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CT-guided obturator nerve block via the posterior approach  

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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.)

2006-04-01

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

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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

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

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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

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

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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

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

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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

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

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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

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

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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

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Ectopic pregnancy presenting with obturator nerve pain.  

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

Ali, H. S.

1998-01-01

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

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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.

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

2014-01-01

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Successful obturator nerve repairing: Intraoperative sural nerve graft harvesting in endometrium cancer patient  

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INTRODUCTION Intraoperative injury of obturator nerve is a rare complication of gynecologic surgeries, it has been reported especially in patients with endometriosis and genitourinary malignancies. Gynecologic patients undergoing open lymphadenectomy are at increased risk of obturator nerve injury. PRESENTATION OF CASE A 60-year-old woman with FIGO stage II Grade II endometrial adenocarcinoma underwent bilateral pelvic paraaortic lymphadenectomy. During right obturator lymph node dissection, the right obturator nerve was inadvertently transected with Harmonic scalpel sealing system. The graft was used to anastomose epyneurium of distal segment of obturator nerve to its counterpart in the proximal segment with 10–0 prolen suture. DISCUSSION In case of iatrogenic nerve transection, microsurgical end to end tension-free coaptation is advocated. In case of the obturator nerve is fixed and because of the thermal injury end to end alignment can not be achieved, nerve grafting is necessary. CONCLUSION According to our knowledge, successful immediate grafting of iatrogenically damaged obturator nerve during pelvic lymphadenectomy in our patient is the third report of such a case, but also it has a unique feature of being the first obturator nerve repairing case after dissected with tissue sealing system which causes large sealed area that does not make it possible to make end-to-end anastomosis without nerve harvesting.

Harma, Muge; Sel, Gorker; Ac?kgoz, Bektas; Harma, Mehmet Ibrahim

2014-01-01

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

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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)

2008-01-01

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[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].  

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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

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

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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. Clin. Anat. 27:783-788, 2014. © 2013 Wiley Periodicals, Inc. PMID:24288352

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

2014-07-01

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

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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

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

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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.

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

2013-01-01

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

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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

17

Techniques of facial nerve block.  

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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

Schimek, F; Fahle, M

1995-01-01

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Techniques of facial nerve block.  

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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

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

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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

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

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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

 
 
 
 
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[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].  

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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

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Peripheral nerve blocks in pediatric anesthesia  

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Introduction Most children undergoing surgery can benefit from regional anesthetic techniques, either as the sole anesthetic regimen or, as usual in pediatric practice, in combination with general anesthesia. The use of peripheral nerve blocks (PNBs) in pediatric anesthesia is an effective way to decrease the side-effects and complications associated with central blocks. In spite of their many advantages, including easy performance end efficacy, peripheral nerve blocks are still underused. Ob...

Novakovi? Dejan; Budi? Ivana; Simi? Dušica; ?or?evi? Nina; Slavkovi? An?elka; Živanovi? Dragoljub

2009-01-01

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CT Guided Pudendal Nerve Block  

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Purpose: Retrospective review of CT-guided pudendal nerve blockade for chronic pelvic pain caused by pudendal neuralgia. Materials & Methods: The study included 23 patients (average age, 40.6 yr; range, 25 - 71 yr

2013-01-01

24

Peripheral nerve blocks in pediatric anesthesia  

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Full Text Available Introduction Most children undergoing surgery can benefit from regional anesthetic techniques, either as the sole anesthetic regimen or, as usual in pediatric practice, in combination with general anesthesia. The use of peripheral nerve blocks (PNBs in pediatric anesthesia is an effective way to decrease the side-effects and complications associated with central blocks. In spite of their many advantages, including easy performance end efficacy, peripheral nerve blocks are still underused. Objective This article discusses a general approach to PNBs in children and provides data concerning the practice of this regional technique in different age groups. Methods Data from 1,650 procedures were prospectively collected during the period from March 1, 2007 to February 29, 2008. The type of PNB, if any, as well as the patient age were noted. Our patients were divided into four groups: 0-3 years, 4-7 years, 8-12 years and 13-18 years. Results During the investigated period, PNBs as a sole technique or in anesthetized children were performed in 7.45% of cases. Ilioingunal/iliohypogastric nerve block and penile block were the most common (70% of all PNBs distributed mainly among the children between 4-7 years of age (p<0.05. In older children, extremity PNBs predominate in regard to other types of blocks. PNBs are most frequently performed under general anesthesia (85%, so the perineural approach requires a safe technique to avoid nerve damage. Conclusion The observed differences in PNB usage seem to be related to patient age and correlate with common pathology and also with technical availability of PNB performance.

Novakovi? Dejan

2009-01-01

25

Occipital Nerve Block for Surgery on the Posterior Scalp  

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Full Text Available Patients that present with scalp lesions within the distribution of cranial and spinal nerves may benefit considerably from regional nerve blocks, in this case, an occipital nerve in combination with spinal anesthesia for lower extremity anesthesia. Such blocks can be used additionally as a source of postoperative pain relief.

Saad Mohammad

2013-01-01

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

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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

27

Obturator Hernia  

International Nuclear Information System (INIS)

Obturator hernia is a rare type of pelvic hernia and the clinical diagnosis is difficult to make. However, a delay in diagnosis is associated with a high mortality rate. Sixty-two patients with obturator hernia undergoing surgery at the Tokyo Metropolitan Geriatric Hospital between 1968 and 2006 were assessed, to identity the clinical features of obturator hernias. Patients with obturator hernias tended to be elderly, thin multiparous females. One-third of the cases had bilateral obturator hernia; therefore, bilateral hernias should be ruled out in patients with one obturator hernia. Most patients had a lower-median incision; a bowel resection was done in more than half of cases. Pelvic CT is very useful for diagnosing obturator hernia and allows an early preoperative diagnosis to be made. In this study it was found that bilateral obturator hernias are more common than previously noted. Unfortunately, it is still common for patients not to be properly diagnosed and to receive conservative treatment; the need to rule out obturator hernia should be stressed to all hospital departments. (author)

2008-09-01

28

Nerve blocks in the critical care environment.  

Science.gov (United States)

The critical care patient population has much to gain from properly administered neural blockade. Effective analgesia alone may make the difference between a patient who is able to compensate for their acute insult and one who cannot. A good example is the patient with multiple fractured ribs, who, after intercostal nerve blocks, no longer requires intubation and mechanical ventilation. The authors believe that effective analgesia is just the beginning of the beneficial effects of neural blockade, because blockade of the afferent limb of sympathetic and sensory nerves may circumvent the neuroendocrine response to acute injury. There is evidence that the stress response is not beneficial in the hospital setting and in fact may be detrimental. Some of the effects include elevated plasma catecholamines, ADH, cortisol, and blood glucose, which contribute to tachycardia, hypertension, increased myocardial work and oxygen consumption, salt and water retention, and a catabolic state with negative nitrogen balance. Whether these changes result in reduced morbidity and mortality has been the subject of several studies, but more studies are needed. It would seem that critically ill patients with little physiologic reserve might be the best population to study because even a small improvement may improve survival. A small beneficial effect in healthy postoperative patients may not be clinically apparent. Most would agree that neural blockade used intraoperatively results in reduced blood loss and a lower incidence of postoperative thromboembolism. The continuation of these techniques into the postoperative period may reduce morbidity and mortality in high-risk patients. A word of caution is in order. The indiscriminate application of the techniques described in this article to critically ill patients would not be in the patients' best interest. Nerve blocks are only safe in the hands of those physicians specifically trained to perform them. In addition, local anesthetics have a low therapeutic ratio, and their administration requires continual observation. The use of epidural or intrathecal opioids alone or in combination with other agents also has potentially serious side effects, and requires continual patient monitoring. The proper performance and maintenance of these techniques requires a large commitment of time, manpower, equipment, and a multidisciplinary approach to include physicians, nursing, and support staff. Nerve blocks and other sophisticated techniques started in the operating room or critical care unit should not necessarily be discontinued when the patient is transferred to a ward bed because the full benefit of this therapy may not have been fully realized.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2188709

Rung, G W; Marshall, W K

1990-04-01

29

Ultrasound Guidance for Deep Peripheral Nerve Blocks: A Brief Review  

Science.gov (United States)

Nerve stimulation and ultrasound have been introduced to the practice of regional anesthesia mostly in the last two decades. Ultrasound did not gain as much popularity as the nerve stimulation until a decade ago because of the simplicity, accuracy and portability of the nerve stimulator. Ultrasound is now available in most academic centers practicing regional anesthesia and is a popular tool amongst trainees for performance of nerve blocks. This review article specifically discusses the role of ultrasonography for deeply situated nerves or plexuses such as the infraclavicular block for the upper extremity and lumbar plexus and sciatic nerve blocks for the lower extremity. Transitioning from nerve stimulation to ultrasound-guided blocks alone or in combination is beneficial in certain scenarios. However, not every patient undergoing regional anesthesia technique benefits from the use of ultrasound, especially when circumstances resulting in difficult visualization such as deep nerve blocks and/or block performed by inexperienced ultrasonographers. The use of ultrasound does not replace experience and knowledge of relevant anatomy, especially for visualization of deep structures. In certain scenarios, ultrasound may not offer additional value and substantial amount of time may be spent trying to find relevant structures or even provide a false sense of security, especially to an inexperienced operator. We look at available literature on the role of ultrasound for the performance of deep peripheral nerve blocks and its benefits.

Wadhwa, Anupama; Kandadai, Sunitha Kanchi; Tongpresert, Sujittra; Obal, Detlef; Gebhard, Ralf Erich

2011-01-01

30

Post operative pain relief through intermittent mandibular nerve block  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Mandibular nerve block is often performed for diagnostic, therapeutic and anesthetic purposes for surgery involving mandibular region. Advantages of a nerve block include excellent pain relief and avoidance of the side effects associated with the use of opiods or Non-steroidal anti-inflammatory drug (NSAIDs). A patient with maxillo facial trauma was scheduled for open reduction and internal fixation of right parasymphyseal mandibular fracture. The mandibular nerve was approached using the lat...

Sawhney, Chhavi; Agrawal, Pramendra; Soni, Kapil Dev

2011-01-01

31

High frequency electrical conduction block of the pudendal nerve  

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A reversible electrical block of the pudendal nerves may provide a valuable method for restoration of urinary voiding in individuals with bladder–sphincter dyssynergia. This study quantified the stimulus parameters and effectiveness of high frequency (HFAC) sinusoidal waveforms on the pudendal nerves to produce block of the external urethral sphincter (EUS). A proximal electrode on the pudendal nerve after its exit from the sciatic notch was used to apply low frequency stimuli to evoke EUS ...

2006-01-01

32

High frequency electrical conduction block of the pudendal nerve  

Science.gov (United States)

A reversible electrical block of the pudendal nerves may provide a valuable method for restoration of urinary voiding in individuals with bladder-sphincter dyssynergia. This study quantified the stimulus parameters and effectiveness of high frequency (HFAC) sinusoidal waveforms on the pudendal nerves to produce block of the external urethral sphincter (EUS). A proximal electrode on the pudendal nerve after its exit from the sciatic notch was used to apply low frequency stimuli to evoke EUS contractions. HFAC at frequencies from 1 to 30 kHz with amplitudes from 1 to 10 V were applied through a conforming tripolar nerve cuff electrode implanted distally. Sphincter responses were recorded with a catheter mounted micro-transducer. A fast onset and reversible motor block was obtained over this range of frequencies. The HFAC block showed three phases: a high onset response, often a period of repetitive firing and usually a steady state of complete or partial block. A complete EUS block was obtained in all animals. The block thresholds showed a linear relationship with frequency. HFAC pudendal nerve stimulation effectively produced a quickly reversible block of evoked urethral sphincter contractions. The HFAC pudendal block could be a valuable tool in the rehabilitation of bladder-sphincter dyssynergia.

Bhadra, Narendra; Bhadra, Niloy; Kilgore, Kevin; Gustafson, Kenneth J.

2006-06-01

33

beta-Bungarotoxin and parasympathetic nerve blocking action.  

Science.gov (United States)

Autonomic effects of beta-bungarotoxin (beta-BuTX), a presynaptic blocking agent at the neuromuscular junction, were examined with parasympathetic (vagus), sympathetic nerve-atrial preparations isolated from guinea pigs. beta-BuTX in concentrations ranging from 0.01 to 10 micrograms/ml abolished the negative inotropic and chronotropic responses to electrical stimulation of the preganglionic trunks of the vagus nerve. This effect was time- and dose-related and was not restored by repeated washings. Such blocking action of beta-BuTX was also obtained when post-ganglionic stimulation was applied. On the other hand, beta-BuTX failed to block the positive inotropic and chronotropic responses to either pre- or postganglionic sympathetic nerve stimulation. The nicotine-induced negative, then positive inotropic and chronotropic effects, under nerve conduction block with tetrodotoxin, were little affected with the application of beta-BuTX. The negative or positive responses to exogenously applied acetylcholine or norepinephrine were also unaffected by beta-BuTX. Thus, beta-BuTX apparently blocks cholinergic transmission in the vagus nerve innervating the guinea-pig heart, probably by acting on the postganglionic nerve terminals, yet does not interfere with preganglionic cholinergic and postganglionic adrenergic transmissions in the sympathetic nerves. PMID:7359364

Muramatsu, I; Fujiwara, M; Miura, A; Hayashi, K; Lee, C Y

1980-04-01

34

Ultrasound-guided nerve blocks in the emergency department  

Directory of Open Access Journals (Sweden)

Full Text Available Peripheral nerve blocks preclude the need for procedural sedation and provide adequate anesthesia during painful procedures. This technique can be performed in the emergency department with the aid of ultrasound imaging to identify target nerves. We describe eight cases of upper and lower extremity nerve blocks performed under ultrasound guidance in the emergency department of the Jai Prakash Narayan Trauma Centre, All India Institute of Medical Sciences, New Delhi. Only two of the patients, both with extensive injuries, required any additional anesthesia during the subsequent procedures and all of them reported significant pain control and muscle relaxation.

Bhoi Sanjeev

2010-01-01

35

Local nerve blocks for postoperative analgesia1  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

36

Ultrasound-guided peripheral nerve blocks: what are the benefits?  

DEFF Research Database (Denmark)

BACKGROUND: Use of ultrasound by anaesthesiologists performing regional blocks is rapidly gaining popularity. The aims of this review were to summarize and update accumulating evidence on ultrasound-guided nerve blocks, with an emphasis on the clinical relevance of the results and to critically appraise changing standards in regional anaesthesia. METHODS: A search of MEDLINE and EMBASE (1966 to 31 December 2007) was conducted using the following free terms: 'ultrasound and regional anesthesia', 'ultrasound and peripheral block' and 'ultrasound and nerve and block'. These were combined with the MESH terms 'nerve block' and 'ultrasonography'. The following limits were applied: studies with abstracts, only in humans, published in core clinical journals. Trial type: meta-analysis, randomized-controlled trial and clinical trial. RESULTS: When peripheral nerves are adequately imaged by ultrasound, the concomitant use of nerve stimulation offers no further advantage. However, several studies reported problems with obtaining satisfactory images in some patients. Ultrasound guidance significantly shortened the block performance time and/or reduced the number of needle passes to reach the target in all comparative studies. The occurrence of paraesthesia during block performance was also reduced, but not the incidence of short-lasting post-operative neuropraxia. The frequency of accidental vascular punctures may be lower, but the data are contradictory. Block onset time was significantly shortened. Block duration was longer in children, but not in adults. Ultrasound also allowed dose reduction of the local anaesthetic (LA). CONCLUSIONS: Ultrasound guidance shortens the block performance time, reduces the number of needle passes and shortens the block onset time. Blocks may be performed using lower LA doses Udgivelsesdato: 2008/7

Nielsen, Zbigniew Jerzy Koscielniak

2008-01-01

37

Ultrasound-guided block of the feline sciatic nerve.  

Science.gov (United States)

This study was conducted to validate an ultrasound-guided technique to block the sciatic nerve in cats. An anatomical study was first carried out in four feline cadavers to evaluate the feasibility of the glutea (cranial and caudal), femoris and poplitea ultrasonographical approaches for the sciatic nerve block. The results showed that the femoris approach was optimal because the region was free of vascular and bony structures, and the needle was easily visualised in-plane. Then, the efficacy of the femoris ultrasonographical approach to block the sciatic nerve was tested in six healthy adult experimental cats. A dose of 2 mg/kg lidocaine 2% diluted in saline to a final volume of 1 ml was administered in all cats. The blockade was successful in all cases and the cats recovered uneventfully. This study shows the usefulness of the femoris approach in performing an ultrasound-guided blockade of the sciatic nerve in cats. PMID:22453303

Haro, Paulina; Laredo, Francisco; Gil, Francisco; Belda, Eliseo; Ayala, María D; Soler, Marta; Agut, Amalia

2012-08-01

38

Nerve stimulator-guided thoracic paravertebral block for gynecomastia surgery  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

39

PHRENIC NERVE PALSY AFTER SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK  

Directory of Open Access Journals (Sweden)

Full Text Available A 67 year old male patient was scheduled for implant removal from right upper limb under supraclavicular block. During procedure patient develops right phrenic nerve palsy & complains of dyspnea which was managed conservatively and no intervention done except chest x-ray for confirming the diagnosis. Surgeons completed the implant removal without any invasive intervention or interruption.

Gupta A K

2009-09-01

40

Bony spurs projecting in the obturator foramen.  

Science.gov (United States)

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

Singh, R

2012-05-01

 
 
 
 
41

Thumb force deficit after lower median nerve block  

Directory of Open Access Journals (Sweden)

Full Text Available 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 constructed using these measured multidirectional forces. Results Blockage of the median nerve resulted in decreased force magnitudes and thus smaller force envelopes. The average force decrease around the force envelope was 27.9%. A maximum decrease of 42.4% occurred in a direction combining abduction and slight flexion, while a minimum decrease of 10.5% occurred in a direction combining adduction and slight flexion. Relative decreases in adduction, extension, abduction, and flexion were 17.3%, 21.2%, 41.2% and 33.5%, respectively. Areas enclosed by pre- and post-block force envelopes were 20628 ± 7747 N.N, and 10700 ± 4474 N.N, respectively, representing an average decrease of 48.1%. Relative decreases in the adduction, extension, abduction, and flexion quadrant areas were 31.5%, 42.3%, 60.9%, and 52.3%, respectively. Conclusion Lower median nerve lesion, simulated by a nerve block at the wrist, compromise normal motor function of the thumb. A median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. From our results, such a means of motor function assessment can potentially be applied to functionally evaluate peripheral neuropathies.

Li Zong-Ming

2004-10-01

42

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

Science.gov (United States)

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

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

2012-11-01

43

Use of femoral nerve blocks in adults with hip fractures.  

Science.gov (United States)

Healthcare professionals will be aware of the need to improve treatment of hip fractures, with the ultimate goal of returning the individual to pre-injury health. Patients with hip fractures awaiting surgery can experience severe pain that may be difficult to relieve with traditional analgesics. Physical assessment and essential nursing care require moving the patient, which further increases pain. Nerve blocks have been administered as a form of post-operative pain relief in a variety of surgical procedures, and there is growing interest in the use of femoral nerve blocks in the pre-operative period for patients with hip fractures. This article looks at the prevalence of hip fractures and associated problems. It highlights the importance of effective management of pain and explores the use of local anaesthetics for pain relief. PMID:23980990

Layzell, M J

44

Suprascapular nerve block: important procedure in clinical practice. Part II.  

