WorldWideScience
1

Does obturator nerve block always occur in 3-1 block?  

Directory of Open Access Journals (Sweden)

Full Text Available In the femoral “3-in-1 block”, obturator nerve block is routinely unsuccessful. Anatomical studies are not available to explain why blockade of obturator nerve or lumbar plexus does not occur. The aim of this study was to examine the effectiveness of femoral “3-in-1 block” obturator nerve block on a cadaver model.Materials and methods: Totally, 12 mature adult human cadavers were selected. Methylene blue dye (30 ml was injected under the fascia iliaca in eight cadavers and into the femoral nerve sheath in four cadavers. Careful bilateral dissections were performed following dye injections.Results: It was seen that the dye did not spread to the medial part of the psoas major muscle and the obturator nerve was not stained with the dye in eight cadavers in whom dye was injected laterally into the femoral sheat. In four cadavers in whom dye was injected into the femoral nerve sheat, metylene blue spread through fascial layers in the plane under the psoas muscle and stained the obturator nerve just before emerging medially from the fascia psoas. At this point, the obturator nerve pierced the psoas fascia and extended extrafascially in the medial and deep borders of the psoas muscle. In this area, the upper section of the obturator nerve was found also to be stained with the dye.Conclusion: We concluded that the cause of an unsuccessful obturator nerve block might be the fascial anatomy of this region. The lateral cutaneous femoral nerve and the femoral nerve easily can be blocked in the fascia iliaca compartment, but the obturator nerve block fails because of its being extrafascial in this region. J Clin Exp Invest 2011;2(2:149-51

?brahim Tekdemir

2011-06-01

2

Efficacy of ultrasound-guided obturator nerve block in transurethral surgery  

OpenAIRE

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. Theref...

Thallaj Ahmed; Rabah Dany

2011-01-01

3

CT-guided obturator nerve block via the posterior approach  

Energy Technology Data Exchange (ETDEWEB)

To describe the technique of obturator nerve block under CT guidance via the posterior approach, and to evaluate the efficacy of the procedure in the short-term and mid-term relief of chronic hip pain. Consecutive patients referred for obturator nerve block were prospectively enrolled in this study. Under CT-guidance, via a posterior approach through the pelvis, local anaesthetic and steroid were infiltrated around the obturator nerve using a 22G spinal needle. Fifty-one patients (19 male, 32 female), mean age 54 years, with hip pain refractory to conventional therapy underwent the procedure. Visual Analogue Scale pain scores were recorded before the procedure and at 30 minutes, 24 hours, 1 week and 3 months thereafter. Pain scores within 30 minutes showed a decrease from a mean {+-} SD score of 8.41{+-}1.22 pre-procedure to 2.86{+-}2.1, p<0.001. At 24 hours, the mean pain score was 2.06{+-}1.76, a decrease of 76% from pre-procedural score, p<0.001. Sustained pain relief at 1 week and 3 months was attained in 92% (mean pain score 2.41{+-}2.2, p<0.001) and 82% (mean pain score 3.80{+-}2.94, p<0.001) of cases respectively. Follow-up data was complete for all 51 patients. No serious side-effects were reported. (orig.)

House, C.V.; Ali, K.E.; Bradshaw, C.; Connell, D.A. [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom)

2006-04-15

4

CT-guided obturator nerve block via the posterior approach  

International Nuclear Information System (INIS)

To describe the technique of obturator nerve block under CT guidance via the posterior approach, and to evaluate the efficacy of the procedure in the short-term and mid-term relief of chronic hip pain. Consecutive patients referred for obturator nerve block were prospectively enrolled in this study. Under CT-guidance, via a posterior approach through the pelvis, local anaesthetic and steroid were infiltrated around the obturator nerve using a 22G spinal needle. Fifty-one patients (19 male, 32 female), mean age 54 years, with hip pain refractory to conventional therapy underwent the procedure. Visual Analogue Scale pain scores were recorded before the procedure and at 30 minutes, 24 hours, 1 week and 3 months thereafter. Pain scores within 30 minutes showed a decrease from a mean ± SD score of 8.41±1.22 pre-procedure to 2.86±2.1, p<0.001. At 24 hours, the mean pain score was 2.06±1.76, a decrease of 76% from pre-procedural score, p<0.001. Sustained pain relief at 1 week and 3 months was attained in 92% (mean pain score 2.41±2.2, p<0.001) and 82% (mean pain score 3.80±2.94, p<0.001) of cases respectively. Follow-up data was complete for all 51 patients. No serious side-effects were reported. (orig.)

5

Ultrasound guided obturator nerve block: a single interfascial injection technique.  

Science.gov (United States)

We describe a new technique of single interfascial injection for 25 patients scheduled for transurethral bladder tumor resection. An ultrasound probe was placed at the midline of inguinal crease and moved medially and caudally to visualize the fascial space between the adductor longus (or pectineus) and adductor brevis muscles. We injected 20 mL 1% lidocaine containing epinephrine into the interfascial space using a transverse plane approach to make an interfascial injection, not an intramuscular swelling pattern. And just distally, firm pressure was applied for 3 min. Afterwards, surgery was performed under spinal anesthesia. The time required for identification and location of the nerve was 20 ± 15 and 30 ± 15 s, respectively. Adductor muscle strength, which was measured with a sphygmomanometer, decreased in all patients, from 122 ± 26 mmHg before blockade to 63 ± 11 mmHg 5 min after blockade. No movement or palpable muscle twitching occurred in 23 cases, slight movement of the thigh not interfering with the surgical procedure was observed in 1 case, thus the obturator reflex was successfully inhibited in 96% of cases. Ultrasound-guided single interfascial injection is an easy and successful technique for obturator nerve block. PMID:21918855

Lee, Seong Heon; Jeong, Cheol Won; Lee, Hyun Jung; Yoon, Myung Ha; Kim, Woong Mo

2011-12-01

6

Combined posterior lumbar plexus–sciatic nerve block versus combined femoral–obturator–sciatic nerve block for ACL reconstruction  

Directory of Open Access Journals (Sweden)

Full Text Available Ayman I TharwatAin Shams University, Cairo, EgyptBackground: We compared the efficacy of combined posterior lumbar plexus–sciatic nerve block with that of combined femoral–obturator–sciatic nerve block as anesthesia for anterior cruciate ligament reconstruction surgery, because both block combinations have been recommended for lower limb arthroscopic and reconstructive surgery.Methods: Forty-eight patients undergoing elective unilateral anterior cruciate ligament reconstruction under local anesthesia were randomized to undergo either combined posterior lumbar plexus–sciatic nerve block (Group 1, or combined femoral–obturator–sciatic nerve block (Group 2. Blocks were performed using nerve stimulation and bupivacaine 0.5% mixed with lignocaine 2%. Systolic and diastolic blood pressure, heart rate, and pulse oximetry were recorded. Quality of anesthesia, motor and sensory block, time to first analgesic use, sedation, and need for general anesthesia were recorded, along with verbal postoperative pain scores, and side effects.Results: No patient in Group 1 and two patients in Group 2 needed general anesthesia. Complete sensory blockade was higher in Group 1 than in Group 2. However, complete motor blockade was similar in both groups. In Group 1, verbal pain scores were lower than in Group 2. Time to first analgesic was similar between the two groups. Total analgesic consumption was lower in Group 1. No significant differences were found for heart rate, pulse oximetry, or systolic and diastolic blood pressure between the groups, and no signs of toxicity were encountered.Conclusion: Combined posterior lumbar plexus–sciatic nerve block provided more comfortable intraoperative anesthesia and better postoperative analgesia than combined femoral–obturator–sciatic nerve block for anterior cruciate ligament reconstruction surgery.Keywords: anterior cruciate ligament reconstruction, local anesthetic, nerve block 

Ayman I Tharwat

2011-02-01

7

Obturator Nerve Block with Botulinum Toxin Type B for Patient with Adductor Thigh Muscle Spasm -A Case Report-  

OpenAIRE

Obturator nerve block has been commonly used for pain management to prevent involuntary reflex of the adductor thigh muscles. One of several options for this block is chemical neurolysis. Neurolysis is done with chemical agents. Chemical agents used in the neurolysis of the obturator nerve have been alcohol, phenol, and botulinum toxin. In the current case, a patient with spasticity of the adductor thigh muscle due to cervical cord injury had obturator nerve neurolysis done with botulinum tox...

Choi, Eun Joo; Byun, Jong Min; Nahm, Francis Sahngun; Lee, Pyung Bok

2011-01-01

8

Efficacy of ultrasound-guided obturator nerve block in transurethral surgery  

Directory of Open Access Journals (Sweden)

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.

Thallaj Ahmed

2011-01-01

9

Obturator nerve block with botulinum toxin type B for patient with adductor thigh muscle spasm -a case report-.  

Science.gov (United States)

Obturator nerve block has been commonly used for pain management to prevent involuntary reflex of the adductor thigh muscles. One of several options for this block is chemical neurolysis. Neurolysis is done with chemical agents. Chemical agents used in the neurolysis of the obturator nerve have been alcohol, phenol, and botulinum toxin. In the current case, a patient with spasticity of the adductor thigh muscle due to cervical cord injury had obturator nerve neurolysis done with botulinum toxin type B (BoNT-B). Most of the previous studies have used BoNT-A with only a few reports that have used BoNT-B. BoNT-B has several advantages and disadvantages over BoNT-A. Thus, we report herein a patient who successfully received obturator nerve neurolysis using BoNT-B to treat adductor thigh muscle spasm. PMID:21935496

Choi, Eun Joo; Byun, Jong Min; Nahm, Francis Sahngun; Lee, Pyung Bok

2011-09-01

10

CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip.  

Science.gov (United States)

Obturator nerve blocks (ONB) have been performed by anaesthesiologists mainly to eliminate the obturator reflex during transurethral resections. An effect on hip pain has also been described. However, being a time-consuming and operator-dependent procedure if performed manually, it has not been widely used for chronic hip pain. The purpose of this pilot study was to check whether CT guidance could improve reproducibility of the block (= immediate effect) and to test its potential value for treatment of chronic hip pain. Fifteen chronically ill patients with osteoarthritis underwent a single ONB. Sixteen millilitres of Lidocaine 1% mixed with 2 ml Iopramide was injected into the obturator canal. The patients were followed up to 9 months after the intervention. With a single injection pain relief was achieved for 1-8 weeks in 7 of 15 patients. Excellent pain relief for 3-11 months was achieved in another 4 patients. Reasons for a mid-term or even long-term effect based on a single injection of local anaesthetic are not exactly known. The CT-guided ONB is a fast, easy and safe procedure that may be useful for mid-term (weeks) and sometimes even long-term (months) treatment of hip pain. PMID:11419151

Heywang-Köbrunner, S H; Amaya, B; Okoniewski, M; Pickuth, D; Spielmann, R P

2001-01-01

11

CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip  

International Nuclear Information System (INIS)

Obturator nerve blocks (ONB) have been performed by anaesthesiologists mainly to eliminate the obturator reflex during transurethral resections. An effect on hip pain has also been described. However, being a time-consuming and operator-dependent procedure if performed manually, it has not been widely used for chronic hip pain. The purpose of this pilot study was to check whether CT guidance could improve reproducibility of the block (= immediate effect) and to test its potential value for treatment of chronic hip pain. Fifteen chronically ill patients with osteoarthritis underwent a single ONB. Sixteen millilitres of Lidocaine 1 % mixed with 2 ml Iopramide was injected into the obturator canal. The patients were followed up to 9 months after the intervention. With a single injection pain relief was achieved for 1-8 weeks in 7 of 15 patients. Excellent pain relief for 3-11 months was achieved in another 4 patients. Reasons for a mid-term or even long-term effect based on a single injection of local anaesthetic are not exactly known. The CT-guided ONB is a fast, easy and safe procedure that may be useful for mid-term (weeks) and sometimes even long-term (months) treatment of hip pain. (orig.)

12

CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip  

Energy Technology Data Exchange (ETDEWEB)

Obturator nerve blocks (ONB) have been performed by anaesthesiologists mainly to eliminate the obturator reflex during transurethral resections. An effect on hip pain has also been described. However, being a time-consuming and operator-dependent procedure if performed manually, it has not been widely used for chronic hip pain. The purpose of this pilot study was to check whether CT guidance could improve reproducibility of the block (= immediate effect) and to test its potential value for treatment of chronic hip pain. Fifteen chronically ill patients with osteoarthritis underwent a single ONB. Sixteen millilitres of Lidocaine 1 % mixed with 2 ml Iopramide was injected into the obturator canal. The patients were followed up to 9 months after the intervention. With a single injection pain relief was achieved for 1-8 weeks in 7 of 15 patients. Excellent pain relief for 3-11 months was achieved in another 4 patients. Reasons for a mid-term or even long-term effect based on a single injection of local anaesthetic are not exactly known. The CT-guided ONB is a fast, easy and safe procedure that may be useful for mid-term (weeks) and sometimes even long-term (months) treatment of hip pain. (orig.)

Heywang-Koebrunner, S.H.; Amaya, B.; Pickuth, D.; Spielmann, R.P. [Dept. of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg (Germany); Okoniewski, M. [Dept. of Orthopaedics, Martin-Luther University Halle-Wittenberg (Germany)

2001-06-01

13

Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block.  

Science.gov (United States)

Femoral nerve block (FNB) does not consistently produce anesthesia of the obturator nerve. In this single-blind, randomized, controlled study we added a selective obturator nerve block (ONB) to FNB to analyze its influence on postoperative analgesia after total knee replacement (TKR). Before general anesthesia, 90 patients undergoing TKR received FNB (Group 1), FNB and selective ONB (Group 2), or placebo FNB (Group 3). Postoperative analgesia was further provided by morphine IV via patient-controlled analgesia. Analgesic efficacy and side effects were recorded in the first 6 h after surgery. Adductor strength decreased by 18% +/- 9% in Group 1 and by 78% +/- 22% in Group 2 (P ONB to FNB improves postoperative analgesia after TKR. PMID:15281539

Macalou, D; Trueck, S; Meuret, P; Heck, M; Vial, F; Ouologuem, S; Capdevila, X; Virion, J M; Bouaziz, H

2004-07-01

14

[Joint and sensory branch block of the obturator and femoral nerves in a case of femoral head osteonecrosis and arthritis].  

Science.gov (United States)

The sensory innervation of the hip joint is complex. The joint and sensory branch block of the obturator and femoral nerves is effective for treating the pain caused due to different hip diseases. This could be an option to be considered in certain circumstances such as, being a surgical-anaesthetic high risk, or if there is significant overweight, It could also be useful on other occasions if the traumatoligist considers that it is better to delay hip replacement for a limited period. PMID:24656423

Cortiñas-Sáenz, M; Salmerón-Velez, G; Holgado-Macho, I A

2014-01-01

15

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

Directory of Open Access Journals (Sweden)

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.

?ulafi? Slobodan

2008-01-01

16

Comparison of inguinal versus classic approach for obturator nerve block in patients undergoing transurethral resection of bladder tumors under spinal anesthesia  

Science.gov (United States)

Background: Selective obturator nerve blockade (ONB) is an effective option to prevent adductor spasm during transurethral resection of bladder tumors (TURBT) involving the lateral wall under spinal anesthesia (SA). The classic approach is less popular as the obturator nerve is deep seated and associated with vascular injury. The inguinal approach was described as a safer alternative. This randomized clinical study was undertaken to compare the ease of block, the success rate and complications of the classic pubic and superficial inguinal approach for ONB. Materials and Methods: A total of 30 patients scheduled to undergo TURBT under SA were administered bilateral ONB. Inguinal approach recently described by Choquet was performed on one side and classic approach described by Labat was performed on the other side in random order using a nerve stimulator. The ease of block, success rate (number of attempts to accomplish the block) and complications were noted and compared between both the approaches. Chi-square analysis was performed to compare the ease of approach of the two techniques. Non-parametric analyses using Mann Whitney test was used to compare the number of attempts to accomplish the block in each approach. A value of P < 0.05 was considered statistically significant. Results: The ease of block (P = 0.09) and the median number of attempts to accomplish the block (P = 0.45) were comparable between the two approaches. The incidence of vascular injury was higher in classic approach (P = 0.056). Conclusions: Inguinal approach is a useful alternative to classic approach block for patients undergoing TURBT under SA. PMID:24574592

Moningi, Srilata; Durga, Padmaja; Ramachandran, Gopinath; Murthy, Pisapati Venkata Lakshmi Narasimha; Chilumala, Rami Reddy

2014-01-01

17

Malignant schwannoma of the obturator nerve.  

Science.gov (United States)

Lesions of obturator nerve are rare. Tumours and mainly malignant schwannoma of this nerve are extremely rare. The authors describe an unusual case of a gigantic schwannoma of the obturator nerve in 69 year old woman. Due to tumour expansion in the proximal part of the thigh MRI was performed and demonstrated extensive tumour originating most probably from the obturator nerve. The patient had no neurological symptoms. Biopsy from the lesion was taken at the Department of Orthopaedics with the following conclusion: malignant schwannoma. The patient received neoadjuvant chemotherapy due to diffuse metastatic spread on the chest X ray, after which metastatic spread subsided. The main lesion reduced its size by 1 cm. In 4 months after biopsy the patient was referred for operation to neurosurgery. The tumour was removed along its borders and except of minimal weakness of adduction of the right thigh there was no neurological deterioration. She was subsequently referred for further care to oncology and radiotherapy.The goal of this work is to emphasize the extremely rare occurrence of tumours of this nerve and suggest therapeutic options (Fig. 4, Ref. 11). PMID:24156686

Kanta, M; Petera, J; Ehler, E; Prochazka, E; Lastovicka, D; Habalova, J; Valis, M; Rehak, S

2013-01-01

18

Obturator nerve schwannoma presenting as an adnexal mass: case report  

Energy Technology Data Exchange (ETDEWEB)

Schwannomas are relatively common, benign nerve-sheath tumours. They arise most commonly from either cranial nerves or the dorsal root of spinal nerves. Schwannomas have also been reported to occur in peripheral nerve-root trunks, although this location is much less common. We report a case of a 45-year-old woman with a large pelvic mass originally believed to be an ovarian tumour. Following surgical excision, the tumour was found to be a schwannoma of the obturator nerve. To our knowledge, there are no reported cases of an obturator nerve schwannoma. The imaging features of schwannomas are reviewed. (author)

Mehta, M.; Thurston, W.A.; Merchant, N. [The Toronto Hospital, Dept. of Medical Imaging, Toronto, Ontario (Canada); Murphy, K.J. [The Toronto Hospital, Dept. of Obstetrics and Gynecology, Toronto, Ontario (Canada)

1999-02-01

19

Obturator nerve schwannoma presenting as an adnexal mass: case report  

International Nuclear Information System (INIS)

Schwannomas are relatively common, benign nerve-sheath tumours. They arise most commonly from either cranial nerves or the dorsal root of spinal nerves. Schwannomas have also been reported to occur in peripheral nerve-root trunks, although this location is much less common. We report a case of a 45-year-old woman with a large pelvic mass originally believed to be an ovarian tumour. Following surgical excision, the tumour was found to be a schwannoma of the obturator nerve. To our knowledge, there are no reported cases of an obturator nerve schwannoma. The imaging features of schwannomas are reviewed. (author)

20

Obturator nerve injury in laparoscopic inguinal hernia mesh repair.  

Science.gov (United States)

Injury to pelvic nerves during laparoscopy mostly occurs in gynecological and urological procedures. In abdominal surgery, these complications are infrequent. We present a case report of a patient who suffered a rare obturator nerve injury during a laparoscopic hernioplasty caused by clipping the nerve to the edge of the mesh. After revision and release of nerve from the clip and scars tissue, the associated pain rapidly disappeared and thigh adduction strength improved. Now, 4 years later, MRI and EMG show no sign of nerve compression. PMID:22836919

Haninec, P; Horak, L; Kaiser, R

2013-12-01

21

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)

22

Obturator Nerve Injury: An Infrequent Complication of TOT Procedure.  

Science.gov (United States)

Transvaginal mid-urethral slings have become the most preferred surgical treatment option for female stress urinary incontinence. However, various complications have been reported for these operations occurring especially during penetration of the retropubic space. It can negatively affect patient's quality of life. Early treatment increases the chance of complete normalization of the functions. In this case report we presented a case of obturator nerve damage that was diagnosed and treated at early stage after TOT operation. PMID:25343052

Aydogmus, S; Kelekci, S; Aydogmus, H; Ekmekci, E; Secil, Y; Ture, S

2014-01-01

23

[The conflict between obturator nerve and ovary: a cadaveric and radioanatomic study].  

Science.gov (United States)

The aim of this study was to describe the anatomical relationships between the ovary and the obturator nerve in its intrapelvic portion. Seven embalmed cadavers were dissected; 20 MRIs were then analyzed. The main distance between the lateral pole of the ovary and the obturator nerve was 29 mm. The authors describe various etiologies responsible for obturator neuralgia. An underdiagnosed cause is gonadal hypertrophy. PMID:23796698

Jendrzejewski, F; Peltier, J; Havet, E; Page, C; Foulon, P; Gondry, J; Le Gars, D

2013-06-01

24

Anatomical feasibility of transferring the obturator and genitofemoral nerves to repair lumbosacral plexus nerve root avulsion injuries.  

Science.gov (United States)

Nerve transfer is a valid surgical procedure for restoring lower-extremity function after lumbosacral plexus nerve root avulsion. We determined the anatomical feasibility of transferring the obturator and genitofemoral nerves for this purpose. The obturator, genitofemoral and femoral nerves, and the S1 and S2 nerve roots on both sides were exposed in 10 cadaver specimens. We traced all nerves to their origins. The lengths of the obturator and genitofemoral nerves were measured from their origins to their exits from the abdominal cavity. The transverse and longitudinal diameters of all nerves were measured. Specimens were obtained to determine the total number of myelinated fibers in each nerve. The proximal part of the left obturator nerve was anastomosed with the distal part of the right femoral nerve, between the vertebrae and the peritoneum, with an overlap of 2-3 cm. Similarly, the proximal parts of the right obturator and genitofemoral nerves were anastomosed with the ipsilateral S1 and S2 nerve roots, respectively, with an overlap of 2-4 cm. The obturator nerve contained approximately one-third of the number of fibers (4,300-7,800) presenting in the femoral nerve (13,500-21,000). Similarly, the number of fibers found in the S1 nerve root was in the range 5,200-8,900. The genitofemoral nerve contained approximately half the number of fibers (3,000-4,500) presenting in the S2 nerve root (4,600-8,400). The obturator and genitofemoral nerves could be suitable donor nerves for repairing lumbosacral plexus nerve root avulsion. PMID:24288352

Gang, Yin; Wang, Tienan; Sheng, Jun; Hou, Chunlin; Lin, Haodong

2014-07-01

25

[Elimination of the obturator reflex as a specific indication for dilute solutions of etidocaine. A study of the suitability of a local anesthetic for reflex elimination in the 3-in-1 block technic].  

Science.gov (United States)

Direct stimulation of the obturator nerve by the electroresectoscope during transurethral resection of tumors in lateral bladder regions is possible under regional or general anaesthesia without muscle relaxation. The resulting obturator reflex may lead to perforation of the bladder. Two different regional techniques can be used to interrupt the obturator reflex arc: (1) separate block of the obturator nerve; or (2) the "3-in-1 block" (Winnie). In the present study elimination of the obturator reflex was carried out by "3-in-1 block" with diluted solutions of etidocaine in 55 cases. Venous plasma levels of etidocaine were measured in 9 patients after application of etidocaine 0.5% (unilateral 30 ml and bilateral 60 ml). Samples were taken 10, 20, 30, 40, 60, and 120 min after the "3-in-1 block". RESULTS. The "3-in-1 block" with diluted etidocaine produced excellent motor block of the obturator nerve. Clinical side effects did not occur. Plasma peak levels reached 2.2 micrograms/ml; the protein binding rate was 85%-95%. DISCUSSION. Elimination of the obturator reflex is the only specific motor nerve block in anesthesia. Diluted etidocaine solutions seem to be adequate: irrespective the technique used for eliminating the reflex, diluted etidocaine produces a good effect and permits a dosage reduction compared with other local anesthetics. It is possible to block the obturator nerve bilaterally by "3-in-1 block" or unilaterally by "3-in-1 block" in combination with epidural analgesia within the recommended dose limits. PMID:2305117

Schwilick, R; Weingärtner, K; Kissler, G V; Reinhold, P

1990-01-01

26

Anatomical feasibility of the anterior obturator nerve transfer to restore bowel and bladder function.  

Science.gov (United States)

Total sacrectomies are radical procedures required to treat tumorigenic processes involving the sacrum. The purpose of our anatomical study was to assess the feasibility of a novel nerve transfer involving the anterior obturator nerve to the pudendal and pelvic nerves to the rectum and bladder. Anterior dissection of the obturator nerve was performed in eight hemipelvis cadaver specimens. The common obturator nerve branched into the anterior and posterior at the level of the obturator foramen. The anterior branch then divided into two separate branches (adductor longus and gracilis). The branch to the gracilis was on average longer and also larger than the branch to the adductor longus (8.7 ± 2.1 cm vs. 6.7 ± 2.6 cm in length and 2.6 ± 0.2 mm vs 1.8 ± 0.4 mm in diameter). Each branch of the anterior obturator was long enough to reach the pelvic nerves. The novel transfer of the anterior branch of the obturator nerve to reinnervate the bladder and bowel is anatomically feasible. This represents a promising option with minimal donor site deficit. PMID:24710737

Houdek, Matthew T; Wagner, Eric R; Wyles, Cody C; Moran, Steven L

2014-09-01

27

The adductor part of the adductor magnus is innervated by both obturator and sciatic nerves.  

Science.gov (United States)

The hip adductor group, innervated predominantly by the obturator nerve, occupies a large volume of the lower limb. However, case reports of patients with obturator nerve palsy or denervation have described no more than minimal gait disturbance. Those facts are surprising, given the architectural characteristics of the hip adductors. Our aim was to investigate which regions of the adductor magnus are innervated by the obturator nerve and by which sciatic nerve and to consider the clinical implications. Twenty-one lower limbs were examined from 21 formalin-fixed cadavers, 18 males and 3 females. The adductor magnus was dissected and was divided into four parts (AM1-AM4) based on the locations of the perforating arteries and the adductor hiatus. AM1 was supplied solely by the obturator nerve. AM2, AM3, and AM4 received innervation from both the posterior branch of the obturator nerve and the tibial nerve portion of the sciatic nerve in 2 (9.5%), 20 (95.2%), and 6 (28.6%) of the cadavers, respectively. The double innervation in more than 90% of the AM3s is especially noteworthy. Generally, AM1-AM3 corresponds to the adductor part, traditionally characterized as innervated by the obturator nerve, and AM4 corresponds to the hamstrings part, innervated by the sciatic nerve. Here, we showed that the sciatic nerve supplies not only the hamstrings part but also the adductor part. These two nerves spread more widely than has generally been believed, which could have practical implications for the assessment and treatment of motor disability. PMID:23813615

Takizawa, Megumi; Suzuki, Daisuke; Ito, Hajime; Fujimiya, Mineko; Uchiyama, Eiichi

2014-07-01

28

Lower extremity nerve blocks.  

Science.gov (United States)

Lower extremity nerve blocks have not become as popular as upper extremity blocks for anesthesia; however, the use of lower extremity nerve blocks will become more widespread, as teaching programs are now providing more regional anesthesia experiences for their trainees so that the anesthesia provider will have the familiarity to use these blocks. To increase the enthusiasm among our surgical colleagues, we must begin to use these blocks for surgery, and if the block must be supplemented with local anesthetic or a light general anesthetic, we must educate them that the block is not a failure but a success, as it will provide analgesia after surgery in a method of multimodal pain control. Lower extremity nerve blocks will become more popular when it is realized that they are an effective way of increasing operating room efficiency. Because the block may be placed in an induction room, there is no induction or emergence in the operating room. Patients may be discharged without the need for pain medications, thus lowering the incidence of nausea postoperatively and decreasing PACU and discharge times. PMID:10935013

Dilger, J A

2000-06-01

29

A clinical comparison of psoas compartment and inguinal paravascular blocks combined with sciatic nerve block.  

Science.gov (United States)

The extent of inguinal paravascular blockade and psoas compartment blockade with sciatic nerve block was evaluated in 60 patients. Volumes of 30 ml and 20 ml 0.35% bupivacaine with 1/200,000 epinephrine were injected for lumbar plexus and sciatic nerve block, respectively. Complete lumbar plexus blockade was achieved in 73% of the group who were treated with the psoas compartment technique and 43% of the group who were treated with the inguinal paravascular technique. Sensory blockade of the femoral, lateral femoral cutaneous and obturator nerves was obtained in 100%, 97% and 77% of the patients in the psoas compartment group, and 93%, 63% and 47% of the patients in the inguinal paravascular group, respectively. Sensory blockade of the lateral femoral cutaneous and obturator nerves was more rapid with psoas compartment block. The study suggests that the psoas compartment block is effective in blocking the femoral, lateral femoral cutaneous and obturator nerves, but the inguinal paravascular block is only effective in blocking the femoral nerve. PMID:12025523

Tokat, O; Türker, Y G; Uckunkaya, N; Yilmazlar, A

2002-01-01

30

Immediate repair of an incompletely transected obturator nerve during robotic-assisted pelvic lymphadenectomy.  

Science.gov (United States)

Intraoperative injury of the obturator nerve may occur in gynecologic oncologic procedures when extensive pelvic side wall dissection is performed. In this case, we report an immediate repair of an incompletely transected obturator nerve during robotic-assisted pelvic lymphadenectomy. A 62-year-old gravida 3, para 3 woman was admitted to our clinic for postmenopausal bleeding. The result of an endometrial biopsy was complex endometrial hyperplasia with atypia, and a robotic-assisted laparoscopic hysterectomy was performed. A frozen section of the specimen revealed grade 1 endometrioid adenocarcinoma with >1/2 myometrial invasion. During the pelvic lymphadenectomy, the left obturator nerve was incompletely transected. The obturator nerve edges were oriented and reapproximated end-to-end with two 6/0 polypropylene sutures. The operation and console times were 244 and 223 minutes, respectively. The final pathologic finding was a stage IB endometrial adenocarcinoma. The number of the obtained lymph nodes was 38. Postoperatively, the patient did not exhibit any clinically apparent loss of adductor function or any other neurologic deficiency. Over 6 months of follow-up, the patient experienced no residual neuropathy or deficit in the left thigh. Robotic-assisted repair of a transected obturator nerve during surgery is feasible, and immediate repair of the damaged nerve may result in no neurologic deficit postoperatively. PMID:25218992

Göçmen, Ahmet; ?anl?kan, Fatih

2015-02-01

31

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

Scientific Electronic Library Online (English)

Full Text Available 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 c [...] línico 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 dos dermátomos que a atividade motora dos miótomos. A partir de conhecimentos anatômicos sobre o percurso dos componentes plexulares do bloqueio 3:1, critérios clínicos complementados por outros meios de diagnóstico esclarecem o envolvimento do nervo obturador. CONCLUSÕES: A simbiose entre o desfecho clínico do bloqueio 3:1 com os diversos meios de complementação diagnóstica são interpretativos e conclusivos e, de acordo com o que a literatura nos indica sobre a participação do nervo obturador, o bloqueio 3:1 com injeção única, não justifica o seu nome. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: En el bloqueo 3:1 es controvertida la participación del nervio obturador. Intervenciones quirúrgicas de superficie en la face medial del muslo inciden sobre los dermátomos de los nervios femoral y obturador, de límites imprecisos, sobrepuestos o mismo ausentes. La correlac [...] ión entre el desenlace clínico con otros medios de diagnóstico pueden ser conclusivos sobre el acometimiento del nervio obturador. CONTENIDO: Comúnmente el desenlace de un bloqueo regional es pesquisado más por la insensibilidad de los dermátomos de que por la actividad motora de los miótomos. A partir de conocimientos anatómicos sobre el trayecto de los componentes plexulares del bloqueo 3:1, criterios clínicos complementados por otros medios de diagnóstico esclarecen el envolvimiento del nervio obturador. CONCLUSIONES: La simbiosis entre el desenlace clínico del bloqueo 3:1 con los diversos medios de complementación diagnóstica son interpretativos y conclusivos y, de acuerdo con lo que la literatura nos indica sobre la participación del nervio obturador, el bloqueo 3:1 con inyección única, no justifica su nombre. Abstract in english BACKGROUND AND OBJECTIVES: The participation of the obturator nerve in 3:1 blockades is controversial. Superficial surgical interventions in the medial face of the thigh strike femoral and obturator nerves dermatomes with imprecise, overlapped or even absent limits. The correlation between clinical [...] outcome and other diagnostic methods may be conclusive about the involvement of the obturator nerve. CONTENTS: In general, regional block outcomes are confirmed more by the lack of dermatome sensitivity than by miotomes motor activity. As from the anatomic understanding of the pathway of plexus components of 3:1 blocks, clinical criteria aided by other diagnostic methods explain obturator nerve involvement. CONCLUSIONS:The symbiosis between 3:1 block outcome and different diagnostic methods is interpretative and conclusive and, according to literature indications about the obturator nerve participation, 3:1 block with single injection does not justify its name.

Karl Otto, Geier.

2003-08-01

32

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?  

Directory of Open Access Journals (Sweden)

Full Text Available 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 dos dermátomos que a atividade motora dos miótomos. A partir de conhecimentos anatômicos sobre o percurso dos componentes plexulares do bloqueio 3:1, critérios clínicos complementados por outros meios de diagnóstico esclarecem o envolvimento do nervo obturador. CONCLUSÕES: A simbiose entre o desfecho clínico do bloqueio 3:1 com os diversos meios de complementação diagnóstica são interpretativos e conclusivos e, de acordo com o que a literatura nos indica sobre a participação do nervo obturador, o bloqueio 3:1 com injeção única, não justifica o seu nome.JUSTIFICATIVA Y OBJETIVOS: En el bloqueo 3:1 es controvertida la participación del nervio obturador. Intervenciones quirúrgicas de superficie en la face medial del muslo inciden sobre los dermátomos de los nervios femoral y obturador, de límites imprecisos, sobrepuestos o mismo ausentes. La correlación entre el desenlace clínico con otros medios de diagnóstico pueden ser conclusivos sobre el acometimiento del nervio obturador. CONTENIDO: Comúnmente el desenlace de un bloqueo regional es pesquisado más por la insensibilidad de los dermátomos de que por la actividad motora de los miótomos. A partir de conocimientos anatómicos sobre el trayecto de los componentes plexulares del bloqueo 3:1, criterios clínicos complementados por otros medios de diagnóstico esclarecen el envolvimiento del nervio obturador. CONCLUSIONES: La simbiosis entre el desenlace clínico del bloqueo 3:1 con los diversos medios de complementación diagnóstica son interpretativos y conclusivos y, de acuerdo con lo que la literatura nos indica sobre la participación del nervio obturador, el bloqueo 3:1 con inyección única, no justifica su nombre.BACKGROUND AND OBJECTIVES: The participation of the obturator nerve in 3:1 blockades is controversial. Superficial surgical interventions in the medial face of the thigh strike femoral and obturator nerves dermatomes with imprecise, overlapped or even absent limits. The correlation between clinical outcome and other diagnostic methods may be conclusive about the involvement of the obturator nerve. CONTENTS: In general, regional block outcomes are confirmed more by the lack of dermatome sensitivity than by miotomes motor activity. As from the anatomic understanding of the pathway of plexus components of 3:1 blocks, clinical criteria aided by other diagnostic methods explain obturator nerve involvement. CONCLUSIONS:The symbiosis between 3:1 block outcome and different diagnostic methods is interpretative and conclusive and, according to literature indications about the obturator nerve participation, 3:1 block with single injection does not justify its name.

