerve complex was taken up. Method. ...

  4. The longitudinal epineural incision and complete nerve transection method for modeling sciatic nerve injury

    OpenAIRE

    Xing-long Cheng; Pei Wang; Bo Sun; Shi-bo Liu; Yun-feng Gao; Xin-ze He; Chang-yu Yu

    2015-01-01

    Injury severity, operative technique and nerve regeneration are important factors to consider when constructing a model of peripheral nerve injury. Here, we present a novel peripheral nerve injury model and compare it with the complete sciatic nerve transection method. In the experimental group, under a microscope, a 3-mm longitudinal incision was made in the epineurium of the sciatic nerve to reveal the nerve fibers, which were then transected. The small, longitudinal incision in the epineur...

  5. Influência da nifedipina no bloqueio neuromuscular produzido pelo atracúrio e pelo cisatracúrio: estudo em preparações nervo frênico-diafragma de rato Influencia de la nifedipina en el bloqueo neuromuscular producido por atracurio y cisatracurio: estudio en preparación nervio frénico diafragma de ratón Influence of nifedipine on the neuromuscular block produced by atracurium and cistracurium: study in rat phrenic-diaphragmatic nerve preparation

    Directory of Open Access Journals (Sweden)

    Silmara Rodrigues de Sousa

    2006-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Os bloqueadores de canais de cálcio podem interagir com bloqueadores neuromusculares potencializando seus efeitos. Os estudos sobre essa interação mostram resultados controversos. Em alguns estudos essas drogas produziram bloqueio neuromuscular, ou contratura, ou nenhum efeito sobre as respostas musculares esqueléticas foi evidenciado. O estudo avaliou, em diafragma de rato, os efeitos da nifedipina sobre a resposta muscular e sua possível interação com os bloqueadores neuromusculares. MÉTODO: Foram utilizados 25 ratos, com peso entre 250 e 300 g sacrificados sob anestesia com pentobarbital (40 mg.kg -1 por via intraperitonial. A preparação foi montada de acordo com a técnica descrita por Bulbring. O diafragma foi mantido sob tensão, ligado a um transdutor isométrico e submetido à estimulação indireta de 0,1 Hz de freqüência. As contrações do diafragma foram registradas em fisiógrafo. Para avaliação dos efeitos das drogas na transmissão neuromuscular, estas foram adicionadas isoladamente ou associadas à preparação, nas seguintes concentrações: nifedipina (4 µg.mL-1; atracúrio (20 µg.mL-1; cisatracúrio (3 µg.mL-1. Nas preparações nervo frênico-diafragma avaliaram-se: 1 a amplitude das respostas do músculo diafragma à estimulação indireta, antes e 45 minutos após a adição da nifedipina e dos bloqueadores neuromusculares isoladamente e após a associação das drogas; 2 os efeitos da nifedipina nos potenciais de membrana (PM e potenciais de placa terminal em miniatura (PPTM. RESULTADOS: A nifedipina empregada isoladamente não alterou a amplitude das respostas musculares, mas aumentou significativamente a atividade bloqueadora neuromuscular do atracúrio e do cisatracúrio. Não alterou o potencial de membrana e ocasionou aumento inicial na freqüência dos PPTM, seguido de bloqueio. CONCLUSÕES: A nifedipina na concentração empregada potencializou o bloqueio neuromuscular produzido pelo atracúrio e cisatracúrio. Estudos eletrofisiológicos demonstraram ação pré-sináptica e ausência de ação despolarizante sobre a fibra muscular.JUSTIFICATIVA Y OBJETIVOS: Los bloqueadores de canales de calcio pueden reaccionar con los bloqueadores neuromusculares potenciando sus efectos. Los estudios sobre esta interacción presentan resultados controvertidos. En algunos estudios estas drogas produjeron el bloqueo neuromuscular, o contractura, o no se observó ningún efecto sobre las respuestas musculares esqueléticas. El estudio evaluó los efectos de la nifedipina sobre la respuesta muscular y su posible relación con los bloqueadores neuromusculares en el diafragma del ratón. MÉTODO: Fueron utilizados 25 ratones, con peso entre 250 y 300 g sacrificadas con anestesia con pentobarbital (40 mg.kg-1 por vía intraperitoneal. La preparación