Science.gov (United States)

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. PMID:22885426

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

2012-08-01

45

Combination of spinal anesthesia and peripheral nerve block: Case report  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 dis...

2010-01-01

46

An approach to posterior femoral cutaneous nerve block.  

Science.gov (United States)

An approach to blocking the posterior femoral cutaneous nerve at the point where its branches emerge from below the medial border of gluteus maximus is described. This is located by inserting the needle at a point one quarter of the distance from the ischial tuberosity to the greater trochanter in the gluteal fold and then feeling two distinct losses of resistance as superficial and deep fascia are penetrated with a short-bevelled needle. PMID:3565724

Hughes, P J; Brown, T C

1986-11-01

47

Fibre function and perception during cutaneous nerve block.  

Science.gov (United States)

In awake human subjects, neural responses in radial nerves to electrical stimulation were recorded with intrafascicular tungsten microelectrodes. Changes in the activity of individual fibre groups during blocking procedures were recorded and correlated with simultaneous alterations in the perception of standardized stimuli. Light touch sensibility in hairy skin appeared to depend on the integrity of A-beta-gamma fibres, cold and pinprick on A-delta fibres, and warmth and dull pain on C fibres. PMID:1185225

Mackenzie, R A; Burke, D; Skuse, N F; Lethlean, A K

1975-09-01

48

Femoral nerve blocks : a comparison of neonatal and adult anatomy  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The femoral nerve (FN) block is regarded as the quickest and most effective method of pain relief for femoral shaft fractures when general anaesthesia is contra-indicated. Correct placement of the needle relies heavily on the pulse of the femoral artery (FA) however, and in times where this pulse is absent, a lack of well-defined and constant bony landmarks increases the chance of a failed block. This study aimed to determine the position of the FN using constant bony landmarks, the anterior ...

Schoor, A.; Bosman, M. C.; Bosenberg, A. T.

2009-01-01

49

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.

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

2014-01-01

50

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

51

Differential nerve blocking activity of amino-ester local anaesthetics.  

Science.gov (United States)

The in vitro sensitivities to local anaesthetic blockade of A, B and C nerve fibres in rabbit vagus nerves were examined using a series of structurally similar amino-ester agents which varied in lipid solubility and anaesthetic potency. A fibres were found to be the most sensitive and C fibres the least sensitive to conduction blockade with all the agents, provided that equilibrium blockade was allowed to develop. A correlation existed between the intrinsic anaesthetic potency of the various agents and their lipid solubilities. Equipotent concentrations of the drugs blocked C fibres at approximately the same rate, but there were marked variations in the rate at which A fibres were blocked. Amethocaine, an agent of high lipid solubility, blocked A fibres more quickly than C. As lipid solubility decreased through the series studied, so the onset of conduction blockade of A fibres was prolonged. It is suggested that this related to decreasing ability to penetrate the lipid diffusion barriers around A fibres. The traditional view that C fibres were more sensitive to block may have arisen because of confusion between absolute sensitivity and rate of development of conduction blockade. PMID:4005099

Wildsmith, J A; Gissen, A J; Gregus, J; Covino, B G

1985-06-01

52

Nerve stimulator-guided thoracic paravertebral block for gynecomastia surgery.  

Science.gov (United States)

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 that the advantages of TPVB could be helpful for early mobilization and discharge of minor breast surgery in male patients. However, to our knowledge, there is no such report suggestive of TPVB for exclusive male breast surgery. We used nerve stimulator-guided TPVB for gynecomastia surgery in two patients where general anaesthesia was not feasible. Both patients had successful block and showed good post-operative recovery and were discharged on the same day. They had long post-operative pain relief without any block-related complication. A case report of two such cases of gynecomastia surgery (male breast surgery) done under TPVB is presented. PMID:22923833

Jadon, Ashok

2012-05-01

53

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

54

Sciatic nerve blocks for diagnosis of piriformis syndrome  

International Nuclear Information System (INIS)

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

2010-01-01

55

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.

56

Anesthetic technique for inferior alveolar nerve block: a new approach  

Directory of Open Access Journals (Sweden)

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

Dafna Geller Palti

2011-02-01

57

Augmented reality guidance system for peripheral nerve blocks  

Science.gov (United States)

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

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

2010-03-01

58

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

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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

59

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

Directory of Open Access Journals (Sweden)

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

2010-01-01

60

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.

 
 
 
 
61

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

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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

62

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

Directory of Open Access Journals (Sweden)

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

K.E. Joubert

2012-07-01

63

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

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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

64

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

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

1985-01-01

65

Unmyelinated Aplysia nerves exhibit a nonmonotonic blocking response to high-frequency stimulation.  

Science.gov (United States)

The application of high-frequency alternating current (HFAC) stimulation to reversibly block conduction in peripheral nerves has been under investigation for decades. Computational studies have produced ambiguous results since they have been based on axon models that are perhaps not valid for the nerves in which the phenomenon has been demonstrated. Though simulations based on the Hodgkin-Huxley unmyelinated nerve cable model have been used to understand the phenomena, the isolated response of an unmyelinated nerve to HFAC waveforms has not been experimentally investigated. To understand the effect of HFAC waveforms in homogenous nerves, experiments were conducted on purely unmyelinated nerves of the sea-slug Aplysia californica. Sinusoidal waveforms in the range of 5-50 kHz were used to block the propagation of action potentials through the nerves. The time for complete recovery from block was found to be dependent on the duration of application of the HFAC waveform but was independent of the frequency of the waveform tested. Unlike data from simulations and experiments on myelinated nerves, the minimum HFAC amplitude for blocking conduction in these unmyelinated nerves exhibited a unique nonmonotonic relationship with frequency, which may be advantageous in various neurophysiological applications. PMID:19666341

Joseph, Laveeta; Butera, Robert J

2009-12-01

66

CT-Guided Nerve Block for Pudendal Neuralgia: Diagnostic and Therapeutic Implications.  

Science.gov (United States)

OBJECTIVE. The objective of our study was to help clarify the role of CT-guided pudendal nerve blocks in the problematic and poorly understood entity of pudendal neuralgia (PN). SUBJECTS AND METHODS. Over a 1-year period, 52 CT-guided pudendal nerve blocks were performed in 31 patients (28 women, three men; age range, 22-80 years) who suffered from chronic pelvic pain with a presumed diagnosis of PN. A combination of anesthetic and steroid was injected into the pudendal (Alcock) canal. Pre- and postprocedural pain scores (0-10) were tallied and assessed by Student t tests. A p value ranged from 2 to 10 (mean score, 6.13) and 0-10 (mean score, 2.14), respectively; the difference was statistically significant for each nerve block session (first session, p < 0.001; second session, p < 0.001; third session, p = 0.049). Of the 31 patients, two had long-term relief with pudendal nerve blocks alone. Fourteen had subsequent surgery based on initial improvement with block(s), and all 14 patients improved with surgical nerve release. Two patients had no diagnostic response and the diagnosis of PN was excluded. The gynecologic service followed the remaining 13 patients clinically. CONCLUSION. CT-guided pudendal nerve blocks appear to be valuable diagnostically for PN and uncommonly therapeutically. On the basis of these preliminary results, we have developed an algorithm for the role of the procedure for PN. PMID:24951215

Mamlouk, Mark D; vanSonnenberg, Eric; Dehkharghani, Seena

2014-07-01

67

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 SciELO Spain | Language: Spanish Abstract in spanish 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.

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

68

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

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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 gener...

Melike Sakall?; Ay?egül Ceyhan; Hale Yarkan Uysal; I??n Yaz?c?; Hülya Ba?ar

2010-01-01

69

Does using a femoral nerve block for total knee replacement decrease postoperative delirium?  

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Abstract Background The effect of peripheral nerve blocks on postoperative delirium in older patients has not been studied. Peripheral nerve blocks may reduce the incidence of postoperative opioid use and its side effects such as delirium via opioid-sparing effect. Methods A prospective cohort study was conducted in patients who underwent total knee replacement. Baseline cognitive function was assessed using the Telephone Interview for Cognitive Status. Postoper...

Kinjo Sakura; Lim Eunjung; Sands Laura P; Bozic Kevin J; Leung Jacqueline M

2012-01-01

70

Plantar flexion seems more reliable than dorsiflexion with Labat's sciatic nerve block: a prospective, randomized comparison.  

Science.gov (United States)

Labat's classic approach to the sciatic nerve has not been able to show which motor response of the foot provides a more frequent rate of complete sensory and motor block. In this prospective, randomized, double-blind study, we compared plantar flexion with dorsiflexion with regard to onset time and efficacy of sciatic nerve block using the classic posterior approach. A total of 80 patients undergoing hallux valgus repair were randomly allocated to receive sciatic nerve block after evoked plantar flexion (n=40) or dorsiflexion (n=40). Twenty milliliters of 0.75% ropivacaine was injected after the motor response was elicited at <0.5 mA. Success rate was defined as complete sensory and motor block in all sciatic nerve distributions associated with a pain-free surgery. Time required for onset of sensory and motor block of the foot was recorded. Success was more frequent after elicited plantar flexion (87.5%) than dorsiflexion (55%; P <0.05). Onset of complete sensory and motor block of the foot was faster after elicited plantar flexion (10 +/- 10 min and 13 +/- 10 min, respectively) compared with dorsiflexion (20 +/- 11 min and 24 +/- 12 min; P <0.05). We conclude that plantar flexion of the foot predicts a shorter onset time and a more frequent success rate than dorsiflexion with Labat's classic posterior sciatic nerve block. PMID:15616086

Taboada, Manuel; Atanassoff, Peter G; Rodríguez, Jaime; Cortés, Joaquín; Del Rio, Sabela; Lagunilla, Juan; Gude, Francisco; Alvarez, Julián

2005-01-01

71

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

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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 direct nerve injury by an injection needle during previous brachial plexus block procedures. Electrodiagnostic studies can be helpful in evaluating cases of sensory disturbance after local anesthesia. To our knowledge, these are the first documented cases of isolated MABC nerve injury following ultrasound-guided axillary brachial plexus block.

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

2013-01-01

72

Ultrasound-guided block of the axillary nerve: a volunteer study of a new method  

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Interscalene brachial plexus block (IBPB) is the gold standard for perioperative pain management in shoulder surgery. However, a more distal technique would be desirable to avoid the side effects and potential serious complications of IBPB. Therefore, the aim of the present study was to develop and describe a new method to perform an ultrasound-guided specific axillary nerve block.

Rothe, C; Asghar, S

2011-01-01

73

Severe cast burn after bunionectomy in a patient who received peripheral nerve blocks for postoperative analgesia  

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Full Text Available Patrick K Boyle, John J Badal, Joelle W BoeveDepartment of Anesthesiology, Arizona Health Sciences Center, Tucson, AZ, USAAbstract: Although regional anesthesia offers advantages for intraoperative and postoperative pain relief, it is not possible without complications. A case of a significant burn injury after splint placement is described after a peripheral nerve block was performed for postoperative pain management. It is our hope that this case alerts physicians and others involved in the management of postoperative patients to the challenges of managing a blocked extremity after thermal cast placement and offers solutions that can be standardized.Keywords: Peripheral nerve block, cast burn, postoperative complication

Joelle W Boeve

2011-03-01

74

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

75

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

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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

76

Does using a femoral nerve block for total knee replacement decrease postoperative delirium?  

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Full Text Available Abstract Background The effect of peripheral nerve blocks on postoperative delirium in older patients has not been studied. Peripheral nerve blocks may reduce the incidence of postoperative opioid use and its side effects such as delirium via opioid-sparing effect. Methods A prospective cohort study was conducted in patients who underwent total knee replacement. Baseline cognitive function was assessed using the Telephone Interview for Cognitive Status. Postoperative delirium was measured using the Confusion Assessment Method postoperatively. Incidence of postoperative delirium was compared in two postoperative management groups: femoral nerve block ± patient-controlled analgesia and patient-controlled analgesia only. In addition, pain levels (using numeric rating scales and opioid use were compared in two groups. Results 85 patients were studied. The overall incidence of postoperative delirium either on postoperative day one or day two was 48.1%. Incidence of postoperative delirium in the femoral nerve block group was lower than patient controlled analgesia only group (25% vs. 61%, P = 0.002. However, there was no significant difference between the groups with respect to postoperative pain level or the amount of intravenous opioid use. Conclusions Femoral nerve block reduces the incidence of postoperative delirium. These results suggest that a larger randomized control trial is necessary to confirm these preliminary findings.

Kinjo Sakura

2012-03-01

77

In select patients, ipsilateral post-thoracotomy shoulder pain relieved by suprascapular nerve block.  

Science.gov (United States)

Shoulder pain following thoracotomy is a common postoperative complaint and can be difficult to treat. This article explores how to select patients who would benefit from a suprascapular nerve block for post-thoracotomy shoulder pain. A retrospective case review of 178 patients who underwent thoracotomy at our institution was performed. Only patients with elicitable local signs of musculoskeletal shoulder pain were offered a suprascapular nerve block with 10 cc of 0.25% bupivicaine. Of 178 patients, 92 (51.7%) complained of post-thoracotomy shoulder pain. Of these patients, 34 (37.0%) had localizing signs of musculoskeletal shoulder pain and underwent suprascapular nerve block. Twenty-nine of 34 (85.3%) patients obtained satisfactory pain relief. We estimate a true-positive rate of 85.3% with a 95% confidence interval of (68.9%, 95.0%) for those patients who received relief from suprascapular nerve block after localizing signs on physical examination of the shoulder. Patients post-thoracotomy with local signs of shoulder pain on physical examination may benefit from suprascapular nerve blocks in the immediate postoperative period. PMID:20215959

Saha, Suparna; Brish, Eldor L; Lowry, Angus M; Boddu, Krishna

2011-07-01

78

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

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Objectives: To evaluate the differences in terms of bevel deformation between two types of needle of the same length and external caliber, but with different internal diameters, during truncal block of the inferior alveolar nerve. Study design: Four operators performed truncal block of the inferior alveolar nerve and infiltrating anesthesia of the buccal nerve for the extraction of a lower third molar in 266 patients. The truncal block was carried out using a standard 27G x 35 mm needle with ...

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

2007-01-01

79

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

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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

80

Tumescent infiltration versus femoral nerve block for skin graft harvest-a prospective randomized study  

Directory of Open Access Journals (Sweden)

Full Text Available In this prospective, randomized study, 60 patients requiring a single sheet of graft were randomized into 2 groups. Tumescent infiltration was used for anesthesia in one group and femoral nerve block in the other. The pain during administration of anesthesia, the time required for onset of action, the pain during graft harvest and the failure rates were recorded. Statistical comparison was done using Fischers Exact probability test for the failure rates and Mann Whitney- U test for the other parameters. The pain during administration was significantly higher for tumescent infiltration. The time for onset of action was significantly faster with femoral nerve block. The pain during harvest and the failure rates did not show any significant difference. We conclude that tumescent infiltration is more painful than femoral nerve block but equally effective as anesthesia with no difference in the failure and complication rates.

Mathew J

2005-01-01

 
 
 
 
81

Frequency-dependent block of nerve conduction by beta-adrenergic blocking agents.  

Science.gov (United States)

We investigated frequency-dependent effects of 12 beta-adrenergic blocking agents, all 1-aryloxy-3-isopropylaminopropane-2-ol derivatives, on the height of the compound action potential of frog sciatic nerves, using sucrose gap techniques. The order of 1/ED50 of these agents at 0.1 Hz for the reduction of the height was: indenolol greater than D-25 greater than propranolol greater than alprenolol greater than pindolol greater than toliprolol greater than oxprenolol greater than befunolol greater than Kö1313 greater than acebutolol greater than metoprolol greater than atenolol. The order was similar also at 100 Hz. Logarithms of n-octanol/buffer partition coefficients (log P) correlated well with log (1/ED50) at either 0.1, 1, 10 or 100 Hz (p less than 0.01). The order of log [(ED50)0.1 Hz/(ED50)100 Hz] was oxprenolol greater than befunolol greater than propranolol greater than alprenolol greater than toliprolol greater than indenolol greater than Kö1313 greater than pindolol greater than D-25. Molecular weight of these drugs correlated well with the difference of log (ED50)100 Hz and log (ED50)10 Hz from log (ED50)0.1 Hz (P less than 0.05). The results indicate that the local anesthetic potency of these beta-blockers is mainly determined by the lipid solubility of the drugs, being modified by the frequency-dependent component of action which is related to the molecular weight. PMID:6121535

Sada, H; Ban, T

1981-11-01

82

Needle in the external auditory canal: an unusual complication of inferior alveolar nerve block.  

Science.gov (United States)

Inferior alveolar nerve block is used to anesthetize the ipsilateral mandible. The most commonly used technique is one in which the anesthetic is injected directly into the pterygomandibular space, by an intraoral approach. The fracture of the needle, although uncommon, can lead to potentially serious complications. The needle is usually found in the pterygomandibular space, although it can migrate and damage adjacent structures, with variable consequences. The authors report an unusual case of a fractured needle, migrating to the external auditory canal, as a result of an inferior alveolar nerve block. PMID:24169469

Ribeiro, Leandro; Ramalho, Sara; Gerós, Sandra; Ferreira, Edite Coimbra; Faria e Almeida, António; Condé, Artur

2014-06-01

83

Bilateral sciatic nerve block after orthopedic surgery in a pediatric patient  

Directory of Open Access Journals (Sweden)

Full Text Available Early postoperative pain is one of the most important problems in pediatric orthopedic surgery. Introduction of the use of ultrasound (US has led to very important developments in pediatric regional anesthesia. We aimed to present with the literature data about that we applied the bilateral US-guided sciatic nerve block to the patient who was operated under bilateral knee disarticulation because of congenital tibia agenesis and talipes equinovarus. In conclusion we entertain that US-guided peripheral nerve blocks are effective and safety for postoperative pain in pediatric orthopedic surgery.

Levent ?ahin

2011-09-01

84

The Incidence of Intravascular Needle Entrance during Inferior Alveolar Nerve Block Injection  

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Full Text Available

Background and aims. Dentists administer thousands of local anesthetic injections every day. Injection to a highly vascular area such as pterygomandibular space during an inferior alveolar nerve block has a high risk of intravascular needle entrance. Accidental intravascular injection of local anesthetic agent with vasoconstrictor may result in cardiovascular and central nervous system toxicity, as well as tachycardia and hypertension. There are reports that indicate aspiration is not performed in every injection. The aim of the present study was to assess the incidence of intravascular needle entrance in inferior alveolar nerve block injections.

Materials and methods. Three experienced oral and maxillofacial surgeons performed 359 inferior alveolar nerve block injections using direct or indirect techniques, and reported the results of aspiration. Aspirable syringes and 27 gauge long needles were used, and the method of aspiration was similar in all cases. Data were analyzed using t-test.