Karl Otto Geier

2003-08-01

33

Laparoscopic injury of the obturator nerve during fertility-sparing procedure for cervical cancer  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Intraoperative injury of the obturator nerve has rarely been reported in patients with gynecological malignancies undergoing extensive radical surgeries. Irreversible damage of this nerve causes thigh paresthesia and claudication. Intraoperative repair may be done by end-to-end anastomosis or grafting when achieving tension-free anastomosis is not possible. Case presentation A 28-year-old woman with stage IB cervical cancer underwent fertility–sparing surgery, including conization and bilateral pelvic lymphadenectomy. The left obturator nerve was damaged intraoperatively during pelvic dissection. Conclusion Immediate laparoscopic repair was successful and there was no functional deficit in the left thigh for six months postoperatively.

Ricciardi Enzo

2012-08-01

34

Evaluation of interadductor approach in neurolytic blockade of obturator nerve in spastic patients  

Science.gov (United States)

Background: Spasticity is a syndrome associated with a persistent increase in involuntary reflex activity of a muscle in response to stretch. Adductor muscle spasticity is a common complication of spinal cord and brain injury. It needs to be treated if it interferes with activities of daily living and self-care. Obturator neurolytic blockade is one of the cost-effective therapeutic possibilities to treat spasticity of adductor group of muscles. In this study, we assessed the efficacy of interadductor approach in alleviating the spasticity. Methods: Obturator neurolysis using 8-10 ml 6% phenol was given with the guidance of a peripheral nerve stimulator in 20 spastic patients. Technical evaluation included number of attempted needle insertions, time to accurate location of the nerve, depth of needle insertion, and success rate. Pain, spasticity, hip abduction range of motion (ROM), number of spasms, gait, and hygiene were evaluated at 1st hour, 24th hour, end of the 1st week, and in the 1st, 2nd, and 3rd months following the intervention. Results: The success rate was 100% with mean time to accurate nerve location 4.9±2.06 min. Average depth of needle insertion was 2.91±0.32 cm. Compared with the scores measured immediately before the block, all studied parameters improved significantly. An increase in the Modified Ashworth Scale values was observed in the 2nd and 3rd months, but they did not reach their initial values. Conclusion: The interadductor approach proved to be accurate and fast, with a high success rate. Phenol blockade is an efficient and cost-effective technique in patients with adductor spasticity. It led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene, with an efficacy lasting for about 3 months. PMID:24348294

Ghai, Anju; Sangwan, Sukhbir Singh; Hooda, Sarla; Garg, Nidhi; Kundu, Zile S.; Gupta, Tushar

2013-01-01

35

Transection of the obturator nerve by an electrosurgical instrument and its immediate repair during laparoscopic pelvic lymphadenectomy: a case report.  

Science.gov (United States)

Obturator nerve injury seldom occurs in gynecologic surgery. However, gynecologic oncologic surgery, including pelvic lymph node dissection, increases the risk of this type of injury. Microsurgical techniques are usually performed for the repair of the nerve injury. Herein the authors report a case of obturator nerve injury caused by an electrosurgical instrument during laparoscopic pelvic lymphadenectomy, and its prompt repair by laparoscopic procedure in a 44-year-old patient with cervical cancer. PMID:24772921

Song, M J; Lee, C W; Yoon, J H; Hur, S Y

2014-01-01

36

Functional recovery of severe obturator and femoral nerve injuries after lateral retroperitoneal transpsoas surgery.  

Science.gov (United States)

The minimally invasive lateral retroperitoneal transpsoas approach is a popular fusion technique. However, potential complications include injury to the lumbar plexus nerves, bowel, and vasculature, the most common of which are injuries to the lumbar plexus. The femoral nerve is particularly vulnerable because of its size and location; injury to the femoral nerve has significant clinical implications because of its extensive sensory and motor innervation of the lower extremities. The authors present an interesting case of a 49-year-old male patient in whom femoral and obturator nerve functional recovery unexpectedly occurred 364 days after the nerves had been injured during lateral retroperitoneal transpsoas surgery. Chronological video and electrodiagnostic findings demonstrate evidence of recovery. Classification and mechanisms of nerve injury and nerve regeneration are discussed. PMID:23432325

Ahmadian, Amir; Abel, Naomi; Uribe, Juan S

2013-04-01

37

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

Science.gov (United States)

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

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

2014-02-01

38

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

OpenAIRE

OBJECTIVES To present our 8 year experience in the prevention of the obturator nerve reflex during transurethral resection of bladder tumors. METHODS 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 pa...

Mehmet Cesur; Erdem, Ali F.; Alici, Haci A.; Turgut Yapanoglu; Yuksek, Mustafa S.; Yilmaz Aksoy

2008-01-01

39

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

Directory of Open Access Journals (Sweden)

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.

Joern William-Patrick Michael

2011-03-01

40

Techniques of facial nerve block.  

Science.gov (United States)

The efficacy of different techniques of facial nerve block for cataract surgery was investigated. Forty four patients underwent either modified O'Brien, Atkinson, van Lint, or lid blocks. Intentional muscle activity of the orbicularis oculi muscle was recorded and the area under the EMG curve calculated for quantitative comparison of muscle activity between the groups before and after injection of lignocaine with the vasoconstrictor naphazoline nitrate. In addition, the force of lid closure was measured and lid motility determined on a subjective score scale. Whereas the modified O'Brien and lid blocks nearly abolished the muscle activity recorded in the EMG (p < 0.003), the Atkinson and van Lint blocks did not significantly affect these variables. The O'Brien and lid blocks decreased the force of lid closure and lid movements far more effectively than the Atkinson and van Lint blocks (p < 0.0001). The topographic distribution of a mixture of metrizamide and lignocaine solutions was evaluated radiographically in eight additional patients, to assess potential causes for differences in the efficacy of the block techniques. The radiological results showed involvement of the region of the facial nerve trunk and its temporal and cervical divisions by the modified O'Brien block. The lid block, on the other hand, affected terminal branches of the facial nerve's temporal division. In this study, complete lid akinesia was achieved by both the modified O'Brien block and the lid block. However, because the modified O'Brien block involves the risk of neural injury to the facial nerve or its main divisions, the lid block is recommended as the most effective and safe method to achieve akinesia of the orbicularis oculi muscle. Images PMID:7696239

Schimek, F; Fahle, M

1995-01-01

41

Combined ultrasound and fluoroscopic guidance for radiofrequency ablation of the obturator nerve for intractable cancer-associated hip pain.  

Science.gov (United States)

Management of pain from skeletal metastases is notoriously difficult. Case reports and case series have described radiofrequency ablation of the obturator nerve branches to the femoral head for treatment of intractable hip pain. Ablation of the obturator branches to the femoral head is technically difficult because of bony and vascular anatomy, including close proximity of the femoral vessels. Here we present the case of a 79-year-old woman with intractable right hip pain and inability to ambulate secondary to metastatic non-small cell lung cancer in the femoral head and acetabulum, treated with thermal radiofrequency ablation of the obturator and femoral nerve branches to the femoral head. Ablation of the obturator nerve was done via anterior placement of the radiofrequency needle under combined ultrasound and fluoroscopic guidance, passing the radiofrequency needle between the femoral artery and femoral vein. Real-time ultrasound guidance was used to avoid vascular puncture. Thermal radiofrequency ablation resulted in sustained pain relief, and resumption in the ability of the patient to ambulate. From this case we suggest that an anterior approach to the obturator nerve branches to the femoral head may be technically feasible using combined ultrasound and fluoroscopic guidance to avoid vascular puncture. PMID:24452660

Stone, Jonathan; Matchett, Gerald

2014-01-01

42

Techniques of facial nerve block.  

OpenAIRE

The efficacy of different techniques of facial nerve block for cataract surgery was investigated. Forty four patients underwent either modified O'Brien, Atkinson, van Lint, or lid blocks. Intentional muscle activity of the orbicularis oculi muscle was recorded and the area under the EMG curve calculated for quantitative comparison of muscle activity between the groups before and after injection of lignocaine with the vasoconstrictor naphazoline nitrate. In addition, the force of lid closure w...

Schimek, F.; Fahle, M.

1995-01-01

43

Pulsed radiofrequency treatment of articular branches of femoral and obturator nerves for chronic hip pain  

Science.gov (United States)

Purpose Chronic hip pain is a common symptom experienced by many people. Often, surgery is not an option for patients with multiple comorbidities, and conventional drugs either have many side effects or are ineffective. Pulsed radiofrequency (PRF) is a new method in the treatment of pain. We attempt to compare the efficacy of PRF relative to conservative management for chronic hip pain. RPatients and methods Between August 2011 and July 2013, 29 patients with chronic hip pain were divided into two groups (PRF and conservative treatment) according to consent or refusal to undergo PRF procedure. Fifteen patients received PRF of the articular branches of the femoral and obturator nerves, and 14 patients received conservative treatment. Visual analog scale (VAS), Oxford hip scores (OHS), and pain medications were used for outcome measurement before treatment and at 1 week, 4 weeks, and 12 weeks after treatment. Results At 1 week, 4 weeks, and 12 weeks after treatment initiation, improvements in VAS were significantly greater with PRF. Improvements in OHS were significantly greater in the PRF group at 1 week, 4 weeks, and 12 weeks. Patients in the PRF group also used less pain medications. Eight subjects in the conservative treatment group switched to the PRF group after 12 weeks, and six of them had >50% improvement. Conclusion When compared with conservative treatment, PRF of the articular branches of the femoral and obturator nerves offers greater pain relief for chronic hip pain and can augment physical functioning. PMID:25834413

Chye, Cien-Leong; Liang, Cheng-Loong; Lu, Kang; Chen, Ya-Wen; Liliang, Po-Chou

2015-01-01

44

What Are Nerve Blocks for Headache?  

Science.gov (United States)

... appropriate for you. Resources: Nerve Blocks for Headaches, Joshua Tobin, MD http://www.achenet.org/resources/nerve_blocks_for_headaches/ Authors: Daniel P. Schwartz, MD is currently a fellow in Headache Medicine ...

45

Obturator Nerve Palsy in a Patient with Fascio Scapulo Humeral Dystrophy Undergoing Scapulopexy in Prone Position: A Rare Occurrence  

Directory of Open Access Journals (Sweden)

Full Text Available All surgical positions carry some degree of position-related risks. The most common serious positional injuries are peripheral nerve injuries. We present a case of 23 years old man with obturator nerve injury with clinically evident sequelae following a scapulopexy of the right shoulder in prone position. Basis on our knowledge, no similar cases have been described in the literature. The purpose of this report is to increase awareness of this unreported potential complication in the prone position.

Hussain Khan Zahid

2009-10-01

46

Withdrawal reflexes in adductor muscles elicited by electrical and magnetic stimulation of the obturator nerve.  

Science.gov (United States)

The withdrawal reflex in the short head of the biceps femoris muscle after electrical stimulation of the sural nerve at the ankle has been investigated in numerous studies. These studies have described two distinct responses: early (R-II) and late (R-III). However, withdrawal reflex activity of the adductor muscles in the legs has not been studied systematically. Adductor muscle reflex activity is important because it can produce serious clinical problems, such as adductor spasticity and spasms, during bladder surgery. The present study examined withdrawal reflex features of adductor muscles obtained by electrical and magnetic stimulation of the obturator nerve (ON) in 34 normal healthy subjects. Early adductor muscle withdrawal reflex responses were elicited by ipsilateral ON electrical stimulation with a mean latency of 45.7+/-2.0 ms (responses in 94% of subjects). Reflex responses were also obtained using magnetic stimulation at a similar incidence rate. Contralateral ON electrical stimulation resulted in a similar reflex, but with a lower incidence. ON and femoral nerve electrical and magnetic coil stimulation produced similar low-incidence responses in the vastus medialis. These findings indicate that short latency adductor withdrawal reflexes are easily obtained on both sides following electrical or magnetic stimulation of the ON, and they can be elicited by both nociceptive and nonnociceptive stimuli. These reflexes prepare the body for a proper response to incoming signals and likely serve to protect the pelvic floor and pelvic organs. PMID:18816621

Ertekin, Cumhur; Bademkiran, Fikret; Yalin, Sevket; Karapinar, Nevin; Uysal, Hilmi

2008-11-01

47

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.  

Science.gov (United States)

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. PMID:25267335

Westergaard, B; Jensen, K; Lenz, K; Bendtsen, T F; Vazin, M; Tanggaard, K; Worm, B S; Krogsgaard, M; Børglum, J

2014-12-01

48

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)

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.

Westergaard, B; Jensen, K

2014-01-01

49

[Case of bladder perforation due to the obturator nerve reflex during transurethral resection (TUR) of bladder tumor using the TUR in saline (Turis) system under spinal anesthesia].  

Science.gov (United States)

Bladder perforation due to the obturator nerve reflex (ONR) is a serious complication during TUR of bladder tumor using the conventional TUR system; requiring monopolar electrocautery and non-conductive solution as perfusate. Recently, the TURis system, which employs bipolar electrocautery and physiological saline as perfusate, has been developed. Electrical resistance of physiological saline and human tissues are approximately 40 and 500 omega, respectively. Thus, theoretically, electrical current flows between the resection loop and the recovery electrode integrated in the outer sleeve of the endoscope, without forming electrical circuit in the patient's body; suggesting possible elimination of the ONR. Here we describe a case of bladder perforation during surgery using the TURis system; the ONR was exaggerated during the procedure to stop bleeding at the lateral wall using bipolar electrocautery. In addition to this case, there have been a few reports of the ONR during surgery using the TURis system, and it is reported that weak electrical current may pass through the patient's body in the TURis system. We consider that evaluation of the necessary precautions, such as the obturator nerve block, for the prevention of the ONR is important even in the surgery using the TURis system. PMID:20229762

Kitamura, Takayuki; Mori, Yoshiteru; Ohno, Nagara; Suzuki, Yoshie; Yamada, Yoshitsugu

2010-03-01

50

Use of ultrasound and fluoroscopy guidance in percutaneous radiofrequency lesioning of the sensory branches of the femoral and obturator nerves.  

Science.gov (United States)

Hip pain is a common condition that is often seen in patients with multiple comorbidities. Often surgery is not an option due to these comorbidities. Percutaneous radiofrequency lesioning of the articular branches of the obturator and femoral nerves is an alternative treatment for hip pain. Traditionally, fluoroscopy is used to guide needle placement. We report a case where a novel approach was used with ultrasound guidance to visualize vascular and soft tissue structures in real time. The use of ultrasound might help to guide the needle to avoid vascular complications due to anatomical variation between patients. PMID:23656575

Chaiban, Gassan; Paradis, Tyler; Atallah, Joseph

2014-04-01

51

Analysis of Nerve Conduction Block Induced by Direct Current  

OpenAIRE

The mechanisms of nerve conduction block induced by direct current (DC) were investigated using a lumped circuit model of the myelinated axon based on Frankenhaeuser-Huxley (FH) model. Four types of nerve conduction block were observed including anodal DC block, cathodal DC block, virtual anodal DC block, and virtual cathodal DC block. The concept of activating function was used to explain the blocking locations and relation between these different types of nerve block. Anodal/cathodal DC blo...

Tai, Changfeng; Roppolo, James R.; Groat, William C.

2009-01-01

52

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

Science.gov (United States)

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 < 0.001). The area under the force curve was reduced from 6.8 Ns (range: 3.5-21.9 Ns) to 0.54 Ns (range: 0.18-0.86 Ns) (p < 0.01). No change in 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.

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

2014-10-01

53

Obturator hernia - MRI image.  

Science.gov (United States)

Obturator hernia although considered a rare entity is the most frequently encountered pelvic floor hernia. Since the first published report in the 18th century, their unusual and unfamiliar clinical presentation still represents a diagnostic dilemma for the modern day clinician. A detailed history and clinical examination in our thin, elderly female patient who presented with intermittent small bowel obstruction and symptoms of right obturator nerve compression with a positive Howship-Romberg sign was crucial in establishing a diagnosis. Sophisticated radiologic modalities such as MRI as shown below in the case of our patient can reliably confirm the diagnosis of obturator hernia. PMID:24426464

Vitone, Louis; Joel, Abraham; Masters, Andrew; Lea, Simon

2013-08-01

54

Ultrasound-Guided Three-In-One Nerve Block for Femur Fractures  

Directory of Open Access Journals (Sweden)

Full Text Available Femur fractures typically affect elderly patients with multiple co-morbidities. Pain control can be difficult, requiring intensive nursing and physician care as elderly patients may manifest cardiovascular and respiratory complications from opiate administration. Ultrasound (US guided three-in-one (3-in-1 femoral nerve block (FNB is an option for pain management in patients with femur fractures, as it provides regional anesthesia to the femoral, obturator and lateral cutaneous nerves. Our goal is to provide medical education regarding the use of US guided 3-in-1FNB as a rapid and easy procedure that may provide optimal patient care in patients with femur fractures. [West J Emerg Med. 2010; 11(4:310-313.

Christos, Steve C

2010-09-01

55

Obturator hernia diagnosed by computed tomography  

Energy Technology Data Exchange (ETDEWEB)

The diagnosis of obturator hernia is clinically difficult in the absence of signs related to the compression of the obturator nerve (Howship-Romberg sign). A specific diagnosis of obturator hernia can be made if computed tomography (CT) of the pelvis is performed when the diagnosis is likely, such as in elderly, debilitated women with small bowel obstruction without a clear cause.

Cubillo, E.

1983-04-01

56

Obturator hernia diagnosed by computed tomography  

International Nuclear Information System (INIS)

The diagnosis of obturator hernia is clinically difficult in the absence of signs related to the compression of the obturator nerve (Howship-Romberg sign). A specific diagnosis of obturator hernia can be made if computed tomography (CT) of the pelvis is performed when the diagnosis is likely, such as in elderly, debilitated women with small bowel obstruction without a clear cause

57

A basic review on the inferior alveolar nerve block techniques  

OpenAIRE

The inferior alveolar nerve block is the most common injection technique used in dentistry and many modifications of the conventional nerve block have been recently described in the literature. Selecting the best technique by the dentist or surgeon depends on many factors including the success rate and complications related to the selected technique. Dentists should be aware of the available current modifications of the inferior alveolar nerve block techniques in order to effectively choose b...

Khalil, Hesham

2014-01-01

58

[Elimination of the obturator reflex with prilocaine in transurethral resection of bladder tumors in combination with spinal and general anesthesia].  

Science.gov (United States)

During transurethral resection of bladder tumors under either spinal or general anesthesia without muscular relaxation, direct stimulation of the obturator nerve by the electroresectoscope is possible. The resulting obturator reflex may lead to severe complications, at the worst to a perforation of the bladder. Therefore, if resection in lateral bladder regions is necessary, blockade of the obturator nerve is often required to provide optimal conditions for transurethral resection of bladder tumors. To interrupt the obturator reflex are, we blocked the inguinal lumbar plexus using the "3-in-1-block" as described by Winnie because of its advantages compared to isolated blockade of the obturator nerve. Prilocaine 1% was the chosen local anesthetic because of its low tendency towards cardiac and cerebral side effects. Spinal anesthesia was induced with 3-4 ml hyperbaric bupivacaine 0.5%. After the onset of analgesia, making use of a nerve stimulator, a "3-in-1-block" was completed with 30-35 ml prilocaine 1%. The study included over 90 patients. Firstly we observed the efficiency of the obturator motor block by the "3-in-1-block"; secondly clinical side effects of prilocaine were evaluated; and finally in 20 cases methemoglobin levels were measured before and 90 min after injection of prilocaine. A "3-in-1-block" with prilocaine 1% provided a good motor block of the obturator nerve. Neither clinical side effects nor relevant methemoglobinemia occurred. In 3 cases methemoglobin levels were elevated by 1%, whereas in the remaining 17 cases methemoglobin values were normal.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3615982

Schwilick, R; Steinhoff, H

1987-04-01

59

Using the nerve stimulator for peripheral or plexus nerve blocks.  

Science.gov (United States)

Conventional methodology for nerve location utilizes anatomical landmarks followed by invasive exploration with a needle to a suitable endpoint. An appropriate endpoint can be either anatomical in nature (e.g. transaterial technique) or functional (paresthesia or motor response to electrical stimulation). Ability to electrically stimulate a peripheral nerve or plexus depends upon many variables, including; 1) conductive area at the electrode, 2) electrical impedance, 3) electrode-to-nerve distance, 4) current flow (amperage), and 5) pulse duration. Electrode conductive area follows the equation R = rhoL/A, where R = electrical resistance, p = tissue resistivity, L = electrode-to-nerve distance, and A = electrode conductive area. Therefore resistance varies to the inverse of the electrode's conductive area. Tissue electrical impedance varies as a function of the tissue composition. In general, tissues with higher lipid content have higher impedances. Modern electrical nerve stimulators are designed to keep current constant, in spite of varying impedance. The electrode-to-nerve distance has the most influence on the ability to elicit a motor response to electrical stimulation. This is governed by Coulomb's law: E = K(Q/r2) where E = required stimulating charge, K= constant, Q = minimal required stimulating current, and r = electrode-to-nerve distance. Therefore, ability to stimulate the nerve at low amperage (e.g. < 0.5 mA), indicates an extremely close position to the nerve. Similarly, increasing current flow (amperage) increases the ability to stimulate the nerve at a distance. Increasing pulse duration increases the flow of electrons during a current pulse at any given amperage. Therefore, reducing pulse duration to very short times (e.g. 0.1 or 0.05 ms) diminishes current dispersion, requiring the needle tip to be extremely close to the nerve to elicit a motor response. The above parameters can be varied optimally to enhance successful nerve location and subsequent blockade. Unlike imaging modalities such as ultrasonography, electrical nerve stimulation depends upon nerve conduction. Similarly, percutaneous electrode guidance (PEG) makes use of the above variables to allow prelocation of the nerve by transcutaneous stimulation. PMID:16682917

Urmey, W F

2006-06-01

60

Arched Needle Technique for Inferior Alveolar Mandibular Nerve Block  

OpenAIRE

One of the most commonly used local anesthetic techniques in dentistry is the Fischer’s technique for the inferior alveolar nerve block. Incidentally this technique also suffers the maximum failure rate of approximately 35–45%. We studied a method of inferior alveolar nerve block by injecting a local anesthetic solution into the pterygomandibular space by arching and changing the approach angle of the conventional technique and estimated its efficacy. The needle after the initial insertio...

Chakranarayan, Ashish; Mukherjee, B.

2011-01-01

61

Clunealgia: CT-guided therapeutic posterior femoral cutaneous nerve block.  

Science.gov (United States)

Clunealgia is caused by neuropathy of inferior cluneal branches of the posterior femoral cutaneous nerve resulting in pain in the inferior gluteal region. Image-guided anesthetic nerve injections are a viable and safe therapeutic option in sensory peripheral neuropathies that provides significant pain relief when conservative therapy fails and surgery is not desired or contemplated. The authors describe two cases of clunealgia, where computed-tomography-guided technique for nerve blocks of the posterior femoral cutaneous nerve and its branches was used as a cheaper, more convenient, and faster alternative with similar face validity as the previously described magnetic-resonance-guided injection. PMID:24667042

Kasper, Jared M; Wadhwa, Vibhor; Scott, Kelly M; Chhabra, Avneesh

2014-01-01

62

Local nerve blocks for postoperative analgesia1  

OpenAIRE

The effect of local nerve blockade on the relief of postoperative pain is reported in a series of 167 patients who underwent surgery of the arm, knee or foot. In 80% of cases analgesics were not required within 4 hours postoperatively, and in 39% analgesics were not required within 8 hours. Conventional methods of postoperative pain relief are not always effective. Local nerve blockade can be used to provide complete analgesia after limb surgery and is therefore of great value to postoperativ...

Edmonds-seal, J.; Paterson, G. M. C.; Loach, A. B.

1980-01-01

63

Obturator neuropathy: an adverse outcome of a trans-obturator vaginal mesh to repair pelvic organ prolapse.  

Science.gov (United States)

We report a case of obturator neuropathy induced by trans-obturator vaginal mesh surgery for symptomatic cystocele. Initial electromyography excluded genito-femoral and pudendal nerve deficiency. Typical clinical arguments for severe obturator neuropathy at physical examination led to vaginal revision surgery with hemi-resection of the mesh to the ischio-pubic branch. This fully relieved obturator-induced pain and reversed adductor muscle motor deficiency. PMID:23754184

Van Ba, Ornella Lam; Wagner, Laurent; de Tayrac, Renaud

2014-01-01

64

Humeral head translation after a suprascapular nerve block.  

Science.gov (United States)

Subacromial impingement syndrome is the most common shoulder disorder. Abnormal superior translation of the humeral head is believed to be a major cause of this pathology. The first purpose of the study was to examine the effects of suprascapular nerve block on superior translation of the humeral head and scapular upward rotation during dynamic shoulder elevation. The secondary purpose was to assess muscle activation patterns during these motions. Twenty healthy subjects participated in the study. Using fluoroscopy and electromyography, humeral head translation and muscle activation were measured before and after a suprascapular nerve block. The humeral head was superiorly located at 60 degrees of humeral elevation, and the scapula was more upwardly rotated from 30 to 90 degrees of humeral elevation after the block. The differences were observed during midrange of motion. In addition, the deltoid muscle group demonstrated increased muscle activation after the nerve block. The study's results showed a compensatory increase in humeral head translation, scapular upward rotation, and deltoid muscle activation due to the nerve block. These outcomes suggest that increasing muscular strength and endurance of the supraspinatus and infraspinatus muscles could prevent any increased superior humeral head translation. This may be beneficial in reducing shoulder impingement or rotator cuff tears over time. PMID:22927503

San Juan, Jun G; Kosek, Peter; Karduna, Andrew R

2013-08-01

65

Ocular complications after posterior superior alveolar nerve block: a case of trochlear nerve palsy.  

Science.gov (United States)

Many intraoperative complications occurring during third molar surgery are described in the literature. Unilateral trochlear nerve palsy secondary to dental anaesthesia is a rare complication. We report the case of a 36-year-old healthy man, ASA I classification, requiring upper third molar extraction. Articaine 1:200,000 epinephrine for right posterior superior alveolar (PSA) nerve block was administered locally in the mucobuccal fold above the upper third molar. A few minutes after PSA nerve block the patient experienced double-vision. The patient was subsequently visited by an ophthalmologist and the condition was diagnosed as transient unilateral vertical diplopia due to temporary paralysis of the superior oblique muscle as a result of the anaesthetic solution involving the IV cranial nerve. The authors report this unusual case and discuss the possible anatomical pathways that might explain this rare phenomenon. PMID:23809987

Chisci, G; Chisci, C; Chisci, V; Chisci, E

2013-12-01

66

Nerve stimulator-guided thoracic paravertebral block for gynecomastia surgery  

OpenAIRE

Thoracic paravertebral block (TPVB) is gaining popularity for female breast surgeries due to various advantages like less nausea and vomiting and better post-operative pain relief, which helps in early ambulation and discharge from the hospital. Use of nerve stimulator during this block has further enhanced its success and safety profile. Male breast surgery is usually done either under general anaesthesia or local infiltrative anaesthesia combining with intravenous sedation. We postulated th...

Jadon, Ashok

2012-01-01

67

Delayed appearance of hypaesthesia and paralysis after femoral nerve block  

Directory of Open Access Journals (Sweden)

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.

Marius von Knoch

2012-01-01

68

New Approach of Ultrasound-Guided Genitofemoral Nerve Block in Addition to Ilioinguinal/Iliohypogastric Nerve Block for Surgical Anesthesia in Two High Risk Patients: Case Report  

Directory of Open Access Journals (Sweden)

Full Text Available We report two high risk patients undergoing inguinal herniorraphy and testicular biopsy under ultrasound-guided ilioinguinal/iliohypogastric and genitofemoral nerve blocks. The addition of the genitofemoral nerve block may enhance the ilioinguinal/iliohypogastric block to achieve complete anesthesia and thus avoid general and neuraxial anesthesia related hypotension that may be detrimental in patients with low cardiac reserve.

Achir A. Al-Alami

2013-07-01

69

Ultrasound-guided block of the axillary nerve : a case series of potential clinical applications  

DEFF Research Database (Denmark)

The specific blocking of the axillary nerve has never been investigated clinically. We present four cases illustrating potential applications of the axillary nerve block in the perioperative setting and discuss possible directions for future research in this area. The axillary nerve blocks were all performed using a newly developed in-plane ultrasound-guided technique. In one patient undergoing arthroscopic shoulder surgery, we used the axillary nerve block as the only analgesic combined with propofol sedation and spontaneous breathing. Chronic shoulder pain was eliminated after the axillary nerve block in two patients. The pain score after arthroscopic shoulder surgery in these two patients remained low until termination of the nerve block. In a fourth patient, severe post-operative pain after osteosynthesis of a displaced proximal humerus fracture was almost eliminated after performing an axillary nerve block. These findings warrant larger clinical trials that investigate the pain-mediating role of the axillary nerve in the perioperative setting.

Rothe, C; Lund, J

2012-01-01

70

Ultrasound guided dorsal penile nerve block in children.  

Science.gov (United States)

We describe a technique for using a portable ultrasound scanner (38 mm broadband (10-5 MHz) linear array transducer (Sonosite Titan SonoSite, Inc. 21919 30th Drive SE Bothell, WA.)) to guide dorsal penile nerve block in children under general anaesthesia. Real-time scanning is used to guide bilateral injections into the sub-pubic space, deep to Scarpa's fascia either side of the midline fundiform ligament. Scanning can confirm that the local anaesthetic has spread to contact the deep fascia on each side. A subcutaneous wheal of local anaesthetic along the penoscrotal junction completes the block. PMID:17444318

Sandeman, D J; Dilley, A V

2007-04-01

71

CT-guided suprascapular nerve blocks: a pilot study  

Energy Technology Data Exchange (ETDEWEB)

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.)

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

72

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.)

73

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

DEFF Research Database (Denmark)

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 non-existing extremity. This sensation was verbally described by the patient and thus used as an alternative to visual identification of motor response. After surgery the patient was pain free. The technique thus presents an alternative method for anesthesia and perioperative pain management in a high-risk group of patients Udgivelsesdato: 2008/2/4

Heiring, C.; Kristensen, Billy

2008-01-01

74

Ultrasound-guided lateral femoral cutaneous nerve block: comparison of two techniques.  

Science.gov (United States)

The aim of this study was to compare the feasibility and efficacy between two techniques of ultrasound-guided lateral femoral cutaneous nerve with or without locating the nerve. The study enrolled 106 patients undergoing knee surgery who received 5 ml of 1% mepivacaine immediately under the inguinal ligament 1 to 2 cm medial to the anterior superior iliac spine (subinguinal technique) or around the lateral femoral cutaneous nerve located (nerve-targeting technique). The time required to perform the block and the onset time of the block were similar for both techniques. However, a significantly higher percentage of patients obtained loss of pinprick sensation on the lateral thigh within 10 minutes with the subinguinal technique than with the nerve-targeting technique. The findings suggest that ultrasound-guided lateral femoral cutaneous nerve blocks can be easily performed and that injecting local anaesthetic immediately under the inguinal ligament rather than around the nerve itself blocks the nerve more reliably. PMID:21375093

Hara, K; Sakura, S; Shido, A

2011-01-01

75

Combination of spinal anesthesia and peripheral nerve block: Case report  

Directory of Open Access Journals (Sweden)

Full Text Available Regional anaesthesia has advantages such as, control of postoperative pain, early mobilization, and does not affect respiratory function. In recent years, regional anaesthesia had improved by the application of the peripheral nerve stimulator and ultrasound guided blocks, new local anaesthetic drugs with the use of additional adjunctive agents. Especially in emergency conditions, combination of regional anaesthesia may avoid the complications of general anesthesia in patients with chronic disease who suffer from upper and lower extremity injuries. In this paper, we present two cases who underwent combined regional anaesthesia techniques for the lower and upper extremity surgery.

Vildan Temel

2010-12-01

76

Manual removal of placenta under pudendal nerve block and sedation.  

Science.gov (United States)

A method of delivering retained placenta quickly without general ane sthesia is described. After failure of other methods, manual removal of placenta was performed for 50 consecutive patients under iv sedation combined with bilateral pudendal block. The pudendal nerve block was accomplished with 20 ml of 1% xylocaine. Local infiltration of the perineum is not necessary. Then pethidine, 50 mg, or in some cases less, and promazine hydrochloride, 50 mg, were given by way of the drip tubing containing 5% iv dextrose. Manual removal of the placenta was then done in the usual way. After the operation ergometrine, .5 mg, was given iv. 4 patients required blood transfusion because of hemorrhage; 1 of these had sickle cell hemoglobin. Prior administration of ergometrine in 1 patient had caused the cervix to contract. This was overcome by inhalation of 3 minims of amyl-nitrite. The method is espec ially suited to a country where there is a shortage of medical personnel. PMID:12306300

Efiong, E

1971-07-01

77

Anesthetic technique for inferior alveolar nerve block: a new approach  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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.

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

2011-02-01

78

Obturator hernia: A diagnostic challenge  

Science.gov (United States)

Patient: Female, 90 Final Diagnosis: Obturator hernia Symptoms: Epigastric pain • vomiting Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Challenging differential diagnosis Background: Obturator hernia (OH) can be difficult to diagnose because it shows only nonspecific signs and symptoms. Although pain in a lower limb caused by compression of the obturator nerve by the hernia in the obturator canal (Howship-Romberg sign) is a characteristic sign, its presence is rather rare. Case Report: We herein describe the case of a 90-year-old woman with an OH that was difficult to diagnose because of her slight abdominal signs and symptoms on admission and subtle abdominal computed tomography (CT) findings. Although the CT images revealed the presence of an OH, this finding was overlooked because it contained only a part of the small intestine wall, which is called the Richter type. Fortunately, her condition improved dramatically with only conservative treatment. Conclusions: Although early diagnosis is essential to reduce morbidity and mortality, OH can be a diagnostic challenge even with abdominal CT. PMID:25006359

Tokushima, Midori; Aihara, Hidetoshi; Tago, Masaki; Tomonaga, Motosuke; Sakanishi, Yuta; Yoshioka, Tsuneaki; Hyakutake, Masaki; Kyoraku, Itaru; Sugioka, Takashi; Yamashita, Shu-ichi

2014-01-01

79

Indications for repeat diagnostic medial branch nerve blocks following a failed first medial branch nerve block.  