fue montada de acuerdo con la técnica descripta por Bulbring. El diafragma fue mantenido bajo tensión, conectado con un transductor isométrico y sometido a estímulo indirecto de 0,1 Hz de frecuencia. Las contracciones del diafragma fueron registradas en un fisiógrafo. Para la evaluación de los efectos de las drogas en la transmisión neuromuscular, las mismas fueron añadidas aisladamente o asociadas a la preparación en las siguientes concentraciones: nifedipina (4 µg.mL-1; atracurio (20 µg.mL-1; cisatracurio (3 µg.mL-1 . En las preparaciones nervio frénico-diafragma se evaluaron: 1 la amplitud de las respuestas del músculo diafragma al estímulo indirecto, antes y 45 minutos después de la adición de nifedipina y de los bloqueadores neuromusculares aisladamente y después de la asociación de las drogas; 2 los efectos de la nifedipina en los potenciales de la membrana (PM y potenciales de la placa terminal en miniatura (PPTM. RESULTADOS: La nifedipina, cuando empleada aisladamente, no cambió la amplitud de las respuestas musculares, pero aumentó significativamente la actividad bloqueadora neuromuscular del atracurio y del cisatracurio, no cambió el potencial de membrana y produjo el aumento inicial en la frecuencia de los PPTM, seguida de bloqueo. CONCLUSIONES: La nifedipina, en la concentración empleada, potenció el bloqueo neuromuscular que el atracurio e cisatracurio produjeron. Estudios electrofisiológicos demostraron una acción presináptica y la ausencia de acción despolarizante sobre la fibra muscular.BACKGROUND AND OBJECTIVES: Calcium channel blockers may interact with neuromuscular blockers, increasing its effects. Research studies about this interaction display controversial results. In some studies these drugs produced neuromuscular blockage, or contracture, or no effect at all was proved over skeletal neuromuscular response. This study assessed the nifedipine effects over muscular responses and its possible interaction with neuromuscular blockers in rat diaphragm. METHODS: A number of 25 rats were used, weighing between 250 and 300 g and sacrificed under anesthesia with intraperitoneal pentobarbital (40 mg.kg-1. Preparation was mounted according to the technique described by Bulbring. Diaphragm was kept under tension, connected to an isometric transducer and subjected to an indirect stimulation of 0.1 Hz frequency. Diaphragm contractions were registered on a physiograph. In order to evaluate the effect of these drugs on neuromuscular transmission, they were added separately or associated to the preparation, on the following concentrations: nifedipine (4 µg.mL-1; atracurium (20 µg.mL-1; cistracurium (3 µg.mL-1. On phrenic-nerve preparation, the assessed items were: 1 the extent of diaphragm muscle response to indirect stimulation, before and 45 minutes after adding nifedipine and neuromuscular blockers separately and after the association of both drugs; 2 nifedipine effects on membrane potentials (MP and miniature end-plate potentials (MEPP. RESULTS: Employed separately, nifedipine did not alter the extent of muscular responses, but it did significantly increase the neuromuscular blocking activity of atracurium and cistracurium. Nifedipine did not alter the membrane potential and caused an initial increase on MEPP frequencies, followed by a blockage. CONCLUSIONS: Nifedipine, on the employed concentration, increased the neuromuscular blockage produced by atracurium and cistracurium. Electrophysiological studies demonstrate the existence of presynaptic action and absence of depolarizing action over the muscle fiber.

  6. Bloqueio do nervo femoral: avaliação da analgesia pós-operatória na operação de reconstrução artroscópica do ligamento cruzado anterior / Femoral nerve block: assessment of postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction / Bloqueo del nervio femoral: evaluación de la analgesia postoperatoria en la operación de reconstrucción artroscópica del ligamento cruzado anterior

    Scientific Electronic Library Online (English)

    Úrsula Bueno do Prado, Guirro; Elizabeth Milla, Tambara; Fernanda Reinaldi, Munhoz.