Results. 15.3% of inferior alveolar nerve block injections were aspiration positive. Intravascular needle entrance was seen in 14.2% of cases using direct and 23.3% of cases using indirect block injection techniques. Of all injections, 15.8% were intravascular on the right side and 14.8% were intravascular on the left. There were no statistically significant differences between direct or indirect block injection techniques (P = 0.127 and between right and left injection sites (P = 0.778.

Conclusion. According to our findings, the incidence of intravascular needle entrance during inferior alveolar nerve block injection was relatively high. It seems that technique and maneuver of injection have no considerable effect in incidence of intravascular needle entrance.

Sara Pourshahidi

2008-04-01

85

[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

86

A conduction block in sciatic nerves can be detected by magnetic motor root stimulation.  

Science.gov (United States)

Useful diagnostic techniques for the acute phase of sciatic nerve palsy, an entrapment neuropathy, are not well established. The aim of this paper is to demonstrate the diagnostic utility of magnetic sacral motor root stimulation for sciatic nerve palsy. We analyzed the peripheral nerves innervating the abductor hallucis muscle using both electrical stimulations at the ankle and knee and magnetic stimulations at the neuro-foramina and conus medullaris levels in a patient with sciatic nerve palsy at the level of the piriformis muscle due to gluteal compression related to alcohol consumption. On the fourth day after onset, magnetic sacral motor root stimulation using a MATS coil (the MATS coil stimulation method) clearly revealed a conduction block between the knee and the sacral neuro-foramina. Two weeks after onset, needle electromyography supported the existence of the focal lesion. The MATS coil stimulation method clearly revealed a conduction block in the sciatic nerve and is therefore a useful diagnostic tool for the abnormal neurophysiological findings associated with sciatic nerve palsy even at the acute phase. PMID:23809191

Matsumoto, Hideyuki; Konoma, Yuko; Fujii, Kengo; Hanajima, Ritsuko; Terao, Yasuo; Ugawa, Yoshikazu

2013-08-15

87

Femoral nerve block versus fentanyl: Analgesia for positioning patients with fractured femur  

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Arissara Iamaroon, Manee Raksakietisak, Pathom Halilamien, Jitaporn Hongsawad, Kwankamol BoonsararuxsapongDepartment of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, ThailandPurpose: Fracture of femur is a painful bone injury, worsened by any movement. This prospective study was performed to compare the analgesic effects of femoral nerve block (FNB) with intravenous (IV) fentanyl prior to positioning patients with fractured femur for spinal block.Patients...

2010-01-01

88

Severe cast burn after bunionectomy in a patient who received peripheral nerve blocks for postoperative analgesia  

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Although regional anesthesia offers advantages for intraoperative and postoperative pain relief, it is not possible without complications. A case of a significant burn injury after splint placement is described after a peripheral nerve block was performed for postoperative pain management. It is our hope that this case alerts physicians and others involved in the management of postoperative patients to the challenges of managing a blocked extremity after thermal cast placement and offers solu...

2011-01-01

89

Severe cast burn after bunionectomy in a patient who received peripheral nerve blocks for postoperative analgesia.  

Science.gov (United States)

Although regional anesthesia offers advantages for intraoperative and postoperative pain relief, it is not possible without complications. A case of a significant burn injury after splint placement is described after a peripheral nerve block was performed for postoperative pain management. It is our hope that this case alerts physicians and others involved in the management of postoperative patients to the challenges of managing a blocked extremity after thermal cast placement and offers solutions that can be standardized. PMID:22915886

Boyle, Patrick K; Badal, John J; Boeve, Joelle W

2011-01-01

90

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

91

Neural Modulation of Hemiparetic Shoulder Pain by Repetitive Ultrasound-Guided Suprascapularis Nerve Block  

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Background: Neural blockade is widely used in clinical practice to alleviate acute or chronic pain, including pain during rehabilitation. To date there is little controlled evidence to confirm the efficacy of nerve blocks in hemiparetic shoulder pain after stroke. Design:

2013-01-01

92

Ultrasound-Guided Nerve Blocks - Is Documentation and Education Feasible Using Only Text and Pictures?  

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Purpose With the advancement of ultrasound-guidance for peripheral nerve blocks, still pictures from representative ultrasonograms are increasingly used for clinical procedure documentation of the procedure and for educational purposes in textbook materials. However, little is actually known about the clinical and educational usefulness of these still pictures, in particular how well nerve structures can be identified compared to real-time ultrasound examination. We aimed to quantify gross visibility or ultrastructure using still picture sonograms compared to real time ultrasound for trainees and experts, for large or small nerves, and discuss the clinical or educational relevance of these findings. Materials and Methods We undertook a clinical study to quantify the maximal gross visibility or ultrastructure of seven peripheral nerves identified by either real time ultrasound (clinical cohort, n?=?635) or by still picture ultrasonograms (clinical cohort, n?=?112). In addition, we undertook a study on test subjects (n?=?4) to quantify interobserver variations and potential bias among expert and trainee observers. Results When comparing real time ultrasound and interpretation of still picture sonograms, gross identification of large nerves was reduced by 15% and 40% by expert and trainee observers, respectively, while gross identification of small nerves was reduced by 29% and 66%. Identification of within-nerve ultrastructure was even less. For all nerve sizes, trainees were unable to identify any anatomical structure in 24 to 34%, while experts were unable to identify anything in 9 to 10%. Conclusion Exhaustive ultrasonography experience and real time ultrasound measurements seem to be keystones in obtaining optimal nerve identification. In contrast the use of still pictures appears to be insufficient for documentation as well as educational purposes. Alternatives such as video clips or enhanced picture technology are encouraged instead of still pictures extracted from basic ultrasonograms.

Worm, Bjarne Skj?dt; Krag, Mette; Jensen, Kenneth

2014-01-01

93

Frequency- and amplitude-transitioned waveforms mitigate the onset response in high-frequency nerve block  

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High-frequency alternating currents (HFAC) have proven to be a reversible and rapid method of blocking peripheral nerve conduction, holding promise for treatment of disorders associated with undesirable neuronal activity. The delivery of HFAC is characterized by a transient period of neural firing at its inception, termed the 'onset response'. The onset response is minimized for higher frequencies and higher amplitudes, but requires larger currents. However, the complete block can be maintained at lower frequencies and amplitudes, using lower currents. In this in vivo study on whole mammalian peripheral nerves, we demonstrate a method to minimize the onset response by initiating the block using a stimulation paradigm with a high frequency and large amplitude, and then transitioning to a low-frequency and low-amplitude waveform, reducing the currents required to maintain the conduction block. In five of six animals, it was possible to transition from a 30 kHz to a 10 kHz waveform without inducing any transient neural firing. The minimum transition time was 0.03 s. Transition activity was minimized or eliminated with longer transition times. The results of this study show that this method is feasible for achieving a nerve block with minimal onset responses and current amplitude requirements.

Gerges, Meana; Foldes, Emily L.; Ackermann, D. Michael; Bhadra, Narendra; Bhadra, Niloy; Kilgore, Kevin L.

2010-12-01

94

Combined usage of intercostal nerve block and tumescent anaesthesia: an effective anaesthesia technique for breast augmentation.  

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Patients are occasionally unhappy with the size, shape, and positioning of breast implants. An option to improve their satisfaction with breast augmentation includes directly involving them in the process with awake surgery done under nerve block and tumescence. This study describes the resultsof using such an awake anaesthesia technique in 35 patients. After the intercostal nerves dominating the Th3 to Th6 regions were anaesthetized using 0.5% bupivacaine, a tumescent solution consisting of lidocaine, epinephrine, and saline was injected around the mammary gland, and breast augmentation was conducted using silicon implants. The majority of patients (31/35) reported no pain during the procedure and all patients were able to choose and confirm their final implant size and positioning. In all cases, blood loss was less than 10 ml. No patient experienced pneumothorax or toxicity of local anaesthetics. Combined usage of the intercostal nerve block and tumescent anaesthesia effectively reduces pain during breast augmentation. Keeping patient conscious enables meeting their requests during operation, contributing to increased satisfaction. For these advantages, combined usage of the intercostal nerve block and tumescent anaesthesia is recommended as a useful anaesthetic technique for breast augmentation. PMID:24325759

Shimizu, Yusuke; Nagasao, Tomohisa; Taneda, Hiroko; Sakamoto, Yoshiaki; Asou, Toru; Imanishi, Nobuyuki; Kishi, Kazuo

2014-02-01

95

Our experience of combined femoral sciatic nerve block in the lower extremity surgery  

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Full Text Available Objectives: In this study, the effectiveness of the combine femoral and sciatic nerve block in lower-extremity surgery was aimed to be investigated.Materals and methods: The patients with ASA I-III group, aged between 18-70 years, who underwent combinede sciatic femoral nerve block in lower-extremity surgery, were retrospectively evaluated.The study included 110 patients. The patients were divided into four groups according to the local anesthetic drugs used; Group I: 30 ml 0.5% Bupivacaine + 10 ml 0.9% NaCl, Group II: 30 ml 0.5% Levobupivacaine + 10 ml 0.9% NaCl, Group III: 30 ml 0.5% Levobupivacaine +10 ml 2% prilocaine HCl, GrupIV: 20 ml 0.5% Bupivacaine + 2 ml 2% Lidocaine HCl. The demographic data, clinical diagnosis, dose and volume of used local anesthetics, application time of the technique, duration of surgery, rates of block success, hemodynamic parameters before and after intervention, the first postoperative analgesic requirements (the first postoperative analgesic need, the amount of analgesic consumption of postoperative first 24 hours, developing complications during and after the process, patient’s and surgical satisfaction data of were recorded.Results: The demographic data of patient group were similar. No significant differences were found in terms of quality of surgical anesthesia and postoperative analgesia between different groups. The combined sciatic femoral nerve block was most frequently performed for ankle surgery. Different local anesthetics doses administered to patients were provided adequate anesthesia. Success of process was found to be 96%.Conclusion: The combined femoral sciatic nerve block applied with the success rate of 96%. The mean duration of adequate anesthesia and postoperative analgesia was 426 minutes. J Clin Exp Invest 2011; 2 (4: 375-379

Taner Çiftçi

2011-12-01

96

Bilateral obturator neuropathy caused by an intrapelvic fibrosarcoma with myofibroblastic features in a dog.  

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A nine-year-old female Rottweiler presented with a 6-week history of progressive impairment of hindlimb adduction. Clinical examination showed abduction of both hind legs when walking on a smooth surface, pain at the medial surface of the left thigh, and an intrarectal palpable mass at the pelvic floor. Electromyography demonstrated fibrillation potentials in the adductor muscles on both sides. Pelvic radiographs showed severe osteolysis of the ischium. Gross post-mortem examination following euthanasia disclosed a large retroperitoneal mass, invading the obturator foramina and compressing both obturator nerves. Histopathological examination revealed a high-grade anaplastic sarcoma. Immunohistochemically, the tumour cells labelled positively for vimentin and alpha-smooth muscle actin, hence the tumour was considered a "myofibroblastic fibrosarcoma". This unique case report describes a novel cause of obturator neuropathy in veterinary medicine. To date, clinical descriptions of obturator nerve lesions have been limited to pelvic fractures in small animals and following difficult labour in large animals. PMID:22691019

Vanhaesebrouck, A E; Maes, S; Van Soens, I; Baeumlin, Y; Saey, V; Van Ham, L M

2012-07-01

97

Effect of a single shot sciatic nerve block combined with a continuous femoral block on pain scores after total knee arthroplasty. A randomized controlled trial  

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Background and Purpose: Postoperative pain after knee arthroplasty (TKA) is reported as severe in up to 60% of patients. Continuous femoral nerve blocks (CFNB) are a choice for major knee repair, but controversies remain about the need of supplemental sciatic Nerve blocks (SNB) for better analgesia. Our aim is to assess the effect of the association of a SNB to a CFNB to reduce postoperative pain after TKA. Methods: A ...

Carvalho, Raul

2012-01-01

98

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

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

T.V.S Gopal

2014-06-01

99

[Anesthetic management of the elderly patients with femoral neck fracture by sevoflurane and femoral nerve block].  

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Fracture of the femoral neck (FNF) is a significant cause of morbidity and mortality in the elderly, and the elderly with FNF are often high-risk patients for anesthesia. We studied 15 patients above 80 years of age with severe physical status (ASA III-IV). After femoral nerve block (for the pain of fracture) and lateral femoral cutaneous nerve block (for the cutting pain), surgical procedure was performed under general anesthesia by laryngeal mask airway under spontaneous ventilation. After the operation, morphine 2 mg was administered subcutaneously. In our experience, the majority of 15 patients cardiovascular status of remained stable, except one patient who needed ephedrine for hypotension and another patient who needed diclofenac sodium for post-operative pain relief. PMID:10885241

Fujimoto, T; Meguro, K; Hase, K; Nagatsuka, C; Kasahara, M

2000-06-01

100

Femoral nerve block versus fentanyl: Analgesia for positioning patients with fractured femur  

Directory of Open Access Journals (Sweden)

Full Text Available Arissara Iamaroon, Manee Raksakietisak, Pathom Halilamien, Jitaporn Hongsawad, Kwankamol BoonsararuxsapongDepartment of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, ThailandPurpose: Fracture of femur is a painful bone injury, worsened by any movement. This prospective study was performed to compare the analgesic effects of femoral nerve block (FNB with intravenous (IV fentanyl prior to positioning patients with fractured femur for spinal block.Patients and methods: Sixty-four ASA I–III patients aged 18–80 years undergoing surgery for femur fracture were randomized into two groups. Fifteen minutes before spinal block, the FNB group received nerve stimulator-assisted FNB with a mixture of 20 mL bupivacaine 0.5% and 10 mL normal saline 0.9%, and the fentanyl group received two doses of IV fentanyl 0.5 ?g/kg with a five-minute interval between doses. Numeric rating pain scores were compared. During positioning, fentanyl in 0.5 ?g/kg increments was given every five minutes until pain scores were ?4.Results: There were no statistically significant differences between the groups according to pain scores, need for additional fentanyl, and satisfaction with positioning before spinal block. Conclusion: We were unable to demonstrate a benefit of FNB over IV fentanyl for patient positioning before spinal block. However, FNB can provide postoperative pain relief, whereas side effects of fentanyl must be considered, and analgesic dosing should be titrated based on pain scores. A multimodal approach (FNB + IV fentanyl may be a possible option.Keywords: femoral nerve block, bupivacaine, fentanyl, pain on positioning

Arissara Iamaroon

2010-03-01

 
 
 
 
101

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

102

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

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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

103

Median nerve injury caused by brachial plexus block for carpal tunnel release surgery.  

Science.gov (United States)

Carpal tunnel release is required to treat patients with severe carpal tunnel syndrome. The regional anesthesia of the upper limb by brachial plexus block (BPB) may be a good alternative to general anesthesia for carpal tunnel release surgery, because it results in less complications. However, the regional anesthesia still has various side effects, such as hematoma, infection, and peripheral neuropathy. We hereby report a rare case of median nerve injury caused by BPB for carpal tunnel release. PMID:24855626

Kim, Tae Hoon; Kim, Cheol Ki; Lee, Kyung Duck; Koo, Jung Hoi; Song, Sun Hong

2014-04-01

104

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

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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.

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

2010-01-01

105

Median Nerve Injury Caused by Brachial Plexus Block for Carpal Tunnel Release Surgery  

Science.gov (United States)

Carpal tunnel release is required to treat patients with severe carpal tunnel syndrome. The regional anesthesia of the upper limb by brachial plexus block (BPB) may be a good alternative to general anesthesia for carpal tunnel release surgery, because it results in less complications. However, the regional anesthesia still has various side effects, such as hematoma, infection, and peripheral neuropathy. We hereby report a rare case of median nerve injury caused by BPB for carpal tunnel release.

Kim, Tae Hoon; Kim, Cheol Ki; Lee, Kyung Duck; Song, Sun Hong

2014-01-01

106

Severe cast burn after bunionectomy in a patient who received peripheral nerve blocks for postoperative analgesia  

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Patrick K Boyle, John J Badal, Joelle W BoeveDepartment of Anesthesiology, Arizona Health Sciences Center, Tucson, AZ, USAAbstract: Although regional anesthesia offers advantages for intraoperative and postoperative pain relief, it is not possible without complications. A case of a significant burn injury after splint placement is described after a peripheral nerve block was performed for postoperative pain management. It is our hope that this case alerts physicians and others involved in the...

2011-01-01

107

Obturator hernia with ureteral entrapment.  

Science.gov (United States)

Obturator hernia of the ureter is uncommon. Computed tomography of a 77-year-old woman with sudden-onset lower left abdominal pain and urinary symptoms showed an obturator hernia with ureteral entrapment. Obturator hernia is a diagnostic challenge because the hernial mass is very insidious. It should be suspected in emaciated, multiparous, elderly women presenting with unexplained pain in the groin, hip, thigh or knee. High levels of clinical suspicion of high-risk patients and recourse to investigation by computed tomography are important, as delay in diagnosis and treatment is associated with increased morbidity and mortality. PMID:24926229

Izzo, Matteo; Regusci, Luca; Fasolini, Fabrizio

2014-05-01

108

Obturator Hernia with Ureteral Entrapment  

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Obturator hernia of the ureter is uncommon. Computed tomography of a 77-year-old woman with sudden-onset lower left abdominal pain and urinary symptoms showed an obturator hernia with ureteral entrapment. Obturator hernia is a diagnostic challenge because the hernial mass is very insidious. It should be suspected in emaciated, multiparous, elderly women presenting with unexplained pain in the groin, hip, thigh or knee. High levels of clinical suspicion of high-risk patients and recourse to investigation by computed tomography are important, as delay in diagnosis and treatment is associated with increased morbidity and mortality.

Izzo, Matteo; Regusci, Luca; Fasolini, Fabrizio

2014-01-01

109

Effects of ramped amplitude waveforms on the onset response of high-frequency mammalian nerve block  

Science.gov (United States)

Though high-frequency alternating current (HFAC) can block nerve conduction, the block is invariably preceded by an onset response which is a period of repetitive nerve firing. We tested the hypothesis that slowly ramping up the amplitude of the HFAC waveform could produce block without this initial onset response. Computer simulations were performed, using the McIntyre-Richardson-Grill (MRG) model of myelinated mammalian axon. A ramped-amplitude HFAC was applied to axons of diameters ranging from 7.3 µm to 16 µm and at frequencies ranging from 3125 Hz to 40 kHz. The ramped-amplitude HFAC was also investigated in vivo in preparations of rat sciatic nerve. Sinusoidal voltage-regulated waveforms, at frequencies between 10 kHz and 30 kHz, were applied with initial amplitudes of 0 V, linearly increasing with time to 10 V. Ramp durations ranged from 0 s to 60 s. In both the MRG model simulations and the experiments, ramping the HFAC waveform did not eliminate the onset response. In the rat experiments, the peak amplitude of the onset response was lessened by ramping the amplitude, but both the onset response duration and the amount of onset activity as measured by the force-time integral were increased.

Miles, J. D.; Kilgore, K. L.; Bhadra, N.; Lahowetz, E. A.