Science.gov (United States)

No studies have directly measured the false negative rate of medial branch block (MBB) with correlation to medial branch neurotomy (MBN) outcome. We investigated the potential false negative MBB rate and the subsequent MBN outcome on a consecutive audit of all patients undergoing a double MBB protocol. We prospectively collected audit data and retrospectively collected data by phone on 229 consecutive patients undergoing diagnostic MBB. One-hundred-twenty-two patients reporting greater than 50% of subjective pain relief subsequently underwent either MBN or a confirmatory block followed by MBN. A total of 55 patients underwent a second confirmatory MBB and within that group 27.3% (15/55) reported less than 50% relief post initial MBB and 30.9% (17/55) between 50% and 69% relief. We performed an in-depth analysis of these 2 subgroups focusing on the reason a second MBB was performed despite a "negative" or "indeterminant" first MBB. We divided the "negative" responders to the first MBB into those reporting < 50% relief (Group 1) and those reporting between 50% and 69% relief (Group 2). We calculated a potential 46.7% false negative rate in Group 1 and 47.1% false negative in Group 2; however, the false negative results in Group 1 were predominately in those patients reporting delayed relief of pain and those re-blocked greater than 2 years after the first MBB. The success rate in all patients undergoing MBN was 87% compared to the 75% relief in the false negative groups with no statistically significant difference. In summary, the false negative rate for patients reporting less than 50% relief post MBB is probably less than 20% although there is a high "apparent negative" responds in patients reporting delayed relief or in those who had a second block 2 or more years post initial MBB. Patients reporting between 50 and 69% pain relief have a false negative response rate of 47.1% and should be considered for a confirmatory block. PMID:24077194

Derby, Richard; Melnik, Irina; Choi, Jongwoo; Lee, Jeong-Eun

2013-01-01

80

Response to occipital nerve block is not useful in predicting efficacy of occipital nerve stimulation.  

Science.gov (United States)

Occipital nerve stimulation (ONS) may be effective for the treatment of headaches that are recalcitrant to medical therapy. The objective of this study was to determine if response to occipital nerve block (ONB) predicts response to ONS in patients with chronic, medically intractable headaches. We evaluated 15 patients who underwent placement of occipital nerve stimulators for the treatment of chronic headaches. Data were collected regarding analgesic response to ONB and to ONS. Nine of 15 patients were ONS responders (> or =50% reduction in headache frequency or severity). Thirteen patients had ONB prior to stimulator implantation. Ten of 13 who had ONB had significant relief of head pain lasting at least 24 h, and three were ONB non-responders. Of the three ONB non-responders, two were ONS responders. Of the two patients who did not have ONB prior to ONS, one was an ONS responder and one was an ONS non-responder. In conclusion, analgesic response to ONB may not be predictive of the therapeutic effect from ONS in patients with medically refractory chronic headaches. PMID:17381559

Schwedt, T J; Dodick, D W; Trentman, T L; Zimmerman, R S

2007-03-01

81

Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?  

OpenAIRE

Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilateral bronchospasm following ultrasound-guided supraclavicular brachial plexus block. Patient did not have clinical features of pneumothorax or drug allergy and was managed with oxygen therapy and sal...

Chaudhuri, Souvik; Gopalkrishna, Md; Paul, Cherish; Kundu, Ratul

2012-01-01

82

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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) undergoin [...] g 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 were blockedin the lumbar plexus-sciatic nerve blocks (LPSB) group (n=40). For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the lumbar plexus-sciatic nerve blocks group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request, and patient and surgeon satisfaction with the anesthetic technique were recorded. RESULTS: One patient in the epidural anesthesia group and three patients in the lumbar plexus-sciatic nerve blocks group required general anesthesia due to failed block. There were no significant differences between the two groups regarding the success of providing adequate anesthesia. Eight patients in the lumbar plexus-sciatic nerve blocks group developed contralateral spread. The onset of sensory-motor block and the time of the first analgesic request were significantly later in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. Although there were no significant differences regarding patient satisfaction with the anesthetic technique between the two groups, surgeon satisfaction was significantly higher in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. CONCLUSION: The lumbar plexus -sciatic nerve blocks provide effective unilateral anesthesia and may offer a beneficial alternative to epidural anesthesia in patients undergoing total knee surgery.

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

83

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

Directory of Open Access Journals (Sweden)

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.

GUO Xiang-fei

2013-10-01

84

Effects of the potassium channel blocking dendrotoxins on acetylcholine release and motor nerve terminal activity.  

OpenAIRE

1. The effects of the K+ channel blocking toxins, the dendrotoxins, on neuromuscular transmission and motor nerve terminal activity were assessed on frog cutaneous pectoris, mouse diaphragm and mouse triangularis sterni nerve-muscle preparations. Endplate potentials (e.p.ps) and miniature e.p.ps were recorded with intracellular microelectrodes, and nerve terminal spikes were recorded with extracellular electrodes placed in the perineural sheaths of motor nerves. 2. Dendrotoxin from green mamb...

Anderson, A. J.; Harvey, A. L.

1988-01-01

85

Analgesic effects of maxillary and inferior alveolar nerve blocks in cats undergoing dental extractions.  

Science.gov (United States)

The aim of this study was to evaluate the analgesic effects of maxillary and/or inferior alveolar nerve blocks with lidocaine and bupivacaine in cats undergoing dental extractions. Twenty-nine cats were enrolled. Using an adapted composite pain scale, cats were pain scored before the dental procedure and 30 mins, and 1, 2 and 4 h after isoflurane disconnection. Cats were sedated with buprenorphine (20 µg/kg), medetomidine (10 µg/kg) and acepromazine (20 µg/kg) intramuscularly. Anaesthesia was induced using alfaxalone (1-2 mg/kg) intravenously and maintained with isoflurane in oxygen. Each cat was randomly assigned to receive maxillary and/or inferior alveolar nerve blocks or no nerve blocks prior to dental extractions. Each nerve block was performed using lidocaine (0.25 mg/kg) and bupivacaine (0.25 mg/kg). Heart rate, systolic arterial blood pressure, respiratory rate, end tidal carbon dioxide and isoflurane vaporiser settings were recorded 5 mins before and after the dental extractions, and the difference calculated. Group mean differences (mean ± SD) for heart rate (-9.7 ± 10.6 vs 7.6 ± 9.5 beats/min [nerve block vs control group, respectively], P heart rate and blood pressure while allowing for a reduction in isoflurane. Cats receiving nerve blocks had lower postoperative pain scores than the group without nerve blocks. PMID:24820999

Aguiar, Joana; Chebroux, Alexandre; Martinez-Taboada, Fernando; Leece, Elizabeth A

2015-02-01

86

[Treatment with stellate ganglion block, continuous epidural block and ulnar nerve block of a patient with postherpetic neuralgia who developed complex regional pain syndrome (CRPS)].  

Science.gov (United States)

We present a case of a 46-year-old female patient with systemic lupus erythematosus who developed herpes zoster of the right eighth cervical nerve. Her whole right forearm, hand and the first through fifth fingers were coated with some gel and protected against pain. She had been suffering from continuous and spasmodic burning pain, hyperalgesia, allodynia, drop in skin temperature, sudmotor disturbance, edema, constructure of the joints, muscle atrophy and bone atrophy of her right upper extremity probably due to postherpetic neuralgia (PHN) associated with complex regional pain syndrome (CRPS). She received right stellate ganglion block (SGB), continuous cervical epidural block and right ulnar nerve block. Reduction of pain and edema as well as improvement in mobility of each joint of her right upper extremity was observed. We suspect that SGB, continuous cervical epidural block and ulnar nerve block are effective and useful alternative treatments in a patient with PHN associated with CRPS of the eighth cervical nerve. PMID:11424478

Mizuno, J; Sugimoto, S; Ikeda, M; Kamakura, T; Machida, K; Kusume, S

2001-05-01

87

[Efficacy of CT-guided splanchnic nerve block for persistent pain after fluoroscopy-guided nerve block in a patient with advanced pancreatic cancer].  

Science.gov (United States)

We report a successful case of CT-guided splanchnic nerve block in a patient with advanced pancreatic cancer. A 76-year-old woman with epigastric distress was diagnosed with pancreatic cancer with multiple metastases. She underwent chemotherapy, but decided on best supportive care when her performance status worsened. Computed tomography revealed a 6 x 8 cm tumor mass in the pancreatic head. Oral oxycodone 20 mg x day(1) was ineffective and her Numerical Rating Scale (NRS) score was 9. Fluoroscopy-guided splanchnic nerve block with alcohol from L1-2 significantly reduced her pain, but she still required a fentanyl patch 2.1 mg x 3 days(-1) and loxoprofen (NRS 3). Four days later, we performed CT-guided splanchnic nerve block with alcohol 10 ml from T11-12. This significantly alleviated her pain and she was discharged uneventfully. She died 3 weeks after discharge. CT-guided splanchnic nerve block may be useful in cases of insufficient pain relief after fluoroscopy-guided splanchnic nerve block. PMID:24558942

Komasawa, Nobuyasu; Hato, Akio; Ikegaki, Junichi

2014-01-01

88

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)

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.

Kumar ER

2008-04-01

89

Dimethylsulfoxide (DMSO) blocks conduction in peripheral nerve C fibers: a possible mechanism of analgesia.  

Science.gov (United States)

Dimethylsulfoxide (DMSO) is readily absorbed through skin, and relieves musculoskeletal pain when applied topically to painful areas. We studied the effects of DMSO on C-type nerve fibers, which mediate pain sensation. DMSO was applied directly to exposed cat sural nerves. C fiber conduction velocity was slowed by DMSO, even in low concentrations (5-7% v/v). Higher concentrations completely blocked C fiber conduction, with a minimum blocking concentration of 9%. Onset of nerve block was almost immediate with 15% DMSO or higher concentrations. C fiber blockade may account for analgesia with DMSO. PMID:8469412

Evans, M S; Reid, K H; Sharp, J B

1993-02-19

90

Ultrasound-guided Lateral Femoral Cutaneous Nerve Block in Meralgia Paresthetica  

OpenAIRE

Meralgia paresthetica is a rarely encountered sensory mononeuropathy characterized by paresthesia, pain or sensory impairment along the distribution of the lateral femoral cutaneous nerve (LFCN) caused by entrapment or compression of the nerve as it crossed the anterior superior iliac spine and runs beneath the inguinal ligament. There is great variability regarding the area where the nerve pierces the inguinal ligament, which makes it difficult to perform blind anesthetic blocks. Ultrasound ...

Kim, Jeong Eun; Lee, Sang Gon; Kim, Eun Ju; Min, Byung Woo; Ban, Jong Suk; Lee, Ji Hyang

2011-01-01

91

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

OpenAIRE

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.

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

2004-01-01

92

Ultrasound-guided Lateral Femoral Cutaneous Nerve Block in Meralgia Paresthetica.  

Science.gov (United States)

Meralgia paresthetica is a rarely encountered sensory mononeuropathy characterized by paresthesia, pain or sensory impairment along the distribution of the lateral femoral cutaneous nerve (LFCN) caused by entrapment or compression of the nerve as it crossed the anterior superior iliac spine and runs beneath the inguinal ligament. There is great variability regarding the area where the nerve pierces the inguinal ligament, which makes it difficult to perform blind anesthetic blocks. Ultrasound has developed into a powerful tool for the visualization of peripheral nerves including very small nerves such as accessory and sural nerves. The LFCN can be located successfully, and local anesthetic solution distribution around the nerve can be observed with ultrasound guidance. Our successfully performed ultrasound-guided blockade of the LFCN in meralgia paresthetica suggests that this technique is a safe way to increase the success rate. PMID:21716611

Kim, Jeong Eun; Lee, Sang Gon; Kim, Eun Ju; Min, Byung Woo; Ban, Jong Suk; Lee, Ji Hyang

2011-06-01

93

Peripheral nerve blocks for intraoperative management in patients with hemophilia A.  

Science.gov (United States)

The use of peripheral nerve blocks as the sole anesthetic, augmented with mild sedation for intraoperative management of surgery on the ankle and knee in two hemophiliac patients, is presented. Peripheral nerve blocks may be safely used for surgery of the extremities in a patient with moderate to severe hemophilia, provided a safe level of Factor VIII is maintained throughout the perioperative period. PMID:19329016

Sripada, Ramprasad; Reyes, Joseph J; Sun, Ruidong

2009-03-01

94

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

OpenAIRE

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...

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

2003-01-01

95

Hypoesthesia after IAN block anesthesia with lidocaine: management of mild to moderate nerve injury  

OpenAIRE

Hypoesthesia after an inferior alveolar nerve (IAN) block does not commonly occur, but some cases are reported. The causes of hypoesthesia include a needle injury or toxicity of local anesthetic agents, and the incidence itself can cause stress to both dentists and patients. This case presents a hypoesthesia on mental nerve area followed by IAN block anesthesia with 2% lidocaine. Prescription of steroids for a week was performed and periodic follow up was done. After 1 wk, the symptoms got mu...

Moon, Sungjoo; Lee, Seung-jong; Kim, Euiseong; Lee, Chan-young

2012-01-01

96

Effect of sympathetic nerve block on acute inflammatory pain and hyperalgesia.  

DEFF Research Database (Denmark)

BACKGROUND: Sympathetic nerve blocks relieve pain in certain chronic pain states, but the role of the sympathetic pathways in acute pain is unclear. Thus the authors wanted to determine whether a sympathetic block could reduce acute pain and hyperalgesia after a heat injury in healthy volunteers. METHODS: The study was made as a randomized, single blinded investigation, in which the volunteers served as their own controls. A lumbar sympathetic nerve block and a contralateral placebo block were performed in 24 persons by injecting 10 ml bupivacaine (0.5%) and 10 ml saline, respectively. The duration and quality of blocks were evaluated by the sympatogalvanic skin response and skin temperature. Bilateral heat injuries were produced on the medial surfaces of the calves with a 50 x 25 mm thermode (47 degrees C, 7 min) 45 min after the blocks. Pain intensity induced by heat, pain thresholds to thermal and mechanical stimulation, and secondary hyperalgesia were assessed before block, after block, and 1, 2, 4, and 6 h after the heat injuries. RESULTS: Of the 24 volunteers, eight were excluded because of somatic block or incomplete sympathetic block. The study revealed no significant differences between sympathetic block and placebo for pain or mechanical allodynia during injury, or pain thresholds, pain responses to heat, or areas of secondary hyperalgesia after the injury. The comparisons were done for the period when the block was effective. CONCLUSION: Sympathetic nerve block did not change acute inflammatory pain or hyperalgesia after a heat injury in human skin.

Pedersen, J L; Rung, G W

1997-01-01

97

Supersensitivity to ACh in muscles after prolonged nerve block.  

Science.gov (United States)

Sciatic nerves of rats and tibial nerves of rabbits were kept anaesthetized in situ for periods of 3-11 days by applying silastic cuffs containing lidocaine base or marcaine hydrochloride. To insure a more uniform release of the rapidly diffusing lidocaine base, the drug was contained in compartments at some distance from the nerve and the cuffs were covered with polystyrene. The completeness of anaesthesia and the functional state of the nerve were tested by stimulating the exposed nerves proximal and distal to the cuff and by observing the behaviour of the muscle prior to killing the animals. The ACh sensitivity was tested by electrophoretic application of ACh from micropipettes and by recording the results changes of the resting membrane potential in individual muscle fibres. The ACh sensitivity was found to be present in the extrajunctional area of all muscle fibres including those displaying miniature end-plate potentials. These was no difference between the behaviour of muscles from rats and rabbits and between the action of lidocaine base and marcaine hydrochloride. Previous reports on the absence of extrajunctional ACh sensitivity in muscles of rabbits whose nerves had been treated by lidocaine base were explained by a relatively rapid loss of the drug from the usual type of nerve cuffs (more than 70% of the drug lost in one day), permitting a premature recovery of the nerves from anaesthesia. PMID:57757

Lorkovi?, H

1975-10-01

98

Thumb force deficit after lower median nerve block  

OpenAIRE

Abstract Purpose The purpose of this study was to characterize thumb motor dysfunction resulting from simulated lower median nerve lesions at the wrist. Methods Bupivacaine hydrochloride was injected into the carpal tunnel of six healthy subjects to locally anesthetize the median nerve. Motor function was subsequently evaluated by measuring maximal force production in all directions within the transverse plane perpendicular to the longitudinal axis of the thumb. Force envelopes were construct...

Li Zong-Ming; Harkness Daniel A; Goitz Robert J

2004-01-01

99

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

OpenAIRE

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...

Shanthanna, Harsha

2014-01-01

100

Tecnica alternativa para prevenir la estimulación del nervio obturador durante la RTU vesical de neoformaciones en cara lateral / An alternative technique to prevent of obturator nerve simulation during lateral bladder tumours transurethral resection  

Scientific Electronic Library Online (English)

Full Text Available Objetivo: Presentamos una alternativa de abordaje para el bloqueo del nervio obturador durante la RTU vesical. Material y Metodos: Se revisan retrospectivamente 400 tumores vesicales intervenidos, correspondientes a 218 pacientes, localizándose un 46,8% de estos en caras laterales. Se utiliza una ví [...] a de abordaje alternativa para el bloqueo del nervio obturador. Resultados: Mediante este abordaje, que simplifica, en posición de litotomía, el bloqueo nervioso del obturador, conseguimos en más del 95% de resecciones el que no se produzca estimulación muscular. Conclusiones: Aplicando esta técnica, disminuimos el riesgo de perforación vesical por esta causa, evitando las complicaciones asociadas. Abstract in english Objetives: We presents an alternative to prevent the obturator nerve stimulation during TUBR. Material and Method: We revise 400 bladder tumours corresponding to 218 patients, 46,8% of them localized in lateral bladder wall. An alternative technique is used for that blockade. Results: There have bee [...] n no adductor contractions in more than 95% of TUBR. Conclusions: The alternative technique may reduce the stimulation of the obturador nerve and the risk of bladder perforation.

J., García Rodríguez; A., Jalón Monzón; R. Carlos, González Álvarez; C., Ardura Laso; J.M., Fernández Gomez; J.J., Rodríguez Martínez; F.J., Martínez Gómez; J., Regadera Sejas; F., González Huergo.

2005-05-01

101

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)

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.

Ilvana Hasanbegovic

2013-12-01

102

Effects of the potassium channel blocking dendrotoxins on acetylcholine release and motor nerve terminal activity.  

Science.gov (United States)

1. The effects of the K+ channel blocking toxins, the dendrotoxins, on neuromuscular transmission and motor nerve terminal activity were assessed on frog cutaneous pectoris, mouse diaphragm and mouse triangularis sterni nerve-muscle preparations. Endplate potentials (e.p.ps) and miniature e.p.ps were recorded with intracellular microelectrodes, and nerve terminal spikes were recorded with extracellular electrodes placed in the perineural sheaths of motor nerves. 2. Dendrotoxin from green mamba (Dendroaspis angusticeps) venom and toxin I from black mamba (D. polylepis) venom increased the amplitude of e.p.ps by increasing quantal content, and also induced repetitive e.p.ps. 3. Perineural recordings revealed that dendrotoxins could decrease the component of the waveform associated with K+ currents at the nerve terminals, and induce repetitive activation of nerve terminals. 4. In frog motor nerves, dendrotoxins are known to block the fast f1 component of the K+ current at nodes of Ranvier. Blockade of a similar component of the K+ current at motor nerve terminals may be responsible for the effects of these toxins on neuromuscular transmission. 5. Similar conclusions can be drawn from the results obtained from mouse neuromuscular junctions. PMID:2450611

Anderson, A J; Harvey, A L

1988-01-01

103

Prolonged vertigo and ataxia after mandibular nerve block for treatment of trigeminal neuralgia  

OpenAIRE

Common complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and...

Chaturvedi, Arvind; Dash, Hh

2011-01-01

104

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

OpenAIRE

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...

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

2012-01-01

105

Suprascapular nerve block for the treatment of frozen shoulder in primary care: a randomized trial.  

OpenAIRE

BACKGROUND: Frozen shoulder is a common problem in general practice, but its treatment is difficult since none of the currently used therapies are proven to be effective. AIM: To assess the effectiveness of suprascapular nerve block to relieve pain and improve range of movement, and its suitability for use in primary care. This small study by a single practitioner aims to justify a larger multicentred trial. METHOD: A randomized trial of 30 patients to compare a single suprascapular nerve blo...

Jones, D. S.; Chattopadhyay, C.

1999-01-01

106

Sciatic nerve block causing heel ulcer after total knee replacement in 36 patients.  

Science.gov (United States)

Femoral and sciatic nerve blocks are often used for postoperative analgesia following total knee replacement surgery. In this report, we focus on cases of heel ulcers which occurred following the implementation of peripheral nerve block in concert with knee replacement surgery. In some instances, heel ulcers have resulted in delayed rehabilitation and prolonged hospital stays in this group of patients, which makes this phenomenon a potential burden on the healthcare system. Pressure points in the foot should be protected after the implementation of nerve blocks to prevent pressure sores. An awareness of this unusual complication related to knee replacement surgery is necessary to prevent its occurrence and avoid delays in patient rehabilitation and recovery. PMID:16459865

Todkar, Manoj

2005-12-01

107

Evaluation of Effect of Pudendal Nerve Block on Post Hemmorrhoidectomy Pain  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction & Objective: Hemorrhoid is one of the most common anorectal disease which presents with pain, bleeding and mass protrusion from anus. One of the most important reasons to avoid operation in these patients fears of the pain. Pain control specially during the first 24 hour postoperation period results in decreasing urinary retension and constipation as well as increasing patients pleasant. In this study we assisted the effect of pudendal nerve block to reduce pain in posthemorrhoidectomy period and compared with those patients without pudendal nerve block.Materials & Methods: We randomized 120 patients with average age of 37.7 year who referred to the hospitals of Ahwaz university for hemorrhoidectomy into 2 groups (N1: 60 N2:60. In the first group pudendal nerve block was done but in the second group we didn't. Then pain scores by analogue scale method were calculated in each group at 2, 6, 12& 24 hours after operations. The scores were matched with Chi- Square test. Also we calculated and compared the dosages of injected narcotics.Results: The average pain scores at 2, 6, 12, 24 hours after operation in the first group (with nerve block. Were 2.53, 2.4, 1.91, 2.7, 2.38, and in the second group (without nerve block were 3.43, 3.23, 2.98, 2.81, 3.11. The average of narcotic dosage in the first group was 0.69 and in the second group was 1.3. P-value in two groups in those times were 0.001, 0.002, 0.001, 0.66. P-value for comparison of two groups was 0.01. P-value for comparison of narcotic consumption was 0.003Conclusions: In this study, we showed that pudendal nerve block in post hemorrhoidectomy period, reduced pain significantly and decreased narcotic consumption as well.

M.H. Sarmast Shoshtari

2008-10-01

108

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

Science.gov (United States)

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. PMID:25024480

Shanthanna, Harsha

2014-05-01

109

Brachial plexus injury as a complication after nerve block or vessel puncture.  

Science.gov (United States)

Brachial plexus injury is a potential complication of a brachial plexus block or vessel puncture. It results from direct needle trauma, neurotoxicity of injection agents and hematoma formation. The neurological presentation may range from minor transient pain to severe sensory disturbance or motor loss with poor recovery. The management includes conservative treatment and surgical exploration. Especially if a hematoma forms, it should be removed promptly. Comprehensive knowledge of anatomy and adept skills are crucial to avoid nerve injuries. Whenever possible, the patient should not be heavily sedated and should be encouraged to immediately inform the doctor of any experience of numbness/paresthesia during the nerve block or vessel puncture. PMID:25031806

Kim, Hyun Jung; Park, Sang Hyun; Shin, Hye Young; Choi, Yun Suk

2014-07-01

110

[Crisis management during regional anesthesia including peripheral nerve block, epidural anesthesia and spinal anesthesia].  

Science.gov (United States)

Crisis management during regional anesthesia including peripheral nerve block, epidural anesthesia and spinal anesthesia was reviewed. Common crisis which is encountered during regional anesthesia includes toxic reaction to local anesthetic drugs, allergic reaction induced by local anesthetic drugs, reaction induced by epinephrine, nerve injury, hematoma etc. Concerning peripheral nerve block, crisis encountered during brachial plexus block, interscalene block and supraclavicular block used for surgical operation of upper extremity was discussed. On the other hands, there are various common crises encountered during epidural anesthesia and spinal anesthesia. These crises include hypotension, bradycardia, total spinal anesthesia, postspinal headache and infection, and hematoma in the spinal canal. Especially, epidural hematoma and epidural abcess have possibility to cause nerve defect symptoms such as motor paralysis and sensory disturbance if appropriate treatment was not started in early stage. Moreover crisis such as cauda equina syndrome and anterior spinal cord syndrome have possibility to remain permanent and hard to cure. We anesthesiologists should make efforts to prevent crisis, to detect crisis in early stage, and to treat it in early stage. PMID:19462797

Saeki, Shigeru; Kobayashi, Makiko; Miyake, Eri; Suzuki, Takahiro

2009-05-01

111

Aminoglycoside antibiotics block voltage-dependent calcium channels in intact vertebrate nerve terminals  

OpenAIRE

Intrinsic and extrinsic optical signals recorded from the intact nerve terminals of vertebrate neurohypophyses were used to investigate the anatomical site and physiological mechanism of the antagonistic effects of aminoglycoside antibiotics on neurotransmission. Aminoglycoside antibiotics blocked the intrinsic light scattering signal closely associated with neurosecretion in the mouse neurohypophysis in a concentration-dependent manner with an IC50 of approximately 60 microM and the block wa...

1992-01-01

112

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

Science.gov (United States)

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.

Gogia, Anoop Raj; Chandra, Kumar Naren

2015-01-01

113

Femoral nerve dysfunction  

Science.gov (United States)

Felice, KJ. Focal neuropathies of the femoral, obturator, lateral femoral cutaneous and other nerves of the thigh and pelvis. In: Bromberg MB, Smith GA, eds. Handbook of Peripheral Neuropathy. Boca Raton, Fl: Taylor and Francis; 2005:chap ...

114

Ultrasound-guided nerve block for inguinal hernia repair : a randomized, controlled, double-blind study  

DEFF Research Database (Denmark)

Open inguinal hernia repair in adults is considered a minor surgical procedure but can be associated with significant pain. We aimed to evaluate acute postoperative pain management in male adults randomized to receive an ultrasound-guided ilioinguinal and iliohypogastric nerve block administered before surgery, in addition to a standard analgesic regimen.

Bærentzen, Finn; Maschmann, Christian

2012-01-01

115

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

OpenAIRE

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 m...

Yamakado K

2014-01-01

116

Late-onset advanced heart block due to vagal nerve stimulation.  

Science.gov (United States)

Vagal nerve stimulation (VNS) is widely accepted as an effective and safe therapy for refractory seizure disorders. Significant cardiac complications, such as complete heart block or symptomatic bradycardia, are extremely rare. We present a case report of a 40-year-old man with drug-resistant epilepsy, treated with VNS, who developed the late-onset (12 months after implant), stimulation-related, symptomatic advanced heart block that was initially misinterpreted for a new type of seizure. The patient was otherwise free from other stimulation-related side effects. To our knowledge, this is the first case report of late-onset advanced heart block due to VNS. PMID:23797757

Schevchuck, Alex; West, Michael B

2014-01-01

117

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

Directory of Open Access Journals (Sweden)

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.

Melike Sakall?

2010-01-01

118

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

Energy Technology Data Exchange (ETDEWEB)

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.

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

119

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 nd other treatments, such as ambulatory phlebectomy and foam sclerotherapy. They may make these procedures more comfortable for the patient and easier for the operator.

120

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

121

Sedation with sufentanil and midazolam decreases pain in patients undergoing upper limb surgery under multiple nerve block.  

Science.gov (United States)

Multiple nerve blocks may be painful and a source of discomfort. We assessed the efficacy of sufentanil 5 microg combined with midazolam 1 mg in decreasing pain in outpatients after a midhumeral multiple nerve stimulation technique. Visual analog scores for pain were significantly lower in those patients who received sedation before the block, both at the time of block performance (14 +/- 1 vs 27 +/- 2 mm, P < 0.0001) and at discharge (11 +/- 1 vs 24 +/- 2 mm, P < 0. 0001). We conclude that the association of sufentanil and midazolam produced minimal sedation while significantly reducing pain experienced by patients undergoing multiple nerve stimulation. PMID:10781464

Kinirons, B P; Bouaziz, H; Paqueron, X; Ababou, A; Jandard, C; Cao, M M; Bur, M L; Laxenaire, M C; Benhamou, D

2000-05-01

122

[Experience of ultrasound-guided popliteal sciatic nerve block and femoral nerve perineural catheter placement in a morbidly obese patient undergoing total knee arthroplasty].  

Science.gov (United States)

A 60-year-old morbidly obese woman (150 cm, 112 kg, BMI 49.8) underwent total knee replacement under general anesthesia combined with sciatic nerve block and continuous femoral nerve block. Following induction of general anesthesia and tracheal intubation, the sciatic nerve was blocked using the popliteal approach with the patient in the supine position. Then the femoral nerve block was performed, followed by perineural catheter placement for postoperative continuous local anesthetic infusion. For both procedures, real-time ultrasound imaging was used to facilitate needle placement and confirm the adequate local anesthetic deposition. Twenty-five and 30 ml of 0.375% ropivacaine was injected around the sciatic and femoral nerves, respectively. Postoperatively 0.15% ropivacaine was infused at the rate of 5 ml x hr(-1) for 60 hours through the femoral catheter, which provided satisfactory pain relief in combination with scheduled loxoprofen administration. No block-related complications were noted. Our experience suggests that the ultrasound-guided technique may prove useful to facilitate safe and accurate block when technical difficulties are anticipated with anatomic landmark-based approaches. PMID:20960897

Hayashi, Hideaki; Ueyama, Hiroshi

2010-10-01

123

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

DEFF Research Database (Denmark)

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.

Andersen, H L; Andersen, S L

2015-01-01

124

Adverse effect profile of Lidocaine injections for occipital nerve block in occipital neuralgia  

OpenAIRE

To determine whether there are differences in the adverse effect profile between 1, 2 and 5% Lidocaine when used for occipital nerve blocks (ONB) in patients with occipital neuralgia. Occipital neuralgia is an uncommon cause of headaches. Little is known regarding the safety of Lidocaine injections for treatment in larger series of patients. Retrospective chart analysis of all ONB was performed at our headache clinic during a 6-year period on occipital neuralgia patients. 89 consecutive patie...

Sahai-srivastava, Soma; Subhani, Dawood

2010-01-01

125

Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain  

OpenAIRE

Occipital nerve block (ONB) has been used in several primary headache syndromes with good results. Information on its effects in facial pain is sparse. In this chart review, the efficacy of ONB using lidocaine and dexamethasone was evaluated in 20 patients with craniofacial pain syndromes comprising 8 patients with trigeminal neuralgia, 6 with trigeminal neuropathic pain, 5 with persistent idiopathic facial pain and 1 with occipital neuralgia. Response was defined as an at least 50% reduction...

Ju?rgens, T. P.; Mu?ller, P.; Seedorf, H.; Regelsberger, J.; May, A.

2012-01-01

126

Effect of saphenous nerve block for postoperative pain on knee surgery: a meta-analysis  

Science.gov (United States)

Early post-operative mobilization is important both to reduce immobility-related complications and to get the best functional result following surgery on knee. We hypothesized that saphenous nerve block would reduce pain in this patient category compared with placebo injection. In this study, two reviewers independently searched the databases of PubMed, EMBASE, and Cochrane Library (last performed on 12 October, 2014) to retrieve eligible randomized controlled clinical trials. The primary outcomes were visual analog scale (VAS) pain scores within 24 hours after operation when at rest and at an active flexion of knee. Mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) was calculated for each end point. Subgroup analysis was calculated to evaluate potential sources of heterogeneity. Nine randomized controlled trials were retrieved and analyzed. We found that VAS pain scores at rest within postoperative 24 hours were significantly decreased in saphenous nerve block group than that in placebo group (MD = -0.79; 95% CI -1.35 to -0.22; P = 0.007), as well as VAS pain scores at an active flexion of knee within postoperative 24 hours (MD = -0.92; 95% CI -1.61 to -0.22; P = 0.010). In addition, compared to placebo injection group, saphenous nerve block resulted in significantly less morphine consumption during the first postoperative 24 hours (MD = -6.56; 95% CI -11.26 to -1.86; P = 0.006). To conclude, this meta-analysis suggests that saphenous nerve block has an advantage in pain relief both at an active flexion of knee and at rest after knee surgery. Further studies are still wanted to validate these conclusions.

Jin, Shu-Qing; Ding, Xi-Bing; Tong, Yao; Ren, Hao; Chen, Zhi-Xia; Wang, Xin; Li, Quan

2015-01-01

127

An evaluation of lidocaine hydrocarbonate compared with lidocaine hydrochloride for inferior alveolar nerve block.  

OpenAIRE

The purpose of this study was to measure the degree of anesthesia obtained with 2.2% lidocaine hydrocarbonate, 2.2% lidocaine hydrocarbonate with 1:100,000 epinephrine, and 2% lidocaine hydrochloride with 1:100,000 epinephrine for inferior alveolar nerve block. Using a repeated-measures design, 30 subjects randomly received an inferior alveolar injection of each solution over the course of three successive appointments. The first molar, first premolar, lateral incisor, and contralateral canin...

Chaney, M. A.; Kerby, R.; Reader, A.; Beck, F. M.; Meyers, W. J.; Weaver, J.

1991-01-01

128

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

DEFF Research Database (Denmark)

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 syndrome is a potentially devastating complication to trauma, typically fractures of the tibial shaft and the forearm because of the relatively tight facias and small volume of these compartments.

Munk-Andersen, H; Laustrup, T K

2013-01-01

129

Rami Communicans Nerve Block for the Treatment of Symptomatic Schmorl's Nodes -A Case Report-.  