    2013-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A operação de reconstrução do ligamento cruzado anterior do joelho (RLCA) pode ter pós-operatório doloroso. O objetivo principal deste estudo foi avaliar se o emprego do bloqueio do nervo femoral (BNF) associado à raquianestesia melhoraria o tratamento da dor pós-operatóri [...] a na RLCA; os objetivos secundários foram avaliar solicitação do tramadol e eventos adversos. MÉTODO: 53 pacientes foram divididos aleatoriamente nos grupos A e B. No Grupo A, 26 receberam raquianestesia e no Grupo B, 27 receberam raquianestesia e BNF. Todos receberam analgesia multimodal e poderiam solicitar analgésico de resgate a qualquer momento. As avaliações ocorreram em 6, 12 e 24 horas. RESULTADOS: Os grupos não apresentaram diferenças quanto às variáveis demográficas e clínico-cirúrgicas. A intensidade da dor não mostrou diferença entre os grupos. Escores médios de dor foram mais elevados 12 horas no Grupo A e não houve variação no Grupo B; 55,6% relataram dor moderada no Grupo A e 53,8% dor leve no Grupo B. Não houve diferença na solicitação de tramadol. Os eventos adversos não foram graves: 80,8% dos pacientes do Grupo B apresentaram bloqueio motor da coxa e dois caíram. CONCLUSÕES: A analgesia foi mais efetiva com a associação de raquianestesia e BNF, que permitiu melhor controle da dor pós-operatória na avaliação em 12 horas após a anestesia. Não houve diferença na solicitação do tramadol. Os eventos adversos apresentados pelos pacientes neste estudo não foram graves, porém deve-se estar atento à paralisia motora e à possibilidade de queda dos pacientes quando o BNF for feito. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: La operación de reconstrucción del ligamento cruzado anterior de la rodilla (RLCA) puede tener un postoperatorio doloroso. El objetivo principal de este estudio fue evaluar si el empleo del bloqueo del nervio femoral (BNF) asociado con la raquianestesia mejoraría el tratam [...] iento del dolor Postoperatorio en la RLCA. Los objetivos secundarios eran evaluar la solicitación del tramadol y eventos adversos. MÉTODO: Cincuenta y tres pacientes fueron divididos aleatoriamente en los grupos A y B. En el Grupo A, 26 recibieron raquianestesia y en el Grupo B, 27 recibieron raquianestesia y BNF. Todos recibieron analgesia multimodal y podrían solicitar analgésico de rescate a cualquier momento. Las evaluaciones se dieron en 6, 12 y 24 horas. RESULTADOS: Los grupos no presentaron diferencias en cuanto a las variables demográficas y clínico-quirúrgicas. La intensidad del dolor no arrojó diferencia entre los grupos. Las puntuaciones promedios de dolor fueron más elevadas 12 horas en el Grupo A y no hubo variación en el Grupo B; 55,6% relataron dolor moderado en el Grupo A y 53,8% dolor leve en el Grupo B. No hubo diferencia en la solicitación de tramadol. Los eventos adversos no fueron graves: 80,8% de los pacientes del Grupo B tenían bloqueo motor del muslo y dos se cayeron. CONCLUSIONES: La analgesia fue más efectiva con la asociación de la raquianestesia y BNF, lo que permitió un mejor control del dolor postoperatorio en la evaluación en 12 horas después de la anestesia. No hubo diferencia en la solicitación del tramadol. Los eventos adversos presentados por los pacientes en este estudio no fueron graves, pero debemos estar atentos a la parálisis motora y a la posibilidad de alguna caída de los pacientes cuando el BNF se realice. Abstract in english BACKGROUND AND OBJECTIVES: Knee anterior cruciate ligament reconstruction (ACLR) may be painful in the postoperative period. The primary objective of this study was to evaluate whether the use of femoral nerve block (FNB) associated with spinal anesthesia would improve the postoperative pain treatme [...] nt in ACLR and the secondary objectives were to evaluate tramadol request and adverse events. METHOD: 53 patients were randomly divided into two groups: GA (n =26) received spinal anesthesia and GB (n = 27) received spinal anesthesia and FNB. All patients r

  7. Ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty: a multicenter randomized controlled study / Bloqueo continuo del nervio femoral guiado por ultrasonido y estimulador de nervio para analgesia posterior a la artroplastia total de rodilla: estudio multicéntrico, aleatorizado y controlado / Bloqueio contínuo do nervo femoral guiado por ultrassom e estimulador de nervo para analgesia após artroplastia total de joelho: estudo multicêntrico, randomizado e controlado

    Scientific Electronic Library Online (English)

    Fen, Wang; Li-Wei, Liu; Zhen, Hu; Yong, Peng; Xiao-Qing, Zhang; Quan, Li.