2007-12-01

110

Neural Modulation of Hemiparetic Shoulder Pain by Repetitive Ultrasound-Guided Suprascapularis Nerve Block  

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Full Text Available Background: Neural blockade is widely used in clinical practice to alleviate acute or chronic pain, including pain during rehabilitation. To date there is little controlled evidence to confirm the efficacy of nerve blocks in hemiparetic shoulder pain after stroke. Design: This study is a prospective, open label, cohort trial reporting result from a cohort of stroke patients affected by shoulder pain. Aim: As a cohort study report, in which it is often firstly reported the possibility of an association between an observed effect and a specific environmental based on detailed clinical evaluations and histories, we aim to firstly provide clues in identifying Suprascapularis Nerve blockade as further valuable approach for shoulder pain after stroke. Population: We studied a cohort of patients affected by hemiparetic shoulder pain after Stroke. Methods: Our protocol foresees nerve blocks to be performed each 3 out of 4 days (treatment lasting 30 days in conjunction with a rehabilitation program with the first aim to provide the window of opportunity to proceed with effective rehabilitation. 47 potential study subjects fulfilled the study criteria and were enrolled. Twenty-four subjects were randomised to the study Group to receive SSNB for the pain of their hemiparetic shoulder while 23 subjects randomized to the control Group whose member did not receive SSNB. They received serial blocks each 3 out of 4 days during rehabilitation.Results: Both treatment reported a reduction in the intensity of their shoulder pain, according to data collected from day 1 through day 42 (6 weeks. Study Group patients, receiving SSNBs, reported significant improvement from entry through the whole follow-up period. The efficiency data were higher for SSNB Group after 2 weeks and again for SSNb group at the end of treatment. Conclusion: Excellent pain relief was achieved in SSNB without clinically relevant complications, these patients having a better improvement on pain during rehabilitation, than the control subjects. Great efficacy has been achieved by combining a nerve block and rehabilitation. About Clinical Rehabilitation Impact, we believe that Suprascapularis nerve blocks can help the stroke survivors maintain an ambulatory or outpatient treatment status, maintain participation in a physical therapy or rehabilitation program, decrease the need for analgesics and in some cases lead to a complete pain relief.

Santopadre Domenico

2013-05-01

111

Fabricating a hollow bulb obturator  

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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.

Ali R?za Tunçdemir

2013-01-01

112

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.

113

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

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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

2007-01-01

114

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

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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...

2012-01-01

115

Combined femoral and sciatic nerve blocks for lower limb anaesthesia in anticoagulated patients with severe cardiac valvular lesions  

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Peripheral nerve block (PNB) in anticoagulated patients is controversial and guidelines are not defined. We report two patients with severe cardiac valvular lesions, who underwent emergency surgeries for lower limb. Both the patients were on anticoagulants, warfarin and heparin in one and aspirin and clopidogrel in the other, with abnormal coagulation profile in the former. Combined femoral and sciatic nerve blocks were used as a sole anaesthetic technique. Postoperatively, the patients were ...

2010-01-01

116

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

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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 appro...

2012-01-01

117

[Partial blocking of the tibial nerve with phenol as treatment of gait disorders due to pes equinus in central paralysis].  

Science.gov (United States)

Partial chemical neurolysis by means of a peripheral nerve block induced with a phenol solution can result in decreasing local muscle hypertonia of central origin. In case of a walking disability resulting from a spastic or dystonic equinovarus position of the ankle the phenol block of the tibial nerve may be a valuable treatment that improves walking ability. The technique of the procedure is explained. A phenol block is induced only after a favourable result of a trial block with a local anaesthetic. In the group of 19 patients who underwent tibial nerve block given by the author in the period 1987-1989 there appears to exist a correlation between the functional results and the extent to which the patient had been active in walking prior to the nerve block. A group of 6 'sitters' and 'hardly walking' patients had poor to moderate results, a group of 13 'walkers' had moderate, good and excellent results. The difference in functional outcome is ascribed by the author to a better possibility to actually utilise a muscular balance improved by the phenol block. In the early--recovery--phase of stroke rehabilitation a phenol block of the tibial nerve may well be useful in cases with equinovarus position of the ankle which interferes with therapeutic exercise and functional progress. PMID:2046769

Wichers, M J

1991-04-27

118

Inferior alveolar nerve blocks for postoperative pain control after mandibular distraction with osteotomies in a neonate.  

Science.gov (United States)

We describe the use of inferior alveolar nerve blocks (IANBs) for postoperative pain control for a neonate undergoing mandibular distraction and osteotomies. In this case, bilateral IANBs were effective in keeping low pain scores as assessed on the neonatal infant pain scale (NIPS) and the amount of opioid and adjuvant analgesics used. The blocks were assessed to have lasted approximately 24 h making serial blocks for pain control logistically feasible. Additionally, pain control was improved throughout the period of distractor advancement (approximately 7 days). We propose the routine use of this regional technique for improved pain control after this procedure in neonates and suggest that improved pain control may facilitate earlier extubation in this challenging population. PMID:24612230

Krodel, David J; Belvis, Dawn; Suresh, Santhanam

2014-06-01

119

Femoral nerve block for pain relief in hip fracture: a dose finding study.  

Science.gov (United States)

Hip fracture is the most common orthopaedic emergency. We investigated the concentration of 30 ml levobupivacaine that provided analgesia to 50% and 95% of patients with a hip fracture when injected around the femoral nerve under ultrasound guidance. We defined analgesia as a ? 20-point decrease on a 100-point pain scale with reduced cold sensation in the middle third of the anterior thigh 30 min after the nerve block. We increased the concentration of levobupivacaine if the preceding dose had been ineffective and decreased it if the preceding dose had been effective. Probit regression modelling estimated the effective (95% CI) concentration of 30 ml levobupivacaine in 50% and 95% of patients with a fractured hip to be 0.026 (0.023-0.028)% w/v and 0.036 (0.027-0.047)% w/v, respectively. PMID:24862655

Watson, M J; Walker, E; Rowell, S; Halliday, S; Lumsden, M A; Higgins, M; Binning, A; McConnachie, A

2014-07-01

120

Popliteal sciatic nerve block versus spinal anesthesia in hallux valgus surgery  

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Background We compared clinical properties and patient satisfaction between spinal anesthesia and popliteal sciatic nerve block (PSNB) for hallux valgus surgery. Methods Forty patients undergoing hallux valgus surgery were divided into spinal group (spinal anesthesia with 2.5 ml of 0.5% bupivacaine [n = 20]) and PSNB group (PSNB with 30 ml of 0.75% ropivacaine mixed with 10 ml of normal saline solution using a nerve stimulator [n = 20]). The PSNB group used a patient-controlled-analgesia (PCA) pump for postoperative pain control. The quality and side effects were compared between the two groups. A questionnaire was used to evaluate patient satisfaction with the use of anesthetic techniques and postoperative pain control in the PSNB group. This study was assessed 3 days postoperatively by a blinded observer. Results Procedure time and time from anesthesia until start of sugery were significantly shorter in the spinal group than those in the PSNB group (P hallux valgus surgery.

Jeon, Hyun-Jun; Lee, Jong Nam; Bae, Jun-Seok

2013-01-01

 
 
 
 
121

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

International Nuclear Information System (INIS)

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

2010-11-01

122

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

123

Anesthetic Efficacy of Lidocaine/Meperidine for Inferior Alveolar Nerve Blocks  

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The authors, using a crossover design, randomly administered, in a single-blind manner, inferior alveolar nerve blocks using 36 mg of lidocaine with 18 ?g of epinephrine or a combination of 36 mg of lidocaine with 18 ?g epinephrine plus 36 mg meperidine with 18 ?g of epinephrine, at 2 separate appointments, to 52 subjects. An electric pulp tester was used to test for anesthesia, in 4-minute cycles for 60 minutes, of the molars, premolars, and central and lateral incisors. Anesthesia was co...

2006-01-01

124

Perioperative continuous peripheral nerve blocks with disposable infusion pumps in children: a prospective descriptive study.  

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Continuous peripheral nerve blocks (CPNB) after pediatric major orthopedic surgery are not widely used. We conducted a prospective descriptive study to evaluate the effectiveness of disposable elastomeric pumps for CPNB in children. After inducing general anesthesia, 25 consecutive children scheduled for major orthopedic surgery received a 0.5-mL/kg bolus of a mixture of 1% lidocaine with epinephrine and 0.25% bupivacaine in axillary, femoral, or popliteal catheters. After surgery, disposable pumps with 0.2% ropivacaine were connected. Pump flows were adjusted to the patient's weight. Postoperative pain was evaluated using a visual analog scale or Children and Infants Postoperative Pain Scale scores at H1, H6, H12, H24, and H48, as well as amounts of rescue analgesia, adverse events, and motor and sensory block. An ambulation score for the children was also evaluated. Eleven popliteal, nine femoral, and five axillary continuous blocks were performed. All the blocks were effective for surgery. The mean total dose consumption of 0.2% ropivacaine was 10.1 mg/kg. Disposable pump flow varied from -9.61% to +8.6% compared with the theoretical one. Postoperative analgesia was excellent. The median of pain score was zero at each period studied. Sensory and motor block were noted at H1 and decreased from the sixth hour. No adverse events were noted. We concluded that the use of elastomeric disposable pumps for CPNB in children was an effective technique. PMID:12933385

Dadure, Christophe; Pirat, Philippe; Raux, Olivier; Troncin, Rachel; Rochette, Alain; Ricard, Christine; Capdevila, Xavier

2003-09-01

125

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

126

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

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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

127

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

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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

128

Anatomical comparison of sciatic nerves between adults and newborns: clinical implications for ultrasound guided block.  

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The sciatic nerve (SN) is easily blocked under ultrasound guidance by identifying either the SN common trunk or its two components: the tibial nerve (TN) and the common peroneal nerve (CPN). The authors investigate whether there are anatomical differences between newborns and adults. The SN, TN and CPN of both lower extremities in 24 (11 neonatal and 13 adults) formolized cadavers were dissected. Distances were measured from the origin of the SN (passing under the piriformis muscle) to its division into TN and CPN, and from there to the popliteal crease. The sciatic/thigh coefficient (proportion relating SN length to thigh length) and the variation coefficient for the SN were calculated. The distance from the popliteal crease to the SN division was significantly shorter in neonates than in adults (1.04 ± 0.9 cm vs. 5.6 ± 5.1 cm, P = 0.0003). In addition, the neonatal SN divided at a proportionally more distal position in the thigh than it did in adults (86 ± 13 vs. 74 ± 15%, P = 0.0059). However, the coefficient of variation between the SN-division distances was not statistically different in infants and adults (12.8 vs. 18.2%, P = 0.4345). The variations in the point of SN division seen in the adult SN are already seen in the neonatal period, but in newborns the SN divided in a more distal position in relation to the thigh than in adults, so this finding of anatomical variability in neonates suggests that ultrasound guidance can be useful when performing a SN block in these small patients. PMID:24433381

Reinoso-Barbero, Francisco; Saavedra, Barbara; Segura-Grau, Elena; Llamas, Alfonso

2014-02-01

129

Perioperative management of an elderly patient of hypertrophic obstructive cardiomyopathy for knee arthroplasty and the role of peripheral nerve blocks  

Science.gov (United States)

This case report exemplifies how the anaesthetic technique of general anesthesia with continuous bilateral femoral nerve block for bilateral knee arthroplasty was well chosen for the management of perioperative complications in an elderly patient with hypertrophic obstructive cardiomyopathy (HOCM). A 69-year-old female patient of HOCM was scheduled for bilateral total knee replacement. Echocardiography revealed severe left ventricular outflow tract obstruction with peak systolic gradient of 56 mmHg. The surgery was conducted under general anaesthesia with invasive monitoring and bilateral continuous femoral nerve blocks for postoperative analgesia. Postoperatively, she developed pulmonary oedema due to the liberal administration of fluids. This complication was successfully managed without interrupting the management of pain. Management of patients with HOCM for noncardiac surgery requires knowledge of variable presentation of two forms of disease. Also, this case report highlights the practical advantage of continuous femoral nerve block (CFNB)s over epidural anaesthesia.

Rupal, Sunny; Swami, Adarsh C; Jindal, Swati; Lata, Sneh

2013-01-01

130

Ropivacaine in ultrasound-guided femoral nerve block: what is the minimal effective anaesthetic concentration (EC90 )?  

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The objective of this study was to estimate the minimal effective anaesthetic concentrations of ropivacaine required to block the femoral nerve in 90% of patients. Forty-five patients who had knee surgery received ultrasound-guided femoral nerve block using 15 ml ropivacaine. The ropivacaine concentration given to a patient relied on the efficacy of the block in the previous patient, using the biased-coin design up-down sequential method. In the event of successful block, the next patient was randomly assigned to receive either the same ropivacaine concentration or a concentration 0.02% w/v less. In the event of a failed block, the next patient received a concentration 0.02% w/v higher. Successful block was defined as complete sensory and motor block before surgery together with pain-free surgery. The minimal effective ropivacaine concentration was estimated to be 0.167% w/v (95% CI 0.14-0.184%). Perineural injection of 15 ml ropivacaine 0.167% w/v under ultrasound guidance can provide successful femoral nerve block in 90% of patients. PMID:24862380

Taha, A M; Abd-Elmaksoud, A M

2014-07-01

131

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

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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

132

Combined femoral and sciatic nerve blocks for lower limb anaesthesia in anticoagulated patients with severe cardiac valvular lesions  

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Full Text Available Peripheral nerve block (PNB in anticoagulated patients is controversial and guidelines are not defined. We report two patients with severe cardiac valvular lesions, who underwent emergency surgeries for lower limb. Both the patients were on anticoagulants, warfarin and heparin in one and aspirin and clopidogrel in the other, with abnormal coagulation profile in the former. Combined femoral and sciatic nerve blocks were used as a sole anaesthetic technique. Postoperatively, the patients were evaluated for bleeding complications at the injection site using high-frequency ultrasound probe. Both had uneventful surgery and recovery. A close postoperative monitoring following PNBs in anticoagulated patients is necessary.

Tantry Thrivikrama

2010-01-01

133

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

134

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

International Nuclear Information System (INIS)

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

2003-01-01

135

Effectiveness of lumbar facet joint nerve blocks in chronic low back pain: a randomized clinical trial.  

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This randomized clinical trial was designed to determine the effectiveness of therapeutic lumbar facet joint nerve blocks. Two hundred patients were evaluated with controlled diagnostic blocks for the presence of facet joint mediated pain. Eighty four patients, or 42% were determined to have lumbar facet joint mediated pain. These patients were randomly allocated into two groups: Group I receiving therapeutic injections with local anesthetic and Sarapin, and Group II receiving therapeutic injections with a mixture of local anesthetic, Sarapin, and methyl prednisolone. A total of 73 patients were treated with medial branch blocks under fluoroscopy. Results showed that patients underwent multiple procedures over a period of 2(1/2) years. The mean number of procedures or interventions was 2.5 +/- 0.09 from 1 to 3 months, whereas it was 4 +/- 0.13 for 4 to 6 months, 6.1 +/- 0.21 for 7 to 12 months, and 8.4 +/- 0.31 for 13 to 32 months. Cumulative significant relief with one to three injections was 100% up to 1 to 3 months, 82% for 4 to 6 months, 21% for 7 to 12 months, and 10% after 12 months, with a mean relief of 6.5 +/- 0.76 months. There was significant improvement noted in overall health status with improvement not only in pain relief, but also with physical, functional, and psychological status, as well as return-to-work status. In conclusion, the results of this study demonstrate that medial branch blocks with local anesthetic and Sarapin, with or without steroids, are a cost effective modality of treatment, resulting in improvement in pain status, physical status, psychological status, functional status and return to work. PMID:16906173

Manchikanti, L; Pampati, V; Bakhit, C E; Rivera, J J; Beyer, C D; Damron, K S; Barnhill, R C

2001-01-01

136

A randomized comparative study of efficacy of axillary and infraclavicular approaches for brachial plexus block for upper limb surgery using peripheral nerve stimulator  

Directory of Open Access Journals (Sweden)

Full Text Available Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing forearm and hand surgeries. After obtaining institutional approval and written informed consent, 60 patients of American Society of Anaesthesiologists grade I or II scheduled for forearm and hand surgeries were included in the study and were randomly allocated into two groups. Brachial plexus block was performed via the vertical infraclavicular approach (VIB in patients of Group I and axillary approach in Group A using a peripheral nerve stimulator. Sensory block in the distribution of individual nerves supplying the arm, motor block, duration of sensory block, incidence of successful block and various complications were recorded. Successful block was achieved in 90% of the patients in group I and in 87% of patients in group A. Intercostobrachial nerve blockade was significantly higher in group I. No statistically significant difference was found in sensory and motor blockade of other nerves. Both the approaches are comparable, but the VIB scores ahead of axillary block in terms of its ability to block more nerves. The VIB because of its easily identifiable landmarks, a comfortable patient position during the block procedure and the ability to block a larger spectrum of nerves should thus be considered as an effective alternative to the axillary approach.

Lahori Vikram

2011-01-01

137

Pain relief in active patients with cancer: the early use of nerve blocks improves the quality of life.  

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Analgesic drugs are the first line of pain relief in cancer, but they should not be the only treatment offered. If nerve blocks and other destructive procedures are to be used they should be used early with conviction and persistence. They might not be being used because there are not enough doctors who can use them properly.

Lipton, S.

1989-01-01

138

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

Science.gov (United States)

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

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

2014-01-01

139

Sciatic nerve blocks in children: comparison of the posterior, anterior, and lateral approaches in 180 pediatric patients.  

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Three techniques for blocking the sciatic nerve, differing in approach (posterior in group P; lateral in group L; and anterior in group A), were prospectively evaluated in 180 children who were also given light general anesthesia for surgery below the knee. Four anesthetic solutions with epinephrine (1% lidocaine, 0.5% bupivacaine, and two mixtures of 0.5% bupivacaine with either 1% lidocaine or 1% etidocaine) were administered to 15 patients in each group. The sciatic nerve was located by electrical stimulation or, when muscle twitches were not elicited, using a loss-of-resistance technique. Twitches were "typical" in 154 patients of whom 153 developed sciatic nerve block. In 26 patients twitches were atypical (eight patients) or absent (18 patients) and a sciatic block developed in only 13 patients (50%). The depth to which the needle was inserted was measured in each procedure; it varied according to patient's age and weight and was significantly less with the posterior approach than with either the lateral or anterior routes. The overall success rate exceeded 90% in the three groups but significantly fewer difficulties were encountered in group P than in group A. Although the spread of the anesthetic was different in the three groups, the distribution of anesthesia in the lower extremity was similar, including not only dermatomes supplied by the sciatic nerve, but also those supplied by the posterior femoral cutaneous nerve. No neurological sequelae were observed. It is concluded that the posterior and lateral approaches are the most suitable in children for blocking the sciatic nerve proximally. PMID:2301744

Dalens, B; Tanguy, A; Vanneuville, G

1990-02-01

140

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

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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

 
 
 
 
141

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

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

Pyylampi Ville

2011-10-01

142

Combined sciatic-femoral nerve block with 0.75% ropivacaine: effects of adding a systemically inactive dose of fentanyl.  