Science.gov (United States)

Histologically, Schmorl's nodes are defined as the loss of nuclear material through the cartilage plate, growth plate, and end plate into the vertebral body. Most Schmorl's nodes are asymptomatic, although there are some reports of symptomatic Schmorl's nodes, which should be treated similarly to vertebral compression fractures, with conservative treatment as the first choice. We report the case that we reduced the pain by blocking the ramus communicans nerve in a patient with Schmorl's node. PMID:21217891

Jang, Ji Su; Kwon, Hyung Ki; Lee, Jae Jun; Hwang, Sung Mi; Lim, So Young

2010-12-01

130

Antiinflammatory effect of peripheral nerve blocks after knee surgery: clinical and biologic evaluation  

Science.gov (United States)

Background Nerve blocks provide analgesia after surgery. We tested whether they have anti-inflammatory effects. Methods Patient had combined sciatic (single shot) and continuous femoral block (48 hours) (block group) or morphine patient-controlled analgesia (PCA group) after total knee arthroplasty. Pain at rest and upon movement was monitored at one (D1), four (D4) and seven days (D7) and one (M1) and three months (M3) after surgery. Knee inflammation was evaluated (skin temperature, knee circumference) before surgery and at D1, D4, D7, M1 and M3. Plasma cytokine concentrations (IL6, IL1?, TNF, IL10, sTNF-R1) were measured before surgery, then at four hours, D1, D4 and D7 after surgery. Capsule and synovial membrane cytokines were measured (IL6, TNF, IL1, IL10). Knee flexion was evaluated before surgery and at D1, D4, D7, M1 and M3. We monitored morphine use and recovery time to autonomy. Results Pain at rest and upon movement was lower in the block group than in PCA patients between D1 and D7 (Anova; P<0.005). Knee flexion was improved in the block group for D1 to M1 (Anova; p<0.0001). Block group patients recovered non-assisted mobilization (t test; p=0.04) and toilet use (t test; p=0.03) more rapidly. Knee circumference and skin temperature were lower in the block group between D1 and D7 (Anova; p<0.05). Synovial membrane IL1 (p<0.05) and IL10 (p<0.01) increased and plasma IL6 and sTNF-R1 peaked at 24 hours, with no difference between groups. Conclusion Nerve blocks inhibited clinical inflammation after total knee arthroplasty with no change in tissue and plasma cytokine concentrations. PMID:18719447

Martin, Frédéric; Martinez, Valéria; Mazoit, Jean Xavier; Bouhassira, Didier; Cherif, Kamel; Gentili, Marc Edouard; Piriou, Philippe; Chauvin, Marcel; Fletcher, Dominique

2008-01-01

131

Speech Therapy with Obturator  

OpenAIRE

Rehabilitation of speech is tantamount to closure of defect in cases with velopharyngeal insufficiency. Often the importance of speech therapy is sidelined during the fabrication of obturators. Usually the speech part is taken up only at a later stage and is relegated entirely to a speech therapist without the active involvement of the prosthodontist. The article suggests a protocol for speech therapy in such cases to be done in unison with a prosthodontist.

Shyammohan, A.; Sreenivasulu, D.

2010-01-01

132

Addition of femoral nerve block to epidural infusion for pain control post total knee arthroplasty: Does it make a difference?  

OpenAIRE

Introduction: Effective post-operative analgesia is a major factor in functional outcome after total knee arthroplasty (TKA). To reduce post-operative pain and expedite recovery, peripheral nerve blocks, such as the femoral nerve block (FNB) have been used as an adjunct to the analgesic regime. We assessed whether the addition of a FNB to continuous epidural analgesia (CEA) would improve pain control after TKA. Materials and Methods: A prospective, randomised, controlled study was conducted o...

Kandasamy, Melvin; Maaya, Muhammad; Abdul Rahman, Raha; Md Nor, Nadia; Yahya, Nurlia

2012-01-01

133

Headache in patients with cervical radiculopathy: a prospective study with selective nerve root blocks in 275 patients  

OpenAIRE

Since many years we routinely use diagnostic selective nerve root blocks (SNRB) at our department when evaluating patients with cervical radiculopathy. Frequently patients who also presented with headache reported that the headache disappeared when the nerve root responsible for the radicular pain was blocked with local anaesthetics. Headache has been described as a companioning symptom related to cervical radiculopathy but has never before been evaluated with SNRB performed in the lower cerv...

Persson, Liselott C. G.; Carlsson, Jane Y.; Anderberg, Leif

2006-01-01

134

Clinical evaluation of inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen.  

OpenAIRE

The conventional inferior alveolar nerve block (conventional technique) has potential risks of neural and vascular injuries. We studied a method of inferior alveolar nerve block by injecting a local anesthetic solution into the pterygomandibular space anterior to the mandibular foramen (anterior technique) with the purpose of avoiding such complications. The insertion angle of the anterior technique and the estimation of anesthesia in the anterior technique were examined. The predicted insert...

Takasugi, Y.; Furuya, H.; Moriya, K.; Okamoto, Y.

2000-01-01

135

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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 sciati [...] c 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.

A.M., Sousa; H.A., Ashmawi; L.S., Costa; I.P., Posso; A., Slullitel.

2012-02-01

136

Adductor Canal Block versus Femoral Nerve Block and Quadriceps Strength : A Randomized, Double-blind, Placebo-controlled, Crossover Study in Healthy Volunteers  

DEFF Research Database (Denmark)

: The authors hypothesized that the adductor canal block (ACB), a predominant sensory blockade, reduces quadriceps strength compared with placebo (primary endpoint, area under the curve, 0.5-6 h), but less than the femoral nerve block (FNB; secondary endpoint). Other secondary endpoints were adductor strength and ability to ambulate.

Jæger, Pia Therese; Nielsen, Zbigniew Jerzy Koscielniak

2013-01-01

137

Nerve Blocks  

Science.gov (United States)

... detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes ... and/or imaging guidance. He or she will clean the area with antiseptic solution, and then the ...

138

The furcal nerve revisited  

OpenAIRE

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 t...

Harshavardhana, Nanjundappa S.; Dabke, Harshad V.

2014-01-01

139

Ultrasonography-guided ilioinguinal-iliohypogastric nerve block for inguinal herniotomies in ex-premature neonates.  

Science.gov (United States)

The ilioinguinal-iliohypogastric (IG-IH) nerve block provides effective opioid-sparing analgesia for inguinal surgeries. The technique is especially useful in apnoea-prone premature neonates with sacral anomalies and coagulopathy. A recent retrospective review of 82 ex-premature neonates who underwent inguinal herniotomy at KK Women's and Children's Hospital, Singapore, reported a success rate of 89% for landmark-guided IG-IH blocks. All blocks in that study were performed by senior paediatric anaesthetists using the landmark-based technique, which relies on fascial clicks. The IG-IH block is expected to be technically more difficult in neonates. There is also a stronger need to ensure success in these patients in order to avoid the use of opioids and reduce the risk of postoperative apnoea. Ultrasonographic guidance has been reported to improve the success of IG-IH blocks in older children to up to 94%. Herein, we report a series of six ex-premature neonates in whom ultrasonography-guided IG-IH blocks were successfully performed using reduced volumes of local anaesthetics (mean volume 0.17 mL/kg) for inguinal herniotomy. PMID:24276107

Lee, Shuying; Tan, Josephine Swee Kim

2013-11-01

140

Evaluation of femoral nerve blockade following inguinal paravascular block of Winnie: are there still lessons to be learnt?  

Science.gov (United States)

Lower limb peripheral nerve blocks are used to provide surgical anaesthesia or postoperative analgesia. Anatomical texts imply that femoral and saphenous nerve blocks be evaluated by sensory testing of the skin overlying the anterior aspect of the thigh, and the medial aspect of the foot, respectively. We have mapped the distribution of anaesthesia in 25 adults following femoral nerve blockade, performed using the inguinal paravascular technique of Winnie. There was substantial interindividual variation in the area of anaesthesia. Only the skin overlying the middle third of the medial thigh was consistently blocked in 100% of patients. The distribution of anaesthesia conformed to anatomical text descriptions in 24% of cases. We conclude that demonstration of complete quadriceps paralysis confirms femoral nerve blockade. Failing that, sensory evaluation of a femoral nerve block should involve testing the skin of the middle third of the medial aspect of the thigh. The skin overlying the anteromedial aspect of the middle third of the leg should be evaluated for saphenous nerve block. PMID:16179041

Jochum, D; O'Neill, T; Jabbour, H; Diarra, P D; Cuignet-Pourel, E; Bouaziz, H

2005-10-01

141

Supra-Clavicular Brachial Plexus Block: Ultra-Sonography Guided Technique Offer Advantage Over Peripheral Nerve Stimulator Guided Technique  

Directory of Open Access Journals (Sweden)

Conclusion: Ultrasonography guided supraclavicular brachial plexus block is quick to perform, offers improved safety and accuracy in identifying the position of the nerves to be blocked and of the structures. [Natl J Med Res 2013; 3(3.000: 241-244

Krutika B Rupera

2013-06-01

142

Duration of experimental nerve block by combinations of local anesthetic agents.  

Science.gov (United States)

The effects of bupivacaine-prilocaine and meperidine-lidocaine combinations (as compared with those of the agents used alone) on the duration of peripheral sensory nerve block were studied with the infraorbital nerve block model (IONB) in the rat, and those on motor block with spinal anesthesia (SA) in the mouse. The duration of bupivacaine-induced IONB was invariably prolonged when prilocaine was included in the solution. When included in 0.125% bupivacaine, 1.0% prilocaine had a slightly less pronounced enhancing effect than 0.5% prilocaine (24-57% vs. 74%-104%, respectively). The duration of IONB with 1.0% prilocaine was significantly reduced (14-37%) by inclusion of 0.125% bupivacaine. In SA, inclusion in 0.125% bupivacaine of prilocaine (0.5% or 1.0%) prolonged motor block by 128% and 192%, respectively. When included in 0.25% bupivacaine, both 0.5% and 1.0% prilocaine significantly reduced the duration of SA, by 42% and 37%, respectively. With one exception, the duration of IONB by meperidine was significantly shortened (< 44%) when lidocaine was included in the solution. In SA, inclusion of 2% lidocaine with 2% meperidine did not affect the duration of meperidine-induced motor block. The duration of SA obtained with the combination of 4% lidocaine and 4% meperidine was 45% shorter than that induced by 4% meperidine alone. The reasons for these variable effects are not clear, but may be due to interaction or antagonism at any of multiple sites. PMID:8424299

Hassan, H G; Youssef, H; Renck, H

1993-01-01

143

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

OpenAIRE

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...

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

2012-01-01

144

Ultrasound-guided serial ilioinguinal nerve blocks for management of chronic groin pain secondary to ilioinguinal neuralgia in adolescents.  

Science.gov (United States)

We examined the efficacy of serial ilioinguinal nerve blocks using ultrasound guidance for management of chronic inguinal pain secondary to persistent ilioinguinal neuralgia in adolescents. This case series consists of two adolescents who had persistent inguinal pain secondary to ilioinguinal neuralgia who were treated with conventional pain medications that did not relieve the pain. One patient had pain immediately following surgery while the other had pain several months after an injury. Serial ilioinguinal nerve blocks were performed with local anesthetic solution using ultrasound guidance in an outpatient setting. Both the adolescents had complete relief of pain symptoms and were able to resume normal activities. There were no adverse effects associated with the blocks. Performance of serial ilioinguinal nerve blocks using ultrasonography in an outpatient setting in adolescents and adolescents with ilioinguinal neuralgia may reduce pain and allow these adolescents to resume their normal activities. PMID:18482237

Suresh, Santhanam; Patel, Amish; Porfyris, Suzanne; Ryee, Mi-Young

2008-08-01

145

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)

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.

Lange, K H W; Jansen, T

2011-01-01

146

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

Directory of Open Access Journals (Sweden)

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

Youm YS

2013-03-01

147

Essential Oil of Croton zehntneri and Its Main Constituent Anethole Block Excitability of Rat Peripheral Nerve.  

Science.gov (United States)

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

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

148

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

Directory of Open Access Journals (Sweden)

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.

Andrew R Bogacz

2012-08-01

149

Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine  

OpenAIRE

In patients with radiculopathy due to degenerative disease in the cervical spine, surgical outcome is still presenting with moderate results. The preoperative investigations consist of clinical investigation, careful history and most often magnetic resonance imaging (MRI) of the cervical spine. When MRI shows multilevel degeneration, different strategies are used for indicating which nerve root/roots are affected. Some authors use selective diagnostic nerve root blocks (SNRB) for segregating ...

Anderberg, Leif; Annertz, Ma?rten; Rydholm, Urban; Brandt, Lennart; Sa?veland, Hans

2005-01-01

150

[Ilio-inguinal Ilio-hypogastic nerve block with a single puncture: an alterantive for anesthesia in emergency inguinal surgery].  

Science.gov (United States)

The authors describe the anaesthetic procedure for a strangulated hernia repair needing resection and anastomosis of the small bowel in an adult patient. This procedure was performed with an ilio-inguinal/ilio-hypogastric nerve block according to a paediatrical simplified technique with a single puncture. For this patient who had relative contraindications for central blocks, this regional technique allowed to avoid general anaesthesia with its gastric aspiration and predictible difficult intubation risks. This block associated with a very light sedation was sufficient for all the surgical procedure, and postoperative analgesia was efficient over 3 hours. This simplified nerve block, better than the conventional approach for the clinical practice, represents a recommended alternative for hernia repair in emergency for high risk patients who could have a general anaesthesia or a central block. PMID:11530753

Carré, P; Mollet, J; Le Poultel, S; Costey, G; Ecoffey, C

2001-08-01

151

Fabricating a hollow bulb obturator  

Directory of Open Access Journals (Sweden)

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.

Fatih Sari

2012-01-01

152

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.

153

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

Directory of Open Access Journals (Sweden)

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.

Koshy Rachel

2010-01-01

154

Study of the anatomical position of the femoral nerve by magnetic resonance imaging in patients with fractured neck of femur: relevance to femoral nerve block.  

LENUS (Irish Health Repository)

STUDY OBJECTIVE: To determine the anatomical location of the femoral nerve in patients who have sustained fracture of the neck of femur, and its relevance to femoral nerve block technique. DESIGN: Prospective, observational clinical study. SETTING: Orthopedic and Radiology departments of a regional hospital. SUBJECTS: 10 consecutive adult ASA physical status II and III patients (mean age, 78.5 yrs) and 4 adult healthy volunteers. INTERVENTIONS: A T1 magnetic resonance imaging scan was performed of both upper thighs in patients and healthy volunteers successfully. MEASUREMENTS: The distance (mm) between the midpoint of the femoral artery and the midpoint of the femoral nerve, and the distance of the femoral nerve from the skin was measured at the mid-inguinal ligament, the pubic tubercle, and at the mid-inguinal crease. Data are shown as means (SD). Differences between both sides were compared using paired Student\\'s t-tests. P < 0.05 was significant. MAIN RESULTS: In patients the mean distance (mm) between the midpoint of the femoral nerve from the midpoint of femoral artery at the mid-inguinal crease on the fractured and non-fractured sides was 10.7 and 11.0, respectively (P = 0.87). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the mid-inguinal ligament on the fractured and non-fractured sides was 9.64 and 12.5, respectively (P = 0.03). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the pubic tubercle on the fractured and non-fractured sides was 8.74 and 10.49, respectively (P = 0.18). CONCLUSIONS: Blockade of the femoral nerve may be easier to perform at the mid-inguinal crease in patients with fractured neck of femur.

Mehmood, Shehzad

2012-01-31

155

Translation of sonoelastography from Thiel cadaver to patients for peripheral nerve blocks.  

Science.gov (United States)

Ultrasound guidance is now common in regional anaesthesia practice, but remains limited by poor visibility of the needle tip and poor quantification of local anaesthetic spread. Sonoelastography based on tissue compression is a technique depicting tissue strain. Hitherto used largely for tumour diagnosis, we used it in both Thiel embalmed cadavers and two patients receiving interscalene and femoral blocks to observe changes in tissue strain during local anaesthetic injection. The primary aim of our study was to measure the area under the curve (weighted for time) of the strain pattern in Thiel perineural tissue when using a range of volumes of embalming fluid (0.25, 0.5, 1, 2.5, 5 and 7.5?ml) for interscalene and femoral blocks using sonoelastography. Our secondary aims were to evaluate static images of anatomy and videos of needle insertion and perineural injection using combined B-Mode ultrasound and sonoelastography. Independent raters assessed the anatomy and spread using a 7-point Likert scale, ranked from extremely poor to extremely good. We performed 83 blocks in cadavers. Concordance between both raters was good, with weighted Kappa (95% CI) 0.66 (0.61-0.71). The characteristics of spread were similar with both interscalene and femoral block; spread increased with injectate volume up to 1 ml. Analysis of variance showed differences in spread between injection volumes (p = 0.009), but not between regional blocks (p = 0.05). Post-hoc analysis showed greater spread with 1 and 2.5 ml volumes compared with 0.25 ml. In patients, visibility of strain during injection was better with sonoelastography than with B-Mode ultrasound and showed a dose response from 1 to 5?ml volumes of local anaesthetic. Colour strain recognition using sonoelastography offers the ability to differentiate between nerve and surrounding tissue during local anaesthetic injection by improving visibility of spread (p = 0.04). PMID:22506553

Munirama, S; Satapathy, A R; Schwab, A; Eisma, R; Corner, G A; Cochran, S; Soames, R; McLeod, G A

2012-07-01

156

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 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

157

General anesthesia plus ilioinguinal nerve block versus spinal anesthesia for ambulatory inguinal herniorrhapy  

Science.gov (United States)

Objective: The aim was to evaluate general anesthesia (GA) plus ilioinguinal nerve block (IIB) versus spinal anesthesia (SA) in patients scheduled for ambulatory inguinal hernia repair regarding pain management, anesthesia recovery and reducing potential complications. Materials and Methods: A double-blind, prospective, randomized, controlled study in patients American Society of Anesthesiologists I-III randomized into two groups: GA plus IIB group, induction of anesthesia with propofol, maintenance with sevoflurane, airway management with laryngeal mask allowing spontaneous ventilation and ultrasound-guided IIB; SA group, patients who underwent spinal block with 2% mepivacaine. The study variables were pain intensity, assessed by visual analog scale, analgesic requirements until hospital discharge, time to ambulation and discharge, postoperative complications-related to both techniques and satisfaction experienced. Results: Thirty-two patients were enrolled; 16 patients in each group. The differences regarding pain were statistically significant at 2 h of admission (P block group. In addition in this group, analgesic requirements were lower than SA group (P < 0.001), with times of ambulation and discharge significantly shorter. The SA group had a higher tendency to develop complications and less satisfaction. Conclusion: General anesthesia plus IIB is better than SA regarding postoperative analgesia, time to mobilization and discharge, side-effect profile and satisfaction experienced by the patients. PMID:25422612

Vizcaíno-Martínez, Lucía; Gómez-Ríos, Manuel Ángel; López-Calviño, Beatriz

2014-01-01

158

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

Science.gov (United States)

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

Ezirganli, Seref; Kazancioglu, Hakki Oguz

2013-11-01

159

Morphometry of stylomastoid foramen and its clinical application in facial nerve block  

Science.gov (United States)

Background: Stylomastoid foramen is an important site for Nadbath facial nerve block. Exact localization of foramen holds the key to success, thus decreasing the complications. Wide racial variation exists in position of stylomastoid foramen in different population groups. Aim: The aim was to study the morphometry of stylomastoid foramen and its location with respect to nearby anatomical landmarks. Materials and Methods: A total of 100 dry skulls (60 male and 40 female) were studied to locate the position of center of stylomastoid foramen (CSMF) with respect to tip and anterior border of the mastoid process and jugular foramen (JF). Along with this angle between antero-posterior line passing through the tip of the mastoid process and line joining the tip with stylomastoid foramen was also measured. Result: In 83.51% sides of skulls, the most common position of foramen was found to be anterior to the line passing through anterior border of the mastoid process. The mean distance of center of foramen from the tip of the mastoid process was 15.26 ± 1.4 mm on right and 14.32 ± 1.8 on the left side (P < 0.001) and from JF was 12.28 ± 1.9 mm and 12.96 ± 2.1 mm on the right and left sides, respectively (P < 0.01). The position of CSMF was found at an angle of 66.57° ± 2.6° and 65.96° ± 1.8° on the right and left sides, respectively from the tip of the mastoid process. Conclusion: This study makes possible the identification of the exact position of stylomastoid foramen and its application in facial nerve block. PMID:25558201

Sharma, Nidhi; Varshney, Rohit

2015-01-01

160

Increased mitochondrial fission and volume density by blocking glutamate excitotoxicity protect glaucomatous optic nerve head astrocytes.  

Science.gov (United States)

Abnormal structure and function of astrocytes have been observed within the lamina cribrosa region of the optic nerve head (ONH) in glaucomatous neurodegeneration. Glutamate excitotoxicity-mediated mitochondrial alteration has been implicated in experimental glaucoma. However, the relationships among glutamate excitotoxicity, mitochondrial alteration and ONH astrocytes in the pathogenesis of glaucoma remain unknown. We found that functional N-methyl-d-aspartate (NMDA) receptors (NRs) are present in human ONH astrocytes and that glaucomatous human ONH astrocytes have increased expression levels of NRs and the glutamate aspartate transporter. Glaucomatous human ONH astrocytes exhibit mitochondrial fission that is linked to increased expression of dynamin-related protein 1 and its phosphorylation at Serine 616. In BAC ALDH1L1 eGFP or Thy1-CFP transgenic mice, NMDA treatment induced axon loss as well as hypertrophic morphology and mitochondrial fission in astrocytes of the glial lamina. In human ONH astrocytes, NMDA treatment in vitro triggered mitochondrial fission by decreasing mitochondrial length and number, thereby reducing mitochondrial volume density. However, blocking excitotoxicity by memantine (MEM) prevented these alterations by increasing mitochondrial length, number and volume density. In glaucomatous DBA/2J (D2) mice, blocking excitotoxicity by MEM inhibited the morphological alteration as well as increased mitochondrial number and volume density in astrocytes of the glial lamina. However, blocking excitotoxicity decreased autophagosome/autolysosome volume density in both astrocytes and axons in the glial lamina of glaucomatous D2 mice. These findings provide evidence that blocking excitotoxicity prevents ONH astrocyte dysfunction in glaucomatous neurodegeneration by increasing mitochondrial fission, increasing mitochondrial volume density and length, and decreasing autophagosome/autolysosome formation. GLIA 2015;63:736-753. PMID:25557093

Ju, Won-Kyu; Kim, Keun-Young; Noh, You Hyun; Hoshijima, Masahiko; Lukas, Thomas J; Ellisman, Mark H; Weinreb, Robert N; Perkins, Guy A

2015-05-01

161

Contralateral Obturator Hernia Immediately after a Right Obturator Herniorrhaphy: A Case Report  

Energy Technology Data Exchange (ETDEWEB)

An obturator hernia is a very rare condition that occurs in elderly debilitated women and its nonspecific symptoms delay the diagnosis. Computed tomography is a useful tool for the early diagnosis of an obturator hernia. Previous studies report that bilateral obturator hernias comprise approximately 6% of all obturator hernias is 6%. To the best of our knowledge, there is no reported case of a contralateral obturator hernia immediately after a herniorrhaphy. We report a case of contralateral obturator hernia that occurred immediately after a right obturator herniorrhaphy

Oh, Soo Jin [Soonchunhyang University Cheonan Hospital College of Medicine, Cheonan (Korea, Republic of); Choi, Gyo Chang; Kim, Hyeong Soo [Soonchunhyang University Gumi Hospital College of Medicine, Gumi (Korea, Republic of)

2010-11-15

162

Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block: A Comparative Study with Nerve Stimulator-Guided Method  

Directory of Open Access Journals (Sweden)

Full Text Available Background: The aim of this study was to compare the efficacy of axillary brachial plexusblock using an ultrasound-guided method with the nerve stimulator-guidedmethod. We also compared the efficacy of ultrasound-guided single-injectionwith those of double-injection for the quality of the block.Methods: Ninety patients scheduled for surgery of the forearm or hand were randomlyallocated into three groups (n = 30 per group, i.e., nerve stimulator-guidedand double-injection (ND group, ultrasound-guided and double-injection(UD group, and ultrasound-guided and single-injection (US group. Eachpatient received 0.5 ml kg-1 of 1.5% lidocaine with 5 ?g kg-1 epinephrine.Patients in the ND group received half the volume of lidocaine injected nearthe median and radial nerves after identification using a nerve stimulator.Patients in the UD group received half the volume of lidocaine injectedaround the lateral and medial aspects of the axillary artery, while those in theUS group were given the entire volume near the lateral aspect of the axillaryartery. The extent of the sensory blockade of the seven nerves and motorblockades of the four nerves were assessed 40 min after the performance ofaxillary brachial plexus block.Results: Seventy percent of the patients in the ND and US groups as well as 73% ofthe patients in the UD group obtained satisfactory sensory and motor blockades.The success rate of performing the block was 90% in patients in theND and UD groups and 70% in the US group. The incidence of adverseevents was significantly higher in the ND group (20% compared with that inthe US group and the UD group (0%; p = 0.03.Conclusions: Ultrasound-guided axillary brachial plexus block, using either single- or double-injection technique, provided excellent sensory and motor blockadeswith fewer adverse events.

Fu-Chao Liu

2005-06-01

163

Adverse effect profile of lidocaine injections for occipital nerve block in occipital neuralgia.  

Science.gov (United States)

To determine whether there are differences in the adverse effect profile between 1, 2 and 5% Lidocaine when used for occipital nerve blocks (ONB) in patients with occipital neuralgia. Occipital neuralgia is an uncommon cause of headaches. Little is known regarding the safety of Lidocaine injections for treatment in larger series of patients. Retrospective chart analysis of all ONB was performed at our headache clinic during a 6-year period on occipital neuralgia patients. 89 consecutive patients with occipital neuralgia underwent a total of 315 ONB. All the patients fulfilled the IHS criteria for Occipital Neuralgia. Demographic data were collected including age, gender, and ethnicity. The average age of this cohort was 53.25 years, and the majority of patients were females 69 (78%). Ethnicity of patients was diverse, with Caucasian 48(54%), Hispanics 31(35%), and others 10 (11%). 69 patients had 1%, 18 patients had 2% and 29 patient were given 5% Lidocaine. All Lidocaine injections were given with 20 mg Depo-medrol and the same injection technique and location were used for all the procedures. Eight patients (9%)had adverse effects to the Lidocaine and Depo-medrol injections, of which 5 received 5% and 3 received 1% Lidocaine. Majority of patients who had adverse effects were female 7(87%), and had received bilateral blocks (75%). ONB is a safe procedure with 1% Lidocaine; however, caution should be exerted with 5% in elderly patients, 70 or older, especially when administering bilateral injections. PMID:20665065

Sahai-Srivastava, Soma; Subhani, Dawood

2010-12-01

164

Embolization of postsurgical obturator artery pseudoaneurysm.  

Science.gov (United States)

The anatomy of the obturator artery in the pelvis makes this vessel and its branches prone to iatrogenic injury during pelvic surgery. We present a postoperative obturator artery pseudoaneurysm treated by transcatheter embolization. Normal and variant obturator vascular anatomy, as well as pathology related to traumatic injury of this vessel, are subsequently discussed. PMID:21326740

Lorenz, Jonathan M; Leef, Jeffrey A

2007-03-01

165

Embolization of Postsurgical Obturator Artery Pseudoaneurysm  

OpenAIRE

The anatomy of the obturator artery in the pelvis makes this vessel and its branches prone to iatrogenic injury during pelvic surgery. We present a postoperative obturator artery pseudoaneurysm treated by transcatheter embolization. Normal and variant obturator vascular anatomy, as well as pathology related to traumatic injury of this vessel, are subsequently discussed.

Lorenz, Jonathan M.; Leef, Jeffrey A.

2007-01-01

166

Comparing the effects of single shot sciatic nerve block versus posterior capsule local anesthetic infiltration on analgesia and functional outcome after total knee arthroplasty: a prospective, randomized, double-blinded, controlled trial.  

Science.gov (United States)

Peripheral nerve blocks appear to provide effective analgesia for patients undergoing total knee arthroplasty. Although the literature supports the use of femoral nerve block, addition of sciatic nerve block is controversial. In this study we investigated the value of sciatic nerve block and an alternative technique of posterior capsule local anesthetic infiltration analgesia. 100 patients were prospectively randomized into three groups. Group 1: sciatic nerve block; Group 2: posterior local anesthetic infiltration; Group 3: control. All patients received a femoral nerve block and spinal anesthesia. There were no differences in pain scores between groups. Sciatic nerve block provided a brief clinically insignificant opioid sparing effect. We conclude that sciatic nerve block and posterior local anesthetic infiltration do not provide significant analgesic benefits. PMID:24559684

Safa, Ben; Gollish, Jeffrey; Haslam, Lynn; McCartney, Colin J L

2014-06-01

167

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)

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.)

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

2012-09-15

168

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

DEFF Research Database (Denmark)

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 release, the placement of a continuous nerve block catheter subsequently allowed for nearly pain-free low impact passive and guided active mobilization by the performing physiotherapist for three consecutive weeks. This case and a short topical review on the use of SSN block in painful shoulder conditions highlight the possibility of a USG continuous nerve block of the SSN as sufficient pain management in the immediate post-operative period following capsular release of the shoulder. Findings in other painful shoulder conditions and suggestions for future studies are discussed in the text.

Neimann, Jens Dupont BØrglum; Bartholdy, Anne

2011-01-01

169

Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain.  

Science.gov (United States)

Occipital nerve block (ONB) has been used in several primary headache syndromes with good results. Information on its effects in facial pain is sparse. In this chart review, the efficacy of ONB using lidocaine and dexamethasone was evaluated in 20 patients with craniofacial pain syndromes comprising 8 patients with trigeminal neuralgia, 6 with trigeminal neuropathic pain, 5 with persistent idiopathic facial pain and 1 with occipital neuralgia. Response was defined as an at least 50% reduction of original pain. Mean response rate was 55% with greatest efficacy in trigeminal (75%) and occipital neuralgia (100%) and less efficacy in trigeminal neuropathic pain (50%) and persistent idiopathic facial pain (20%). The effects lasted for an average of 27 days with sustained benefits for 69, 77 and 107 days in three patients. Side effects were reported in 50%, albeit transient and mild in nature. ONBs are effective in trigeminal pain involving the second and third branch and seem to be most effective in craniofacial neuralgias. They should be considered in facial pain before more invasive approaches, such as thermocoagulation or vascular decompression, are performed, given that side effects are mild and the procedure is minimally invasive. PMID:22383125

Jürgens, T P; Müller, P; Seedorf, H; Regelsberger, J; May, A

2012-04-01

170

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

Directory of Open Access Journals (Sweden)

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.

A GHAFOURI

2001-09-01

171

Preventive Effect of Greater Occipital Nerve Block on Severity and Frequency of Migraine Headache  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Despite a favorable clinical experience, little evidence exists for the efficacy of greater occipital nerve block (GONB in migraine treatment. Considering such a premise, we wished to evaluate the therapeutic efficacy of GONB in patients affected by migraine headaches. Methods: A randomized double-blinded controlled trial was conducted on 48 patients suffering from migraine headaches. A syringe containing 1.0 mL of lidocaine 2%, 0.5 mL of either saline (control group, N = 24 or triamcinolone 0.5 mL (intervention group, N = 24 was prepared for each patient. Patients were assessed prior to the injection, and also 2 weeks, 1 month, and 2 months thereafter for severity and frequency of pain, times to use analgesics and any appeared side effects. Results: No significant differences were revealed in pain severity, pain frequency, and analgesics use between the two groups at the four study time points including at baseline, and 2, 4, and 8 weeks after the intervention. However, in both groups, the indices of pain severity, pain frequency, and analgesics use were significantly reduced at the three time points after the intervention compared with before the intervention. Conclusion: GONB with triamcinolone in combination with lidocaine or normal saline with lidocaine results in reducing pain severity and frequency as well as use of analgesics up to two months after the intervention, however any difference attributed to the drug regimens by assessing of the trend of pain characteristics changes.

Davood Kashipazha

2014-06-01

172

MORPHOLOGICAL STUDY OF OBTURATOR ARTERY  

Directory of Open Access Journals (Sweden)

Full Text Available Background: The obturator artery normally arises from the anterior trunk of internal iliac artery. High frequency of variations in its origin and course has drawn attention of pelvic surgeons, anatomists and radiologists. Normally, artery inclines anteroinferiorly on the lateral pelvic wall to the upper part of obturator foramen. The obturator artery may origin individually or with the iliolumbar or the superior gluteal branch of the posterior division of the internal iliac artery. However, the literature contains many articles that report variable origins. Interesting variations in the origin and course of the principal arteries have long attracted the attention of anatomists and surgeons. Methods: 50 adult human pelvic halves were procured from embalmed cadavers of J.J.M. Medical College and S.S.I.M.S & R.C, Davangere, Karnataka, India for the study. Results: The obturator artery presents considerable variation in its origin. It took origin most frequently from the anterior division of internal iliac artery in 36 specimens (72%. Out of which, directly from anterior division in 20 specimens (40%, with ilio-lumbar artery in 5 specimens (10%, with inferior gluteal artery in 3 specimens (6%, with inferior vesical artery in 2 specimens (4%, with middle rectal artery in 1 specimen (2%, with internal pudendal artery in 4 specimens (8% and with uterine artery in 1 specimen (2%. The obturator artery took origin from the posterior division of internal iliac artery in 9 specimens (18%, from external iliac artery in 1 specimen (2%, from inferior epigastric artery in 3 specimens (6% and was found to be absent in 1 specimen (2%.

Pavan P Havaldar

2014-06-01

173

Block of synaptic vesicle exocytosis without block of Ca2+-influx. An ultrastructural analysis of the paralysing action of Habrobracon venom on locust motor nerve terminals.  

Science.gov (United States)

The venom of the wasp Habrobracon hebetor presynaptically blocks excitatory but not inhibitory neuromuscular transmission at locust skeletal muscle. Its mode of action on excitatory motor nerve terminals has been studied at the retractor unguis muscle of Schistocerca by means of ultrastructural stereology. paralysed and unparalysed preparations, either resting or stimulated for 7 min at 20 Hz, were compared. Paralysis does not cause structural damage to the nerve terminals but prevents the depletion of vesicles occurring upon nerve stimulation in the controls. Prolonged paralysis leads to an increase in the number and the size of vesicles resulting in an increase of total membrane per terminal cross-section by about 33% after 2 days. Stimulation causes swelling of mitochondria both in controls and in paralysed preparations, resulting from a rise of intraterminal [Ca2+] as is indicated by the absence of the swelling if extracellular Ca2+ is replaced by Mg2+. In addition, stimulation leads to a reduction of vesicle size, an increase in the area of axolemma and in the number of cisternae and of profiles of the smooth endoplasmic reticulum in controls but not in paralysed preparations. However, neither in controls nor in paralysed preparations is the total amount of membrane per terminal cross-section affected by stimulation. Under paralysis, vesicles tend to stick to the presynaptic membrane. It is concluded that Habrobracon venom does not block the depolarizing-dependent Ca2+-influx into the nerve terminal and that it is unlikely to interfere with some transmitter-related process. Rather, the venom seems to block vesicle exocytosis itself. The results lend further support to the view that in insect neuromuscular synapses exocytosis is the mechanism whereby transmitter quanta are released. PMID:6308503

Walther, C; Reinecke, M

1983-05-01

174

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

Directory of Open Access Journals (Sweden)

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.

Manal el Gohary

2009-01-01

175

Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis.  

OpenAIRE

Chronic shoulder pain is a common and disabling symptom in patients with rheumatoid arthritis (RA). It has been previously shown that a suprascapular nerve block (SSNB) using the standard mixture of bupivacaine and adrenaline (Ba) plus methylprednisolone (P), which is routinely used in pain clinics, results in a considerable improvement in pain relief and range of movement compared with conventional intra-articular steroid injections in such patients. A double blind study was carried out in 2...