    2015-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Analgesia pós-operatória é fundamental para o exercício funcional precoce logo após a artroplastia total de joelho. O objetivo foi investigar a eficácia clínica do bloqueio contínuo do nervo femoral guiado [...] por ultrassom e estimulador de nervo em analgesia após artroplastia total do joelho. MÉTODOS: Receberam analgesia pós-operatória, de outubro de 2012 a janeiro de 2013, 46 pacientes, estado físico ASA I-III, submetidos à artroplastia total de joelho. Em 22 pacientes, o bloqueio femoral contínuo foi guiado por ultrassom e estimulador de nervo para analgesia (grupo BFC); em 24 pacientes, analgesia foi administrada por via epidural (grupo ACP). Os efeitos analgésicos, efeitos colaterais, a recuperação articular e as complicações foram comparados entre os dois grupos. RESULTADOS: Às seis e 12 horas após a cirurgia, os escores de dor no joelho (escore EVA) durante os testes funcionais após exercício ativo e passivo foram significativamente menores no grupo BFC do que no grupo ACP. A quantidade usada de parecoxib nos pacientes do grupo BFC foi significativamente menor em comparação com o grupo ACP. Quarenta e oito horas após a cirurgia, o grau de força muscular no grupo BFC foi significativamente maior e o tempo de atividade ambulatória foi menor do que no grupo ACP. A incidência de náusea e vômito em pacientes do grupo BFC foi significativamente menor em comparação com o grupo ACP. CONCLUSÃO: O bloqueio femoral contínuo guiado por ultrassom e estimulador do nervo proporcionou melhor analgesia às seis e 12 horas, demonstrada por EVA-R e EVA-P. A quantidade de parecoxib também foi menor, a incidência de náusea e vômito diminuiu, a influência sobre a força muscular é comprometida e os pacientes podem fazer atividade ambulatorial sob essa condição. Abstract in spanish JUSTIFICACIÓN Y OBJETIVOS: La analgesia postoperatoria es fundamental para el ejercicio funcional precoz posteriormente a la artroplastia total de rodilla. El objetivo fue investigar la eficacia clínica del bloqueo continuo del nerv [...] io femoral guiado por ultrasonido y estimulador de nervio en analgesia después de la artroplastia total de la rodilla. MÉTODOS: Cuarenta y seis pacientes, con estado físico ASA I-III, sometidos a artroplastia total de rodilla recibieron analgesia postoperatoria de octubre de 2012 a enero de 2013. En 22 pacientes, el bloqueo femoral continuo fue guiado por ultrasonido y estimulador de nervio para analgesia (grupo BFC); en 24 pacientes, la analgesia fue administrada por vía epidural (grupo ACP). Los efectos analgésicos, efectos colaterales, recuperación articular y las complicaciones fueron comparados entre los 2 grupos. RESULTADOS: A las 6 y 12 h después de la operación, las puntuaciones de dolor en la rodilla (puntuación EVA) durante los test funcionales después del ejercicio activo y pasivo fueron significativamente menores en el grupo BFC que en el grupo ACP. La cantidad usada de parecoxib en los pacientes del grupo BFC fue significativamente menor en comparación con el grupo ACP. Cuarenta y ocho horas después de la operación, el grado de fuerza muscular en el grupo BFC fue significativamente mayor y el tiempo de actividad ambulatoria fue menor que en el grupo ACP. La incidencia de náuseas y vómitos en pacientes del grupo BFC fue significativamente menor en comparación con el grupo ACP. CONCLUSIÓN: El bloqueo femoral continuo guiado por ultrasonido y estimulador del nervio proporcionaron una mejor analgesia a las 6 y 12 horas, lo que quedó demostrado por EVA-R y EVA-P. La cantidad de parecoxib también fue menor, la incidencia de náuseas y vómito disminuyó, la influencia sobre la fuerza muscular está comprometida y los pacientes pueden realizar una actividad ambulatoria bajo esa condición. Abstract in english BACKGROUND AND OBJECTIVES: Postoperative analgesia is crucial for early functional excise after total knee arthroplasty. To investigate the clinical efficacy of ultrasound and nerve stimulator guided c

  8. Cutaneous Sensory Block Area, Muscle-Relaxing Effect, and Block Duration of the Transversus Abdominis Plane Block : A Randomized, Blinded, and Placebo-Controlled Study in Healthy Volunteers

    DEFF Research Database (Denmark)