Science.gov (United States)

To evaluate the effects of adding low-dose fentanyl to 0.75% ropivacaine during peripheral nerve blocks, 30 ASA physical status I-II patients undergoing hallux valgus repair under combined sciatic-femoral nerve block were randomly allocated in a double-blind fashion to receive nerve block placement with 30 mL of either 0.75% ropivacaine alone (group: ropivacaine, n = 15) or 0.75% ropivacaine plus fentanyl 1 microg kg(-1) (group: ropivacaine-fentanyl, n = 15). A blinded observer recorded haemodynamic variables and sedation, as well as the time required to achieve surgical block and the first request for analgesia. Readiness to surgery required 10 min (5-20 min) with 0.75% ropivacaine and 10 min (3-20 min) with the ropivacaine-fentanyl mixture. No differences in the degree of sedation, peripheral oxygen saturation, and haemodynamic variables were observed between the two groups. The degree of pain measured at first analgesic request, and the consumption of postoperative analgesics, was similar in the two groups, while the mean time from block placement to the first request for pain medication was 13.7 h (25-75th percentiles: 11.8-14.5 h) in the ropivacaine group and 13.9 h (25-75th percentiles: 10.5-14.5 h) in the ropivacaine-fentanyl group (P = not significant). We conclude that adding fentanyl 1 microg kg(-1) to 0.75% ropivacaine did not provide clinically relevant advantages in terms of onset time, quality and duration of combined sciatic-femoral nerve block in patients undergoing elective hallux valgus repair. PMID:10928433

Magistris, L; Casati, A; Albertin, A; Deni, F; Danelli, G; Borghi, B; Fanelli, G

2000-06-01

143

Use of dexamethasone with TTX block of nerve conduction shows that muscle membrane properties are fully controlled by evoked activity.  

Science.gov (United States)

This paper provides further evidence that motorneurons control extrajunctional properties of skeletal muscles through the activity evoked in the muscle fibres. The experiments compare the amount of action potential resistance to tetrodotoxin (TTX resistance) in denervated soleus muscle with that in soleus whose nerve was crushed and then allowed to regenerate in the presence of a block of the sciatic impulse conduction. Measurements were taken after about 2-3 weeks to allow full reinnervation and recovery of trophic regulation by the nerve. Blocking sciatic impulse conduction with TTX solutions containing low doses of the anti-inflammatory drug dexamethasone induced values of extrajunctional TTX resistance identical to those caused by denervation. In contrast lower levels of TTX resistance were obtained with dexamethasone-free solutions or when the drug was administered through the systemic path rather than topically applied to the nerve. These results indicate that physiological neural regulatory signals other than activity do not participate to the regulation of extrajunctional properties of skeletal muscles. Furthermore the low levels of TTX resistance measured with dexamethasone-free blocks confirm our previous experiments indicating that reported differences between denervation and pure inactivity are attributable to incomplete suppression of nerve impulse conduction. PMID:9372225

Pasino, E; Buffelli, M; Busetto, G; Cangiano, A

1997-10-01

144

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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, ultrasou...

2005-01-01

145

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

146

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

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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

147

The Relationship of Age, Gender and Injection Side with Positive Blood Aspiration During the Inferior Alveolar Nerve Block  

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The Inferior Alveolar Nerve Block (IANB) is the most frequently used injection technique in dentistry and has the greatest risk of accidental intravascular injection. This study conducted to determine the possible differences in blood aspiration during IANB between different ages, genders and injection sides. Four hundred and thirty four IANB were performed in 2-18 year-old patients by the principal author. Blood aspiration was accepted only if a blood jet rose forcefully along the cartridge ...

Bargrizan Majid; Tadayon Nikoo; Ghasemi Amir

2008-01-01

148

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

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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 previousl...

2010-01-01

149

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

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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

150

Pyomyositis of Obturator Muscles: Unusual Late Presentation  

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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

151

Obturator hernia: diagnosis through medical imaging  

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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

1995-08-01

152

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

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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

153

Three-dimensional analysis of maxillary anatomic landmarks for greater palatine nerve block anesthesia.  

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Greater palatine nerve block anesthesia (GPNBA) is a local anesthetic procedure used for maxillary and nasal treatment. Investigation of the three-dimensional anatomic location of the greater palatine foramen (GPF) is important for successful local anesthesia. The study aim was to provide standards for anatomic structures in the oral cavity that can be easily referred to in GPNBA. Maxillary computed tomography data were obtained from patients between 8 and 16 years of age whose maxillary incisors and first molars had already erupted (the growth group, n = 103); changes in the maxilla were observed over time in this group. Reference values for GPNBA in adults were measured in 107 patients older than 18 years. Maxillary computed tomography images were reconstructed three-dimensionally. Regression analysis demonstrates that all maxillary measurements in the growth group except for the distance from the posterior nasal spine to the GPF in the coronal plane correlated significantly with age. In adults, the mean perpendicular distance from the interdental alveolar bone between the left and right central incisors (1alvB) to the GPF in the coronal plane was 46.16 mm, and the mean distance from 1alvB to the GPF was 51.05 mm. The mean distance from the maxillary central incisor to the GPF was 57.58 mm. The mean angle between the line from the maxillary central incisor to each GPF and the sagittal plane was 16.49 degrees. The mean perpendicular distance from the anterior nasal spine to the GPF in the coronal plane was 43.49 mm, whereas the mean perpendicular distance from the GPF to the bone plane was 12.67 mm, and the mean perpendicular distance from the GPF to the occlusal plane was 22.13 mm. These measurements can be used to find the height of the GPF. In adults, the measured perpendicular distance from the incisive foramen to the GPF in the coronal plane was 32.04 mm, and the perpendicular distance from the median of the line that connects both of the contact points between the maxillary tuberosity and the pterygoid plate to the GPF in the coronal plane was 5.23 mm. Three-dimensional reference values relative to the anatomic structures in the oral cavity may increase the success rate of GPNBA and reduce complications. Although the maxillary growth pattern was analyzed, a limitation of this study is that maxillary anatomic measurements were not analyzed with regard to race or ethnicity. PMID:22627432

Kang, Sang-Hoon; Byun, In-Young; Kim, Jin-Hong; Park, Hee-Keun; Kim, Moon-Key

2012-05-01

154

Onset and Duration Period of Pulpal Anesthesia of Articaine and Lidocaine in Inferior Alveolar Nerve Block  

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Full Text Available SciELO Brazil | Language: English Abstract in portuguese A proposta deste estudo prospectivo, randomizado e duplo cego foi comparar o período de latência e duração da anestesia pulpar utilizando lidocaina 2% com epinefrina 1:100.000, articaina 4% com epinefrina 1:100.000 e articaina 4% com epinefrina 1:200.000 no bloqueio do nervo alveolar inferior (BNAI) [...] . Trinta pacientes receberam 1,8 mL de cada uma das soluções anestésicas no BNAI. Os períodos de latência e duração da anestesia pulpar foram determinados usando estimulação pulpar elétrica. O tempo médio da latência da anestesia pulpar foi 8,7, 7,4 e 7,7 min e da duração média da anestesia pulpar foi 61,8, 106,6 e 88,0 min para lidocaina 2% com epinefrina 1:100.000, articaina 4% com epinefrina 1:100.000 e articaina 4% com epinefrina 1:200.000, respectivamente. Para latência houve somente diferença significante entre lidocaina 2% com epinefrina 1:100.000 e articaina 4% com epinefrina 1:100.000 (p=0,037). Para a duração houve diferença significante para todas as soluções anestésicas locais (p?0,05). Em conclusão, articaina 4% com epinefrina 1:100.000 exibiu mais rápida latência e também obteve mais longa duração da anestesia pulpar no BNAI. Abstract in english The purpose of this prospective, randomized, double blind study was to compare the onset and duration periods of pulpal anesthesia using 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:100,000 epinephrine and 4% articaine with 1:200,000 epinephrine in inferior alveolar nerve block (IANB [...] ). Thirty subjects received 1.8 mL of each of the three local anesthetic solutions in IANB. Onset and duration periods of pulpal anesthesia were determined using electric pulp stimulation. The mean time of onset of pulpal anesthesia was 8.7, 7.4 and 7.7 min and the mean duration of pulpal anesthesia was 61.8, 106.6 and 88.0 min for 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:100,000 epinephrine and 4% articaine with 1:200,000 epinephrine, respectively. For onset, there was only a significant difference between 2% lidocaine with 1:100,000 epinephrine and 4% articaine with 1:100,000 epinephrine (p=0.037). For duration, there was significant difference for all the local anesthetic solutions (p?0.05). In conclusion, 4% articaine with 1:100,000 epinephrine exhibited faster onset and also had longest duration of pulpal anesthesia in IANB.

Isabel Peixoto, Tortamano; Marcelo, Siviero; Sara, Lee; Roberta Moura, Sampaio; Jose Leonardo, Simone; Rodney Garcia, Rocha.

155

Herniography off femoral, obturator and perineal hernias  

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Positive contrast herniography was used in the workup of 550 patients with unclear groin pain. The majority of these patients had rather characteristic hernias of indirect, direct or femoral type. However, now and then diagnostic problems arose. A femoral hernia may look like a direct or even obturator hernia. There is also a variety of multilocular femoral hernias and other types. A femoral hernia may be present together with other hernias in the ipsilateral or contralateral groin. Obturator hernias are usually small but are always confined to the obturator canal laterally in the obturator foramen. Abnormalities in the pouch of Douglas may include a deep rectogenital pouch, diverticula and true herniations. These uncommon herniographic findings are described and discussed. (orig.)

1985-01-01

156

Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery  

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Full Text Available JunLe Liu,1,* WeiXiu Yuan,1,* XiaoLin Wang,1,* Colin F Royse,2,3 MaoWei Gong,1 Ying Zhao,1 Hong Zhang1 1Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital and Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China; 2Anesthesia and Pain Management Unit, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; 3Department of Anesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia *These authors contributed equally to this work Background: Both peripheral nerve blocks with sedation or general anesthesia can be used for total knee replacement surgery. Objectives: We compared these anesthetic techniques on the postoperative quality of recovery early in elderly patients. Materials and methods: In our study, 213 patients who were ?65 years old and undergoing total knee replacement were randomized to peripheral nerve blocks (PNBs – lumbar plexus and sciatic – with propofol sedation, or general anesthesia with combined propofol and remifentanil. Blocks were performed using nerve stimulation and 0.35% ropivacaine. All patients received postoperative multimodal analgesia. Postoperative recovery was assessed at 15 minutes, 40 minutes, 1 day, 3 days, and 7 days after surgery, with the Postoperative Quality of Recovery Scale, in physiological, nociceptive, emotive, modified activities of daily living, modified cognitive, and overall patient perspective domains. Results: Intraoperative blood pressure and heart rate were more stable with PNBs (P<0.001. The recovery was better with PNBs in physiological (P<0.001, emotive (depression and anxiety (P<0.001, nociceptive (pain and nausea (P<0.001, modified cognitive (P<0.001, and all domains recovery (P<0.001, but not in activities of daily living (P=0.181. Intraoperative drugs and the postoperative sulfentanil requirement of the PNBs group were lower (all P<0.001. Differences were greatest early after surgery with equivalence by 1 week. Satisfaction was high and not different between groups (P=0.059. Conclusion: Lumbar plexus and sciatic blocks with sedation facilitates faster postoperative recovery than general anesthesia, but not at 1 week after total knee replacement in patients who were 65 years or older. The trial has been registered at ClinicalTrials.gov. (NCT01871012. Keywords: nerve block, general anesthesia, knee replacement, perioperative care

Liu JL

2014-02-01

157

Intra and postoperative outcome of adding clonidine to bupivacaine in infraorbital nerve block for young children undergoing cleft lip surgery  

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Aims and Context: To evaluate the efficacy of adding clonidine to bupivacaine in bilateral infraorbital nerve block for hemodynamic changes, requirement of opioids, volatile agent, and muscle relaxants intraoperatively and relief of pain postoperatively Setting and Design: Prospective, randomized, double-blind study. Methods: Fifty pediatric patients aged less than 24 months undergoing elective cleft lip repair were randomly allocated to two groups of 25 each. After tracheal intubation, group A received bilateral infraorbital nerve block with 1 ml solution of clonidine (1 ?g/kg) and bupivacaine 0.25%, and group B received 1 ml of 0.25% bupivacaine. Hemodynamic parameters, intraoperative requirement of volatile anesthetic agent, muscle relaxant, and analgesic were recorded. Pain was assessed postoperatively using the Face, Legs, Activity, Cry, Consolability scale till the first rescue drug was given. Statistical Analysis: Two sample unpaired t-test and the correlation r test. Results: The duration of analgesia from the time of administration of block in group A was 667.72 ± 210.74 min compared to 558.48 ± 150.28 min in group B (P<0.05). Conclusion: Addition of clonidine as an adjunct to local anesthetic significantly decreased the requirement of other anesthetic drugs and significantly prolonged the duration of postoperative analgesia without any adverse effects.

Jindal, Parul; Khurana, Gurjeet; Dvivedi, Sanjay; Sharma, J. P.

2011-01-01

158

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

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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

159

Criteria for conduction block based on computer simulation studies of nerve conduction with human data obtained in the forearm segment of the median nerve.  

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The finding of conduction block (CB) on nerve conduction studies supports the diagnosis of potentially treatable immune-mediated neuropathies. CB in a number of axons may result in reduction of the compound muscle action potential (CMAP) on proximal versus distal stimulation (decrement). Decrement may also result from increased temporal dispersion (TD) as this leads to desynchronization and phase cancellation of the motor unit action potentials (MUAPs) out of which the CMAP is built up; polyphasia of MUAPs possibly yields additional decrement. To prove the occurrence of CB, decrement has to be larger than can be explained by increased TD or increased phase cancellation. This was established previously by simulations using MUAPs recorded in rats assuming maximal TD. Unfortunately, criteria based on human data and criteria for nerves with limited TD are not available. In the present study, criteria for CB were derived using simulations with thenar surface recorded MUAPs affected by collateral reinnervation that were obtained in patients with lower motor neurone disease (LMND). The effect of TD on decrement was determined for a wide range of TDs in the forearm segment of the median nerve and the segment distal to this. Our criteria for CB were based on area decrement because this was less influenced by TD and more by CB than amplitude decrement. The maximal area decrement in the forearm segment increased as TD in the forearm segment increased but decreased as TD in the distal segment increased. This suggests that, when desynchronization and phase cancellation occur in the distal segment due to TD, less phase cancellation and, therefore, less decrement can occur due to TD in the forearm. The finding that duration prolongation on proximal versus distal stimulation reflected TD within the forearm segment and that distal duration reflected TD in the distal segment allowed proposal of a more flexible set of criteria for forearm segments when TD in the forearm segment is limited or TD in the distal segment is pronounced. A separate investigation showed that the maximal TD in chronic inflammatory demyelinating polyneuropathy was within the range of our simulations, indicating that these were realistic. Our criteria were validated retrospectively in patients with multifocal motor neuropathy and patients with LMND. In the forearm segment of the median nerve, our criteria were more sensitive and equally specific for CB as compared with criteria for CB based on the study using rats. Our criteria have to be evaluated prospectively. PMID:16923956

Van Asseldonk, J T H; Van den Berg, L H; Wieneke, G H; Wokke, J H J; Franssen, H

2006-09-01

160

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

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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

 
 
 
 
161

Multilevel nerve stimulator-guided paravertebral block as a sole anesthetic technique for breast cancer surgery in morbidly obese patients.  

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In this case series, we present the effectiveness of multilevel nerve stimulator-guided paravertebral block (PVB) technique in obese women of body mass index ?30 kg/m(2) undergoing breast cancer surgery with or without axillary dissection. Twenty-six obese women were included in this case series. Block classification, hemodynamics and complication rate, postoperative nausea and vomiting, postoperative analgesic consumption, post-anesthesia care unit (PACU) stay, and hospital stay were recorded. All patients were hemodynamically stable during the operation, and no complications were noted. Patients stayed 69 min on average in the PACU and were discharged within 2 days. Confirmation of the landmark was established from the initial attempt in 61.5%. Surgical PVB was achieved in 76.9% of the patients; the failure rate of the technique was 11.5%. This case series suggested that the multilevel nerve stimulator-guided PVB may be an effective technique for obese patients undergoing breast cancer surgery, although further studies are needed to compare PVB and general anesthesia. PMID:21748373

Naja, Zoher M; Naccache, Nicole; Ziade, Fouad; El-Rajab, Mariam; Itani, Taha; Baraka, Anis

2011-10-01

162

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

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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

163

A triple-masked, randomized controlled trial comparing ultrasound-guided brachial plexus and distal peripheral nerve block anesthesia for outpatient hand surgery.  

Science.gov (United States)

Background. For hand surgery, brachial plexus blocks provide effective anesthesia but produce undesirable numbness. We hypothesized that distal peripheral nerve blocks will better preserve motor function while providing effective anesthesia. Methods. Adult subjects who were scheduled for elective ambulatory hand surgery under regional anesthesia and sedation were recruited and randomly assigned to receive ultrasound-guided supraclavicular brachial plexus block or distal block of the ulnar and median nerves. Each subject received 15?mL of 1.5% mepivacaine at the assigned location with 15?mL of normal saline injected in the alternate block location. The primary outcome (change in baseline grip strength measured by a hydraulic dynamometer) was tested before the block and prior to discharge. Subject satisfaction data were collected the day after surgery. Results. Fourteen subjects were enrolled. Median (interquartile range [IQR]) strength loss in the distal group was 21.4% (14.3, 47.8%), while all subjects in the supraclavicular group lost 100% of their preoperative strength, P = 0.001. Subjects in the distal group reported greater satisfaction with their block procedures on the day after surgery, P = 0.012. Conclusion. Distal nerve blocks better preserve motor function without negatively affecting quality of anesthesia, leading to increased patient satisfaction, when compared to brachial plexus block. PMID:24839439

Lam, Nicholas C K; Charles, Matthew; Mercer, Deana; Soneru, Codruta; Dillow, Jennifer; Jaime, Francisco; Petersen, Timothy R; Mariano, Edward R

2014-01-01

164

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)

2002-09-01

165

MR Imaging Features of Obturator Internus Bursa of the Hip  

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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.

Hwang, Ji Young; Lee, Sun Wha; Kim, Jong Oh

2008-01-01

166

Wheat germ agglutinin blocks the biological effects of nerve growth factor  

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The binding of nerve growth factor (NGF) to specific cell surface receptors initiates a variety of effects that lead to the morphological and biochemical differentiation of clonal pheochromocytoma, PC12, cells. The lectin wheat germ agglutinin (WGA) alters the characteristics of NGF-receptor interaction. We have found that treatment of PC12 cells with WGA dramatically and reversibly inhibits the ability of NGF to elicit three distinct biological effects characteristic of NGF action. Two of th...

1985-01-01

167

Local anesthetics potently block a potential insensitive potassium channel in myelinated nerve  

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Effects of some local anesthetics were studied in patch clamp experiments on enzymatically demyelinated peripheral amphibian nerve fibers. Micromolar concentrations of external bupivacaine depolarized the excised membrane considerably. The flicker K+ channel was found to be the most sensitive ion channel to local anesthetics in this preparation. Half-maximum inhibiting concentrations (IC50) for extracellular application of bupivacaine, ropivacaine, etidocaine, mepivacaine, lidocaine, and QX-3...