Gado, K.; Emery, P.

1993-01-01

176

Does suprascapular nerve block reduce shoulder pain following stroke: a double-blind randomised controlled trial with masked outcome assessment  

OpenAIRE

Abstract Background Shoulder pain is a common complication of a stroke which can impede participation in rehabilitation programs and has been associated with poorer outcomes. The evidence base for current medical and therapeutic management options of hemiplegic shoulder pain is limited. This study will evaluate the use of suprascapular nerve block injection as part of an interdisciplinary approach to the treatment of shoulder pain following stroke. The technique has previously been proven saf...

Crotty Maria; Shanahan E; Allen Zoe A

2010-01-01

177

Suprascapular Nerve Block and Glenohumeral Injection in Hemiplegic Shoulder Pain: To Compare the Effectiveness on Pain and Disability  

OpenAIRE

Objective: The aim of this study was to compare the effectiveness of glenohumeral (GH) joint injection and suprascapular nerve block (SNB) in patients with hemiplegic shoulder pain.Materials and Methods: Thirty-six patients with shoulder pain lasting for at least 3 months were randomized into two groups in which SNB was applied in the first and GH joint steroid injection in the second group. All patients were evaluated before treatment, after 30 minutes, second week and third month after the ...

Tubay, Ays?egu?l; Bal, Serpil; Bayram, Korhan Bar?s?; Koc?yig?it, Hikmet; Gu?rgan, Alev

2012-01-01

178

Medial Antebrachial Cutaneous Nerve Injury After Brachial Plexus Block: Two Case Reports  

OpenAIRE

Medial antebrachial cutaneous (MABC) nerve injury associated with iatrogenic causes has been rarely reported. Local anesthesia may be implicated in the etiology of such injury, but has not been reported. Two patients with numbness and painful paresthesia over the medial aspect of the unilateral forearm were referred for electrodiagnostic study, which revealed MABC nerve lesion in each case. The highly selective nature of the MABC nerve injuries strongly suggested that they were the result of ...

Jung, Mi Jin; Byun, Ha Young; Lee, Chang Hee; Moon, Seung Won; Oh, Min-kyun; Shin, Heesuk

2013-01-01

179

Comparison between ?three in one femoral nerve block? and psoas compartment block for post-operative pain relief following lower limb surgical procedures  

Directory of Open Access Journals (Sweden)

Full Text Available Aim of this study was to compare anterior approach (?three in one block? and posterior approach (psoas compartment block of lumbar plexus block in relieving the post-operative pain in patients operated for unilateral hip, femur or knee surgery under spinal anaesthesia. 40 patients undergoing elective orthopedic procedure in hip, femur or knee were randomized into group A and group B. Surgery was done under spinal anaesthesia. At the end of the surgery, single shot lumbar plexus block was given by anterior approach (3 in 1 block in group A and by posterior approach (psoas compartment block in group-B patients with 30 ml of 0.25% of bupivacaine. Pain was assessed using verbal rating scale. The time for first rescue analgesic, need of additional analgesic and overall satisfaction of post-operative pain relief were noted. Both the groups were comparable in age, sex, weight, height, vital signs, duration and type of surgery. There is no significant difference in pain level between two groups. The mean time for first rescue analgesia was 9.10 (± 1.52 and 9.90 (± 1.21 hours in group A and group B respectively (p>0.05 not significant. Requirement of additional analgesic was reduced in both groups. More than 90% of patients expressed overall satisfaction of post-operative pain relief in both groups. Both approaches of lumbar plexus block by Three in one femoral nerve block (Group A and psoas compartment block (Group B were effective in providing post-operative analgesia after hip, femur, or knee surgery. [Int J Res Med Sci 2014; 2(1.000: 264-269

S. Ponnambala Namasivayam

2014-02-01

180

Effects of Perineural Administration of Dexmedetomidine in Combination with Levobupivacaine in a Rat Sciatic Nerve Block?  

Science.gov (United States)

Objective The aim of this study was to assess if perineural administration of dexmedetomidine combined with levobupivacaine increases the duration of the sensory and motor blockade of a sciatic peripheral nerve block in rats. Methods Forty male Sprague–Dawley rats were randomly divided into 5 experimental groups: Group 1, sham; Group 2, perineural levobupivacaine (0.2 mL of a 0.5% solution) and subcutaneous saline; Group 3, perineural levobupivacaine (0.2 mL of a 0.5% solution) plus dexmedetomidine (20 µg/kg dexmedetomidine) and subcutaneous saline; Group 4, perineural saline and subcutaneous dexmedetomidine; and Group 5, perineural saline and subcutaneous saline. Pain reflexes in response to a thermal stimulus were measured at 0 and 240 minutes after drug administration by using a hot-plate and tail-flick tests. Neurobehavioral status, including sensory and motor functions, was assessed by an investigator who was blinded to the experimental groups every 30 minutes until normal functioning resumed. Results The sensory and motor blockades of the rats did not increase in the treatment with dexmedetomidine plus levobupivacaine when compared with the treatment with levobupivacaine alone at all the time points (P > 0.05). Compared with rats in Group 2, those in Group 3 showed significantly higher latency times at 30 and 60 minutes in the hot plate test (P < 0.01). At 30 and 60 minutes, the latency times of the rats in Group 3 were longer than those in Group 2 in the tail-flick test (P < 0.01). Furthermore, the durations of the complete sensory and motor blockade were similar when treatment with levobupivacaine plus dexmedetomidine was compared with treatment with levobupivacaine alone. Conclusions A 20µg/kg dose of dexmedetomidine added to levobupivacaine did not increase the duration of the sensory and motor blockades in rats. However, treatment with dexmedetomidine plus levobupivacaine increased the quality of analgesia in rats. PMID:24385106

Ali Erdogan, Mehmet; Polat, Alaaddin; Yucel, Aytac; Aydogan, Mustafa Said; Parlakpinar, Hakan; Tekin, Suat; Durmus, Mahmut; Ozcan Ersoy, Mehmet

2013-01-01

181

The Split Obturator: An Innovative Technique  

OpenAIRE

A palatal prosthesis can improve function by closing the palatal defect, preventing regurgitation, improving swallowing and speech. Although techniques have been previously described for fabrication of palatal obturator but there have not been any techniques to devise an obturator for a patient with palatal defect and that too with a quad helix orthodontic appliance overlying it. This article describes an innovative method of fabricating a palatal obturator which aims at restoring the above m...

Bhatia, Vishwas; Bhatia, Garima

2011-01-01

182

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)

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

Yamakado K

2014-05-01

183

Subdural spread of injected local anesthetic in a selective transforaminal cervical nerve root block: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Although uncommon, selective cervical nerve root blocks can have serious complications. The most serious complications that have been reported include cerebral infarction, spinal cord infarction, transient quadriplegia and death. Case presentation A 40-year-old Japanese woman with a history of severe right-sided cervical radicular pain was scheduled to undergo a right-sided C6 selective cervical nerve root block using a transforaminal approach under fluoroscopic guidance. An anterior oblique view of the C5-C6 intervertebral foramen was obtained, and a 23-gauge spinal needle, connected to the normal extension tube with a syringe filled with contrast medium, was introduced into the posterior-caudal aspect of the C5-C6 intervertebral foramen on the right side. In the anteroposterior view, the placement of the needle was considered satisfactory when it was placed no more medial than halfway across the width of the articular pillar. Although the spread of the contrast medium along the C6 nerve root was observed with right-sided C6 radiculography, the subdural flow of the contrast medium was not observed with real-time fluoroscopy. The extension tube used for the radiculography was removed from the spinal needle and a normal extension tube with a syringe filled with lidocaine connected in its place. We performed a negative aspiration test and then injected 1.5?mL of 1.0% lidocaine slowly around the C6 nerve root. Immediately after the injection of the local anesthetic, our patient developed acute flaccid paralysis, complained of breathing difficulties and became unresponsive; her respiratory pattern was uncoordinated. After 20 minutes, she regained consciousness and became alert, and her muscle strength in all four limbs returned to normal without any sensory deficits after receiving emergent cardiorespiratory support. Conclusions We believe that confirming maintenance of the appropriate needle position in the anteroposterior view by injecting local anesthetic is important for preventing central needle movement. Because the potential risk of serious complications cannot be completely eliminated during the use of any established selective cervical nerve root block procedure, preparation for an emergency airway, ventilation and cardiovascular support is indispensable in cases of high spinal cord anesthesia.

Tofuku Katsuhiro

2012-06-01

184

Safety and Efficacy of Continuous Femoral Nerve Catheter with Single Shot Sciatic Nerve Block vs Epidural Catheter Anesthesia for Same-Day Bilateral Total Knee Arthroplasty.  

Science.gov (United States)

In a retrospective analysis, we evaluated the safety and efficacy of peripheral nerve blocks (PNB) compared to epidural anesthesia in 221 consecutive patients undergoing same-day bilateral total knee arthroplasty (TKA). Primary outcome measures included: hypotension requiring physician intervention, number of blood transfusions, perioperative hespan and crystalloid consumption, incidences of respiratory desaturation, pruritis, urinary retention, and nausea/vomiting. The incidences of hypotension, urinary retention, and pruritis were all higher in the epidural group, compared to PNB. Epidural patients also required more blood transfusions and greater volumes of hespan and crystalloid. PNB are safe and efficacious modality of analgesia for same day bilateral TKA and provide adequate pain relief with a significant decrease in postoperative complications compared to epidural anesthesia. PMID:25445854

Patel, Nimit; Solovyova, Olga; Matthews, Greg; Arumugam, Sivasenthil; Sinha, Sanjay K; Lewis, Courtland G

2015-02-01

185

Poly(D,L-lactide)-block-poly(2-hydroxyethyl acrylate) block copolymers as potential biomaterials for peripheral nerve repair: in vitro and in vivo degradation studies.  

Science.gov (United States)

The properties of poly(D,L-lactide)-block-poly(2-hydroxyethyl acrylate) (PLA-b-PHEA) block copolymers by means of in vitro / in vivo (rat) degradation are investigated and compared to those of PLA homopolymer. Over 12 weeks, we observe mass loss and molecular weight decrease. In vitro and in vivo findings are very similar for each polymer tested. When a short PHEA block is used (PLA-b-PHEA 15?000-3?000?g?·?mol(-1) , 85/15?wt%), the degradation process is found to be very similar to that of homo-PLA, and to be typical of a bulk erosion mechanism, with no mass loss observed until week 7 and continuous decrease of molar mass within this timeframe. For a longer PHEA block length within the block copolymer (PLA-b-PHEA 15?000-7?500?g?·?mol(-1) , 65/35?wt%), the degradation mechanism is modified, with a significant mass loss observed at early times and only a slight decrease in molar mass. The latter finding is related to the pronounced hydrophilicity and softness of the material induced by the PHEA block, which allow easy diffusion and rapid leakage of the degradation residues from the material towards the aqueous medium. Schwann cells are found to better adhere on spin-coated films of PLA-b-PHEA (85/15?wt%) than on PLA ones. These results show the potential of such hydrophilized PLA-based copolymers for use in peripheral nerve repair. PMID:21681960

Clément, Benoît; Decherchi, Patrick; Féron, François; Bertin, Denis; Gigmes, Didier; Trimaille, Thomas; Marqueste, Tanguy

2011-09-01

186

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

OpenAIRE

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 t...

Er, Kumar; Venugopal K; Tharion G; Bhattacharji S

2008-01-01

187

A K+ channel in Xenopus nerve fibres selectively blocked by bee and snake toxins: binding and voltage-clamp experiments.  

Science.gov (United States)

1. The effects of mast cell degranulating peptide (MCDP), a toxin from the honey bee, and of dendrotoxin (DTX), a toxin from the green mamba snake, were studied in voltage-clamp experiments with myelinated nerve fibres of Xenopus. 2. MCDP and DTX blocked part of the K+ current. About 20% of the K+ current, however, was resistant to the toxins even in high concentrations. In Ringer solution half-maximal block was reached with concentrations of 33 nM-MCDP and 11 nM-DTX. In high-K+ solution the potency of both toxins was lower. beta-Bungarotoxin (beta-BuTX), another snake toxin, also blocked part of the K+ current, but was less potent than MCDP and DTX. 3. Tail currents in high-K+ solution were analysed and three K+ current components were separated according to Dubois (1981 b). Both MCDP and DTX selectively blocked a fast deactivating, slowly inactivating K+ current component which steeply activates between E = -60 mV and E = -40 mV (component f1). In concentrations around 100 nM, MCDP and DTX blocked neither the slow K+ current (component s) nor the fast deactivating, rapidly inactivating K+ current which activates between E = -40 mV and E = 20 mV (component f2). Similar results could be derived from K+ outward currents in Ringer solution. In high-K+, IC50 of MCDP for component f1 was 99 nM, whereas it was 7.6 microM for f2. Corresponding values for DTX are 68 nM and 1.8 microM. 4. Binding studies with nerve fibre membranes of Xenopus reveal high-affinity binding sites for 125I-labelled DTX (KD = 22 pM in Ringer solution and 81 pM in high-K+ solution). 125I-labelled DTX can be displaced from its sites completely by unlabelled DTX, toxin I (black mamba toxin), MCDP, and partially by beta-BuTX. 5. Immunocytochemical staining demonstrates that binding sites for DTX are present in nodal and paranodal regions of the axonal membrane. 6. The axonal membrane of motor and sensory nerve fibres is equipped with three types of well-characterized K+ channels and constitutes so far the best preparation to study MCDP- and DTX-sensitive K+ channels with electrophysiological and biochemical methods. PMID:2324990

Bräu, M E; Dreyer, F; Jonas, P; Repp, H; Vogel, W

1990-01-01

188

The furcal nerve revisited  

Directory of Open Access Journals (Sweden)

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.

Nanjundappa S. Harshavardhana

2014-08-01

189

The furcal nerve revisited.  

Science.gov (United States)

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. PMID:25317309

Harshavardhana, Nanjundappa S; Dabke, Harshad V

2014-08-01

190

Does suprascapular nerve block reduce shoulder pain following stroke: a double-blind randomised controlled trial with masked outcome assessment  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Shoulder pain is a common complication of a stroke which can impede participation in rehabilitation programs and has been associated with poorer outcomes. The evidence base for current medical and therapeutic management options of hemiplegic shoulder pain is limited. This study will evaluate the use of suprascapular nerve block injection as part of an interdisciplinary approach to the treatment of shoulder pain following stroke. The technique has previously been proven safe and effective in the treatment of shoulder pain associated with rheumatoid arthritis and degenerative shoulder conditions but its usefulness in a stroke population is unclear. Methods/Design A double blind randomised placebo controlled trial will assess the effect of a suprascapular nerve block compared with placebo in a population of 66 stroke patients. The trial will measure effect of injection on the primary outcome of pain, and secondary outcomes of function and quality of life. Measurements will take place at baseline, and 1, 4 and 12 weeks post intervention. Both groups will continue to receive routine physiotherapy and standard ward care. Discussion The results of this study could reduce pain symptoms in persons with mechanical shoulder pain post stroke and provide improvement in upper limb function. Trial Registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR - ACTRN12609000621213.

Crotty Maria

2010-09-01

191

Pyomyositis of Obturator Muscles: Unusual Late Presentation  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: Pyomyositis of obturator muscles is rare condition. Late presentation with deformities of hip misleads the clinician. Late presentation (6 weeks of this condition has not been reported earlier. This report highlights this unusual presentation of Pyomyositis of the obturator muscles. Case Report: We are reporting a 14year old female patient presented with limp and pain in hip since 6 weeks. Her hip radiographs were unremarkable. Patient was admitted and MRI done. MRI findings were consistent with obturator pyomyositis. Diagnosis of pyomyositis confirmed by MRI and we performed percutaneous aspiration and drained about 25ml of purulent material mixed with blood. The culture grew Staphylococcus aureus. Patient received intravenous antibiotic for 1week and oral antibiotic for 2weeks. Patient was immobilized in fixed skin traction in Thomas splint for 5days, later gentle mobilization was started. Her condition improved dramatically after aspiration. A follow up MRI done at 3 weeks following aspiration revealed a significant reduction in intramuscular collection of obturator internus and obturator externus. Three weeks following aspiration patient was relieved of the pain and was able to walk normally. At 6 months follow up visit patient was asymptomatic. Conclusion: Late presentation of obturator pyomyositis is rare. We emphasise on careful examination and need for early imaging for diagnosis. Percutaneous drainage results in successful treatment. Keywords: Pyomyositis, septic arthritis, infection, obturator muscle.

Prasad Channappa Soraganvi

2013-04-01

192

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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

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

2013-06-01

193

Extended Use of Vettath’s Anastomotic Obturator (VAO  

Directory of Open Access Journals (Sweden)

Full Text Available Stroke rate in redo coronary artery bypass surgery has remained a stumbling block, where the aorta is used as origin for the top end of the vein graft. Avoiding the side-clamp on these redo aortas by using the Vettath’s Anastomotic Obturator (VAO technique of anatomosing the vein graft could bring this down. We have also been able to use this technique in combined aortic valve replacement and CABG. These two situations where the VAO is used are elucidated here.

Vettath Prabhakaran Murali

2011-11-01

194

The neuromuscular blocking activity of spectinomycin on the rat sciatic nerve-gastrocnemius muscle preparation.  

Science.gov (United States)

Spectinomycin displays a dose-dependent neuromuscular blocking activity in vivo. The neuromuscular blockade elicited by spectinomycin is potentiated by d-tubocurarine. Neostigmine methylsulfate is unable to reverse the neuromuscular blocking activity of spectinomycin, whereas calcium chloride counteracts the neuromuscular blockade induced by this antibiotic. PMID:3016766

Renna, G; Cagiano, R; Fiore, T; Cuomo, V

1986-05-01

195

Obturator hernia: diagnosis through medical imaging  

Energy Technology Data Exchange (ETDEWEB)

A rare case of obturator hernia is presented in a patient with persistent small bowel obstruction. There was a paucity of specific signs and poor general health which caused a delay in diagnosis. Ultimately delayed films from a barium follow through showed barium-filled bowel in the region of the right obturator foramen. A computed tomography scan then confirmed the diagnosis by demonstrating the barium-filled small bowel herniating through the right obturator foramen. It is estimated that the CT scan can make an accurate noninvasive diagnosis thus allowing swift and appropriate intervention. 10 refs., 2 figs.

O`Connell, G.; Cole, A. [Townsville General Hospital, Townsville, QLD (Australia). Dept. of Radiology

1995-08-01

196

Nerve Growth Factor Inhibits Metalloproteinase-Disintegrins and Blocks Ectodomain Shedding of Platelet Glycoprotein VI*  

OpenAIRE

Nerve growth factor (NGF) plays an important role in regulating mammalian neuronal/embryonic development, angiogenesis, and other physiological processes and has recently been investigated as a potential treatment for the neurodegenerative disorder, Alzheimer disease. In this study, we provide evidence that human NGF may also function as a metalloproteinase inhibitor, based on studies of NGF from snake venom. Originally, our aim was to isolate snake venom metalloproteinases targeting platelet...

Wijeyewickrema, Lakshmi C.; Gardiner, Elizabeth E.; Gladigau, Elsa L.; Berndt, Michael C.; Andrews, Robert K.

2010-01-01

197

A simulation study of the combined thermoelectric extracellular stimulation of the sciatic nerve of the Xenopus laevis: the localized transient heat block.  

Science.gov (United States)

The electrical behavior of the Xenopus laevis nerve fibers was studied when combined electrical (cuff electrodes) and optical (infrared laser, low power sub-5?mW) stimulations are applied. Assuming that the main effect of the laser irradiation on the nerve tissue is the localized temperature increase, this paper analyzes and gives new insights into the function of the combined thermoelectric stimulation on both excitation and blocking of the nerve action potentials (AP). The calculations involve a finite-element model (COMSOL) to represent the electrical properties of the nerve and cuff. Electric-field distribution along the nerve was computed for the given stimulation current profile and imported into a NEURON model, which was built to simulate the electrical behavior of myelinated nerve fiber under extracellular stimulation. The main result of this study of combined thermoelectric stimulation showed that local temperature increase, for the given electric field, can create a transient block of both the generation and propagation of the APs. Some preliminary experimental data in support of this conclusion are also shown. PMID:22510941

Mou, Zongxia; Triantis, Iasonas F; Woods, Virginia M; Toumazou, Christofer; Nikolic, Konstantin

2012-06-01

198

Blood reinfusion combined with femoral nerve block in total knee replacement for patients with increased risk of bleeding  

DEFF Research Database (Denmark)

PURPOSE. To compare patients with increased risk of bleeding who received combined blood reinfusion and femoral nerve block in total knee replacement (TKR) to regular patients treated routinely with respect to pain relief, blood loss, and knee function. METHODS. In a consecutive series of 67 patients who underwent unilateral TKR, 12 patients with increased risk of bleeding owing to cardiac disease or previous thromboembolic events received continuous femoral nerve block and blood reinfusion, without tranexamic acid (TA) injection. The remaining 55 patients were controls who received standard postoperative treatment (TA injection, local injection of analgesics, and suction drainage without reinfusion). The volume of blood loss (drained or reinfused), pain score (using a visual analogue scale) and knee function (using the Knee Society Score [KSS]) in the 2 groups were compared. RESULTS. In the study group, patients were 5 years older and tended to have a lower preoperative KSS function score (35 vs. 45, p=0.08)and a higher function-related pain score (6.5 vs. 6, p=0.10). The mean volume of drained blood wasted in the study group did not differ significantly from the mean total volume of drained blood in the control group (235 vs. 300 ml, p=0.14). Similarly, the mean decrease in postoperative haemoglobin concentration did not differ significantly between the respective groups (2.1 vs. 2.1 mmol/l, p=0.97). A significantly greater proportion of patients received allogenic blood transfusion in the study group than in controls (3/12 vs. 2/55, p

Simonsen, O H; Gorst-Rasmussen, Anders

2011-01-01

199

Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Blocks for Persistent Inguinal Postherniorrhaphy Pain : A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial  

DEFF Research Database (Denmark)

Background:Ilioinguinal and iliohypogastric nerve blocks are used in the clinical management of persistent inguinal postherniorrhaphy pain, but no controlled studies have been published on the subject. In this controlled study, we investigated the analgesic and sensory effects of ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerves with lidocaine.Methods:A randomized, double-blind, placebo-controlled, crossover trial in 12 patients with severe persistent inguinal postherniorrhaphy pain, including a control group of 12 healthy controls, was performed. Assessments included pain ratings under standardized conditions with numerical rating scale (0-10), sensory mapping to a cool roller, and quantitative sensory testing (QST), in the groin regions, before and after each ultrasound-guided block. A needle approach of 1 to 2 cm superior and medial to the anterior superior iliac spine was used. Outcomes were changes in pain ratings, sensory mapping, and QST compared with preblock values. Lidocaine responders were a priori defined by a pain reduction of =80% after lidocaine block and =25% after placebo block, nonresponders by pain reduction of 25% after placebo block.Results:One of 12 pain patients was a lidocaine responder, 6 patients were nonresponders, and 5 patients were placebo responders. No consistent QST changes were observed in patients after the lidocaine block. In 10 of 12 healthy controls, a cool hypoesthesia area developed in the groin after the lidocaine block. Furthermore, QST assessments demonstrated significantly decreased suprathreshold heat pain perception in the groin after lidocaine versus placebo blocks (95% confidence interval = -3.5 to -0.5, P = 0.008).Conclusion:Ultrasound-guided lidocaine blocks of the ilioinguinal and iliohypogastric nerves, at the level of the anterior superior iliac spine, are not useful in diagnosis and management of persistent inguinal postherniorrhaphy pain.

Bischoff, Joakim Mutahi; Koscielniak-Nielsen, Zbigniew J

2012-01-01

200

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 carciof great clinical value in relieving carcinomatous abdominal pain. (authors)

201

Ketamine as an adjuvant in sympathetic blocks for management of central sensitization following peripheral nerve injury  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Proliferation of NMDA receptors and role of glutamate in producing central sensitization and 'wind up' phenomena in CRPS [complex regional pain syndrome] forms a strong basis for the use of Ketamine to block the cellular mechanisms that initiate and maintain these changes. In this case series, we describe 3 patients of CRPS Type II with debilitating central sensitization, heat/mechano allodynia and cognitive symptoms that we termed 'vicarious pain'. Each of these patients had dramatic relief with addition of Ketamine as an adjuvant to the sympathetic blocks after conventional therapy failed. Case Reports All 3 patients suffered gunshot wounds and developed characteristic features of CRPS Type II. Within 2–3 weeks they developed extraterritorial symptoms typical of central sensitization. The generalized mechanical allodynia and debilitating heat allodynia described to be rare in human subjects had life altering affect on their daily life. Case 2 and 3 also described an unusual cognitive phenomenon i.e. visual stimuli of friction would evoke severe pain in the affected limb that we have termed as 'vicarious pain'. They responded positively to sympathetic blocks but the sympatholysis did not bring relief to the heat and mechanical allodynia. Addition of Ketamine 0.5 mg/kg to the sympathetic blocks elicited resulted in marked relief in the allodynia. Conclusion Ketamine has a special role in patients with debilitating heat allodynia and positive cognitive symptoms via its action on central pain pathway. As an adjuvant in sympatholytic blocks it has a targeted action without significant neuropsychiatric side effects.

Dureja GP

2008-10-01

202

[Femoral and sciatic nerve blocks for open reduction and internal fixation of a femoral condylar fracture in a patient with post-polio syndrome].  

Science.gov (United States)

The post polio symdrome (PPS) refers to the development of delayed neuromuscular symptoms among survivors, years after the initial presentation of acute poliomyelitis. The symptoms of PPS vary widely and include flaccid palsy, muscle weakness, scoliosis, osteoarthritis, gait disturbance, sleep apnea syndrome (SAS), dysphagia, chronic lung dysfunction, and others. We report the successful combination of peripheral nerve blocks, femoral and sciatic nerve blocks, for surgery on the lower extremity in a patient with PPS. A 51-year-old man with continuous positive airway pressure therapy for restrictive ventilatory impairment due to scoliosis and SAS as part of the PPS was scheduled for open reduction and internal fixation (OR-IF) for a right femoral condylar fracture. Respiratory function tests demonstrated a vital capacity (VC) 1.41l (41% predicted). Arterial blood gas analysis on room air was; pH 7.376, PaCO2 55.0 mmHg, and PaO2 77.9 mmHg. With the patient in the supine position, ultrasound-guided right femoral nerve block in the infra-inguinal region was performed using 1.5% mepivacaine 10 ml and 0.75% ropivacaine 5 ml, followed by sciatic nerve block in the popliteal fossa using 1.5% mepivacaine 8 ml and 0.75% ropivacaine 4 ml in the prone position. OR-IF of the fractured femoral condyle was then successfully performed with propofol under spontaneous ventilation. Postoperatively, there were no adverse events; respiratory function was adequate, and his pain was within manageable bounds. Femoral and sciatic nerve blocks are safe and effective anesthetic methods for lower extremity surgery in patients with restrictive ventilatory impairment and hypercapnia due to scoliosis and SAS as PPS. PMID:21861427

Nagaoka, Takehiko; Mizuno, Ju; Ino, Kentaro; Yoshimura, Tatsuya; Sakamoto, Hidetoshi; Morita, Shigeho

2011-08-01

203

Ketamine as an adjuvant in sympathetic blocks for management of central sensitization following peripheral nerve injury  

OpenAIRE

Abstract Proliferation of NMDA receptors and role of glutamate in producing central sensitization and 'wind up' phenomena in CRPS [complex regional pain syndrome] forms a strong basis for the use of Ketamine to block the cellular mechanisms that initiate and maintain these changes. In this case series, we describe 3 patients of CRPS Type II with debilitating central sensitization, heat/mechano allodynia and cognitive symptoms that we termed 'vicarious pain'. Each of these patients had dramat...

Gp, Dureja; Toshniwal Gokul; Sunder Rani A

2008-01-01

204

Apical leakage of root canal system obturation materials  

OpenAIRE

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 ...

Miti? Aleksandar; Miti? Nadica; Toši? Goran

2005-01-01

205

Diagnosis and treatment of obturator hernia  

Energy Technology Data Exchange (ETDEWEB)

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)

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

2002-09-01

206

Diagnosis and treatment of obturator hernia  

International Nuclear Information System (INIS)

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)

207

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

LENUS (Irish Health Repository)

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.

Mannion, Stephen

2012-02-03

208

Minimum effective anaesthetic volume of 0.5% ropivacaine for ultrasound-guided popliteal sciatic nerve block in patients undergoing foot and ankle surgery: determination of ED50 and ED95.  

Science.gov (United States)

Compared to nerve stimulation or classic paraesthesia techniques, ultrasound (US)-guided popliteal sciatic nerve block requires a smaller volume of local anaesthetic. The up-and-down method was used to determine the minimum effective anaesthetic volume of 0.5% ropivacaine necessary for US-guided popliteal sciatic nerve block to achieve successful surgical anaesthesia for foot and ankle surgery. The study included 32 patients receiving an US-guided popliteal sciatic nerve bock. The starting dose of 0.5% ropivacaine was set at 30 ml, which was decreased by 3 ml if the block succeeded and increased by 3 ml if the block failed. After the injection of local anaesthetic, the degree of sensory and motor blockade of the tibial and common peroneal nerves was assessed every 5 minutes for 30 minutes. The ED50 and ED95 volumes of local anaesthetic were 6 ml and 16 ml, respectively. The success rates of sensory blockade of the tibial nerve and common peroneal nerve were 69% and 88%, respectively. The success rates of motor blockade of these nerves were 75% and 90%, respectively. The ED50 and ED95 of 0.5% ropivacaine for US-guided popliteal sciatic nerve block were 6 ml and 16 ml, respectively. PMID:25579295

Jeong, J S; Shim, J C; Jeong, M A; Lee, B C; Sung, I H

2015-01-01

209

MR Imaging Features of Obturator Internus Bursa of the Hip  

International Nuclear Information System (INIS)

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

210

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

LENUS (Irish Health Repository)

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.

Szucs, Szilard

2012-06-27

211

Suprascapular Nerve Block and Glenohumeral Injection in Hemiplegic Shoulder Pain: To Compare the Effectiveness on Pain and Disability  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: The aim of this study was to compare the effectiveness of glenohumeral (GH joint injection and suprascapular nerve block (SNB in patients with hemiplegic shoulder pain.Materials and Methods: Thirty-six patients with shoulder pain lasting for at least 3 months were randomized into two groups in which SNB was applied in the first and GH joint steroid injection in the second group. All patients were evaluated before treatment, after 30 minutes, second week and third month after the treatment. Pain at rest, with motion and nocturnal pain were determined by the visual analogue scale. Shoulder joint range of motion was recorded for all patients. Disability status was assessed using the Functional Independence Measure (FIM. Results: There was a significant decrease in VAS scores for pain at rest, night and activity immediately after, at the second week and at the third month after the treatment in both groups. Change scores were similar in both groups. Conclusion: Although, both GH joint injection and SNB reduced pain and improved functional status at upto 3 months, there was no superiority of the one over the other. Turk J Phys Med Re­hab 2012;58:299-306.

Ay?egu?l TUBAY

2012-12-01

212

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

DEFF Research Database (Denmark)

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

Toftdahl, Karen; Nikolajsen, Lone

2007-01-01

213

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)

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.

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

2004-05-01

214

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)

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.

V. Domingo

2004-05-01

215

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)

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.

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

2010-01-01

216

Comparação da intensidade de dor em bloqueios do nervo alveolar inferior / Comparison of pain intensity during inferior alveolar nerve block  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Languages: English, Portuguese Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: Este estudo foi idealizado para investigar o desconforto dos procedimentos odontológicos associados à anestesia. Este procedimento frequentemente gera uma grande ansiedade, o que aumenta a dor. O medo da injeção tem sido relatado como sendo um fator determinante à não proc [...] ura do tratamento dental. O presente estudo teve como objetivo comparar o nível de dor na perfuração, penetração e deposição da solução anestésica no bloqueio do nervo alveolar inferior nas Técnicas Direta e Vazirani-Akinosi. MÉTODOS: Estudo clínico randomizado, cruzado e duplamente encoberto envolvendo 30 pacientes atendidos no Departamento de Odontologia da Universidade Federal de Sergipe (DOD-UFS) que necessitaram de tratamento odontológico e que se submeteram a bloqueio bilateral do nervo alveolar inferior. Estes foram interrogados a respeito da intensidade de dor durante as seguintes etapas: perfuração, penetração e deposição do anestésico local. A mensuração da intensidade dolorosa foi realizada através da escala analógica visual (EAV) com comprimento de 10 cm, sem a existência de marcações pré-definidas. Os dados obtidos foram tabulados e submetidos aos testes estatísticos de Friedman e Wilcoxon com índice de significância estatística de 5%. RESULTADOS: A análise dos dados revelou que não houve diferenças estatisticamente significantes (Wilcoxon, p > 0,05) entre os valores de EAV das duas técnicas anestésicas em nenhum dos momentos operatórios. Para ambas as técnicas, a dor induzida pela penetração foi maior (Friedman, p Abstract in english BACKGROUND AND OBJECTIVES: This study was developed to investigate anesthesia-related discomfort during dental procedures. This procedure often generates major anxiety, which increases pain. Fear of injection has been reported as a determining factor for not looking for dental treatment. This study [...] aimed at comparing the level of pain during perforation, penetration and anesthetic solution deposition during inferior alveolar block by the Direct and Vazirani-Akinosi techniques. METHODS: Randomized, crossover, double-blind clinical trial involving 30 patients seen by the Dentistry Department of the Federal University of Sergipe (DOD-UFS) who needed dental treatment and were submitted to bilateral inferior alveolar nerve block. Patients were asked about pain intensity during the following stages: perforation, penetration and local anesthetic deposition. Pain intensity was measured by the 10-cm visual analog scale (VAS), without predefined marks. Data were tabulated and submitted to statistical Friedman and Wilcoxon tests with statistical significance of 5%. RESULTS: Data have not shown statistically significant differences (Wilcoxon, p > 0.05) between VAS values of both anesthetic techniques in all operatory moments. For both techniques, penetration-induced pain was higher (Friedman, p

Felippe Almeida, Costa; Liane Maciel de Almeida, Souza; Francisco, Groppo.

2013-09-01

217

Apical leakage of root canal system obturation materials  

Directory of Open Access Journals (Sweden)

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.

Miti? Aleksandar

2005-01-01

218

Effects of adjuvants to local anaesthetics on their duration. II. Studies of some substituted dextrans and other macromolecules in rat infraorbital nerve block.  