    StØving, Kion; Rothe, Christian

    2015-01-01

    BACKGROUND AND OBJECTIVES: The transversus abdominis plane (TAP) block is a widely used nerve block. However, basic block characteristics are poorly described. The purpose of this study was to assess the cutaneous sensory block area, muscle-relaxing effect, and block duration. METHODS: Sixteen healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 90 minutes after performing the block. Cutaneous sensory block area was mapped and separated into a medial and lateral part by a vertical line through the anterior superior iliac spine. We measured muscle thickness of the 3 lateral abdominal muscle layers with ultrasound in the relaxed state and during maximal voluntary muscle contraction. The volunteers reported the duration of the sensory block and the abdominal muscle-relaxing effect. RESULTS: The lateral part of the cutaneous sensory block area was a median of 266cm (interquartile range, 191-310 cm) and the medial part 76 cm (interquartile range, 54-127 cm). In all the volunteers, lateral wall muscle thickness decreased significantly by 9.2 mm (6.9-15.7 mm) during a maximal contraction. Sensory block and muscle-relaxing effect duration were 570 minutes (512-716 minutes) and 609 minutes (490-724 minutes), respectively. CONCLUSIONS: Cutaneous sensory block area of the TAP block is predominantly located lateral to a vertical line through the anterior superior iliac spine. The distribution is nondermatomal and does not cross the midline. The muscle-relaxing effect is significant and consistent. The block duration is approximately 10 hours with large variation.

  9. AN UNUSUAL CASE OF MULTIFOCAL MOTOR NEUROPATHY WITH CRANIAL NERVE INVOLVEMENT AND HYPERREFLEXIA

    OpenAIRE

    Murat Sar?ca; Levent Güngör; Oytun Bayrak; Hande Türker; Musa Onar

    2006-01-01

    Multifocal motor neuropathy is characterized by progressive, asymmetric weakness of the limbs with persistent conduction blocks (CB). Sensory loss is very rare and it also rarely presents with cranial nerve involvement and hyperreflexia. Here we described a 32-year-old woman with progressive weakness of hand muscles associated with weakness of orbicularis oculi muscles and fasciculations of tongue. The electrophysiological examination revealed persistent conduction blocks in both of the ulnar...

  10. Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics

    Directory of Open Access Journals (Sweden)

    Ying Liu

    2015-01-01

    Full Text Available Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we performed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduction function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regenerated potentials first appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering ?excellent? and ?good? muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The functional recovery of a transplanted nerve can be dynamically observed after the surgery.

  11. Transvaginal obturatriz tape en el tratamiento de la incontinencia urinaria de esfuerzo femenina Transvaginal obturator-tape to treat stress urinary incontinence in females

    Directory of Open Access Journals (Sweden)

    Yordanis Álvarez Riveras

    2012-04-01

    Full Text Available Introducción: El emplazamiento de un sling suburetral a través de los agujeros obturadores constituye un nuevo abordaje para el tratamiento de la incontinencia de orina de esfuerzo en la mujer. Objetivo: Describir la técnica quirúrgica, medir la seguridad, resultados y posibles complicaciones a medio plazo. Material y método: Análisis retrospectivo de pacientes con incontinencia urinaria de esfuerzo operadas en nuestro servicio, mediante la técnica transvaginal obturatriz tape. Se evaluó la continencia postoperatoria, considerando a las pacientes curadas si presentaban continencia total y como fracaso a cualquier tipo de pérdida involuntaria con el esfuerzo, independientemente de su severidad, registrándose el momento de su aparición. Se presentan los 120 primeros casos operados en el Hospital General Docente "Abel Santamaría Cuadrado" entre octubre del año 2011 y febrero de 2012. En 21 de ellos, se realizó sólo el transvaginal obturatriz Tape, mientras que en 99 casos se emplazó el transvaginal obturatriz tape en el contexto de otra intervención quirúrgica. Resultados: En 120 casos se asociaron 99 cirugías, la asociación mayor fue transvaginal obturatriz tape a colpoperineoplastia anterior. La edad media de 49 años, paridad de 3 y todas multíparas, cursando la mayoría la peri menopausia. Asociado a otra cirugía, 99 pacientes, predominó la colpoperinorrafia anterior. El tiempo de internación posoperatorio en los casos de emplazamiento sólo de transvaginal obturatriz tape fue de 6 horas. Solo existió una lesión vesical, ninguna de uretrales, ni de otras vísceras. Los resultados a mediano plazo son muy satisfactorios. Conclusiones: La técnica quirúrgica es reglada, segura y reproducible. Es posible adaptar la técnica a otras intervenciones reparadoras del piso pélvico.Introduction: The emplacement of a sub-urethral sling through the obturator foramens constitutes a new approach to treat stress urinary incontinence in females. Objective: To describe the surgical procedure, measuring the security, results and possible complications at medium term. Material and method: Retrospective analysis of patients suffering from stress urinary incontinence operated in the service by transvaginal obturator-tape. Postoperative continence considering the patients that were cured, who had total continence, together with the analysis of failures of any type of involuntary loss with stress, regardless its severity and checking the onset were included, being the first 120 cases operated at "Abel Santamaria Cuadrado" University Hospital from October 2011 to February 2012. In 21 cases (out of the 120 Transvaginal obturator-tape procedure was used, meanwhile in 99 cases this procedure was performed in the context of another surgical treatment. Results: In 120 cases only 99 surgeries were associated, the major association corresponded to transvaginal obturator-tape and anterior colpoperineorrhaphy. The time of admission for the postoperative period in the cases of transvaginal obturator-tape was 6 hours. Only a vesical lesion was observed, neither the urethra nor viscera were affected. Results at medium term are very satisfactory. Conclusion: The surgical procedure is regulated, safe and it can be reproduced. It is possible to apply this procedure in other surgeries to correct the pelvic floor.