1995-01-01

168

A prospective, randomized comparison between the popliteal and subgluteal approaches for continuous sciatic nerve block with stimulating catheters.  

Science.gov (United States)

In this prospective, blinded study, we randomized 56 patients undergoing hallux valgus repair to receive continuous sciatic nerve block using a subgluteal (n = 28) or a posterior popliteal approach (n = 28) with a perineural stimulating catheter. Postoperatively, the stimulating catheter was connected to a patient-controlled analgesia pump with 0.0625% levobupivacaine (basal infusion rate of 3 mL/h, patient-controlled bolus dose of 3 mL, and lockout time of 20 min). Both approaches provided similar postoperative analgesia; however, local anesthetic consumption was larger in the popliteal group (4.9 +/- 1.4 mL/h) compared with the subgluteal group (3.8 +/- 1.1 mL/h; P < 0.05). We conclude continuous postoperative analgesia using stimulating catheters was effective at both injection sites; however, a subgluteal approach reduced the overall amount of local anesthetic. PMID:16790661

Taboada, Manuel; Rodríguez, Jaime; Valiño, Cristina; Vazquez, Miriam; Laya, Araceli; Garea, Manuel; Carceller, Javier; Alvarez, Julian; Atanassoff, Vanessa; Atanassoff, Peter G

2006-07-01

169

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

170

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

Scientific Electronic Library Online (English)

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

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

171

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

172

Small-dose clonidine prolongs postoperative analgesia after sciatic-femoral nerve block with 0.75% ropivacaine for foot surgery.  

Science.gov (United States)

To evaluate the effects of adding small-dose clonidine to 0.75% ropivacaine during peripheral nerve blocks, 30 ASA physical status I and II patients undergoing hallux valgus repair under combined sciatic-femoral nerve block were randomly allocated in a double-blinded fashion to receive block placement with 30 mL of either 0.75% ropivacaine alone (group Ropivacaine, n = 15) or 0.75% ropivacaine plus 1 microg/kg clonidine (group Ropivacaine-Clonidine, n = 15). Hemodynamic variables, oxygen saturation, and levels of sedation, as well as the time required to achieve surgical block and time to first analgesic request, were recorded by a blinded observer. Time to surgical blockade required 10 min in both groups. Patients in the Ropivacaine-Clonidine group were more sedated than patients in the Ropivacaine group only 10 min after block placement. No differences in oxygen saturation and hemodynamic variables, degree of pain measured at first analgesic request, and consumption of postoperative analgesics were observed between the two groups. The mean time from block placement to first request for pain medication was shorter in group Ropivacaine (13.7 h; 25th-75th percentiles: 11. 8-14.5 h) than in group Ropivacaine-Clonidine (16.8 h; 25th-75th percentiles: 13.5-17.8 h) (P = 0.038). We conclude that adding 1 microg/kg clonidine to 0.75% ropivacaine provided a 3-h delay in first request for pain medication after hallux valgus repair, with no clinically relevant side effects. Implications: This prospective, randomized, double-blinded study demonstrated that, when providing combined sciatic-femoral nerve block for hallux valgus repair, the addition of 1 microg/kg clonidine to 0.75% ropivacaine prolongs the duration of postoperative analgesia by 3 h, with only a slight and short-lived increase in the degree of sedation and no hemodynamic adverse effects. PMID:10910854

Casati, A; Magistris, L; Fanelli, G; Beccaria, P; Cappelleri, G; Aldegheri, G; Torri, G

2000-08-01

173

Trial of finger contamination reduction of the operator in nerve block treatment. Comparison of over- and under-table systems  

International Nuclear Information System (INIS)

Fluoroscopy-guided intervention of the lumbar spine, such as nerve block, plays an important role in the management of disc hernia patients. However, irradiation of operators' fingers remains a problem even with careful collimation and operation, especially when performed by non-radiologists. We compared the irradiation doses of under-table and over-table fluoroscopy systems, and we discuss the most advantageous method of reducing irradiation. The effectiveness and conditions of use of lead protection gloves were also evaluated. Skin dose was monitored using polymethyl methacrylate (PMMA) and an electronic dose meter. The skin doses of over- and under-table fluoroscopy were compared using C-arm fluoroscopy. Finger irradiation dose with 0.03 mmPb protection gloves was also measured. The under-table method reduced skin dose by 95% compared with the over-table method. Thicker PMMA resulted in a higher rate of irradiation reduction. Protection gloves reduced radiation dose by half, although this reduction was cancelled when automatic brightness control (ABC) was utilized. Under-tube fluoroscopy was superior to over-tube fluoroscopy in reducing irradiation to the fingers. (author)

2004-03-01

174

[Trial of finger contamination reduction of the operator in nerve block treatment: comparison of over- and under-table systems].  

Science.gov (United States)

Fluoroscopy-guided intervention of the lumbar spine, such as nerve block, plays an important role in the management of disc hernia patients. However, irradiation of operators' fingers remains a problem even with careful collimation and operation, especially when performed by non-radiologists. We compared the irradiation doses of under-table and over-table fluoroscopy systems, and we discuss the most advantageous method of reducing irradiation. The effectiveness and conditions of use of lead protection gloves were also evaluated. Skin dose was monitored using polymethyl methacrylate (PMMA) and an electronic dose meter. The skin doses of over- and under-table fluoroscopy were compared using C-arm fluoroscopy. Finger irradiation dose with 0.03 mmPb protection gloves was also measured. The under-table method reduced skin dose by 95% compared with the over-table method. Thicker PMMA resulted in a higher rate of irradiation reduction. Protection gloves reduced radiation dose by half, although this reduction was cancelled when automatic brightness control (ABC) was utilized. Under-tube fluoroscopy was superior to over-tube fluoroscopy in reducing irradiation to the fingers. PMID:15131509

Saito, Hajime; Okabe, Keigo; Nakazawa, Yasuo

2004-03-01

175

Differences in tip visibility and nerve block parameters between two echogenic needles during a simulation study with inexperienced anesthesia trainees.  

Science.gov (United States)

Needle tip visualization during ultrasound-guided regional anesthesia (UGRA) is necessary for safety and efficacy. However, disruption of the image of the needle tip driven toward the target is a general problem, especially for beginners. The purpose of this study was to compare performance parameters between using the Sonoplex and Stimuplex D-Plus echogenic needles in a simulated ultrasound-guided interventional task by inexperienced anaesthesia residents. After a standardized training session, 28 anesthesiology residents performed simulated nerve blocks in a beef phantom with each needle. All ultrasound images were digitally stored for analysis. The absolute time the needle tip was in view, total procedure time, and angle of needle insertion were subsequently measured objectively by two single investigators. The procedures that used the Sonoplex echogenic needle had significantly better tip visibility and shorter total procedure time at insertion angles between 42° and 64° relative to the phantom surface. We have demonstrated that inexperienced users who used the Sonoplex echogenic needle were able to complete the procedure more quickly. Needles with improved visibility would be a very useful addition to UGRA for inexperienced users. PMID:24127134

Kilicaslan, Alper; Topal, Ahmet; Tavlan, Aybars; Erol, Atilla; Otelcioglu, Seref

2014-06-01

176

The Relationship of Age, Gender and Injection Side with Positive Blood Aspiration During the Inferior Alveolar Nerve Block  

Directory of Open Access Journals (Sweden)

Full Text Available The Inferior Alveolar Nerve Block (IANB is the most frequently used injection technique in dentistry and has the greatest risk of accidental intravascular injection. This study conducted to determine the possible differences in blood aspiration during IANB between different ages, genders and injection sides. Four hundred and thirty four IANB were performed in 2-18 year-old patients by the principal author. Blood aspiration was accepted only if a blood jet rose forcefully along the cartridge on aspiration. Multiple logistic regression analysis was used to estimate the relationship of age, gender and injection side with incidence of positive blood aspiration with alpha value set at 0.05. No significant differences (p<0.05 were observed on contrasting the incidence of positive blood aspiration with the age. However, significant differences were seen on correlating aspiration to the gender and injection side. Blood aspiration was observed in 12.9% of cases. The high incidence of intravascular injection during IANB that we found proves aspiration is necessary regardless of the age of the patient.

2008-01-01

177

A Prospective, Randomized, Double-Blind Study of the Anesthetic Efficacy of Sodium Bicarbonate Buffered 2% Lidocaine With 1?:?100,000 Epinephrine in Inferior Alveolar Nerve Blocks  

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The authors, using a crossover design, randomly administered, in a double-blind manner, inferior alveolar nerve (IAN) blocks using a buffered 2% lidocaine with 1?:?100,000 epinephrine/sodium bicarbonate formulation and an unbuffered 2% lidocaine with 1?:?100,000 epinephrine formulation at 2 separate appointments spaced at least 1 week apart. An electric pulp tester was used in 4-minute cycles for 60 minutes to test for anesthesia of the first and second molars, premolars, and latera...

Whitcomb, Michael; Drum, Melissa; Reader, Al; Nusstein, John; Beck, Mike

2010-01-01

178

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  

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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 trial 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 Barce...

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

2007-01-01

179

Identification of Materials from 60-mm Mortar Obturators.  

Science.gov (United States)

Two plastic obturators for the 60-mm mortar were submitted for physical and chemical analysis. One of the obturators was from current U.S. Army stock while the other was from a contractor which had failed by misfire during field tests. The analysis reveal...

A. F. Tatyrek

1988-01-01

180

A Rare Cause of Small Intestinal Obstruction: Obturator Hernia  

Directory of Open Access Journals (Sweden)

Full Text Available Obturator hernia is an uncommon disease and its diagnosis is challenging. It is more prevalent in thin, multiparous, elderly women. In this case report a 93-year-old woman patient with a right-sided strangulated obturator hernia was discussed with review of the relevant literature. [Cukurova Med J 2014; 39(3.000: 654-657

Erdal Karagulle

2014-06-01

 
 
 
 
181

Anaesthetic efficacy of bupivacaine 2-hydroxypropyl-?-cyclodextrin for dental anaesthesia after inferior alveolar nerve block in rats.  

Science.gov (United States)

Bupivacaine is a long-acting local anaesthetic that is widely used in medicine and dentistry. The duration and intensity of its sensory blockade in animal models is increased by its inclusion in complexes with cyclodextrins. The aim of the present study was to evaluate the anaesthetic efficacy of bupivacaine 2-hydroxypropyl-?-cyclodextrin (HP?CD) inclusion complex for dental anaesthesia after inferior alveolar nerve block in rats. Thirty rats were each given an injection close to the mandibular foramen of 0.2ml of one of the following formulations: 0.5% bupivacaine alone; 0.5% bupivacaine with 1:200,000 epinephrine; and 0.5% bupivacaine-HP?CD inclusion complex (bupivacaine-HP?CD). The other sides were used as controls, with either 0.9% saline or anaesthetic-free HP?CD solution being injected. The onset, success, and duration of pulpal anaesthesia were assessed by electrical stimulation ("pulp tester") on inferior molars. Results were analysed using ANOVA (Tukey), log rank, and chi square tests (?=5%). There were no differences among the formulations in onset of anaesthesia (p=0.59) or between the bupivacaine plus epinephrine and bupivacaine plus HP?CD in duration of anaesthesia, but bupivacaine plus epinephrine gave significantly higher values than bupivacaine alone (p=0.007). Bupivacaine plus epinephrine was a better anaesthetic than bupivacaine alone (p=0.02), while Bupi-HP?CD gave intermediate results, and therefore did not differ significantly from the other 2 groups (p=0.18 with bupivacaine alone; and p=0.44 with bupivacaine plus epinephrine). The bupivacaine-HP?CD complex showed similar anaesthetic properties to those of bupivacaine with epinephrine. PMID:24673836

Serpe, L; Franz-Montan, M; Dos Santos, C P; da Silva, C B; Nolasco, F P; Caldas, C S; Volpato, M C; de Paula, E; Groppo, F C

2014-05-01

182

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 | Language: 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.

183

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

184

Our anesthesia experiences with geriatric patients at high risk group undergoing hip surgery under combined psoas compartment-sciatic nerve block  

Directory of Open Access Journals (Sweden)

Full Text Available Aim. The effect of psoas compartment and sciatic nerve block combination on hemodynamic parameters in high risk geriatric patients with hip fracture surgeries was evaluated. Methods. In this study, high risk old patients who underwent psoas compartment block and sciatic nerve block for hip surgery anesthesia were evaluated retrospectively. In Group 1 there were 14 patients with levobupivacaine and lidocaine combination and in Group 2 there were 10 patients with levobupivacaine and prilocaine combination. In our study we evaluated the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure levels and sedation need between groups, between age over and below 85 years and in all patients. Results. There were no statistically significant difference in heart rate and mean arterial blood pressure levels between groups and age groups (p?0.05. There were a 6.18% and 16.52% decrease in mean arterial blood pressure in Group 1 and 2 respectively. When we evaluated the whole patients there was a 10.06% decrease in mean arterial blood pressure. Conclusion. We consider that the combination of psoas and sciatic block as an anesthetic method may be a proper option especially in the elderly and high-risk patients who were underwent the hip surgery.

Kas?m Tuzcu

2013-09-01

185

[Sciatic and femoral nerve block with electro-neural stimulator (ENS) in surgery of the knee in day-care surgery].  

Science.gov (United States)

This study was designed to evaluate locoregional anesthesia (double block of sciatic and femoral nerves with ENS) for ambulatory knee arthroscopic surgery. A statistical evaluation was performed in 50 adult outpatients (41 males, 9 females, ASA class 1 or 2) undergoing ambulatory knee arthroscopic procedures. Basal and intraoperative BP, HR SaO2 were recorded and the intensity of analgesia was also assessed according to the patient's subjective evaluation. Extra sedative or analgesic requirements were also recorded. There were no statistical changes in hemodynamic parameters during the perioperative period. The effectiveness of the anaesthetic block was classified as very good in 84% of patients, good in 2%, sufficient in 6% and inadequate in 8%. All patients were discharged in four hours after surgery. Our study shows that in ambulatory arthroscopic surgery, sciatic and femoral block with ENS is a valuable alternative to general anaesthesia. PMID:8090303

Cornaggia, G; Capucci, R; Bassani, L; Stella, L; Sansone, V; Gobbi, A

1994-03-01

186

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

187

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.

188

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

189

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

190

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

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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...

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

2008-01-01

191

Morphological examination of the obturator notch and canal in cervidae.  

Science.gov (United States)

The purpose of this study was to investigate gross findings of the obturator notch (ON) and obturator canal (OC) in Cervidae. A total of 183 pelvic girdles from 26 species of deer were examined, and the obturator canal (OC) was classified into 4 types based on the degree of separation from the obturator foramen (OF). The deep ON was observed primarily in the subfamily Capreolinae (telemetacarpal deer). The small bony OC was frequently observed in Hydropotes inermis, Mazama gouazoubira and Ozotoceros bezoarticus. A canal without a tubercle or bony bridge structure was mainly observed in the subfamily Cervinae (plesiometacarpal deer). These results suggest that the deep ONs or the OCs separated by bony structures are more common in telemetacarpal rather than plesiometacarpal deer. PMID:24430657

Tae, Hyun-Jin; Park, Byung-Yong; Kim, In-Shik; Ahn, Dongchoon

2014-06-01

192

Variability in the origin of the obturator artery  

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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

193

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

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

194

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

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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

195

Adding clonidine to the induction bolus and postoperative infusion during continuous femoral nerve block delays recovery of motor function after total knee arthroplasty.  

Science.gov (United States)

We evaluated the effects of adding clonidine for continuous peripheral nerve infusions. Sixty patients undergoing total knee arthroplasty under combined single-injection sciatic block and continuous femoral infusion were randomly allocated to three groups: block induction with 0.75% ropivacaine followed by 0.2% ropivacaine (group control; n = 20); block induction with 0.75% ropivacaine and 1 microg/kg clonidine followed by 0.2% ropivacaine (group cloni-bolus; n = 20), and block induction with 0.75% ropivacaine and 1 microg/kg clonidine followed by 0.2% ropivacaine with 1 microg/mL clonidine (group cloni-infusion; n = 20). After surgery, continuous femoral infusion was provided with a patient-controlled infusion pump (basal infusion rate, 6 mL/h; incremental dose, 2 mL; lockout time, 15 min). The median (range) onset time of surgical block was 15 min (5-30 min) in group control, 10 min (5-35 min) in group cloni-bolus, and 10 min (5-30 min) in group cloni-infusion (P = 0.07). No differences were reported among groups in the degree of pain measured with the visual analog scale. The total consumption of local anesthetic solution after a 24-h infusion was 170 mL (144-220 mL) in group control, 169 mL (144-260 mL) in group cloni-bolus, and 164 mL (144-248 mL) in group cloni-infusion (P = 0.51); after the second day of infusion, total consumption was 168 mL (144-200 mL) in group control, 156 mL (144-288 mL) in group cloni-bolus, and 150 mL (144-210 mL) in group cloni-infusion (P = 0.48). Hemodynamic profiles and sedation were similar in the three groups. Motor function impairment after 48 h of infusion was observed in 27% of cloni-infusion patients but in only 6% of both the control and cloni-bolus groups (P = 0.05). We conclude that adding clonidine 1 microg/mL to local anesthetic for continuous femoral nerve block does not improve the quality of pain relief but has the potential for delaying recovery of motor function. PMID:15728080

Casati, Andrea; Vinciguerra, Federico; Cappelleri, Gianluca; Aldegheri, Giorgio; Fanelli, Guido; Putzu, Marta; Chelly, Jacques E

2005-03-01

196

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

197

A review of 12 cases of obturator hernia  

International Nuclear Information System (INIS)

We report on our evaluation in twelve cases of obturator hernia in our hospital. The subjects were twelve patients who underwent an operation for obturator hernia in our hospital between April 2001 and August 2009. We divided these patients into two groups, namely the intestinal resection group and the non-intestinal resection group, and evaluated both groups for duration from onset, radiographic findings and so on. The average age of the patients was 83.5 years (73-93 yr), and all patients were women. The average body mass index (BMI) was 17.6 kg/m2. The majority of the chief complaints was vomiting (7 cases 58.3%). The Howship-Romberg sign was observed in only three patients (25%). Preoperative CT scan revealed obturator hernia in nine patients. Preoperative duration from onset was 5-528 hr (average 120 hr). Emergency surgery was performed in all cases, and we tried the open method for eleven cases and the laparoscopic method for one case. The hernia hilus in four cases was closed with simple closure, and with mesh in eight cases. Recently, early diagnosis and treatment of obturator hernia has become feasible. Therefore, minimally invasive surgery such as laparoscopic surgery might be desirable as the first choice of surgical treatment for obturator hernia in the future. (author)

2010-09-01

198

Anesthetic management with scalp nerve block and propofol/remifentanil infusion during awake craniotomy in an adolescent patient -A case report-  

Science.gov (United States)

Despite of various neurophysiologic monitoring methods under general anesthesia, functional mapping at awake state during brain surgery is helpful for conservation of speech and motor function. But, awake craniotomy in children or adolescents is worrisome considering their emotional friabilities. We present our experience on anesthetic management for awake craniotomy in an adolescent patient. The patient was 16 years old male who would undergo awake craniotomy for removal of brain tumor. Scalp nerve block was done with local anesthetics and we infused propofol and remifentanil with target controlled infusion. The patient endured well and was cooperative before scalp suture, but when surgeon sutured scalp, he complained of pain and was suddenly agitated. We decided change to general anesthesia. Neurosurgeon did full neurologic examinations and there was no neurologic deficit except facial palsy of right side. Facial palsy had improved with time.