Science.gov (United States)

The effects of adding various macromolecular substances to 2% prilocaine on duration of rat infraorbital nerve block were investigated. The tested substances consisted of dextrans with lipophilic or charged substituents as well as other neutral or highly charged macromolecules. Most of the adjuvants caused significant prolongations of sensory block. For substituted dextrans the duration of sensory block degree 3 amounted to between 120% (3% capryldextran II) and 350% (3% carboxymethyldextran) in comparison to prilocaine plain. The corresponding values for hydroxypropylstarch (3%) alginic acid (0.5%), beta-cyclodextrin (1.5%) and hyaluronic acid (0.25%) were about 170%, 285% and 380%, respectively. The results suggest that the increased duration of local analgesia by prilocaine is related to increased viscosity of the solution produced by the macromolecular compounds. The mechanism seems to be of a physical character, and hyaluronic acid seems to be worthy of further studies. PMID:2409732

Hassan, H G; Renck, H; Lindberg, B; Lindquist, B; Akerman, B

1985-05-01

219

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)

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.

Hala Mostafa

2008-01-01

220

The effects of dexketoprofen on duration of analgesia to a thermal stimulus when compared with a systemic control in a rat sciatic nerve block with levobupivacaine.  

Science.gov (United States)

This study was designed to investigate whether dexketoprofen added to perineuraly or subcutaneously alters the effects of levobupivacaine in a rat model of sciatic nerve blockade. Thirty-six rats received unilateral sciatic nerve blocks along with a subcutaneous injection by a blinded investigator assigned at random. Combinations were as follows: Group 1 (sham) perineural and subcutaneous saline; Group 2, perineural levobupivacaine alone and subcutaneous saline; Group 3, perineural levobupivacaine plus dexketoprofen and subcutaneous saline; Group 4, perineural levobupivacaine and subcutaneous dexketoprofen; Group 5, perineural dexketoprofen and subcutaneous saline; and Group 6, perineural saline and subcutaneous dexketoprofen. The levobupivacaine concentration was fixed at 0.05%, and the dose of dexketoprofen was 1 mg kg(-1) . Sensory analgesia was assessed by paw withdrawal latency to a thermal stimulus every 30 min. The unblocked paw served as the control for the assessment of systemic, centrally mediated analgesia. Perineural and subcutaneous dexketoprofen coadministered with perineural levobupivacaine did not enhance the duration of sensory blockade when compared with levobupivacaine alone. There were significant differences between the operative and control paws for time points 30-90 min in the perineural levobupivacaine alone, levobupivacaine + dexketoprofen and subcutaneous dexketoprofen added levobupivacaine group. Significant differences were not determined between the levobupivacaine alone group and dexketoprofen added groups in operative paw. The effects of dexketoprofen are unknown for perineural administration. There is no significant difference between the analgesic effects of peripheral nerve blocks using levobupivacaine alone and plus subcutaneous or perineural dexketoprofen. PMID:23127168

Kara, Inci; Apiliogullari, Seza; Bagc? Taylan, Sengal; Bariskaner, Hulagu; Celik, Jale Bengi

2014-04-01

221

Obturator prostheses following palatal resection: clinical cases.  

Science.gov (United States)

Malignant tumours of the upper gum and hard palate account for 1-5% of malignant neoplasms of the oral cavity; two thirds of the lesions which involve these areas are squamous cell carcinomas. Most of these carcinomas are diagnosed late, when they invade the underlying bone. The procedures of choice for removal are: alveolectomy, palatectomy, maxillectomy, which may be total or partial. Surgical reconstruction of the defect may be carried out using a wide range of microvascularized flaps: osteomuscolocutaneous of the internal iliac crest, an osteocutaneous flap of the fibula or scapula, fascia, or osteocutaneous radial flap, or a pedicled flap of temporal muscle. These flaps are supported by single or multiple obturator prostheses. Rehabilitation via palatal obturators is preferred in patients with a poor prognosis or in weak condition. Rehabilitation aims to: restore the separation between the oral and nasal cavities, enable the patient to swallow, maintain or provide mastication, sufficient occlusion and mandibular support, support the soft facial tissues, re-establish speech and restore an aesthetically pleasing smile. Hence, it is crucial to work in close cooperation with the staff who makes the prosthesis and who evaluates the case when the surgery is planned and obtains the necessary gnatological, anatomical and functional information. Thereafter, during the surgical stage, for the immediate obturators, or in the successive days, for the temporary obturators, work is devoted to making the prostheses. In this regard, the Odonto-prostheses Service of the Stomatological Clinic does not follow a rigid protocol but materials and techniques are selected on a personal basis, according to the features of each individual clinical case. Mobile rehabilitative systems are the systems of choice, both of which related to the traditional concepts of retention and stability and systems of self-stabilizing prostheses according to J. Dichamp, albeit modified in materials, limiting, when possible the use of prostheses which are fixed on natural teeth, on appliances or combined. PMID:20559471

Tirelli, G; Rizzo, R; Biasotto, M; Di Lenarda, R; Argenti, B; Gatto, A; Bullo, F

2010-02-01

222

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)

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.

Long, Ronan M

2012-01-31

223

Buprenorphine added to bupivacaine prolongs femoral nerve block duration and improves analgesia in patients undergoing primary total knee arthroplasty-a randomised prospective double-blind study.  

Science.gov (United States)

The aim of the study was to determine whether the addition the long-acting opioid buprenorphine as an adjuvant to the local anaesthetic agent would improve quality and prolong duration of femoral nerve blockade in post-operative analgesia following primary total knee arthroplasty. The study involved 48 patients. The femoral nerve was anaesthetised with a 0.25% solution of bupivacaine with adrenaline or with the addition of 0.3mg of buprenorphine. The duration of the sensory block and analgesic effect was assessed according to NRS scale at 12, 24, 36, 48, 60 and 72hours post-surgery. Patients who received buprenorphine as an adjuvant to the local anaesthetic had significantly longer sensory blockade and lower NRS-rated pain intensity with the difference reaching statistical significance at 12hours post-surgery. PMID:25512031

Kosel, Juliusz; Bobik, Piotr; Siemi?tkowski, Andrzej

2015-02-01

224

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)

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.

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

225

Effect of Addition of Magnesium Sulphate and Fentanyl to Ropivacaine Continuous Femoral Nerve Block in Patients Undergoing Elective Total Knee Replacement  

OpenAIRE

This prospective double blinded study was designed to compare the effect of magnesium or fentanyl addition to ropivacaine in continuous femoral nerve block in patients undergoing elective total knee replacement under general anesthesia. Sixty patients undergoing elective TKR under general anesthesia, were randomly allocated into three equal groups, Group (R): given 30 mL Ropivacaine 0.2%. Group (R+F): given 30 mL Ropivacaine 0.2% and 4 ?g mL-1 fentanyl. Group (R+M): given 30 mL Ropivac...

Md. Ashraf Abd Elmawgoud; Ahmed Badawy; Samaa Abu Elkassem; Doaa Rashwan

2008-01-01

226

Effects of adjuvants to local anaesthetics on their duration. I. Studies of dextrans of widely varying molecular weight and adrenaline in rat infraorbital nerve block.  

Science.gov (United States)

Local anaesthetics of the amide type were studied in a modified rat infraorbital nerve block model, with which it was possible to determine varying degrees of sensory block. Of the agents investigated, 0.5% bupivacaine tended to give a longer duration of block than 2% prilocaine or 2% lidocaine, while 0.5% etidocaine had the shortest duration. The duration of prilocaine was prolonged by addition of adrenaline, 5 micrograms/ml, more than that of the other agents. Addition of dextrans of Mw 40-110 X 10(3) did not cause any prolongation of block induced by bupivacaine. When mixed with dextrans over a wide range of Mw (40-4900 X 10(3), prilocaine exhibited significant prolongations of its action by up to 200%. The extent of prolongation was dependent on the degree of block, the concentration of dextrans in the local anaesthetic solution, and the Mw of the dextran although in a less uniform way. An increase in the relative viscosity of the solutions might be a factor of importance for the prolonging effect of addition of dextran to local anaesthetics. Since a formulation providing analgesia of a long duration would be of clinical value, further studies on combinations of the comparatively low-toxicity agent prilocaine and macromolecular substances are of interest. PMID:2409731

Hassan, H G; Renck, H; Lindberg, B; Akerman, B; Hellquist, R

1985-05-01

227

Obturator Hernia: A Rare Case of Acute Mechanical Intestinal Obstruction  

OpenAIRE

Obturator hernia is a rare type of pelvic hernia which generally occurs in elderly patients with accompanying diseases. Because it is difficult to diagnose before surgery, the morbidity and mortality rates for obturator hernia are high. The most common symptom is strangulation combined with mechanical intestinal obstruction.

Ibrahim Aydin; Ahmet Fikret Yucel; Ahmet Pergel; Dursun Ali Sahin

2013-01-01

228

Single-cone obturation technique: a literature review  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: The technique of single-cone obturation is a technique that uses only the master cone. There have been an increase in its use, especially by employing larger cones with larger taper sizes that best match the geometry of rotary nickel-titanium systems (NiTi, not requiring the use of accessory cones, thus reducing the time spent in endodontic obturation. Objective: To review the literature on this technique and to compare it with other existing techniques, as well as to elucidate its advantages and disadvantages. Literature review: The single-cone obturation technique enables an easier and faster endodontic obturation. However, regarding to the aspects such as the obturation quality, apical microleakage and bacterial penetration, this technique is similar to or lower than others. Conclusion: This technique has the advantage of saving time during the filling of the root canal. However, further studies are necessary to evaluate its prognosis, especially in canals with complex anatomy.

Lidiane de Castro Pinto

2012-12-01

229

Peripheral nerve blocks for paediatric day-stay surgery: one year's experience in a district general hospital.  

OpenAIRE

Two hundred children underwent day-care surgery using peripheral nerve blockade as an adjunct to general anaesthesia during a twelve month period. Total post-operative analgesia was achieved in 86%, simple oral analgesia was needed in 9% and the remaining 5% of patients required systemic opiate administration for pain.

Keohane, M.; Mcauley, D.; Ardill, A. C.

1995-01-01

230

Essential oil of croton nepetaefolius and its main constituent, 1,8-cineole, block excitability of rat sciatic nerve in vitro.  

Science.gov (United States)

1. The effects of the essential oil of Croton nepetaefolius (EOCN) and its major constituent, 1,8-cineole, on the compound action potential (CAP) of nerve were investigated. 2. Experiments were performed in sciatic nerves dissected from Wistar rats, mounted in a moist chamber and stimulated at a frequency of 0.2 Hz, with electric pulses of 100 micros duration at 20-40 V. Evoked CAP were displayed on an oscilloscope and recorded on a computer. The CAP control parameters were as follows: peak-to-peak amplitude 8.1 +/- 0.6 mV (n = 15); conduction velocity 83.3 +/- 4.2 m/s (n = 15); chronaxie 58.0 +/- 6.8 msec (n = 6); and rheobase 2.8 +/- 0.1 V (n = 6). 3. Lower concentrations of EOCN (100 and 300 microg/mL) and 1,8-cineole (153 and 307 microg/mL; i.e. 1 and 2 mmol/L, respectively) had no significant effects on CAP control parameters throughout the entire recording period. However, at the end of 180 min exposure of the nerve to the drug, peak-to-peak amplitude was significantly (P Chronaxie and rheobase were significantly increased by the higher concentrations of both EOCN and 1,8-cineole. 4. It is concluded that EOCN and its main constituent 1,8-cineole block nerve excitability in a concentration-dependent manner, an effect that was totally reversible with 1,8-cineole but not with EOCN. This suggests that other constituents of EOCN, in addition to 1,8-cineole, may contribute to the mediation of this effect of EOCN. PMID:17184495

Lima-Accioly, P M; Lavor-Porto, P R; Cavalcante, F S; Magalhães, P J C; Lahlou, S; Morais, S M; Leal-Cardoso, J H

2006-12-01

231

Epinephrine as an adjuvant to amino-amide local anesthetics does not prolong their duration of action in infraorbital nerve block in the rat.  

Science.gov (United States)

The effects of epinephrine as an adjuvant to local anesthetics were studied in the rat infraorbital nerve block (IONB) model, using solutions of 0.5% prilocaine, 0.5% mepivacaine, 0.125% bupivacaine or 0.125% ropivacaine in 50 mmol/l tris-hydroxymethylaminomethane (THAM) tested both without and with epinephrine (EPI) added at 2, 4, 8 or 16 micrograms/ml. Solutions of THAM and EPI in normal saline did not induce IONB. THAM-buffered solutions of bupivacaine induced IONB of longer duration than bicarbonate-buffered solutions. Intensity of block during onset was increased only when EPI at 2 and 16 micrograms/ml was included in bupivacaine solutions. The duration of block induced by prilocaine, bupivacaine and ropivacaine was not significantly prolonged by addition of EPI at any of the concentrations tested. Only at a concentration of 16 micrograms/ml did EPI significantly prolong the duration of mepivacaine-induced block (+48%). Low concentrations of EPI in solutions of bupivacaine and ropivacaine significantly reduced their duration of action by up to 22% and 57%, respectively. It is concluded that the duration of action of local anesthetics in buffered solutions is only moderately affected by the inclusion of EPI, the effects differing only slightly from one to another. The efficacy of EPI as an adjuvant would seem to be governed by factors affecting the local disposition of the main drugs, such as non-specific binding, buffering of solutions and tissue pH. PMID:1632160

Renck, H; Hassan, H G

1992-07-01

232

Temperature-dependence of the action of nerve blocking agents and its relationship to membrane-buffer partition coefficients: thermodynamic implications for the site of action of local anaesthetics.  

OpenAIRE

The local anaesthetic action of a series of nerve blocking agents was examined at temperatures between 4 degrees C and 20 degrees C in isolated sciatic nerves from cold-adapted frogs. Cooling alone had little effect on the amplitude of the action potential but the conduction velocity was decreased and the duration increased. Cooling had little effect on the local anaesthetic action of the short chain alkanols but that of the long chain alkanols, benzyl alcohol, benzocaine and pentobarbitone w...

Bradley, D. J.; Richards, C. D.

1984-01-01

233

The Midline Protein Regulates Axon Guidance by Blocking the Reiteration of Neuroblast Rows within the Drosophila Ventral Nerve Cord  

OpenAIRE

Guiding axon growth cones towards their targets is a fundamental process that occurs in a developing nervous system. Several major signaling systems are involved in axon-guidance, and disruption of these systems causes axon-guidance defects. However, the specific role of the environment in which axons navigate in regulating axon-guidance has not been examined in detail. In Drosophila, the ventral nerve cord is divided into segments, and half-segments and the precursor neuroblasts are formed i...

Manavalan, Mary Ann; Gaziova, Ivana; Bhat, Krishna Moorthi

2013-01-01

234

Variability in the origin of the obturator artery  

Directory of Open Access Journals (Sweden)

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.

Mangala M. Pai

2009-01-01

235

Variability in the origin of the obturator artery  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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.

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

236

Trans-obturator Tape in surgical treatment of urinary incontinence  

Directory of Open Access Journals (Sweden)

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.

Ashrafi M

2008-06-01

237

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)

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.

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

2012-08-01

238

Prospective randomized trial of iliohypogastric-ilioinguinal nerve block on post-operative morphine use after inpatient surgery of the female reproductive tract  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Objective To determine the impact of pre-operative and intra-operative ilioinguinal and iliohypogastric nerve block on post-operative analgesic utilization and length of stay (LOS. Methods We conducted a prospective randomized double-blind placebo controlled trial to assess effectiveness of ilioinguinal-iliohypogastric nerve block (IINB on post-operative morphine consumption in female study patients (n = 60. Patients undergoing laparotomy via Pfannenstiel incision received injection of either 0.5% bupivacaine + 5 mcg/ml epinephrine for IINB (Group I, n = 28 or saline of equivalent volume given to the same site (Group II, n = 32. All injections were placed before the skin incision and after closure of rectus fascia via direct infiltration. Measured outcomes were post-operative morphine consumption (and associated side-effects, visual analogue pain scores, and hospital length of stay (LOS. Results No difference in morphine use was observed between the two groups (47.3 mg in Group I vs. 45.9 mg in Group II; p = 0.85. There was a trend toward lower pain scores after surgery in Group I, but this was not statistically significant. The mean time to initiate oral narcotics was also similar, 23.3 h in Group I and 22.8 h in Group II (p = 0.7. LOS was somewhat shorter in Group I compared to Group II, but this difference was not statistically significant (p = 0.8. Side-effects occurred with similar frequency in both study groups. Conclusion In this population of patients undergoing inpatient surgery of the female reproductive tract, utilization of post-operative narcotics was not significantly influenced by IINB. Pain scores and LOS were also apparently unaffected by IINB, indicating a need for additional properly controlled prospective studies to identify alternative methods to optimize post-surgical pain management and reduce LOS.

Saltzman Steven L

2008-11-01

239

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)

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.

Marcos Rassi Fernandes

2012-08-01

240

Variability in the Origin of the Obturator Artery  

OpenAIRE

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 e...

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

2009-01-01

241

The Obturator Guiding Technique in Percutaneous Endoscopic Lumbar Discectomy  

OpenAIRE

In conventional percutaneous disc surgery, introducing instruments into disc space starts by inserting a guide needle into the triangular working zone. However, landing the guide needle tip on the annular window is a challenging step in endoscopic discectomy. Surgeons tend to repeat the needling procedure to reach an optimal position on the annular target. Obturator guiding technique is a modification of standard endoscopic lumbar discectomy, in which, obturator is used to access triangular w...

Han, In Ho; Choi, Byung Kwan; Cho, Won Ho; Nam, Kyoung Hyup

2012-01-01

242

Lack of correlation between obturation limits and apical leakage  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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

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

2013-07-01

243

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

Directory of Open Access Journals (Sweden)

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 anestesiologistas 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 consideradoJUSTIFICATIVA 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 cada 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 cuentaBACKGROUND 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

Marcos Rassi Fernandes

2012-02-01

244

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)

Full Text Available SciELO Brazil | Languages: English, Portuguese, Spanish Abstract in portuguese 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

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

2012-02-01

245

Time Course of the Soleus M Response and H Reflex after Lidocaine Tibial Nerve Block in the Rat  

OpenAIRE

Aims. In spastic subjects, lidocaine is often used to induce a block predictive of the result provided by subsequent surgery. Lidocaine has been demonstrated to inhibit the Hoffmann (H) reflex to a greater extent than the direct motor (M) response induced by electrical stimulation, but the timecourse of these responses has not been investigated. Methods. An animal (rat) model of the effects of lidocaine on M and H responses was therefore developed to assess this time course. M and H responses...

Xe Vin Buffenoir, K.; Philippe Decq; Xe Rot, Chantal P.

2013-01-01

246

CT imaging features of obturator prostheses in patients following palatectomy or maxillectomy.  

Science.gov (United States)

Palatal tumors are often treated with palatectomy or maxillectomy. The resulting surgical defect produces an oroantral communication. An obturator is a removable prosthesis used to close the palatal or maxillectomy defect. Fifteen patients who had undergone palatectomy or maxillectomy for carcinoma and subsequent obturator prosthesis placement were retrospectively studied. Obturators were characterized by Hounsfield units and were subdivided into 3 CT imaging groups: either hyperattenuated, hollow (air-containing), or heterogeneous (isoattenuated to hyperattenuated with internal foci of air). Eight patients had hyperattenuated obturators either representing acrylic resin or Trusoft. Four patients had hollow obturators also composed of acrylic resin or Trusoft. Three patients had heterogeneous obturators, which were composed of only Trusoft. The postoperative imaging of patients treated for palatal or maxillary tumors can be complicated by the presence of obturator prostheses. The intent of this article was to familiarize the reader with the CT imaging features of obturator prostheses. PMID:21799037

Kumar, V A; Hofstede, T M; Ginsberg, L E

2011-01-01

247

The midline protein regulates axon guidance by blocking the reiteration of neuroblast rows within the Drosophila ventral nerve cord.  

Science.gov (United States)

Guiding axon growth cones towards their targets is a fundamental process that occurs in a developing nervous system. Several major signaling systems are involved in axon-guidance, and disruption of these systems causes axon-guidance defects. However, the specific role of the environment in which axons navigate in regulating axon-guidance has not been examined in detail. In Drosophila, the ventral nerve cord is divided into segments, and half-segments and the precursor neuroblasts are formed in rows and columns in individual half-segments. The row-wise expression of segment-polarity genes within the neuroectoderm provides the initial row-wise identity to neuroblasts. Here, we show that in embryos mutant for the gene midline, which encodes a T-box DNA binding protein, row-2 neuroblasts and their neuroectoderm adopt a row-5 identity. This reiteration of row-5 ultimately creates a non-permissive zone or a barrier, which prevents the extension of interneuronal longitudinal tracts along their normal anterior-posterior path. While we do not know the nature of the barrier, the axon tracts either stall when they reach this region or project across the midline or towards the periphery along this zone. Previously, we had shown that midline ensures ancestry-dependent fate specification in a neuronal lineage. These results provide the molecular basis for the axon guidance defects in midline mutants and the significance of proper specification of the environment to axon-guidance. These results also reveal the importance of segmental polarity in guiding axons from one segment to the next, and a link between establishment of broad segmental identity and axon guidance. PMID:24385932

Manavalan, Mary Ann; Gaziova, Ivana; Bhat, Krishna Moorthi

2013-01-01

248

Resistance to fracture of dental roots obturated with different materials.  

Science.gov (United States)

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

Celikten, Berkan; Uzuntas, Ceren Feriha; Gulsahi, Kamran

2015-01-01

249

An Evaluation of the Effectiveness of Hyaluronidase in the Selective Nerve Root Block of Radiculopathy: A Double Blind, Controlled Clinical Trial  

Science.gov (United States)

Study Design Prospective, double-blind, randomized controlled trial. Purpose To determine the ability of hyaluronidase to provide longer lasting pain relief and functional improvement in patients with lumbar radiculopathy. Overview of Literature Selective nerve root block (SNRB) is a good treatment option in lumbar radiculopathy. We studied the effectiveness of hyaluronidase when added to the traditional SNRB regimen. Methods A sample size of 126 patients per group was necessary. A sample of 252 patients who underwent an injection procedure with or without hyaluronidase due to radiculopathy was included in this study. The patients were randomly divided into two groups: the control (C) group and the hyaluronidase (H) group. After SNRB due to radiculopathy, the visual analog scale (VAS) was compared at 2, 4, 6, 8, and 12 weeks between the two groups, and the Oswestry disability index (ODI) was compared at 12 weeks between the two groups. Results Both groups seemed to have general improvement in VAS, but in C group, the VAS was higher than the H group 2 and 4 weeks after the surgery, and the difference in time-group change between 2 groups was statistically significant (p 0.05). Conclusions The rebound pain (the re-occurrence of pain within 2-4 weeks after injection) that occurs within 2-4 weeks after the injection of the routine regimen can be reduced when hyaluronidase is added to the routine SNRB regimen. PMID:25705339

Ko, Sang-Bong; Vaccaro, Alexander R; Shin, Dong-Young

2015-01-01

250

Tacrolimus reduces scar formation and promotes sciatic nerve regeneration?  

OpenAIRE

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...

Que, Jun; Cao, Quan; Sui, Tao; Du, Shihao; Zhang, Ailiang; Kong, Dechao; Cao, Xiaojian

2012-01-01

251

Bloqueo ciático continuo con catéter estimulador guiado mediante ecografía para tratamiento del miembro fantasma doloroso / Ultrasound-guided continuous sciatic nerve block with stimulating catheter for the treatment of phantom limb pain  

Scientific Electronic Library Online (English)

Full Text Available Los bloqueos nerviosos periféricos pueden ser una alternativa a la analgesia intravenosa y epidural en el tratamiento del miembro fantasma doloroso. La dificultad en la localización del nervio ciático mediante neuroestimulación en pacientes con arteriopatía periférica y neuropatía puede verse aument [...] ada por el hecho de presentar una amputación del miembro inferior, que imposibilita la observación de una respuesta motora en el pie coincidiendo con la localización del nervio. En estos casos, la ecografía puede convertirse en una técnica de localización nerviosa determinante del éxito de la analgesia ya que permite la identificación del nervio, así como la visualización en tiempo real de la posición relativa de la aguja y catéter respecto al nervio y la difusión del anestésico local administrado. Se presenta el caso de un paciente con miembro fantasma doloroso resistente al tratamiento convencional que se controló con un bloqueo ciático continuo con catéter estimulador guiado con ecografía. Abstract in english Peripheral nerve blocks can be an alternative to intravenous and epidural analgesia in the treatment of phantom limb pain. The difficulty of localizing the sciatic nerve through neurostimulation in patients with peripheral arteriopathy and neuropathy can be increased by lower limb amputation, making [...] it impossible to observe a motor response in the foot coinciding with localization of the nerve. In these cases, ultrasonography can become a technique for nerve localization and determine the success of analgesic strategy, since it allows nerve identification, as well as visualization in real time of the relative position of the needle and catheter with respect to the nerve and the diffusion of the local anesthetic administered. We report the case of a patient with phantom limb pain refractory to conventional treatment, in whom pain control was achieved by ultrasound-guided continuous sciatic block with stimulating catheter.

A., Martínez Navas; R., Ortiz de la Tabla González; M., Echevarría Moreno.

2009-02-01

252

Obturating surfaces in the junction of two CANDU fuel bundles  

International Nuclear Information System (INIS)

At the Institute for Nuclear Research Pitesti it was developed a general code/program/software needed to design and calculate the aria of the obturating surface at the junction of two CANDU fuel bundles, for rotations, degree by degree, in the [0 angle - 360 angle] range. The code also calculates all local (input, output, in spacers' zone, in junctions etc.), distributed and total pressure drops for a fuel bundles string. The paper presents the graphical results representing the variations of the obturating surfaces for 68 types of junctions, at a [0 - 360 angle] rotation, degree by degree. (authors)

253

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

Directory of Open Access Journals (Sweden)

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.

R.K. Syal

2013-04-01

254

Obturator prostheses in post-oncological maxillofacial patients: our experience  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Surgical procedures for tumors of the paranasal sinus, palatal epithelium, minor salivary glands or osteosarcoma of the upper jaw require a partial or total maxillectomy of the upper jaw. When the surgical procedure and/or radiation therapy result in a communication, the solution is necessarily prosthetical, through a palatal obturator that recreates a partition between the oral and nasal cavities. Methods: Authors selected 32 post-oncological patients with the upper maxilla completely edentulous prosthetically rehabilitated with a palatal obturator. Results: No serious complications or adverse reactions were reported during the fabrication of surgical or definitive obturators. All patients stated to benefit the palatal obturator in terms of quality of life. Conclusion: Prosthetic rehabilitation of edentulous maxillectomy with oral communication is a demanding challenge for the prosthodontist. The goals of prosthetic rehabilitation include separation of oral and nasal cavities to allow adequate deglutition and articulation of teeth, restore midfacial soft tissue contour and a satisfactory esthetic outcome. When, for any reason, the patient is not a suitable candidate for an implant-retained overdenture, a total removable prosthesis should ensure the most comfort in terms of swallowing, phonation and aesthetics.

Edoardo Brauner

2014-12-01

255

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)

Full Text Available SciELO Chile | Language: English Abstract in spanish 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

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

2012-04-01

256

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)

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.

Sung Chul Lim

2012-01-01

257

Nerve conduction  

Science.gov (United States)

... spinal cord to muscles and sensory receptors. A peripheral nerve is composed of nerve bundles (fascicles) that contain hundreds of individual nerve fibers (neurons). Neurons consist of dendrites, axon, and cell body. The dendrites are the tree- ...

258

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

Directory of Open Access Journals (Sweden)

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 ??-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.

Makedonova Y.A.

2012-03-01

259

Tailor-made endodontic obturator for the management of Blunderbuss canal  

OpenAIRE

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 ...

Reddy, Smitha; Sukumaran, Vg; Bharadwaj, Narasimha

2011-01-01

260

Inflatable hollow obturator prostheses for patients undergoing an extensive maxillectomy: a case report  

OpenAIRE

The presence of a large palatal or maxillary defect after partial or total maxillectomy for tumor, trauma or congenital deformation poses a challenge to prosthodontists, particularly when the use of an implant cannot be considered. This case report described the use of an air valve in a hollow silicone obturator to manufacture an inflatable obturator that could be extended further into undercut area to retain itself. The inflatable obturator exhibited adequate retention, stability and border ...

Hou, Yue-zhong; Huang, Zhi; Ye, Hong-qiang; Zhou, Yong-sheng

2012-01-01

261

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)

Full Text Available SciELO Argentina | Language: Spanish Abstract in spanish 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.

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

2013-09-01

262

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)

263

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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 Abstract in spanish 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 d [...] el 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 Abstract in english 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 o [...] f 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.

Karl Otto, Geier.

2003-06-01

264

Bilateral eventration of sciatic nerve.  

Science.gov (United States)

During routine dissection of a 60 years male cadaver, it was observed that the two divisions of sciatic nerve were separate in the gluteal region on both the sides with the tibial nerve passing below the piriformis and the common peroneal nerve piercing the piriformis muscle. The abnormal passage of the sciatic nerve (SN), the common peroneal nerve (CPN), and the tibial nerve (TN), either through the piriformis or below the superior gemellus may facilitate compression of these nerves. Knowledge of such patterns is also important for surgeons dealing with piriformis syndrome which affects 5-6% of patients referred for the treatment of back and leg pain. A high division may also account for frequent failures reported with the popliteal block. PMID:22049898

Sharma, T; Singla, R K; Lalit, M

2010-01-01

265

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

Science.gov (United States)

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

Mirilas, Petros; Skandalakis, John E

2010-03-01

266

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)

Full Text Available SciELO Spain | Language: English Abstract in spanish 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

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

2007-03-01

267

Fabrication of a Movable Obturator Following Maxillary Reconstruction with Slit-Shaped Fenestration.  

Science.gov (United States)

Extensive maxillary resection has generally been reconstructed with free skin flaps. Because drooping of the transferred flap causes instability of the obturator prosthesis, maxillary reconstruction often incorporates a slit-shaped oronasal fenestration. Although obturator prostheses for edentulous patients are stabilized with the help of oronasal slits, those for dentate patients are unstable because of flap mobility, resulting in a harmful lateral force exerted on the abutment teeth, causing dislodging of the denture. This report evaluates the benefits of a movable obturator prosthesis for a 60-year-old dentulous patient with maxillary sinus carcinoma. The patient underwent left-sided total maxillectomy, and the defect was reconstructed with a slit-shaped fenestration using a rectus abdominis flap. A conventional obturator prosthesis was inserted; however, drooping of the flap caused instability of the obturator, resulting in nasal regurgitation and fracture of the clasp. To solve this problem, we designed an obturator prosthesis with a movable connection consisting of a ball attachment (patrix) in the metal base and a socket (matrix) in the obturator, which acted as a stress breaker against the harmful force exerted by the flap. Application of this movable obturator prosthesis was a useful solution for a compromising situation created by the surgical procedure. No clinical disorders were observed at the 3-year follow-up. PMID:25092072

Murakami, Mamoru; Nishi, Yasuhiro; Umezono, Minoru; Kamashita, Yuji; Nishimura, Masahiro

2014-08-01

268

Evaluation of apical obturation quality of diferent endodontic materials  

OpenAIRE

The aim of this study was to determine the quality of apical obturation of different endodontic materials, using the colored solutions method. As a material, we used 40 single-rooted teeth, extracted from persons of different ages and sex. We did the root-canals preparation using standard endodontical procedure with KERR reamers and files. After we had prepared root canals, we filled them up, using the lentulo-spirals and Gutta-percha points. For the opturation, we used four different endodon...

Matovi? Ivan R.

2002-01-01

269

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)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish 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

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

2014-07-01

270

Terminal nerve: cranial nerve zero  

Directory of Open Access Journals (Sweden)

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.

Jorge Eduardo Duque Parra

2006-12-01

271

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)

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 a

Karl Otto Geier

2003-06-01

272

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

Scientific Electronic Library Online (English)

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.

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

273

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

Directory of Open Access Journals (Sweden)

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.

E. M. Rickes

2012-04-01

274

Investigation of obturator and ignitor effects on low velocity starting of the ram accelerator  

Energy Technology Data Exchange (ETDEWEB)

An experimental investigation of the effects of obturator geometry, propellant chemistry, and onboard pyrotechnic ignitor systems on the starting characteristics of the ram accelerator at low launch velocity has been conducted at the University of Washington 38-mm-bore facility. The ram accelerator was successfully started at entrance velocities as low as 760 m/s using stoichiometric methane/oxygen propellants with various levels of carbon dioxide dilution and obturator configurations at a fill pressure of 2.5 MPa. Experiments using an onboard pyrotechnic ignitor demonstrated that ignition of the propellant and starting of the ram accelerator could occur without the presence of the obturator-driven normal shock. (orig.)

Knowlen, C.; Bundy, C.; Bruckner, A.P. [Washington Univ., Seattle, WA (United States). Aerospace and Energetics Research Program; Kruczynski, D. [Washington Univ., Seattle, WA (United States). Aerospace and Energetics Research Program; Utron Inc., Manassas, VA (United States)

2000-11-01

275

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)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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.

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

2013-04-01

276

Estudo comparativo entre dois protocolos anestésicos envolvendo bloqueio do nervo alveolar inferior convencional e de Vazirani-Akinosi para exodontia de terceiro molar inferior / Comparative study of two anaesthetic protocols involving conventional and Vazirani-Akinosi alveolar inferior nerve block for lower third molar extraction  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese INTRODUÇÃO: O bloqueio do nervo alveolar inferior (BNAI) apresenta alta porcentagem de falha na Odontologia. A fim de melhorar esse índice, vêm-se estudando diferentes alternativas, como diferentes técnicas e soluções anestésicas. OBJETIVO: Avaliar duas diferentes técnicas - técnica convenciona [...] l e de Vazirani-Akinosi - para o bloqueio do nervo alveolar inferior, bem como compará-las quanto à sua efetividade e quantificar o percentual de aspirações positivas nas duas diferentes técnicas. MATERIAL E MÉTODO: Foram avaliados 160 pacientes de ambos os sexos, sendo 80 submetidos ao bloqueio do nervo alveolar inferior de Vazirani-Akinosi e bloqueio do nervo bucal (G1), e 80 submetidos ao bloqueio do nervo alveolar inferior convencional e ao bloqueio do nervo bucal (G2). Em ambos os grupos, utilizou-se a combinação de articaína 4% com epinefrina 1:100.000 para bloqueio do nervo bucal, e lidocaína 2% com epinefrina 1:100.000 para bloqueio do nervo alveolar inferior. Foram avaliados: a quantidade de aspirações positivas, a eficácia da anestesia e o momento em que ocorreu a falha anestésica durante o procedimento cirúrgico. RESULTADO: Não houve diferenças estatisticamente significantes (p = 0,2453) entre os grupos G1 e G2 observando-se a eficácia e o índice de aspirações positivas, e o momento em que ocorreu a falha anestésica, observando-se uma maior eficácia de ambas as técnicas, quando comparadas com a literatura (90%) CONCLUSÃO: Não houve diferença significativa entre o BNAI pela técnica convencional e o BNAI pela técnica de Vazirani-Akinosi quanto a quantidade de aspirações positivas e eficácia, sendo que o uso da articaína 4% com epinefrina 1:100.000 no bloqueio do nervo bucal possivelmente aumentou a eficácia anestésica de ambas as técnicas. Abstract in english INTRODUCTION: The inferior alveolar nerve block has a high percentage of failure in dentistry. To improve this ratio, has been studied different alternatives, as different techniques, as well as anesthetics. OBJECTIVE: Evaluate two different techniques (conventional technique and Vazirani-Akino [...] si) for inferior alveolar nerve block, and compare them regarding their effectiveness and quantify the percentage of positive aspirations in both techniques. MATERIAL AND METHOD: 160 patients were evaluated for both sex, with 80 undergoing Vazirani-Akinosi technique plus buccal nerve block (G1), and 80 to conventional inferior alveolar nerve block plus buccal nerve block (G2), both groups using a combination of 4% articaine with 1:100.000 epinephrine to buccal nerve block and 2% lidocaine with 1:100.000 epinephrine to inferior alveolar nerve block. We evaluated the amount of positive aspirations, the effectiveness or not of anesthesia (pain) and when it occurred during the surgical procedure. RESULT: There were no statistically significant differences (p = 0.2453) between G1 and G2 observing the positive aspiration. It was obtained efficiency of 90% for both techniques. CONCLUSION: No significant difference between the conventional alveolar inferior nerve block technique and Vazirani-Akinosi alveolar nerve block technique considering the amount of positive aspirations and efficacy, and the use of 4% articaine with 1:100.000 epinephrine in buccal nerve block possibly increased the anesthetic efficacy of both techniques.