  12. Transvaginal obturatriz tape en el tratamiento de la incontinencia urinaria de esfuerzo femenina / Transvaginal obturator-tape to treat stress urinary incontinence in females

    Scientific Electronic Library Online (English)

    Yordanis, Álvarez Riveras; Nersa, Gutiérrez Valdés; Yohanys María, Zubizarreta Vega.

    2012-04-01

    Full Text Available Introducción: El emplazamiento de un sling suburetral a través de los agujeros obturadores constituye un nuevo abordaje para el tratamiento de la incontinencia de orina de esfuerzo en la mujer. Objetivo: Describir la técnica quirúrgica, medir la seguridad, resultados y posibles complicaciones a medi [...] o plazo. Material y método: Análisis retrospectivo de pacientes con incontinencia urinaria de esfuerzo operadas en nuestro servicio, mediante la técnica transvaginal obturatriz tape. Se evaluó la continencia postoperatoria, considerando a las pacientes curadas si presentaban continencia total y como fracaso a cualquier tipo de pérdida involuntaria con el esfuerzo, independientemente de su severidad, registrándose el momento de su aparición. Se presentan los 120 primeros casos operados en el Hospital General Docente "Abel Santamaría Cuadrado" entre octubre del año 2011 y febrero de 2012. En 21 de ellos, se realizó sólo el transvaginal obturatriz Tape, mientras que en 99 casos se emplazó el transvaginal obturatriz tape en el contexto de otra intervención quirúrgica. Resultados: En 120 casos se asociaron 99 cirugías, la asociación mayor fue transvaginal obturatriz tape a colpoperineoplastia anterior. La edad media de 49 años, paridad de 3 y todas multíparas, cursando la mayoría la peri menopausia. Asociado a otra cirugía, 99 pacientes, predominó la colpoperinorrafia anterior. El tiempo de internación posoperatorio en los casos de emplazamiento sólo de transvaginal obturatriz tape fue de 6 horas. Solo existió una lesión vesical, ninguna de uretrales, ni de otras vísceras. Los resultados a mediano plazo son muy satisfactorios. Conclusiones: La técnica quirúrgica es reglada, segura y reproducible. Es posible adaptar la técnica a otras intervenciones reparadoras del piso pélvico. Abstract in english Introduction: The emplacement of a sub-urethral sling through the obturator foramens constitutes a new approach to treat stress urinary incontinence in females. Objective: To describe the surgical procedure, measuring the security, results and possible complications at medium term. Material and meth [...] od: Retrospective analysis of patients suffering from stress urinary incontinence operated in the service by transvaginal obturator-tape. Postoperative continence considering the patients that were cured, who had total continence, together with the analysis of failures of any type of involuntary loss with stress, regardless its severity and checking the onset were included, being the first 120 cases operated at "Abel Santamaria Cuadrado" University Hospital from October 2011 to February 2012. In 21 cases (out of the 120) Transvaginal obturator-tape procedure was used, meanwhile in 99 cases this procedure was performed in the context of another surgical treatment. Results: In 120 cases only 99 surgeries were associated, the major association corresponded to transvaginal obturator-tape and anterior colpoperineorrhaphy. The time of admission for the postoperative period in the cases of transvaginal obturator-tape was 6 hours. Only a vesical lesion was observed, neither the urethra nor viscera were affected. Results at medium term are very satisfactory. Conclusion: The surgical procedure is regulated, safe and it can be reproduced. It is possible to apply this procedure in other surgeries to correct the pelvic floor.