Sung, Bohyun; Park, Jin-Woo; Byon, Hyo-Jin; Kim, Jin-Tae; Kim, Chong Sung

2010-01-01

199

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

Directory of Open Access Journals (Sweden)

Full Text Available 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 Ropivacaine 0.2% and 50 mg mL-1 of magnesium sulphate, through femoral catheter. The following parameters were evaluated: (1 demographic data of the patients and duration of the surgery, (2 intraoperative and postoperative hemodynamics, (3 intraoperative fentanyl requirements, (4 the severity of postoperative pain for 24 h, (5 time to first request of analgesia and (6 amount of postoperative morphine consumed in 0-6, 6-12, 12-18, 18-24 and 0-24 h, postoperatively. There were no difference among the three groups as regards the demographic data, the duration of the surgery, the pre and postoperative hemodynamics, the total intraoperative fentanyl consumption and the VAS during the 1st postoperative hour. The postoperative pain showed significant lower values in groups (R+F and (R+M compared to group (R when measured at 6, 12, 18 and 24 postoperative hours. The time for the first postoperative request for analgesia was statistically longer in the (R+M group and (R+F group compared with group (R. The postoperative morphine consumption was statistically lower in groups (R+F and (R+M compared to group (R but insignificant between groups (R+F and (R+M. The admixture of magnesium sulphate or fentanyl to ropivacaine for continuous femoral nerve block provided a significant prolongation of postoperative analgesia than ropivacaine alone.

Md. Ashraf Abd Elmawgoud

2008-01-01

200

Skeletal muscle and skin as targets for powerful homeostatic vasomotor baroreflexes in humans during prolonged circulatory stress: a study on the innervated and nerve blocked forearm.  

Science.gov (United States)

Flow (vascular resistance) was followed in the innervated and axillary nerve blocked arm during prolonged low to high and barely tolerated circulatory stress [15-85 mmHg LBNP (lower body negative pressure) for 10 min; room temperature 24.8-25.7 degrees C]. With intact innervation LBNP caused initial graded and potent forearm vasoconstriction. At low LBNP, however, there was soon significant and maintained partial (50%) abolition of the early response. At high LBNP, the initial striking vasoconstriction remained constant throughout 10 min of pronounced circulatory stress [marked tachycardia; fall in systolic pressure but mean arterial pressure (MAP) normal]. Flow decreased in steady state by 15 +/- 4, 38 +/- 5, 63 +/- 2 and by pronounced 78 +/- 3% at 15, 40, 70, and 85 mmHg LBNP (resistance raised 27 +/- 7, 78 +/- 16, 192 +/- 18, and 387 +/- 55% above control), alterations ascribed to constriction in both muscle and skin. Comparison of LBNP responses with intact and blocked innervation revealed that the vasoconstriction was neurogenic with little or no humoral contribution. The overall observations show that under normal comfortable (thermoneutral) conditions the resistance vessels in muscle and skin, with haemodynamically important large tissue mass and great tolerance to even drastic and prolonged ischaemia, indeed are important targets in the homeostatic sympathetic control, especially when cardiovascular homeostasis is challenged by marked stress with urgent need for strong, maintained compensatory vasoconstriction. The study also demonstrated > three-fold (4.1 +/- 0.5 to 13.1 +/- 1.9 ml min-1 100 ml-1) forearm flow increases upon blockade of resting nervous vasoconstrictor tone. It thus appears that the sympathetic nerves not only can elicit prominent and maintained baroreflex limb vasoconstriction but also that, in humans, reflex inhibition of resting tone might allow surprisingly large resistance decline. PMID:8048337

Edfeldt, H; Lundvall, J

1994-05-01

 
 
 
 
201

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

202

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

203

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 SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

204

Strategy of diagnosis and treatment for obturator hernia  

International Nuclear Information System (INIS)

We clinically reviewed patients with obturator hernia who were treated in our hospital. The subjects were 11 patients who underwent surgery in our hospital between January 2006 and July 2009. The mean age was 82.5 years, and all patients were females. The mean body mass index was 19.1, and the mean frequency of delivery was 2.6. The Howship-Romberg sign was present in 6 of the 11 patients. All patients with an obturator hernia had the correct diagnosis with preoperative computed tomography. All patients underwent emergency operations, and 6 of the 11 patients underwent partial resection of the small intestine because of necrosis of the intestinal wall. All the patients were discharged or transferred to another hospital. Almost all the patients with obturator hernia were slender females. A pelvic CT scan should be performed early, because their prognosis was affected by the time to diagnosis and critical treatment. (author)

2010-09-01

205

The diagnostic validity and therapeutic value of lumbar facet joint nerve blocks with or without adjuvant agents.  

Science.gov (United States)

Facet joints have been described as an important source of low back pain. The value of medial branch blocks in the diagnosis of facet joint mediated pain is considered important. However, the therapeutic value of medial branch blocks has not been determined. This study was designed to evaluate the duration of relief obtained and therapeutic value following controlled medial branch blocks with or without adjuvant agents Sarapin (High Chemical Company, Levittown, PA) and Depo-medrol (Pharmacia and Upjohn Company, Kalamazoo, MI). The study population consisted of 180 consecutive patients seen in a single pain management practice, divided into three groups with 60 patients in each group. Group I was treated with local anesthetic only, Group II with the addition of Sarapin, and Group III with the addition of Depo-medrol along with Sarapin. The prevalence of facet joint pain in chronic low back pain was determined as 36%, with a false-positive rate of 25%. Comparison of duration of relief in days with each block in the three groups showed that the relief was significantly superior in Group III compared with Group I and Group II, whereas Group II was superior to Group I. PMID:10998741

Manchikanti, L; Pampati, V; Fellows, B; Bakhit, C E

2000-01-01

206

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)

2009-05-27

207

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

208

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 | Language: Portuguese 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.

209

Nerve injuries in total hip arthroplasty.  

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Nerve injury occurs in 1% to 2% of patients who undergo total hip arthroplasty and is more frequent in patients who need acetabular reconstruction for dysplasia and those undergoing revision arthroplasty. Injury to the peroneal division of the sciatic nerve is most common, but the superior gluteal, obturator, and femoral nerves can also be injured. Nerve injury can be classified as neurapraxia, axonotmesis, or neurotmesis. The worst prognosis is seen in patients with complete motor and sensory deficits and in patients with causalgic pain. Prevention is of overriding importance, but use of ankle-foot orthoses and prompt management of pain syndromes can be useful in the treatment of patients with nerve injury. Electrodiagnostic studies hold promise in complex cases; however, their intraoperative role requires objective, prospective, controlled scientific study before routine use can be recommended. PMID:10217818

DeHart, M M; Riley, L H

1999-01-01

210

A Prospective, Randomized, Double-Blind Study of the Anesthetic Efficacy of Sodium Bicarbonate Buffered 2% Lidocaine With 1 : 100,000 Epinephrine in Inferior Alveolar Nerve Blocks  

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Abstract The authors, using a crossover design, randomly administered, in a double-blind manner, inferior alveolar nerve (IAN) blocks using a buffered 2% lidocaine with 1?:?100,000 epinephrine/sodium bicarbonate formulation and an unbuffered 2% lidocaine with 1?:?100,000 epinephrine formulation at 2 separate appointments spaced at least 1 week apart. An electric pulp tester was used in 4-minute cycles for 60 minutes to test for anesthesia of the first and second molars, premolars, and lateral and central incisors. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes, and the 80 reading was continuously sustained for 60 minutes. For the buffered 2% lidocaine with 1?:?100,000 epinephrine/sodium bicarbonate formulation, successful pulpal anesthesia ranged from 10–71%. For the unbuffered 2% lidocaine with 1?:?100,000 epinephrine formulation, successful pulpal anesthesia ranged from 10–72%. No significant differences between the 2 anesthetic formulations were noted. The buffered lidocaine formulation did not statistically result in faster onset of pulpal anesthesia or less pain during injection than did the unbuffered lidocaine formulation. We concluded that buffering a 2% lidocaine with 1?:?100,000 epinephrine with sodium bicarbonate, as was formulated in the current study, did not statistically increase anesthetic success, provide faster onset, or result in less pain of injection when compared with unbuffered 2% lidocaine with 1?:?100,000 epinephrine for an IAN block.

Whitcomb, Michael; Drum, Melissa; Reader, Al; Nusstein, John; Beck, Mike

2010-01-01

211

Comparison of different techniques for obturating experimental internal resorptive cavities.  

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Forty extracted maxillary central incisors were instrumented at the working length to a #50 file. The roots were sectioned transversely with a diamond disk at 7 mm from the anatomical apex. At the opening of the root canal of each section, hemicircular cavities were drilled with a specially designed bur. The corresponding root sections were cemented with glue, thus obtaining root canals with similar cavities that simulated internal resorptions. Teeth were embedded in plaster casts to facilitate their handling. The specimens were randomly separated into four groups of 10. The following obturation techniques were evaluated: lateral compaction (group A), hybrid technique (group B), Obtura II (group C), and Thermafil (group D). AH26 was used as the sealer. After obturation, the plaster was removed and the teeth were radiographed in buccolingual and mesiodistal directions to evaluate the quality of the obturation at the IRC. The incisors were then cut with a scalpel at the same level as the previous section, to examine, under a stereomicroscope, the type of material that filled the IRC. Obtura II gave the best results and in most of the specimens obturated with this technique, the IRC were filled mainly with gutta-percha. Statistical analysis of the data indicated that the differences between group C and the other groups were significant (P < 0.05). PMID:11202867

Goldberg, F; Massone, E J; Esmoris, M; Alfie, D

2000-06-01

212

Levobupivacaine 0.2% or 0.125% for continuous sciatic nerve block: a prospective, randomized, double-blind comparison with 0.2% ropivacaine.  

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In 60 patients receiving elective hallux valgus repair, we compared the efficacy of continuous popliteal sciatic nerve block produced with 0.2% ropivacaine (n = 20), 0.2% levobupivacaine (n = 20), or 0.125% levobupivacaine (n = 20) infused with a patient-controlled system starting 3 h after a 30-mL bolus of the 0.5% concentration of the study drug and for 48 h (baseline infusion rate, 6 mL/h; incremental dose, 2 mL; lockout time, 15 min; maximum incremental doses per hour, 3). No differences were reported in the intraoperative efficacy of the nerve block. The degree of pain was similar in the three groups throughout the study period, both at rest and during motion. Total consumption of local anesthetic solution during the first 24 h was 148 mL (range, 144-228 mL) with 0.2% ropivacaine, 150 mL (range, 144-200 mL) with 0.2% levobupivacaine, and 148 mL (range, 144-164 mL) with 0.125% levobupivacaine (P = 0.59). The volume of local anesthetic consumed during the second postoperative day was 150 mL (range, 144-164 mL) with 0.2% ropivacaine, 154 mL (range, 144-176 mL) with 0.2% levobupivacaine, and 151 mL (range, 144-216 mL) with 0.125% levobupivacaine (P = 0.14). A smaller proportion of patients receiving 0.2% levobupivacaine showed complete recovery of foot motor function as compared with 0.2% ropivacaine and 0.125% levobupivacaine, both at 24 h (35% vs 85% and 95%; P = 0.0005) and at 48 h (60% vs 100% and 100%; P = 0.001). We conclude that sciatic infusion with both 0.125% and 0.2% levobupivacaine provides adequate postoperative analgesia after hallux valgus repair, clinically similar to that provided by 0.2% ropivacaine; however, the 0.125% concentration is preferred if early mobilization of the operated foot is required. PMID:15333432

Casati, Andrea; Vinciguerra, Federico; Cappelleri, Gianluca; Aldegheri, Giorgio; Grispigni, Crispino; Putzu, Marta; Rivoltini, Paola

2004-09-01

213

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

LENUS (Irish Health Repository)

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

Mannion, Stephen

2012-02-03

214

No correlation between minimal electrical charge at the tip of the stimulating catheter and the efficacy of the peripheral nerve block catheter for brachial plexus block: a prospective blinded cohort study  

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Background Stimulating catheters offer the possibility of delivering an electrical charge via the tip of the catheter. This may be advantageous as it allows verifying if the catheter tip is in close proximity to the target nerve, thereby increasing catheter performance. This prospective blinded cohort study was designed to investigate whether there is a correlation between the minimal electrical charge at the tip of the stimulating catheter, and the efficacy of the peripheral nerve block (PNB) catheter as determined by 24 h postoperative morphine consumption. Methods Forty adult patients with ASA physical health classification I-III scheduled for upper extremity surgery under combined continuous interscalene block and general anesthesia were studied. Six patients were excluded from analysis. After inserting a stimulating catheter as if it were a non-stimulating catheter for 2–5 cm through the needle, the minimal electrical charge necessary to obtain an appropriate motor response was determined. A loading dose of 20 mL ropivacaine 0.75% ropivacaine was then administered, and postoperative analgesia was provided by a continuous infusion of ropivacaine 0.2% 8 mL.h-1 via the brachial plexus catheter, and an intravenous morphine patient-controlled analgesia (PCA) device. Main outcome measures include the minimal electrical charge (MEC) at the tip of the stimulating catheter necessary to elicit an appropriate motor response, and the efficacy of the PNB catheter as determined by 24 h postoperative PCA morphine consumption. Results Mean (SD) [range] MEC at the tip of the stimulating catheter was 589 (1414) [30 – 5000] nC. Mean (SD) [range] 24 h morphine consumption was 8.9 (9.9) [0–29] mg. The correlation between the MEC and 24 h postoperative morphine consumption was Spearman’s Rho rs?=?-0.26, 95% CI -0.56 to 0.09. Conclusion We conclude that there is no proportional relation between MEC at the tip of the blindly inserted stimulating catheter and 24 h postoperative morphine consumption. Trial registration Trialregister.nl identifier: NTR2328

2014-01-01

215

The Comparison of Effects of Suprascapular Nerve Block, Intra-articular Steroid Injection, and a Combination Therapy on Hemiplegic Shoulder Pain: Pilot Study  

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Objective To assess the relative effectiveness of three injections methods suprascapular nerve block (SSNB) alone, intra-articular steroid injection (IAI) alone, or both-on relief of hemiplegic shoulder pain. Methods We recruited 30 patients with hemiplegic shoulder pain after stroke. SSNB was performed in 10 patients, IAI in 10 patients, and a combination of two injections in 10 patients. All were ultrasonography guided. Each patient's maximum passive range of motion (ROM) in the shoulder was measured, and the pain intensity level was assessed with a visual analogue scale (VAS). Repeated measures were performed on pre-injection, and after injection at 1 hour, 1 week, and 1 month. Data were analyzed by Kruskal-Wallis and Friedman tests. Results All variables that were repeatedly measured showed significant differences in shoulder ROM with time (p<0.05), but there was no difference according injection method. In addition, VAS was statistically significantly different with time, but there was no difference by injection method. Pain significantly decreased until a week after injection, but pain after a month was relatively increased. However, pain was decreased compared to pre-injection. Conclusion The three injection methods significantly improved shoulder ROM and pain with time, but no statistically significant difference was found between them.

Jeon, Woo Hyun; Park, Gun Woong; Jeong, Ho Joong

2014-01-01

216

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  

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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 aumentada 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.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

2009-02-01

217

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)

2009-10-12

218

Management of maxillectomy defect with a hybrid hollow bulb obturator.  

Science.gov (United States)

A woman having already undergone maxillectomy came to the department complaining of difficulty in eating and speech. During the construction of an obturator, the bulb area should be hollowed to reduce weight so that the teeth and supporting tissues are not stressed unnecessarily. The conventional open design drains fluid from the adjacent mucosa, possibly increasing the weight of the prosthesis, and is difficult to clean. The closed bulb design does not drain secretions and may cause obstruction and susceptibility to infection in the paranasal and pharyngeal regions, though it is easier to maintain. An alternative to the two designs, combining their advantages, is presented in this report. As the open hollow part of the obturator was shallow, it was easy to clean. Making the inferior part of the bulb hollow and closed led to a reduction in the overall weight of the prosthesis while increasing its resonance. PMID:23436886

Singh, Kamleshwar; Singh, Saumyendra V; Mishra, Niraj; Agrawal, Kaushal Kishor

2013-01-01

219

Second phase of formalin-induced excitation of spinal dorsal horn neurons in spinalized rats is reversed by sciatic nerve block.  

Science.gov (United States)

Considerable debate persists concerning peripheral vs. central mechanisms underlying the second phase of the nociceptive response in the formalin test in the rat. To gain insight into the neurophysiological basis of this pain, we investigated the effects of block of afferent nerve conduction during the second phase of formalin-evoked excitation of single nociceptive neurons recorded extracellularly from rat spinal dorsal horn segments (L(3-4)) in pentobarbital-anaesthetized, male Sprague-Dawley rats. Rats were spinally transected (T(9)) to examine exclusively peripheral and spinal nociceptive processing. In six control rats, hind paw intraplantar formalin injection (50 microL, 2.5%) induced the typical biphasic increase in the discharge rate of the six wide dynamic range neurons tested. This response consisted of a relatively brief immediate phase (approximately 5 min), followed by decreased firing. An ensuing second phase of elevated discharge began approximately 35 min after injection and persisted to at least 80 min. In this control group, 0.9% saline was applied to the exposed ipsilateral sciatic nerve after onset of the second phase (40 min after formalin injection). In a group of six test rats, application of 2% lidocaine instead of saline reversed the second phase of excitation in all six wide dynamic range neurons examined. When the firing rate was normalized to that at 40 min (100%), the time of saline or lidocaine administration, the rate at 50 min was 120 +/- 7.5% in the saline-treated group and 31 +/- 7.4% in the lidocaine-treated group; following lidocaine treatment firing rate remained markedly less than that before administration throughout the remainder of the recording. It is concluded that: (i) spinal mechanisms alone are not sufficient for induction and maintenance of second phase increased discharge of spinal nociceptive dorsal horn neurons; (ii) descending influences via supraspinal inputs are not causal in the development and maintenance of second phase increased discharge and (iii) tonic input from afferent neurons during the second phase plays a primary and essential role in generating and sustaining the second phase of elevated discharge of dorsal horn neurons and, thus, presumably the second phase of nociceptive scores in the formalin test. The data in this study reveal how much of an altered synaptically elicited response in the spinal dorsal horn can be attributed to postsynaptic plastic changes vs. how much can be simply due to increased synaptic input. The present results are important not only in the context of the formalin test but also in the context of other models related to inflammatory pain and neuropathic pain. PMID:12028361

Pitcher, Graham M; Henry, James L

2002-05-01

220

Pinched Nerve  

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NINDS Pinched Nerve Information Page Table of Contents (click to jump to sections) What is Pinched Nerve? Is there any treatment? ... being done? Clinical Trials Organizations What is Pinched Nerve? The term "pinched nerve" is a colloquial term ...