Danilo de Paula Ribeiro, Borges; Liane Maciel de Almeida, Souza; Maria Luisa Silveira, Souto; Liliane Poconé, Dantas; Mônica Silveira, Paixão; Francisco Carlos, Groppo.

2014-01-01

277

[Obturation, aspiration, and inhalation in case of mechanical asphyxia].  

Science.gov (United States)

This paper aims at updating terminology employed for the characteristic of selected forms of mechanical asphyxia. The medical terms "obturation", "aspiration", and "inhalation" are not infrequently used by forensic medical experts and pathological anatomists engaged in diagnostics of mechanical asphyxia, elucidation of the mechanism of the accompanying injury and causes underlying its fatal outcome. It is argued that the use of these terms for the purpose is sometimes either unjustified or incorrect or both. To begin with, they have different meanings in different situations. Second, the mechanism of death from mechanical asphyxia is variable and associated with specific morphological features that are directly dependent not only on the route by which a foreign body enters the respiratory tract but also on its size, weight, structure, shape, properties, and aggregated state. Third, it is necessary to differentiate between inhalation of a toxicant in case of poisoning and inhalation of a gaseous substance leading to mechanical asphyxia. PMID:21516805

Putintsev, V A; Bogomolov, D V; Sundukov, D V; Shaman, P

2011-01-01

278

Evaluation of apical obturation quality of diferent endodontic materials  

Directory of Open Access Journals (Sweden)

Full Text Available The aim of this study was to determine the quality of apical obturation of different endodontic materials, using the colored solutions method. As a material, we used 40 single-rooted teeth, extracted from persons of different ages and sex. We did the root-canals preparation using standard endodontical procedure with KERR reamers and files. After we had prepared root canals, we filled them up, using the lentulo-spirals and Gutta-percha points. For the opturation, we used four different endodontic materials a?26, Ketac Endo, Endomethasone and Sealapex. Under the in vitro conditions, we checked the quality of the apical opturation, using the linear dye leakage method and 2 % methylen blue solution. According to results, we can conclude that endodontic materials AH26 (x=1, 37 and Ketac Endo (x=1,17 showed a significantly lower degree of apical leakage than Endomethasone (x=2. 51 and Sealapex (x=3,25.

Matovi? Ivan R.

2002-01-01

279

Comparative evaluation of sealing ability of different obturation materials  

Directory of Open Access Journals (Sweden)

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.

Melih Irena

2010-01-01

280

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

OpenAIRE

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...

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

2010-01-01

281

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

OpenAIRE

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 compac...

Ili? Dragan

2004-01-01

282

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

OpenAIRE

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...

Soganci, Gokce; Yalug, Suat; Kocacikli, Mustafa

2011-01-01

283

Usage of a Trans-Obturator-Tape (T.O.T. "outside-in" approach in surgical treatment of female stress urinary incontinence  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: The aim of the study was to analyzed the efficacy and safety of a new minimally invasive surgical procedure using the Trans-Obturator-Tape with "outside-in" approach for treatment female stress urinary incontinence. Patients and Methods: 31 women with stress urinary incontinence (SUI associated with urethral hypermobility, underwent the T.O.T. procedure (March 2010 to January 2011. 5 patients were previously operated for incontinence. Mean age was 59 years (37- 80. 10 patients were having mixed incontinence. A non-elastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, coughstress test (full bladder, uroflowmetry, and post-voiding residual assessment. Results: Mean follow-up was 5 months (1-9. At 6 months follow-up 96,7% of the patients were completely cured. The overall peri-operative complication rate was 6,4% with no vascular, nerve or bowel injury. One patients (3,4% had post-operative urinary retention. Conclusion: The present study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence.

Jovanovic Mirko

2011-01-01

284

Assessment of swallowing and masticatory performance in obturator wearers: a clinical study  

Science.gov (United States)

PURPOSE To assess function by identifying changes in swallowing and masticatory performance in maxillary obturator prosthesis wearers. MATERIALS AND METHODS Sixty subjects were recruited for the study, of which 20 were obturator wearers, 20 were completely dentulous and 20 had removable partial/complete dentures with similar Eichner's Index. Swallowing ability was evaluated with and without obturator using the "Water Drinking Test"; Masticatory performance was evaluated with the Sieve test; and maximum occlusal force was recorded with the help of a digital bite sensor. The data was analyzed using the Statistical Package for Social Science version 15.0 with a confidence level at 95%. RESULTS Profile, behavior of drinking and time taken to drink were significantly improved (P<.001) in subjects after wearing obturator. Masticatory performance was not significantly different (P=.252) in obturator wearer when compared with dentulous or removable partial/complete denture wearer, but significantly (P<.001) high inter group difference in maximum occlusal force existed. Correlation between masticatory performance and maximum occlusal force was not significant (P=.124). CONCLUSION Swallowing ability was significantly improved after wearing obturator but masticatory performance was not significantly different from those having similar occlusal support zone in their dentition. PMID:25722831

Vero, Nungotso; Mishra, Niraj; Singh, Kamleshwar; Jurel, Sunit Kumar; Kumar, Vijay

2015-01-01

285

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

Science.gov (United States)

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. PMID:25657530

Hegde, Vibha; Arora, Shashank

2015-01-01

286

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)

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

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

2007-10-01

287

Distribuição do nervo fibular comum em fetos de equinos e descrição anatômica de pontos para bloqueio anestésico Distribution of common peroneal nerve in equine fetuses and anatomical description of sites for anesthetic block  

Directory of Open Access Journals (Sweden)

Full Text Available Analisou-se a distribuição do nervo fibular comum em 30 fetos de equinos, sem raça definida, provenientes do acervo do Laboratório de Anatomia Animal da Faculdade de Medicina Veterinária da Universidade Federal de Uberlândia, que foram injetados e conservados em solução aquosa de formaldeído a 10%. Contatou-se que o referido nervo deriva do isquiático, divide-se em nervos fibulares superficial e profundo, distribuindo-se para os músculos extensores lateral e longo do dedo, fibular terceiro e tibial cranial. Traçando-se uma linha imaginária na região médio-lateral da tuberosidade do osso tíbia, o nervo fibular comum pode ser bloqueado em sua parte proximal, no terço caudal, entre o tendão de inserção do músculo bíceps femoral e a face lateral do músculo gastrocnêmio lateral (terço médio; e o nervo fibular profundo, na parte proximal da tíbia, crânio-distalmente ao fibular comum. O bloqueio do nervo fibular superficial pode ser realizado em duas regiões da tíbia: na proximal, considerando-se a linha imaginária, distalmente ao ponto citado para o fibular comum e caudalmente ao descrito para o fibular profundo; e na distal, na face lateral da articulação tíbio-társica, entre os tendões de inserção dos músculos extensores lateral e longo do dedo.The distribution of the nervus fibularis communis was analyzed in 30 equine fetuses, mongrel, from the collection of the Animal Anatomy Laboratory at the School of Veterinary Medicine of Universidade Federal de Uberlândia, which were injected and stored in an aqueous solution of 10% formaldehyde. It was found that this nerve emerges from the ischiadicus, divides itself into nervus fibularis profundus and nervus fibularis superficialis distributing to the musculi extensor digitorum lateralis, extensor digitorum longus, fibularis tertius, and tibialis cranialis. Drawing an imaginary line in the medial-lateral region of the tuberositatis tibia, the nervus fibularis communis may be blocked in its proximal portion, in the caudal third, between the tendon of insertion of the biceps femoris and the lateral side of the musculus gastrocnemius (medium third; and the nervus fibularis profundus may be blocked in the proximal tibia, cranio-distally to the nervus fibularis communis. The block of nervus fibularis profundus may be performed in two regions of the tibia: proximal, considering the imaginary line, distal to the site referred to the nervus fibularis communis, and caudal to that described for the nervus fibularis profundus; and distal, on the lateral side of the tibiotarsal joint, between the tendons of insertion of the musculi extensor digitorum lateralis and extensor digitorum longus.

Luciana P. Iglesias

2012-07-01

288

An implantable electrical stimulator for phrenic nerve stimulation  

OpenAIRE

Phrenic nerve stimulation is a technique whereby a nerve stimulator provides electrical stimulation of the phrenic nerve to cause diaphragmatic contraction in patients with respiratory failure due to cervical spinal cord injury. This paper presents an eigth-channel stimulator circuit with an output stage (electrode driving circuit) that doesn’t need off-chip blocking-capacitors and is used for phrenic nerve stimulation. This stimulator circuit utilizes only 1 output stage for 8 channels. Th...

Mohammad Pooyan; Shima Sardarzadeh

2012-01-01

289

A simplified technique of orthograde MTA obturation on the elected canals of posterior teeth: Two case reports.  

Science.gov (United States)

This article suggests a simplified technique of orthograde MTA obturation in less accessible canal(s) of posteriors teeth without using costly ultrasonics or specialised carrier. Essentially few finger pluggers, absorbent points and a simple canal projection method were used. The orifice(s) of the elected canal(s) to be obturated with MTA were projected onto the external occlusal surface for easy delivery and predictive instrumentation. The idea was based on 'easy access', 'working one canal with one mix at one time', 'thorough condensation' and 'removal of excess moisture'. In case I, palatal canal of tooth no. 2 with gross apical perforation and suspected VRF was obturated with MTA. And in Case II, tooth no. 19 presented with incomplete furcal fracture extending into the canal was obturated with MTA in all 3 canals unitarily. Dense homogenous MTA obturation was achieved and both cases healed uneventfully. PMID:24554868

Wahengbam, Brucelee; Wahengbam, Pragya; Tikku, Aseem Prakash

2014-01-01

290

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)

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

Patrícia Falcão Pitombo

2013-02-01

291

Rhinorrhea triggered by obturator prosthesis after surgical intervention of partial maxillary resection: a clinical report.  

Science.gov (United States)

This clinical report describes a case of rhinorrhea that arose after surgical intervention of partial maxillary resection and obturator prosthesis positioning. Ultimately, the diagnosis was that rhinorrhea was induced by mechanical irritation of the nasal mucosa determined by the nasal part of the obturator prosthesis. The differential diagnosis of nasal irritation, vasomotor rhinitis, gustatory rhinorrhea are presented and discussed, as well as the technical notes and measures taken to reach the final diagnosis and a satisfactory functional and aesthetic result for the patient. PMID:25503096

Procacci, P; Ferrari, F; Zambotti, T; Donadello, D; Prandi, E; Zanette, G; Bertossi, D; Nocini, P F

2014-10-01

292

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

Directory of Open Access Journals (Sweden)

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.

Davidovi? Lazar B.

2002-01-01

293

[An obturator or "lateral" bypass in infected vascular prostheses in the groin?].  

Science.gov (United States)

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 pseudoaneurysms in the groin after PTA 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 femoro-popliteal reconstructions--4 cases; infection after iliac-femoral reconstruction--2 patients, and one infected pseudoaneurysm in the groin after PTA 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 superficial 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 transperitoneal 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 reconstructions 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 angiography 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) 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. PMID:12073284

Davidovi?, Lazar B; Kuzmanovi?, Ilija B; Kosti?, Dusan M; Cinara, Ilijas S; Cvetkovi?, Slobodan D; Risti?, Miljko V; Velimirovi?, Dusan B; Jadranin, Dragica B

2002-01-01

294

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)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish 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

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

2013-06-01

295

Columbia University researchers find that severing nerves in mice may shrink stomach cancers  

Science.gov (United States)

Research from Columbia University Medical Center shows that nerves may play a critical role in stomach cancer growth and that blocking nerve signals using surgery or Botox (onabotulinumtoxinA) could be an effective treatment for the disease.

296

Influence of smear layer removal on the obturation of root canal ramifications  

Scientific Electronic Library Online (English)

Full Text Available OBJECTIVE: This study evaluated whether smear layer removal has any influence on the filling of the root canal system, by examining the obturation of lateral canals, secondary canals and apical deltas. MATERIAL AND METHODS: Eighty maxillary and mandibular canines were randomly divided into two group [...] s, according to their irrigation regimen. Both groups were irrigated with 1% NaOCl during canal shaping, but only the teeth in Group II received a final irrigation with 17% EDTA for smear layer removal. The root canals were obturated with lateral condensation of gutta-percha and the specimens were cleared, allowing for observation under the microscope. RESULTS: In Groups I and II, 42.5% and 37.5% of the teeth, respectively, presented at least one filled canal ramification. Although a larger number of obturated ramifications was found in Group I, there were no statistically significant differences between the two groups (p = 0.4957). CONCLUSIONS: Smear layer removal under the conditions tested in this study did not affect the obturation of root canal ramifications when lateral condensation of gutta-percha was the technique used for root canal filling.

Elaine Vianna Freitas, Fachin; Roberta Kochenborger, Scarparo; Liliane Inês Sachet, Massoni.

2009-06-01

297

Influence of smear layer removal on the obturation of root canal ramifications  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVE: This study evaluated whether smear layer removal has any influence on the filling of the root canal system, by examining the obturation of lateral canals, secondary canals and apical deltas. MATERIAL AND METHODS: Eighty maxillary and mandibular canines were randomly divided into two groups, according to their irrigation regimen. Both groups were irrigated with 1% NaOCl during canal shaping, but only the teeth in Group II received a final irrigation with 17% EDTA for smear layer removal. The root canals were obturated with lateral condensation of gutta-percha and the specimens were cleared, allowing for observation under the microscope. RESULTS: In Groups I and II, 42.5% and 37.5% of the teeth, respectively, presented at least one filled canal ramification. Although a larger number of obturated ramifications was found in Group I, there were no statistically significant differences between the two groups (p = 0.4957. CONCLUSIONS: Smear layer removal under the conditions tested in this study did not affect the obturation of root canal ramifications when lateral condensation of gutta-percha was the technique used for root canal filling.

Elaine Vianna Freitas Fachin

2009-06-01

298

Bacterial entombment by intratubular mineralization following orthograde mineral trioxide aggregate obturation: a scanning electron microscopy study.  

Science.gov (United States)

The time domain entombment of bacteria by intratubular mineralization following orthograde canal obturation with mineral trioxide aggregate (MTA) was studied by scanning electron microscopy (SEM). Single-rooted human premolars (n=60) were instrumented to an apical size #50/0.06 using ProFile and treated as follows: Group 1 (n=10) was filled with phosphate buffered saline (PBS); Group 2 (n=10) was incubated with Enterococcus faecalis for 3 weeks, and then filled with PBS; Group 3 (n=20) was obturated orthograde with a paste of OrthoMTA (BioMTA, Seoul, Korea) and PBS; and Group 4 (n=20) was incubated with E. faecalis for 3 weeks and then obturated with OrthoMTA-PBS paste. Following their treatments, the coronal openings were sealed with PBS-soaked cotton and intermediate restorative material (IRM), and the roots were then stored in PBS for 1, 2, 4, 8 or 16 weeks. After each incubation period, the roots were split and their dentin/MTA interfaces examined in both longitudinal and horizontal directions by SEM. There appeared to be an increase in intratubular mineralization over time in the OrthoMTA-filled roots (Groups 3 and 4). Furthermore, there was a gradual entombment of bacteria within the dentinal tubules in the E. faecalis inoculated MTA-filled roots (Group 4). Therefore, the orthograde obturation of root canals with OrthoMTA mixed with PBS may create a favorable environment for bacterial entombment by intratubular mineralization. PMID:25012869

Yoo, Jun Sang; Chang, Seok-Woo; Oh, So Ram; Perinpanayagam, Hiran; Lim, Sang-Min; Yoo, Yeon-Jee; Oh, Yeo-Rok; Woo, Sang-Bin; Han, Seung-Hyun; Zhu, Qiang; Kum, Kee-Yeon

2014-12-01

299

Flank hernia secondary to phenol nerve block.  

LENUS (Irish Health Repository)

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.

Al-Hilli, Z

2010-09-01

300

A method for obturating microscopic ports in parts submitted to stresses, e.g. heat-exchangers  

International Nuclear Information System (INIS)

The invention relates to the obturation of cracks in metal-parts. It refers to a method for obturating the micropores of a member adapted to be submitted to stresses, said method being characterized in that it comprises the steps of exposing one surface of said member to a mixture of nickel-carbonyl and hydrogen sulfide with an inert gaseous carrier, and exposing the member other surface to air or nitrogen with oxygen or steam, the gases being at substantially the same pressure and at a temperature of from 290 to 330 deg K. This can be applied to the obturation of micropores in the heat exchangers of sodium cooled nuclear reactor

301

Neuromodulation of the suprascapular nerve.  

Science.gov (United States)

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

Elahi, Foad; Reddy, Chandan G

2014-12-01

302

Improved technique for CT-guided celiac ganglia block  

Energy Technology Data Exchange (ETDEWEB)

Celiac nerve blocks have been performed without radiologic guidance, but recently several groups have reported computed tomography (CT)-guided techniques. The authors present a new technique of CT-guided celiac nerve block using an 18 gauge Teflon catheter, which permits a test block dose and permanent alcohol block with one procedure. The results of this new technique were very encouraging. Of nine cancer patients who had the test block, seven had good pain relief; these same patients had good pain control with the permanent block. Of six patients with pancreatitis, six had good pain relief from the test block, and three had some long-term relief from the permanent block.

Haaga, J.R.; Kori, S.H.; Eastwood, D.W.; Borowski, G.P.

1984-06-01

303

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

304

Palsies of Cranial Nerves That Control Eye Movement  

Science.gov (United States)

... Cranial Nerve (Oculomotor Nerve) Palsy Fourth Cranial Nerve (Trochlear Nerve) Palsy Sixth Cranial Nerve (Abducens Nerve) Palsy Trigeminal ... Nerve (Oculomotor Nerve) Palsy , see Fourth Cranial Nerve (Trochlear Nerve) Palsy , and see Sixth Cranial Nerve (Abducens Nerve) ...

305

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)

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. CONCLUS?ES: 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

Luis Henrique Cangiani

2008-04-01

306

Nerve conduction velocity  

Science.gov (United States)

... the presence of a myelin sheath on the axon) of the nerve. Newborn infants have values that ... systemic amyloidosis Sensorimotor polyneuropathy Tibial nerve dysfunction Ulnar nerve dysfunction Any peripheral neuropathy can cause abnormal results. Damage to the ...

307

Tibial nerve dysfunction  

Science.gov (United States)

... through the nerve. The tibial nerve is often injured by pressure from a ligament on the inner part of the ankle. Injury or disease of structures near the knee may also damage the tibial nerve. The tibial ...

308

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)

Full Text Available SciELO Chile | Language: English Abstract in spanish 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

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

2011-09-01

309

Single-incision laparoscopic totally extraperitoneal obturator hernia repair in a patient on antiplatelet therapy: a case report.  

Science.gov (United States)

An 83-year-old woman who complained of right lower limb discomfort was diagnosed with a right obturator hernia by CT scan. On examination, she had a soft and flat abdomen without signs of peritoneal irritation. The Howship-Romberg sign was present. She had a history of vasospastic angina and paroxysmal supraventricular tachycardia, and took aspirin and dipyridamole until she was admitted to the hospital. Exploratory laparoscopy identified a spontaneously reduced small bowel from the right obturator canal, but there were no signs of ischemic and necrotic bowel. The patient underwent SILS for totally extraperitoneal obturator hernia repair without a dissection balloon. The patient recovered without perioperative complications such as hemorrhage and thrombotic episodes. She remains well, and CT scans showed no signs of obturator hernia recurrence at the 7-month follow-up. PMID:25598062

Wakasugi, Masaki; Masuzawa, Toru; Tei, Mitsuyoshi; Omori, Takeshi; Ueshima, Shigeyuki; Tori, Masayuki; Akamatsu, Hiroki

2015-02-01

310

Collagen nerve wrap for median nerve scarring.  

Science.gov (United States)

Nerve wrapping materials have been manufactured to inhibit nerve tissue adhesions and diminish inflammatory and immunologic reactions in nerve surgery. Collagen nerve wrap is a biodegradable type I collagen material that acts as an interface between the nerve and the surrounding tissues. Its main advantage is that it stays in place during the period of tissue healing and is then gradually absorbed once tissue healing is completed. This article presents a surgical technique that used a collagen nerve wrap for the management of median nerve tissue adhesions in 2 patients with advanced carpal tunnel syndrome due to median nerve scarring and adhesions. At last follow-up, both patients had complete resolution with no recurrence of their symptoms. Complications related to the biodegradable material were not observed. PMID:25665110

Kokkalis, Zinon T; Mavrogenis, Andreas F; Ballas, Efstathios G; Papagelopoulos, Panayiotis J; Soucacos, Panayotis N

2015-02-01

311

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

Scientific Electronic Library Online (English)

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.

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

1479-14-01

312

Rehabilitation of post surgical maxillectomy defects using interim obturators-a case series.  

Science.gov (United States)

Prosthetic rehabilitation of extensive maxillectomy defects are exigent given the difficulties faced due to loss of palatal bone,teeth and surrounding supporting tissues which help in retention, support and stability of the prosthesis. An interim maxillary obturator is a prosthesis which is made after surgical resection of a portion or all of one or both maxilla where initial healing is completed. Frequently many or all teeth in the defect area are replaced by this prosthesis. It plays a vital role in preventing the facial disfigurement and irritation to the surgical site thereby enhancing the healing and restores the functional capabilities such as speech, mastication, deglutition etc. To gain better retention and stability, preservation of the unaffected regions is needed which can be achieved by proper surgical planning and designing of the prosthesis. This case series describes rehabilitation of three extensive maxillectomy defects with hollow open and closed interim obturators. PMID:25767349

Choudhury, Minati; Shanmuganathan, N; Padmanabhan, T V; Swarup, Shailee; Grover, Manita; Arumugam, Mahalakshmi

2014-12-01

313

Pharmacological properties of a C-fibre response evoked by saphenous nerve stimulation in an isolated spinal cord-nerve preparation of the newborn rat.  

Science.gov (United States)

1. An isolated spinal cord-peripheral nerve preparation of the newborn rat was developed. In this preparation it is possible to record spinal reflexes from a lumbar ventral root in response to stimulation of the ipsilateral saphenous or obturator nerve. 2. Single shock, weak intensity stimulation of the saphenous nerve induced a fast conducted compound action potential in the L3 dorsal root and a fast depolarizing response in the ipsilateral L3 ventral root. As a stronger stimulus was applied to the saphenous nerve, a slowly conducted compound action potential appeared in the dorsal root and a slow depolarizing ventral root potential (v.r.p.) in the L3 ventral root. 3. Single shock stimulation of the obturator nerve induced a rapidly conducted compound action potential in the L3 dorsal root and monosynaptic and polysynaptic reflexes, with a fast time course, in the ipsilateral L3 ventral root. 4. The slow v.r.p. evoked by saphenous nerve stimulation was depressed by the tachykinin antagonist, [D-Arg1, D-Trp7,9, Leu11] substance P (spantide), 4-16 microM. The response recovered its original shape and size 30-60 min after the removal of this antagonist. 5. The saphenous nerve-evoked slow v.r.p. was depressed by [Met5] enkephalin (0.1-1 microM), dynorphin (1-13)(0.2 microM) and morphine (1-2 microM), and these effects were reversed by naloxone (1 microM). 6. Two endogenous peptides, galanin (1-2 microM) and somatostatin (1-2.5 microM), inhibited the slow v.r.p. evoked by saphenous nerve stimulation, whereas another endogenous peptide, calcitonin gene-related peptide (0.1-0.5 microM), potentiated the slow v.r.p. The slow v.r.p. was also inhibited by gamma-aminobutyric acid (GABA, 20 microM) and muscimol (0.2 microM), and their effects were antagonized by bicuculline (1 microM). 7. The present results suggest that substance P and neurokinin A are involved in the saphenous nerve-evoked C-fibre response in the spinal cord of the newborn rat. PMID:2479438

Nussbaumer, J C; Yanagisawa, M; Otsuka, M

1989-10-01

314

Silicone obturators and the bacterial flora in symptomatic nasal septal perforations  

OpenAIRE

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 nasa...

Hulterstro?m, Anna Karin

2012-01-01

315

Rehabilitation of Hemimaxillectomy with Foldable Obturator in Restricted Mouth Opening: A Case Report  

OpenAIRE

Acquired defects of the head and neck region as in case of hemimaxillectomy can be devastating to the patients and presents considerable reconstructive challenge for the Prosthodontists. The defects created by the surgery results in damaging effects on functional, cosmetic, and psychological aspects of the patient. The purpose of this clinical report is to discuss the method of fabricating a foldable obturator for rehabilitation of a patient of hemimaxillectomy with restricted mouth opening.

Patil, Padmakar S.; Rajkumar, K.

2012-01-01

316

Life-threatening urethral bleeding induced by a pseudoaneurysm of the obturator artery.  

Science.gov (United States)

We report the case of a 56-year-old man who in a motor vehicle collision developed a pelvic fracture and complete urethra rupture. Sudden onset of intermittent severe urethral bleeding occurred and it led to life-threatening blood pressure drop and dyspnea. An angiography of internal iliac artery showed a pseudoaneurysm involving the right obturator artery. Super-selective embolization of the feeding vessel was performed with cessation of the blood flow immediately. PMID:24295270

Huang, Tsung-Yi; Huang, Chun-Nung; Lee, Yung-Chin

2013-12-01

317

Coronal Microleakage in Root Canals Obturated with Lateral Compaction, Warm Vertical Compaction and Guttaflow System  

OpenAIRE

INTRODUCTION: Root canal obturation seals the root canal system to prevent re-entry and/or growth of microorganisms. The provision of an appropriate restoration to coronally seal the access cavity affects the success of endodontic treatment. The purpose of this study was to evaluate the coronal microbial leakage in root canals that were either filled by lateral compaction, GuttaFlow or warm vertical compaction. MATERIALS AND METHODS: In this ex vivo study, 80 single-rooted human extracted tee...

Mohsen Aminsobhani; Abdollah Ghorbanzadeh; Behnam Bolhari; Noushin Shokouhinejad; Sholeh Ghabraei; Hadi Assadian; Marzieh Aligholi

2010-01-01

318

Effect of irrigation with Tetraclean on bacterial leakage of obturated root canals.  

Science.gov (United States)

The purpose of the study presented here was to evaluate the effect of Tetraclean, Hypoclean, Chlor-XTRA, 2% chlorhexidine and 6% sodium hypochlorite/17% EDTA as a final irrigant on bacterial leakage of the root canal. One hundred and fifty-five extracted human maxillary central incisors were randomly divided into five experimental groups of 25 teeth each and two control groups of 15 teeth each. The root canals in each group were irrigated with 2 ml of the relevant irrigant between each filing. The root canals in group 5 were irrigated with 5 ml of 17% EDTA at the end of root canal preparation. The teeth in each group were obturated with gutta-percha and AH-26 sealer. Positive control teeth were obturated with a single gutta-percha cone without sealer, and negative controls were obturated in the same way as experimental groups. The coronal portion of each root was placed in contact with inoculum of Enterococcus faecalis in Brain Heart Infusion (BHI) culture media. Findings showed that the mean number of days for bacterial penetration in the Tetraclean group was greater than for other experimental groups. On the other hand, the Chlor-XTRA Vista group showed the fewest mean number of days for bacterial leakage. PMID:24933773

Mohammadi, Zahed; Shalavi, Sousan; Giardino, Luciano; Palazzi, Flavio

2014-04-01

319

Reverse endoventricular artificial obturator in tricuspid valve position. Experimental feasibility research study.  

Science.gov (United States)

The concept of vena contracta space reduction in tricuspid valve position was tested in an animal model. Feasibility of specific artificial obturator body (REMOT) fixed to the right ventricular apex and interacting with tricuspid valve leaflets was evaluated in three different animal studies. Catheter-based technique was used in three series of experiment in 7 sheep. First acute study was designed for evaluation if the screwing mode of guide wire anchoring to the right ventricular apex is feasible for the whole REMOT body fixing. Longer study was aimed to evaluate stability of the REMOT body in desired position when fixing the screwing wire on its both ends (to the right ventricular apex and to the skin in the neck area). X-ray methods and various morphological methods were used. The third acute study was intended to the REMOT body deployment without any fixing wire. In all of 7 sheep the REMOT was successfully inserted into the right heart cavities and then fixed to the right ventricular apex area. When the REMOT was left in situ more than 6 months it was stable, induced adhesion to the tricuspid valve leaflet and was associated with a specific cell invasion. Releasing of the REMOT from the guiding tools was also successfully verified. Deployment of the obturator body in the aim to reduce the tricuspid valve orifice is feasible and well tolerated in the short and longer term animal model. Specific cell colonization including neovascularization of the obturator body was observed. PMID:24397800

Sochman, J; Peregrin, J H; Pavcnik, D; Uchida, B T; Timmermans, H A; Sedmera, D; Benada, O; Kofronova, O; Keller, F S; Rosch, J

2014-01-01

320

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)

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 defini? 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.

Pedro Aravena Torres

2011-09-01

321

Obturator bypass: a classic approach for the treatment of contemporary groin infection.  

Science.gov (United States)

As the number of cardiac and interventional radiologic procedures has risen, the frequency with which surgeons are called to treat groin complications has increased. Infectious groin problems that often involve foreign prosthetic material or remnants of percutaneous femoral closure devices are particularly challenging and require control of bleeding, removal of foreign material, wide debridement, and sometimes arterial resection. Management of the consequential limb ischemia in such cases is controversial. The purpose of this study is to review the utility of extra-anatomic common femoral bypass through the obturator foramen (obturator bypass) as a method of treating limb ischemia after arterial groin infection. From July 1992 through June 2001 a total of 12 patients (six male) presented with severe vascular infections of the groin and underwent obturator bypass. Infections occurred as a consequence of an isolated vascular graft infection (nine) or after a percutaneous interventional femoral access procedure (three). Patients presented with systemic sepsis and a draining sinus (six), infected pseudoaneurysm (two), or hemorrhage (four). Treatment included debridement of the groin wound, sartorius muscle flap coverage of the femoral vessels, antibiotics and synthetic (eight polytetrafluoroethylene and four Dacron) obturator bypass via a lower abdominal extraperitoneal incision from an aortobifemoral bypass graft limb to the superficial femoral artery (six), native iliac to femoral artery (three), iliac to popliteal artery (two), and aortobifemoral bypass limb to the popliteal artery (one). Graft patency and limb salvage were assessed by Kaplan-Meier life table analysis. There were two (17%) deaths (multisystem organ failure at postoperative days 9 and 6) and four major complications (25%) requiring reoperation in the first 30 days. Ten patients (83%) survived, healed their groin wounds, and are infection free. With a mean follow-up of 37 months graft patency and limb salvage at 60 months were 80 and 60 per cent, respectively. There were no late graft infections. We conclude that the obturator bypass is an effective and durable means of revascularization in the presence of the septic groin. This procedure belongs in the armamentarium of all surgeons managing these complications. PMID:12206597

Patel, Ajay; Taylor, Spence M; Langan, Eugene M; Snyder, Bruce A; Cull, David L; Sullivan, Timothy M; Youkey, Jerry R; Gray, Bruce H; Carsten, Christopher G

2002-08-01

322

Bilateral optic nerve injury.  

OpenAIRE

Bilateral optic nerve injury is a rare condition and is reported in 5-6 percent of all optic nerve injuries. However, there is no published series on bilateral optic nerve injury. Analysis of 31 cases of bilateral optic nerve involvement seen amongst 275 patients with optic nerve injury (11.5 percent) is discussed. Road traffic accident which is the most common cause of optic nerve injury, was recorded in 61 percent. Shotgun injury and blast in jury was the cause in 22.5 percent of cases. All...

Mahapatra A

1999-01-01

323

Recurrent rectal cancer causing lumbosacral plexopathy with perineural spread to the spinal nerves and the sciatic nerve: an anatomic explanation.  

Science.gov (United States)

Several groups have reported cases of rectal cancer with carcinomatous involvement of the lumbosacral plexus and sciatic, obturator, pudendal, or spinal nerves. To our best knowledge, clear examples of perineural tumor spread in rectal carcinoma have not yet been described. We retrospectively reviewed clinical data and imaging studies of three patients with primary or recurrent rectal cancer involving the lumbosacral plexus. Imaging studies included MRI and (18)FDG PET/CT scans in all (n?=?3) patients, histological samples were available in two (n?=?2). Imaging studies demonstrated distinct features of tumor spread from the organ to the plexus and beyond in all cases (n?=?3), histological specimens demonstrated perineural involvement thus supporting our theory (n?=?2). We present these three cases of perineural tumor spread in rectal cancer as a proof of concept. We hypothesize that not only our cases, but other similar reported cases can be explained anatomically by extension of the rectal cancer to the inferior hypogastric plexus with perineural tumor spread to the lumbosacral plexus using the pelvic and sacral splanchnic nerves as conduits. Once the tumor reaches the lumbosacral plexus, it can continue to spread proximally or distally. We believe that perineural spread of colon cancer represents an important, under-recognized mechanism of recurrence to neighboring major nerves in the pelvis. PMID:25090969

Capek, Stepan; Sullivan, Patrick S; Howe, Benjamin M; Smyrk, Thomas C; Amrami, Kimberly K; Spinner, Robert J; Dozois, Eric J

2015-01-01

324

Sealing Efficacy of Single-cone Obturation Technique with MTA and CEM Cement: An in Vitro Bacterial Leakage Study.  