  13. Incomplete block designs

    CERN Document Server

    Dey, Aloke

    2010-01-01

    This book presents a systematic, rigorous and comprehensive account of the theory and applications of incomplete block designs. All major aspects of incomplete block designs are considered by consolidating vast amounts of material from the literature - the classical incomplete block designs, like the balanced incomplete block (BIB) and partially balanced incomplete block (PBIB) designs. Other developments like efficiency-balanced designs, nested designs, robust designs, C-designs and alpha designs are also discussed, along with more recent developments in incomplete block designs for special t

  14. Imaging the ocular motor nerves

    Energy Technology Data Exchange (ETDEWEB)

    Ferreira, Teresa [Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: T.A.Ferreira@lumc.nl; Verbist, Berit [Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: B.M.Verbist@lumc.nl; Buchem, Mark van [Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: M.A.van_Buchem@lumc.nl; Osch, Thijs van [C.J. Gorter for High-Field MRI, Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: M.J.P.van_Osch@lumc.nl; Webb, Andrew [C.J. Gorter for High-Field MRI, Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: A.Webb@lumc.nl

    2010-05-15

    The ocular motor nerves (OMNs) comprise the oculomotor, trochlear and the abducens nerves. According to their course, they are divided into four or five anatomic segments: intra-axial, cisternal, cavernous and intra-orbital and, for the abducens nerve, an additional interdural segment. Magnetic resonance imaging is the imaging method of choice in the evaluation of the normal and pathologic ocular motor nerves. CT still plays a limited but important role in the evaluation of the intraosseous portions at the skull base and bony foramina. We describe for each segment of these cranial nerves, the normal anatomy, the most appropriate image sequences and planes, their imaging appearance and pathologic conditions. Magnetic resonance imaging with high magnetic fields is a developing and promising technique. We describe our initial experience with a Phillips 7.0 T MRI scanner in the evaluation of the brainstem segments of the OMNs. As imaging becomes more refined, an understanding of the detailed anatomy is increasingly necessary, as the demand on radiology to diagnose smaller lesions also increases.

  15. Imaging the ocular motor nerves

    International Nuclear Information System (INIS)

    The ocular motor nerves (OMNs) comprise the oculomotor, trochlear and the abducens nerves. According to their course, they are divided into four or five anatomic segments: intra-axial, cisternal, cavernous and intra-orbital and, for the abducens nerve, an additional interdural segment. Magnetic resonance imaging is the imaging method of choice in the evaluation of the normal and pathologic ocular motor nerves. CT still plays a limited but important role in the evaluation of the intraosseous portions at the skull base and bony foramina. We describe for each segment of these cranial nerves, the normal anatomy, the most appropriate image sequences and planes, their imaging appearance and pathologic conditions. Magnetic resonance imaging with high magnetic fields is a developing and promising technique. We describe our initial experience with a Phillips 7.0 T MRI scanner in the evaluation of the brainstem segments of the OMNs. As imaging becomes more refined, an understanding of the detailed anatomy is increasingly necessary, as the demand on radiology to diagnose smaller lesions also increases.

  16. Ultrasound-Guided HIFU Neurolysis Of Peripheral Nerves to Treat Spasticity and Pain

    Science.gov (United States)

    Foley, Jessica L.; Little, James W.; Starr, Frank L.; Frantz, Carie; Vaezy, Shahram

    2005-03-01

    Spasticity, a major complication of disorders of the central nervous system (CNS) signified by uncontrollable muscle contractions, is difficult to treat effectively. We report on the use of image-guided high-intensity focused ultrasound (HIFU) to target and suppress the function of the sciatic nerve complex of rabbits in vivo as a possible treatment of spasticity and pain. In situ focal acoustic intensity of 1480-1850 W/cm2 was applied using a scanning method. HIFU treatment of 36 ± 14 s (mean ± standard deviation) was effective in achieving complete conduction block in 100% of the 22 nerves treated (11 rabbits). Histological examination indicated axonal demyelination as a probable mechanism of nerve block.