Science.gov (United States)

Background and aims. Various materials and methods have been introduced for obturating cleaned and shaped root canal systems. This in vitro study aimed to evaluate the sealing ability of single-cone obturation technique with mineral trioxide aggregate and calcium-enriched mixture based on bacterial leakage approach. Materials and methods. Sixty-four single-canal teeth were prepared and randomly divided into 5 groups, consisting of three experimental groups (n = 16) and two control groups (n = 8).In group 1, root canal obturation was performed using gutta-percha with 0.02 taper and AH26 sealer by lateral compaction technique. In groups 2 and 3, single Protaper gutta-percha cone was used for obturation with MTA and CEM cement, respectively. A bacterial leakage apparatus was utilized for leakage assessment for 60 days. Leakage comparison between the experimental groups was performed by one-way ANOVA using SPSS 16 statistical software. Results. The mean bacterial leakage intervals in groups 1, 2 and 3 were 33.68 ± 9.39, 40.68 ± 11.03 and 39.56 ± 9.03 days, respectively. One-way ANOVA indicated no significant differences in bacterial leakage between the three experimen-tal groups (P = 0.109). Conclusion. Single-cone obturation with well-fitted gutta-percha and MTA and CEM cement is an appropriate alternative for traditional lateral compaction technique. PMID:25093050

Samiei, Mohammad; Aghazade, Mohammad; Farhadi, Farrokh; Shahveghar, Naeimeh; Torab, Ali; Vahid Pakdel, Seyyed Mahdi

2014-01-01

325

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)

Full Text Available SciELO Brazil | Languages: English, Portuguese Abstract in portuguese 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 c

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

2008-04-01

326

Bloqueio dos nervos ilioinguinal e iliohipogástrico guiado por ultra-sonografia associado à anestesia geral: relato de caso / Ultrasound-guided ileoinguinal and ileohypogastric nerve block associated with general anesthesia: case report / Bloqueo de los nervios íleoinguinal e íleohipogástrico guiado por ultrasonografía asociado a anestesia general: relato de caso  

Scientific Electronic Library Online (English)

Full Text Available JUSTIFICATIVA E OBJETIVOS: Procedimentos cirúrgicos realizados em regime ambulatorial estão se tornando mais freqüentes. O bloqueio dos nervos ilioinguinal e iliohipogástrico tem sido usado para analgesia pós-operatória de pacientes submetidos à herniorrafia inguinal em regime ambulatorial. A ultra- [...] sonografia auxilia as técnicas de anestesia regional possibilitando mais precisão no depósito do anestésico local ao redor dos nervos. O objetivo deste relato foi apresentar um caso de bloqueio dos nervos ilioinguinal e iliohipogástrico guiado por ultra-sonografia em paciente agendado para herniorrafia inguinal em regime ambulatorial. RELATO DO CASO: Paciente do sexo masculino, 36 anos, 74 kg, estado físico ASA I, agendado para realização de herniorrafia inguinal. Foi realizado o bloqueio dos nervos ilioipogástrico e ilioinguinal guiado por ultra-sonografia com ropivacaína a 0,5% e, em seguida, realizada anestesia venosa total. O paciente recebeu alta hospitalar quatro horas após o procedimento com escore de dor avaliado pela Escala Analógica Verbal de 3. CONCLUSÕES: O bloqueio dos nervos iliohipogástrico e ilioinguinal guiado por ultra-sonografia em pacientes submetidos à herniorrafia inguinal em regime ambulatorial pode ser utilizado no auxílio do controle da dor pós-operatória. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: Procedimientos quirúrgicos realizados en régimen ambulatorial se están convirtiendo cada vez más frecuentes. El bloqueo de los nervios íleoinguinal e íleohipogástrico ha sido usado para la analgesia postoperatoria de pacientes sometidos a la herniorrafia inguinal en régime [...] n ambulatorial. La ultrasonografía auxilia las técnicas de anestesia regional posibilitando una mayor precisión en el depósito del anestésico local el rededor de los nervios. El objetivo de este relato fue presentar un caso de bloqueo de los nervios íleoinguinal e íleohipogástrico guiado por ultrasonografía en paciente a realizar herniorrafia inguinal en régimen ambulatorial. RELATO DEL CASO: Paciente del sexo masculino, 36 años, 74 kg, estado físico ASA I, listo para la realización de herniorrafia inguinal. Fue realizado el bloqueo de los nervios íleohipogástrico e íleoinguinal guiado por ultrasonografía con ropivacaína a 0,5% y enseguida fue realizada anestesia venosa total. El paciente tuvo alta 4 horas después del procedimiento con puntuación de dolor evaluado por la Escala Analógica Verbal de 3. CONCLUSIONES: El bloqueo de los nervios íleohipogástrico e íleoinguinal guiados por ultrasonografía en pacientes sometidos a herniorrafia inguinal en régimen ambulatorial, puede ser utilizado en el auxilio del control del dolor postoperatorio. Abstract in english BACKGROUND AND OBJECTIVES: Outpatient surgeries are becoming more frequent. Ilioinguinal and iliohypogastric nerve block has been used in postoperative analgesia of patients undergoing outpatient inguinal herniorrhaphy. Ultrasound-guided regional anesthesia increases the accuracy of deposition of th [...] e local anesthetic around the nerves. The objective of this report was to present a case of ultrasound-guided ilioinguinal and iliohypogastric nerve block for outpatient inguinal herniorrhaphy. CASE REPORT: A 36-year old male patient, 74 kg, physical status ASA I, was scheduled for inguinal herniorrhaphy. Ultrasound-guided iliohypogastric and ilioinguinal nerve block was accomplished with 0.5% ropivacaine, followed by total intravenous anesthesia. The patient was discharged from the hospital 4 hours after the procedure with a pain score of 3 in the Verbal Analogue Scale. CONCLUSION: Ultrasound-guided iliohypogastric and ilioinguinal nerve block in patients undergoing outpatient inguinal herniorrhaphy can be done as an aid to postoperative analgesia.

Diogo Brüggemann da, Conceição; Pablo Escovedo, Helayel.

2008-02-01

327

Diabetes and nerve damage  

Science.gov (United States)

Nerve damage that occurs in people with diabetes is called diabetic neuropathy. This condition is a complicaiton of diabetes . ... About half of people with diabetes develop nerve damage. Symptoms often do not begin until many years ...

328

Ulnar nerve palsy due to axillary crutch.  

Directory of Open Access Journals (Sweden)

Full Text Available A young lady with residual polio, using axillary crutch since early childhood, presented with tingling, numbness and weakness in ulnar nerve distribution of five months duration. Ulnar motor conduction study revealed proximal conduction block near the axilla, at the point of pressure by the crutch while walking. Distal ulnar sensory conduction studies were normal but proximal ulnar sensory conduction studies showed absence of Erb?s point potential. These findings suggested the presence of conduction block in sensory fibers as well. Proper use and change of axillary crutch resulted in clinical recovery and resolution of motor and sensory conduction block.

Veerendrakumar M

2001-01-01

329

The Physics of Nerves  

CERN Document Server

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.

Heimburg, Thomas

2010-01-01

330

Cranial Nerves Model  

Science.gov (United States)

Lesson is designed to introduce students to cranial nerves through the use of an introductory lecture. Students will then create a three-dimensional model of the cranial nerves. An information sheet will accompany the model in order to help students learn crucial aspects of the cranial nerves.

Juliann Garza (University of Texas-Pan American Physician Assistant Studies)

2010-08-16

331

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)

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

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

2011-10-01

332

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

Directory of Open Access Journals (Sweden)

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.

Özgür Genç

2011-08-01

333

Comparison of root canal sealer distribution in obturated root canal: An in-vitro study  

Science.gov (United States)

Background and Objectives: Endodontic sealer is currently regarded with such importance in the root canal treatment that it is often considered to be more important than the core obturating material itself. Sealer with the least film thickness is favorable for minimizing microleakage. The aim of the study is to compare sealer distribution in root canal using three different sealers with three different obturation techniques. Materials and Methods: AH plus, Fuji-1, Tubliseal Extended Working Time (EWT) was placed into the prepared root canals of 90 maxillary central incisors using a lentulospiral. Thereafter, the canals were obturated using three different gutta-percha root filling techniques (single cone, lateral condensation, vertical condensation). Horizontal sectioning was carried out at 3 mm and 6 mm from the apex with a diamond disk. The two specimens thus obtained were examined for sealer distribution using a stereomicroscope and the percentage of sealer coating the perimeter (PSCP) was calculated using a digital imaging system. Results: A significant difference existed in the mean PSCP values of three different sealers (P < 0.000), where Tubliseal (EWT) had the highest PSCP values followed by the AH plus and Fuji-1. Also, between techniques, differences were observed (P < 0.00), where a single cone technique had the highest mean values followed by lateral condensation and vertical condensation. Between the 3 mm and 6 mm sections a non-significant difference was observed (P < 0.945). Conclusion: Tubliseal EWT showed highest PSCP value and Single cone technique showed the higher PSCP value then lateral and vertical condensation technique at 3 mm and 6 mm sections. PMID:25374839

Setya, Gaurav; Nagpal, Ajay; Kumar, Sunil; Ingle, Navin Anand

2014-01-01

334

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)

335

[Hypoglossal nerve neuropraxia after shoulder hemiarthroplasty].  

Science.gov (United States)

We report a case of hypoglossal nerve damage after shoulder hemiarthroplasty with the patient in "beach chair" position, performed with general anesthesia with orotracheal intubation, and without complications. An ultrasound-guided interscalene block was previously performed in an alert patient. After the intervention, the patient showed clinical symptomatology compatible with paralysis of the right hypoglossal nerve that completely disappeared after 4 weeks. Mechanisms such as hyperextension of the neck during intubation, endotracheal tube cuff pressure, excessive hyperextension, or head lateralization during surgery have been described as causes of this neurological damage. We discuss the causes, the associated factors and suggest preventive measures. PMID:23787368

Pariente, L; Camarena, P; Koo, M; Sabaté, A; Armengol, J

2014-05-01

336

[Application of ultrasound in paediatric abdominal trunk blocks].  

Science.gov (United States)

Although relatively few studies have compared US guidance with established "blind" techniques, the available evidence suggests that the use of US guidance is a safe and effective way to facilitate correct needle placement and adequate spread of LA for abdominal wall nerve blocks. It improves block effectiveness and safety by reducing LA doses and by detecting anatomic variants or unsuspected pathologies. Different techniques are described and discussed: the transverse abdominal nerve blocks, the paraombilical block, the inguinal field block and the fascia transversalis block. Matched with improving technology, the use of US has significant benefits over conventional techniques to perform classic and new abdominal wall nerve blocks in children. However, more studies are required to evaluate the potential of US to support this finding. PMID:22197343

Ludot, H

2012-01-01

337

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)

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.

Guilherme de Castro Santos

2011-10-01

338

[Case of inguinal hernia repair with transversus abdominis plane block and rectus sheath block].  

Science.gov (United States)

Transversus abdominis plane block is effective for lower abdominal and inguinal operations, and rectus sheath block is effective for abdominal operations. Recently, ultrasound guided nerve block has been employed, and these techniques can be performed with ultrasound scanning. An 82-year-old man with severe coronary failure and chronic obstructive pulmonary disease was scheduled for inguinal hernia repair. We did not want to select general anesthesia for him, and performed rectus sheath block and transversus abdominis plane block. We achieved good anesthetic management using two peripheral blocks under ultrasound scanning. PMID:19860241

Tanaka, Masaaki; Azuma, Satomi; Hasegawa, Yuko; Mori, Naohiro; Takahashi, Noriko; Oku, Kazunori; Hiramatsu, Runa; Yasumoto, Kazumasa

2009-10-01

339

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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

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

2011-08-01

340

Photoelastic analysis to compare implant-retained and conventional obturator dentures  

Science.gov (United States)

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.

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

341

Coronal microleakage in intact and carious teeth obturated using lateral compaction of gutta-percha  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: Coronal microleakage is one of the most important factors for the success and longevity of endodontically treated teeth. Aim: The aim of this study was to evaluate in vitro the coronal microleakage in carious and intact teeth obturated with lateral compaction of gutta-percha using the dye penetration method. Materials and Methods: Forty extracted human teeth were allocated to two groups: Group I consisted of 20 intact teeth (10 single-rooted and 10 multi-rooted and Group II comprised 20 carious teeth (10 single-rooted and 10 multi-rooted. Root canal preparation was performed using the Step-back technique and copious irrigation with 2.5% NaOCl. All root canals were obturated using lateral compaction and AH Plus endodontic sealer. The teeth were coronally filled with either CAVIT only or the combination of GIC and CAVIT, coated with 2 layers of nail varnish and immersed in 50% AgNO3. Afterwards, the teeth were sectioned mesio-distally using a diamond disc and linear dye penetration was evaluated using a stereo loupe with a micrometer scale at x6 magnification. Results: The results showed dye penetration in 70% of teeth filled with CAVIT and in 10% of teeth filled with GIC+CAVIT. The difference was statistically significant (p<0.05. Conclusion: Based on the obtained results, it may be concluded that the least coronal microleakage was observed in intact teeth temporarily filled with the GIC+CAVIT combination.

?eri Aleksandra

2008-01-01

342

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

Directory of Open Access Journals (Sweden)

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.

Anna Kierklo

2014-03-01

343

Imaging the trigeminal nerve  

Energy Technology Data Exchange (ETDEWEB)

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.

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

344

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

Directory of Open Access Journals (Sweden)

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.

Pécora Jesus Djalma

2002-01-01

345

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)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

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

2009-03-01

346

Conjoined lumbosacral nerve roots  

International Nuclear Information System (INIS)

Several kinds of the lumbosacral nerve root anomalies have already been recognized, and the conjoined nerve roots is the most common among them. It does not make symptoms by itself, but if there is a causation of neural entrapment, for example, disc herniation, lateral recessus stenosis, spondylolisthesis, etc., so called ''biradicular syndrome'' should occur. Anomalies of the lumbosacral nerve roots, if not properly recognized, may lead to injury of these nerves during operation of the lumbar spine. Recently, the chance of finding these anomalous roots has been increased more and more with the use of metrizamide myelography and metrizamide CT, because of the improvement of the opacification of nerve roots. We describe the findings of the anomalous roots as revealed by these two methods. They demonstrate two nerve roots running parallel and the asymmetrical wide root sleeve. Under such circumstances, it is important to distinguish the anomalous roots from the normal ventral and dorsal roots. (author)

347

Population Blocks.  

Science.gov (United States)

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…

Smith, Martin H.

1992-01-01

348

Axillary block as the sole anesthetic for peripherally inserted central catheter placement in an infant with goldenhar syndrome.  

Science.gov (United States)

The use of peripheral nerve block as the sole anesthetic in infants is not very common. Studies have demonstrated that ultrasound guided (USG) peripheral nerve block is associated with higher overall success rate when compared with nerve stimulation (Rubin et al., 2009, and Gelfand et al., 2011). Described below is a medically complex infant who had an USG axillary brachial plexus block for peripherally inserted central catheter (PICC) placement. PMID:24371529

Bernardo-Ocampo, Ma Carmen

2013-01-01

349

Axillary Block as the Sole Anesthetic for Peripherally Inserted Central Catheter Placement in an Infant with Goldenhar Syndrome  

OpenAIRE

The use of peripheral nerve block as the sole anesthetic in infants is not very common. Studies have demonstrated that ultrasound guided (USG) peripheral nerve block is associated with higher overall success rate when compared with nerve stimulation (Rubin et al., 2009, and Gelfand et al., 2011). Described below is a medically complex infant who had an USG axillary brachial plexus block for peripherally inserted central catheter (PICC) placement.

Ma. Carmen Bernardo-Ocampo

2013-01-01

350

Recurrent obturator abscess with spontaneous expulsion of the mesh after transobturator tape operation.  

Science.gov (United States)

The transobturator tape operation has been the most popular method of SUI surgery worldwide owing to its low complication rate and high success rate. However, erosions and abscesses secondary to transobturator tape have been observed. Here we report a 36-year-old woman referred to our unit with fever, persistent swelling in the left groin, difficulty in walking, and a tape that came through the vagina, 4 years after the transobturator tape operation. She had a history of ischiorectal abscess and rectovaginal fistula. A recurrent obturator abscess with fistula formation and spontaneous expulsion of the mesh was diagnosed. The patient underwent antibiotic therapy, incision through the fistula tract, drainage of the abscess, and removal of the necrotic material. Patients should be informed about risks of erosion and infection and that pain and foul smelling vaginal discharge might be the first signs of severe infectious morbidities after transobturator tape operation. PMID:23512114

Ugurlucan, Funda Gungor; Ozsurmeli, Mehmet; Bakir, Baris; Saygili, Halil; Yalcin, Onay

2013-12-01

351

Cross-sectional assessment of apical dye penetration following three endodontic obturation techniques.  

Science.gov (United States)

This study sought to investigate apical leakage following three endodontic obturation techniques. Fifty-one recently extracted maxillary and mandibular canines were decoronated at the cementoenamel junction (CEJ) level and a size 10 file was passed to the exit of the apical foramen. Working distance was established 0.5 mm from where the file could be seen exiting the apical foramen. All teeth were instrumented using Brasseler Sequence files to a .06 taper size 40 file at working distance. The teeth were randomly divided into three groups: Group A (lateral condensation of gutta-percha with Roth's 811 Elite sealer), Group B (gutta-percha with GuttaFlow sealer), and Group C (Activ GP gutta-percha cone with Activ GP glass ionomer sealer). Two groups of three teeth served as positive and negative controls. There were no significant differences between Groups A and B; however, Group C was significantly different from Groups A and B. PMID:19906611

Gatewood, R Scott; Farrar, J Roman

2009-01-01

352

Optic nerve oxygenation  

DEFF Research Database (Denmark)

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 similar levels of perfusion pressure. The levels of perfusion pressure that lead to optic nerve hypoxia in the laboratory correspond remarkably well to the levels that increase the risk of glaucomatous optic nerve atrophy in human glaucoma patients. The risk for progressive optic nerve atrophy in human 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 tension. Lowering the intraocular pressure tends to increase the optic nerve oxygen tension, even though this effect may be masked by the autoregulation when the optic nerve oxygen tension and perfusion pressure is in the normal range. Carbonic anhydrase inhibitors increase the optic nerve oxygen tension through a mechanism of vasodilatation and lowering of the intraocular pressure. Carbonic anhydrase inhibition reduces the removal of CO2 from the tissue and the CO2 accumulation induces vasodilatation resulting in increased blood flow and improved oxygen supply. This effect is inhibited by the cyclo-oxygenase inhibitor, indomethacin, which indicates that prostaglandin metabolism plays a role. Laboratory studies suggest that carbonic anhydrase inhibitors might be useful for medical treatment of optic nerve and retinal ischemia, potentially in diseases such as glaucoma and diabetic retinopathy. However, clinical trials and needed to test this hypotheses.

Stefánsson, Einar; Pedersen, Daniella Bach

2005-01-01

353

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

Directory of Open Access Journals (Sweden)

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.

Ili? Dragan

2004-01-01

354

Robot-Assisted Gynecologic Oncology Surgery  

Medline Plus

Full Text Available ... obturator vein that was isolated. This is the obturator nerve. We take the lymphatics ventral to the nerve ... much less blood loss. And we see the obturator nerve coming up close in view here, so we' ...

355

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

Directory of Open Access Journals (Sweden)

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

AR - Farhad

2006-01-01

356

Optic nerve sheath meningocele  

Directory of Open Access Journals (Sweden)

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

Juan Carlos Mesa-Gutiérrez

2008-10-01

357

The vestibulocochlear nerve.  

Science.gov (United States)

The eighth nerve provides sensory connection for balance and sound. Our ability to evaluate its morphology and pathology with magnetic resonance imaging (MRI) has been substantially improved over the past 20 years. This article reviews the relevant anatomy of the eighth nerve. A thorough discussion of the potential pathologic processes affecting its function also is included. Foremost, is a review of acoustic schwannomas, emphasizing the role of imaging in the work-up and ongoing evaluation of these patients. Discussion and examples of the plethora of neoplastic, inflammatory, infectious, congenital, ischemic, and compressive pathologies involving the nerve are included as well. PMID:12168998

Spickler, Eric M; Govila, Lisa

2002-06-01

358

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

Scientific Electronic Library Online (English)

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

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

359

Fibrolipomatous hamartoma of median nerve  

International Nuclear Information System (INIS)

Full text: Fibrolipomaous hamartoma is a benign neoplasm of nerves, resulting from anomalous growth of fibroadipose tissue of the nerve sheath. The median nerve is the most commonly involved nerve. Magnetic resonance imaging (MRI) features are pathognomonic, showing a coaxial cable-like appearance on axial images and spaghetti-like appearance on coronal images. Preferred management of the lesion is conservative

360

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)

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.

Reinaldo Grueso Angulo

2010-04-01

361

Transvaginal Oocyte Retrieval Complicated by Life-Threatening Obturator Artery Haemorrhage and Managed by a Vessel-Preserving Technique.  

OpenAIRE

We report the case of a 36-year-old woman with secondary infertility who underwent routine transvaginal oocyte retrieval as part of IVF treatment. Four days following the procedure she presented with life threatening haemorrhagic shock. She underwent surgical laparotomy followed by CT and selective angiography, which demonstrated haemorrhage from a pseudoaneurysm of the obturator artery. The haemorrhage was successfully managed endovascularly with a vessel preserving covered stent.

Bolster, Ferdia; Mocanu, Edgar; Geoghegan, Tony; Lawler, Leo

2014-01-01

362

Transvaginal oocyte retrieval complicated by life-threatening obturator artery haemorrhage and managed by a vessel-preserving technique.  

Science.gov (United States)

We report the case of a 36-year-old woman with secondary infertility who underwent routine transvaginal oocyte retrieval as part of IVF treatment. Four days following the procedure she presented with life threatening haemorrhagic shock. She underwent surgical laparotomy followed by CT and selective angiography, which demonstrated haemorrhage from a pseudoaneurysm of the obturator artery. The haemorrhage was successfully managed endovascularly with a vessel preserving covered stent. PMID:25484463

Bolster, Ferdia; Mocanu, Edgar; Geoghegan, Tony; Lawler, Leo

2014-09-01

363

High-resolution measurement of electrically-evoked vagus nerve activity in the anesthetized dog  

Science.gov (United States)

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.

Yoo, Paul B.; Lubock, Nathan B.; Hincapie, Juan G.; Ruble, Stephen B.; Hamann, Jason J.; Grill, Warren M.

2013-04-01

364

Cervical Radiculopathy (Pinched Nerve)  

Science.gov (United States)

... by the American Academy of Orthopaedic Surgeons. Cervical Radiculopathy (Pinched Nerve) Some people have neck pain that ... The medical term for this condition is cervical radiculopathy. Understanding your spine and how it works can ...

365

Lymphoma Nerve Infiltration  

Directory of Open Access Journals (Sweden)

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.

Baehring JM

2014-01-01

366

Vagus Nerve Stimulation.  

Science.gov (United States)

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. Right cervical VNS is effective for treating heart failure in preclinical studies and a phase II clinical trial. The effectiveness of various forms of non-invasive transcutaneous VNS for epilepsy, depression, primary headaches, and other conditions has not been investigated beyond small pilot studies. The relationship between depression, inflammation, metabolic syndrome, and heart disease might be mediated by the vagus nerve. VNS deserves further study for its potentially favorable effects on cardiovascular, cerebrovascular, metabolic, and other physiological biomarkers associated with depression morbidity and mortality. PMID:24834378

Howland, Robert H

2014-06-01

367

Recurrent laryngeal nerve injury  

OpenAIRE

Injury to the recurrent laryngeal nerve is accompanied by a poor functional recovery of the target organ, the larynx. For the patient this means impairments of vocal fold mobility and various kinds of voice disorders. In this thesis, an experimental model in the rat is used to identify the most important pathological factors involved after recurrent laryngeal nerve injury. The results demonstrate that the posterior cricoarytenoid muscle, the only abductor of the vocal fold, ...

Hydman, Jonas

2008-01-01

368

Nerve conduction study of the medial and lateral plantar nerves.  

Science.gov (United States)

The medial and lateral plantar nerves may be evaluated through the recordings of the compound sensory nerve action potentials (CSNAP), compound mixed nerve action potentials (CMNAP) and compound muscular action potentials (CMAP). As some of these potentials are not easily and always obtainable in normal individuals, our purpose was to verify the consistency of these potentials for the study of these nerves. Fifty-one normal adult volunteers were examined. The CSNAP, CMNAP and CMAP, related to the medial and lateral plantar nerves were evaluated bilaterally. CSNAP were not obtained in 7.8% and in 17.6% from the medial and lateral plantar nerves respectively. CMNAP from the lateral plantar nerve were not obtained in 15.6%. CMNAP from the medial plantar nerves and CMAPs from the abductor hallucis and abductor digiti quinti were obtained for all nerves tested. Our results, therefore, suggest that these last 3 parameters are the ones more reliable for clinical application. PMID:10812535

Antunes, A C; Nobrega, J A; Manzano, G M

2000-01-01

369

Influence of irrigation and obturation techniques on artificial lateral root canal filling capacity  

Scientific Electronic Library Online (English)

Full Text Available SciELO Argentina | Language: English Abstract in portuguese O objetivo do presente estudo foi avaliar a influencia de dois diferentes protocolos de irrigacao na capacidade de penetracao de canais artificiais, utilizando diferente tecnicas de obturacao. Sessenta dentes humanos unirradiculares foram utilizados. Dois canais laterais artificiais foram confeccion [...] ados no terco apical do dente. Os canais foram instrumentados ate uma lima K 45 no comprimento de trabalho. Antes do uso de cada lima, os canais radiculares foram irrigados com 2 mL de NaOCl 2.5% ou com Clorexidina gel 2% seguido de solucao salina. Ambos os grupos receberam no final da instrumentacao 3 mL de EDTA 17%. Os especimes foram randomicamente separados em 3 subgrupos de acordo com a tecnica de obturacao utilizada: (1) tecnica de compactacao lateral; (2) tecnica hibrida de Tagger; e (3) tecnica termoplastica utilizando o BeeFill 2 em 1. Em todos os grupos o cimento utilizado foi o AH Plus. Depois, os elementos foram diafanizados utilizando metil salicilato. As extensoes de pe - netracao dos cimentos nos canais laterais foram realizadas utilizando estereomicroscopio (X30). Os dados de cada grupo foram analizados utilizando ANOVA e o teste de Tukey (p0.05). Pode-se concluir que independente da substancia quimica auxiliar utilizada, as tecnicas termoplasticas de obturacao demonstraram maior penetracao de canais laterais do que a tecnica de compactacao lateral. Abstract in english The aim of this study was to evaluate the influence of two different irrigation protocols on artificial lateral root canal filling capacity using different obturation techniques. Sixty single-root human teeth were used. Two artificial lateral canals were created in the apical third. Root canals were [...] instrumented up to a 45 K-file to the working length. Before each file, root canals were irrigated either with 2 mL of 2.5% NaOCl or 2% chlorhexidine gel with further irrigation with saline solution and 3 mL of 17% EDTA. Specimens were randomly divided into three groups according to the obturation technique: (1) lateral compaction technique; (2) Tagger hybrid technique; and (3) thermoplasticized technique using BeeFill 2 in 1. All groups used AH Plus as the root canal sealer. The specimens were decalcified and cleared in methyl salicylate. The total length of lateral canals was observed under X30 magnification with a stereomicroscope and measured on the buccal and lingual root surfaces using Leica IM50 software. The data were submitted to ANOVA and Tukey test (p0.05). Regardless of the irrigant used during endodontic procedures, the thermoplasticized techniques showed higher penetration behavior for filling artificial lateral canals than the lateral compaction technique.

Emmanuel J, Silva; Daniel R, Herrera; Eduardo J, Souza-Júnior; João M, Teixeira.

2013-10-01

370

Effects of two new aminoglycoside antibiotics on the rat sciatic nerve-gastrocnemius muscle preparation.  

Science.gov (United States)

2'-Amino-2'-deoxy-kanamycin (bekanamycin, Kanendomycin) and pentisomicin displayed a neuromuscular blocking activity on the rat sciatic nerve-gastrocnemius muscle preparation. Pentisomicin showed the highest neuromuscular blocking effect; the neuromuscular blocking potency of bekanamycin was similar to that of tobramycin, another new aminoglycoside. The neuromuscular block produced by these antibiotics was reversed by calcium chloride whereas it was not influenced by neostigmine methylsulfate. PMID:6686047

Renna, G; Siro-Brigiani, G; Cagiano, R; Cuomo, V

1983-01-01

371

Root canal obturation: experimental study on the thermafil system related to different irrigation protocols  

Science.gov (United States)

Summary Aim The aim of this study was to stress the ability of a specific obturation technique (thermafil technique) to seal root canal system in presence or absence of smear layer. Methodology Sixteen monoradicular teeth, extracted for periodontal reasons, were collected for this study. All specimens were prepared with nickel-titanium rotary files, and then divided into two groups: for each group was applied a different kind of irrigation method, verifying the effectiveness in removing the smear layer, thus rendering the dentinal tubules more permeable for penetration of softened gutta-percha. Thermafil system was used to fill the root canals, and then all the specimens were observed under scanning electron microscope (SEM). Results The results showed that the Group which followed irrigation only with sodium hypochlorite exhibited significantly less gutta-percha tags when compared to the second Group, which was irrigated with sodium hypochlorite and EDTA. Conclusion The thermafil systems have a very good quality of compression and fluency that permit to gain a good seal of endodontic space; furthermore it allows the penetration of gutta-percha with the formation of numerous of gutta-percha tags inside the dentinal tubules above all when smear layer is reduced or eliminated. PMID:25506413

Migliau, Guido; Sofan, Afrah Ali Abdullah; Sofan, Eshrak Ali Abdullah; Cosma, Salvatore; Eramo, Stefano; Gallottini, Livio

2014-01-01

372

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

Science.gov (United States)

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

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

373

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)

Full Text Available SciELO Brazil | Languages: English, Portuguese, Spanish Abstract in portuguese 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

Evren, Yucel; Iclal Ozdemir, Kol; Cevdet, Duger; Kenan, Kaygusuz; Sinan, Gursoy; Caner, Mimaroglu.

2013-08-01

374

A VARIATION IN THE HIGH DIVISION OF THE SCIATIC NERVE AND ITS RELATION WITH PIRIFORMIS MUSCLE  

Directory of Open Access Journals (Sweden)

Full Text Available The aim of the study was to describe and analyze sciatic nerve variation especially the higher division within the lesser pelvis and its different routes of exit from pelvis. The sciatic nerve (SN separates into its branches, the tibial and common peroneal nerves, outside the pelvis. However, it may rarely be separated within the pelvis. In such cases, the tibial nerve and the common peroneal nerve may leave the pelvis through different routes. These variations may cause nerve compressions under other anatomic structures, resulting in non-discogenic sciatica. 86 gluteal regions were examined in 43 formalin-fixed adult cadavers from different medical colleges of Gujarat region. From the study we found higher division of sciatic nerve bilaterally mainly in the female which is very rare and unilateral higher division of sciatic nerve which is also rare. The differences in the exit routes of these two nerves are important for surgeons, as this is the area of frequent surgical manipulation, nerve injury during deep intramuscular injections in gluteal region, failed sciatic nerve block in anesthesia and injury during posterior hip operations. [National J of Med Res 2011; 1(2.000: 27-30

Shailesh Patel

2011-04-01

375

Vagus Nerve Stimulation (VNS Therapy)  

Medline Plus

Full Text Available ... a little battery that constantly delivers small electrical impulses to a nerve that is in the neck. ... big nerve in the neck and it delivers impulses toward the brain on a continuous basis. The ...

376

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, ...

377

Vagus Nerve Stimulation (VNS Therapy)  

Medline Plus

Full Text Available ... the area where the nerve is. It lies right next to an artery and a vein, which ... called the carotid sheath. The vagus nerve runs right between the carotid artery and the jugular vein, ...

378

Multispectral photoacoustic imaging of nerves with a clinical ultrasound system  

Science.gov (United States)

Accurate and efficient identification of nerves is of great importance during many ultrasound-guided clinical procedures, including nerve blocks and prostate biopsies. It can be challenging to visualise nerves with conventional ultrasound imaging, however. One of the challenges is that nerves can have very similar appearances to nearby structures such as tendons. Several recent studies have highlighted the potential of near-infrared optical spectroscopy for differentiating nerves and adjacent tissues, as this modality can be sensitive to optical absorption of lipids that are present in intra- and extra-neural adipose tissue and in the myelin sheaths. These studies were limited to point measurements, however. In this pilot study, a custom photoacoustic system with a clinical ultrasound imaging probe was used to acquire multi-spectral photoacoustic images of nerves and tendons from swine ex vivo, across the wavelength range of 1100 to 1300 nm. Photoacoustic images were processed and overlaid in colour onto co-registered conventional ultrasound images that were acquired with the same imaging probe. A pronounced optical absorption peak centred at 1210 nm was observed in the photoacoustic signals obtained from nerves, and it was absent in those obtained from tendons. This absorption peak, which is consistent with the presence of lipids, provides a novel image contrast mechanism to significantly enhance the visualization of nerves. In particular, image contrast for nerves was up to 5.5 times greater with photoacoustic imaging (0.82 +/- 0.15) than with conventional ultrasound imaging (0.148 +/- 0.002), with a maximum contrast of 0.95 +/- 0.02 obtained in photoacoustic mode. This pilot study demonstrates the potential of photoacoustic imaging to improve clinical outcomes in ultrasound-guided interventions in regional anaesthesia and interventional oncology.

Mari, Jean Martial; West, Simeon; Beard, Paul C.; Desjardins, Adrien E.

2014-03-01

379

Variant anatomy of sciatic nerve in a black Kenyan population.  

Science.gov (United States)

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

Ogeng'o, J A; El-Busaidy, H; Mwika, P M; Khanbhai, M M; Munguti, J

2011-08-01

380

Peripheral nerve injury and regeneration  

OpenAIRE

The process of nerve regeneration has been studied extensively by traditional morphological methods, but it is only recently that has been possible to identify more precisely the contribution of different nerve subpopulations. By studying different models of nerve repair and regeneration, it is becoming apparent that other tissue components are contributing to the overall process. When muscle grafting is carried out to repair an injured nerve, the regenerating ...

Terenghi, G.

1995-01-01

381

Ultrasound-guided supra-inguinal fascia iliaca block: a cadaveric evaluation of a novel approach.  

Science.gov (United States)

Existing descriptions of ultrasound-guided fascia iliaca block focus on injection of local anaesthetic inferior to the inguinal ligament, relying on supra-inguinal spread to block the lateral femoral cutaneous nerve in the iliac fossa. In this study, we explored injectate spread and nerve involvement in a cadaveric dye-injection model, using a supra-inguinal ultrasound-guided technique that places local anaesthetic directly into the iliac fossa. Bilateral injections of 20 ml 0.25% aniline blue dye were made in six unembalmed cadavers. The femoral nerve was stained by the dye in all twelve injections. The lateral femoral cutaneous nerve was stained bilaterally in five cadavers, but the nerve was absent on both sides in the sixth cadaver. The ilio-inguinal nerve passed into the iliac fossa over the iliacus muscle in eight of the hemi-pelvi and was stained in seven of these occasions. We have performed more than 150 blocks in patients using this approach without complications. Injection using this technique in cadavers leads to extensive fluid spread throughout the iliac fossa. In patients this approach may allow