  17. Evaluation of the nerve-injured patient.

    Science.gov (United States)

    Novak, Christine B

    2003-04-01

    The evaluation of patients with nerve injury or nerve compression requires an accurate history and subjective report to determine the tests that are the most useful in providing the essential information. Motor and sensory evaluation is necessary inglobal mixed-nerve injuries, but in cases of nerve compression, tests of provocation give more accurate information for detecting the site of nerve compression. There is no gold standard test in the evaluation of patients with nerve injury or compression; therefore, a battery of valid and reliable sensory and motor tests provides the most complete information to formulate a treatment plan. PMID:12737348

  18. Neurophysiological approach to disorders of peripheral nerve

    DEFF Research Database (Denmark)

    Crone, Clarissa; Krarup, Christian

    2013-01-01

    Disorders of the peripheral nerve system (PNS) are heterogeneous and may involve motor fibers, sensory fibers, small myelinated and unmyelinated fibers and autonomic nerve fibers, with variable anatomical distribution (single nerves, several different nerves, symmetrical affection of all nerves...... methods including nerve conduction studies and electromyography used in the study of patients suspected of having a neuropathy and the significance of the findings are discussed in detail and more novel and experimental methods are mentioned. Diagnostic considerations are based on a flow chart classifying...

  19. Study on Variant Anatomy of Sciatic Nerve

    OpenAIRE

    Adibatti, Mallikarjun; V, Sangeetha

    2014-01-01

    Introduction: Sciatic Nerve (SN) is the nerve of the posterior compartment of thigh formed in the pelvis from the ventral rami of the L4 to S3 spinal nerves. It leaves the pelvis via the greater sciatic foramen below piriformis and divides into Common Peroneal Nerve (CPN) and Tibial Nerve (TN) at the level of the upper angle of the popliteal fossa. Higher division of the sciatic nerve is the most common variation where the TN and CPN may leave the pelvis through different routes. Such variati...

  20. Continuous celiac plexus block and spread of contrast media

    International Nuclear Information System (INIS)

    A continuous celiac plexus block has been developed and is available for use. With this method, the drug can be repeatedly applied and the reproducibility of imaged findings is secured. It is possible to accurately judge the effect by the use of a local anesthetics before the injection of the neurolytics. Imaged findings at the celiac plexus block were classified into 4 types according to the pattern of CT images. Paticularly interesting is a finding that the contrast media injected in the retrocrural space for retrocrural splanchnic nerve block (RSB) permeates through the aortic hiatus as far as the area surrounding the celiac plexus and so-called transcrural celiac plexus block (TCB) takes place. Thus, it was found that the celiac plexus block so far used was a complex of RSB and TCB. (author)

  1. Block That Pain!

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues Block That Pain! Past Issues / Fall 2007 Table of ... contrast, most pain relievers used for surgical procedures block activity in all types of neurons. This can ...

  2. Paradoxical antagonism of neuromuscular block by vecuronium metabolites.

    Directory of Open Access Journals (Sweden)

    Ohta,Yoshio

    1985-12-01

    Full Text Available Vecuronium is hydrolyzed in the body to 3-deacetyl (ORG 7268, 17-deacetyl (ORG NC58, and 3, 17-bis-deacetyl (ORG 7402 derivatives. Interactions of vecuronium and these metabolites were studied in phrenic nerve-hemidiaphragm preparations of rats. As already reported, ORG 7268 had a potent neuromuscular blocking action, and ORG NC58 and ORG 7402 had a weak neuromuscular blocking action. As expected, ORG 7268 increased the degree of neuromuscular block by vecuronium. However, a low concentration (10 microM of ORG NC58 and ORG 7402 reversed the block by vecuronium. At a high concentration (50 microM, ORG NC58 and ORG 7402 increased the degree of block by vecuronium. Although we do not have enough data to explain these paradoxical reversal of neuromuscular block at this moment, we postulate that these results reflect the interaction between "slow" and "fast" competitive antagonists. Regardless of the mechanism, it should be emphasized that the concentrations of ORG NC58 and ORG 7402 which are necessary to reverse the block are much lower than those which facilitate the block. It is conceivable that this paradoxical reversal of the block occurs in experimental and clinical situations. Therefore, in determining the neuromuscular blocking action of a compound, the "antagonistic" effect of its metabolites should also be considered.

  3. Facial nerve paralysis in children.

    Science.gov (United States)

    Ciorba, Andrea; Corazzi, Virginia; Conz, Veronica; Bianchini, Chiara; Aimoni, Claudia

    2015-12-16

    Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology. PMID:26677445

  4. Magnetic stimulation of curved nerves.

    Science.gov (United States)

    Rotem, A; Moses, E

    2006-03-01