 
 
 
 
221

High division of sciatic nerve  

Directory of Open Access Journals (Sweden)

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

Tripti Shrivastava

2014-04-01

222

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.

223

Strangulated Intestinal Obstruction Secondary to a Typical Obturator Hernia: A Case Report with Literature Review  

Directory of Open Access Journals (Sweden)

Full Text Available Obturator hernia is a rare pelvic hernia with incidence of 1%. It's a significant cause of intestinal obstruction in emaciated elderly women. Delayed diagnosis and surgical intervention contributed to its relatively high morbidity and mortality. We present a typical case of obturator hernia with positive Howship-Romberg sign and Hannington-Kiff sign. The diagnosis was confirmed by spiral CT preoperatively. During the emergency laparotomy, the incarcerated intestine was reduced and removed. Obturator foramen was repaired by simple suture. The patient recovered uneventfully and no recurrence occurred during the follow-up. The obturator hernia should be included in the differential diagnosis if clinically suspected. Early diagnosis and prompt surgical treatment are essential to reduce the morbidity and mortality associated with obturator hernia.

Xiaoyan Cai, Xiangyang Song, Xiujun Cai

2012-01-01

224

Three-dimensional finite element analysis of Aramany Class IV obturator prosthesis with different clasp designs.  

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The purpose of this study was to evaluate the stress distribution on the alveolar bone surrounding abutment teeth and the displacement of the Aramany Class IV obturator prosthesis with two different clasp designs. Three-dimensional finite element models of an Aramany Class IV maxillary defect were constructed. Two different clasp designs on an obturator prosthesis (double Akers clasps and multiple Roach clasps) and two different load conditions (vertical and horizontal) were compared. Finite element analysis was used to calculate the equivalent stress. The difference in the clasp design of the Aramany Class IV obturator prosthesis affected the stress distribution of the alveolar bone surrounding the abutment teeth and the displacement of the obturator prosthesis. Multiple Roach clasps reduced the stress distribution on the alveolar bone surrounding the abutment teeth and the displacement of the Aramany Class IV obturator prosthesis compared to double Akers clasps. PMID:24786346

Hase, Hideaki; Shinya, Akikazu; Yokoyama, Daiichiro; Shinya, Akiyoshi; Takahashi, Yutaka

2014-05-31

225

Strangulated obturator hernia - an unusual presentation of intestinal obstruction.  

LENUS (Irish Health Repository)

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

Zeeshan, Saqib

2012-01-31

226

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  

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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 (LD)versus...

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

2011-01-01

227

Electrophysiological study of conditioning lesion effects on rat sciatic nerve regeneration following either prior section or freeze. II. Blocking by prior tenotomy.  

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The conditioning lesion effects refer to the earlier formation and the accelerated regeneration of axonal sprouts following two successive axotomies. In a previous study, we observed that a prior freeze or a prior cut of rat sciatic nerve resulted in differences in the enhancement of the regeneration rate and the reduction of the initial delay. These differences were interpreted as a possible non-neuronal cells influence on the intrinsic regulation of the conditioning lesion phenomenon. In the present study, we attempted to modify the status of the muscles using tenotomy before the prior nerve injury to determine the respective influence of the muscular cells on conditioning lesion effects. Thus, the conditioning lesion, which was either a cut or a freeze of the tibial nerve at the ankle, was performed 14 days after foot sole muscles were tenotomized, close to their insertion into the calcaneus bone. The test lesion was always a freeze of the sciatic nerve at midthigh performed 7 days following the prior lesion. The elongation of the regenerating sprouts was electrophysiologically evaluated and the regeneration rate as well as the initial delay were calculated by means of regression analysis. Tenotomy did not influence the regeneration as was demonstrated in a group with a single sciatic nerve lesion. In contrast, when prior lesion was performed, the tenotomy prevented both the enhancement of the rate of regeneration and the reduction of the initial delay, whatever was the type of the conditioning lesion.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3395843

Bondoux-Jahan, M; Sebille, A

1988-05-24

228

The Effective Injection Zone at the Popliteal Crease for Tibial and Common Peroneal Nerve Blocks and its Relation with the Origin Point of the Medial and Lateral Sural Cutaneous Nerves / Zona de Inyección Eficaz en el Pliegue Poplíteo para el Bloqueo de los Nervios Tibial y Fibular Común y su Relación con el Punto de Origen de los Nervios Cutáneo Sural Medial y Lateral  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: English Abstract in spanish El bloqueo nervioso poplíteo puede ser utilizado para proporcionar anestesia y analgesia prolongada del miembro inferior y para aliviar el dolor postoperatorio severo y duradero. El objetivo fue determinar la localización anatómica de los nervios tibial (NT) y fibular común (NFC) en el pliegue poplí [...] teo para un bloqueo nervioso efectivo. Se utilizaron 50 miembros inferiores frescos pertenecientes a 27 cadáveres adultos chinos (16 hombres y 11 mujeres, rango de edad entre 35-87 años). Se utilizaron 22 cadáveres para identificar la localización de los nervios y los 5 restantes para determinar la profundidad de los nervios en una sección transversal. El NT se encontró en el 50% de los casos desde el punto más lateral del pliegue poplíteo a 1,4 cm de la superficie. En el 20% de 50 muestras, el nervio cutáneo sural medial se ramificó por debajo o en el pliegue poplíteo, mientras que el NFC se encontró en el 26% de los casos desde el punto más lateral del pliegue poplíteo a 0,7 cm de la superficie. Además, en el 6% de las muestras, el nervio cutáneo sural lateral se ramificó por debajo o en el pliegue poplíteo. Nuestros resultados sugieren que el NT y NFC emergen del nervio ciático a distancias variables del pliegue poplíteo. Creemos que los resultados sobre la ubicación de NT y NFC en el pliegue poplíteo ofrecen una buena guía para el adecuado bloqueo nervioso. Abstract in english A popliteal nerve block may be used to provide anesthesia and extended analgesia of the lower extremity, to ameliorate severe and long lasting postoperative pain. The aim of this study was to elucidate the anatomical location of tibial (TN) and common peroneal (CPN) nerves in the popliteal crease fo [...] r effective nerve block. Fifty fresh specimens from 27 adult Chinese cadavers (16 males and 11 females, age range from 35 to 87 years) were investigated. Twenty-two cadavers were used to identify nerve locations and 5 cadavers were used to determine the depths of nerves in cross section. TN was found to be located at 50% from the most lateral point of the popliteal crease at 1.4 cm deep to the surface. In 20% of the 50 specimens, the medial sural cutaneous nerve branched out below or at the popliteal crease, whereas the CPN was located at 26.0% from the most lateral point of the popliteal crease and at 0.7 cm deep to the surface. Furthermore, in 6.0% of specimens the lateral sural cutaneous nerve branched out below or at the popliteal crease. This study suggests that the TN and CPN leave the sciatic nerve at variable distances from the popliteal crease. However, we believe that the results of the present study about the location of TN and CPN at the popliteal crease offer a good guide to optimal nerve block.

Lei, Zhong; Jincheng, Wang; Hongjuan, Fang; Yanguo, Qin; Jianlin, Zuo; Zhongli, Gao.

229

[Bile-diverting anastomoses in tumorous obturation of the bile ducts].  

Science.gov (United States)

The authors make an analysis of the operative treatment of 525 patients with cancer of the hepato-biliary and pancreatoduodenal zones. The distal, central and proximal obturations of bile ducts were found which determined the indications to formation of various bilio-digestive anastomoses. The operation of choice for distal obturation is a wide areflux cholecystogastrostomy with the use of blanket suture with the chromium-coated catgut. In the central and proximal obturation the precision suture with an atraumatic suture material and magnifying optics are recommended. PMID:2409658

Vinogradov, V V; Lapkin, K V; Liutfaliev, T A; Kunda, M A

1985-04-01

230

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.

231

An apparatus for obturating leaky tubes in heat exchangers  

International Nuclear Information System (INIS)

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

1974-01-01

232

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 super...

2002-01-01

233

Prosthetic Rehabilitation of A Unilateral Maxillary Defect with an Intermediate Obturator  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Acquired maxillary defects resulting from surgical resection of tumors or trauma can lead to devastating effects on aesthetics, functional and psychological aspect of the patient. Prosthetic rehabilitation of such defect often possesses a great challenge and the goals are usually achieved by means of obturator prosthesis. Insertion of a large prosthetic appliance may not be well tolerated and accepted by many patients. Hence, a simple acrylic plate resembling a surgical obturator can be advoc...

Mirna Garhnayak; Lokanath Garhnayak; Aswini Kumar Kar; Chittaranjan B

2010-01-01

234

A Prosthodontic Rehabilitation of a Partial Maxillectomy Patient with Hollow Bulb Obturator  

Directory of Open Access Journals (Sweden)

Full Text Available Rehabilitating patients with maxillofacial defects is one of the most difficult therapies of the stomatognathic system. Maxillary defects being the most common of these defects need to be rehabilitated to restore the lost form, function and speech. Prosthetic reconstruction of these defects may be made with the help of obturator prosthesis. The present case report describes the steps in the fabrication of hollow bulb obturator prosthesis.

Kiran Kumar Thota

2010-12-01

235

Biocompatibility of root canal obturation materials implanted in rats muscular tissue  

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

2009-01-01

236

Biocompatibility of root canal obturation materials implanted in rats muscular tissue  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

2009-01-01

237

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

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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

238

Selective inhibition of extracellular signal-regulated kinases 1/2 blocks nerve growth factor to brain-derived neurotrophic factor signaling and suppresses the development of and reverses already established pain behavior in rats.  

Science.gov (United States)

Brain-derived neurotrophic factor (BDNF) plays a key role in the development of pathological pain. Although it is known that nerve growth factor (NGF) induces BDNF mRNA through extracellular signal-regulated kinases (ERK), whether ERK1/2 or ERK5, two closely related members of the ERK family, mediate this signal is still unclear because classical MEK inhibitors block both pathways. We studied the involvement of ERK-signaling in NGF induction of BDNF in PC12 cells, cultured dorsal root ganglia neurons, and in rats subjected to neuropathic pain models using ERK1/2- and ERK5-specific tools. Selective activation of ERK1/2 upregulated BDNF mRNA in PC12 cells, whereas selective ERK5 activation did not. AZD6244, a potent selective inhibitor of ERK1/2 activation, blocked NGF induction of BDNF mRNA in vitro suggesting that NGF induction of BDNF is mediated by ERK1/2. siRNA experiments indicated that both ERK1 or ERK2 can signal suggesting that both pathways must be blocked to prevent NGF-induced increase in BDNF mRNA. I.p. injection of AZD6244 prevented the development of pain in rats subjected to the chronic constriction injury and reversed already established pain in the spared nerve injury model. Immunohistochemical studies showed decreased phospho-ERK1/2-immunoreactivity in dorsal root ganglia and BDNF immunoreactivity in ipsilateral spinal dorsal horn in the drug-treated rats. Our results suggest the possible use of AZD6244, already in human clinical trials as an anticancer agent, for the treatment of pathological pain. PMID:22280975

Matsuoka, Y; Yang, J

2012-03-29

239

Sensory nerve conduction and nociception in the equine lower forelimb during perineural bupivacaine infusion along the palmar nerves  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The purpose of this investigation was to study lateral palmar nerve (LPN) and medial palmar nerve (MPN) morphology and determine nociception and sensory nerve conduction velocity (SNCV) following placement of continuous peripheral nerve block (CPNB) catheters along LPN and MPN with subsequent bupivacaine (BUP) infusion. Myelinated nerve fiber distribution in LPN and MPN was examined after harvesting nerve specimens in 3 anesthetized horses and processing them for morphometric analysis. In 5 s...

Zarucco, Laura; Driessen, Bernd; Scandella, Massimiliano; Cozzi, Francesca; Cantile, Carlo

2010-01-01

240

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

 
 
 
 
241

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.

242

Nerve biopsy  

Science.gov (United States)

Abnormal results may be due to: Amyloidosis (sural nerve biopsy is most often used) Demyelination Inflammation of the nerve Leprosy Loss of axon tissue Metabolic neuropathies Necrotizing vasculitis Sarcoidosis

243

Candida albicans in patients with oronasal communication and obturator prostheses  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Os pacientes portadores de prótese obturadora freqüentemente apresentam estomatite protética. Com o objetivo de detectar a presença de Candida albicans oral em pacientes com comunicação oronasal e avaliar a eficácia de um tratamento tópico antifúngico foi realizada citologia esfoliativa da mucosa pa [...] latina e jugal e da superfície acrílica nasal da prótese obturadora. O protocolo terapêutico consistiu de nistatina (Mycostatin®) para tratamento da mucosa oral e uma solução de hipoclorito de sódio para desinfecção da prótese. Sete pacientes (70%) apresentaram resultado positivo para C. albicans na mucosa, com um resultado negativo para a superfície protética neste grupo. A avaliação após o tratamento revelou ausência de C. albicans na mucosa oral de todos os pacientes, bem como na superfície protética. A infecção por C. albicans das mucosas jugal e palatina diferiram significantemente, enquanto que a mucosa palatina e a superfície protética apresentaram valores semelhantes. O grau de infecção da mucosa palatina foi significantemente maior quando comparado àquele da mucosa jugal e semelhante ao apresentado pela prótese, sugerindo que a mucosa subjacente à prótese é mais susceptível à infecção. O protocolo terapêutico foi efetivo em todos os casos, o que enfatiza a necessidade da desinfecção protética para se evitar a reinfecção da mucosa oral. Abstract in english Patients using obturator prostheses often present denture-induced stomatitis. In order to detect the presence of oral Candida albicans in patients with oronasal communications and to evaluate the effectiveness of a topical antifungal treatment, cytological smears obtained from the buccal and palatal [...] mucosa of 10 adult patients, and from the nasal acrylic surface of their obturator prostheses were examined. A therapeutic protocol comprising the use of oral nystatin (Mycostatin®) and prosthesis disinfection with sodium hypochlorite was prescribed for all patients. Seven patients were positive for C. albicans in the mucosa, with 1 negative result for the prosthetic surface in this group of patients. Post-treatment evaluation revealed the absence of C. albicans on prosthesis surface and on the oral mucosa of all patients. The severity of the candidal infection was significantly higher in the palatal mucosa than in the buccal mucosa, but similar in the palatal mucosa and prosthesis surface, indicating that the mucosa underlying the prosthesis is more susceptible to infection. The therapeutic protocol was effective in all cases, which emphasizes the need for denture disinfection in order to avoid reinfection of the mucosa.

Beatriz Silva Câmara, Mattos; Andréa Alves de, Sousa; Marina Helena C. G. de, Magalhães; Marcia, André; Reinaldo, Brito e Dias.

244

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 d [...] iferentes técnicas - técnica convencional 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.

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

245

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

246

Prosthetic Rehabilitation of A Unilateral Maxillary Defect with an Intermediate Obturator  

Directory of Open Access Journals (Sweden)

Full Text Available Acquired maxillary defects resulting from surgical resection of tumors or trauma can lead to devastating effects on aesthetics, functional and psychological aspect of the patient. Prosthetic rehabilitation of such defect often possesses a great challenge and the goals are usually achieved by means of obturator prosthesis. Insertion of a large prosthetic appliance may not be well tolerated and accepted by many patients. Hence, a simple acrylic plate resembling a surgical obturator can be advocated in such patient as a training device which can be later converted to an intermediate/definite prosthesis. This is particularly helpful in patients who have a gagging tendency. This clinical report described fabrication of an intermediate obturator for rehabilitation of a maxillary defect (Aramany class II to improve patient's phonetic, aesthetics, masticatory efficiency and deglutition.

Mirna Garhnayak

2010-12-01

247

Depression-related behavior and mechanical allodynia are blocked by 3-(4-fluorophenylselenyl)-2,5-diphenylselenophene in a mouse model of neuropathic pain induced by partial sciatic nerve ligation.  

Science.gov (United States)

Clinically, it is suggested that chronic pain might induce mood disorders like depression and anxiety. Based on this antidepressant drugs have emerged as a new therapy for pain. In this study, the effect of acute and subchronic treatments with 3-(4-fluorophenylselenyl)-2,5-diphenylselenophene (F-DPS) on behavioral changes induced by partial sciatic nerve ligation (PSNL) was evaluated. At the 4th week after surgery, PSNL caused a significant depression-like behavior in mice evaluated in the forced swimming test (FST) and the tail suspension test (TST), which was accompanied by increased pain sensitivity. The anxiety-like behavior assessed in the light-dark test (LDT) was not modified by PSNL. Acute treatment with F-DPS, at a dose of 1 mg/kg, intragastrically (i.g.) administered 30 min before the FST, produced a significant anti-immobility effect in PSNL mice. The antidepressant drug paroxetine showed acute antidepressant-like action at a dose 10 times higher than F-DPS. Subchronic treatment with F-DPS (0.1 mg/kg, i.g.) reversed depression-like behavior of sciatic nerve-ligated mice in the TST and FST and produced a significant anxiolytic-like action in both sham-operated and PSNL animals. Although the acute F-DPS treatment did not produce anti-allodynic effect, F-DPS subchronic treatment significantly reduced pain sensitivity in PSNL mice. These findings demonstrated that F-DPS blocked behavioral changes induced by neuropathic pain, suggesting that it might be attractive in the pharmacological approach of pain-emotion diseases. PMID:24467850

Gai, Bibiana Mozzaquatro; Bortolatto, Cristiani Folharini; Brüning, César Augusto; Zborowski, Vanessa Angonesi; Stein, André Luiz; Zeni, Gilson; Nogueira, Cristina Wayne

2014-04-01

248

Sensory nerve conduction and nociception in the equine lower forelimb during perineural bupivacaine infusion alongthe palmar nerves.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The purpose of this investigation was to study lateral (LPN) and medial palmar nerve (MPN) morphology and determine nociception and sensory nerve conduction velocity (SNCV) following placement of continuous peripheral nerve block (CPNB) catheters along LPN and MPN with subsequent bupivacaine (BUP) infusion. Myelinated nerve fiber distribution in LPN and MPN was examined after harvesting nerve specimens in three anesthetized horses and processing them for morphometric analysis. In 5 sedated ho...

Zarucco, Laura

2010-01-01

249

[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

250

Nerve repair, grafting, and nerve transfers.  

Science.gov (United States)

Advances in the field of peripheral nerve surgery have increased our understanding of the complex cellular and molecular events involved in nerve injury and repair. Application of these important discoveries has led to important developments in the techniques of nerve repair, nerve grafting, nerve allografts, end-to-side repairs, and nerve-to-nerve transfers. As our understanding of this dynamic field increases, further improvement in functional outcomes after nerve injury and repair can be expected. PMID:12737353

Dvali, Linda; Mackinnon, Susan

2003-04-01

251

Common peroneal nerve dysfunction  

Science.gov (United States)

Neuropathy - common peroneal nerve; Peroneal nerve injury; Peroneal nerve palsy ... The peroneal nerve is a branch of the sciatic nerve, which supplies movement and sensation to the lower leg, foot and ...

252

Application of palatal RB obturator in babies with isolated palatal cleft  

Directory of Open Access Journals (Sweden)

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

Radoji?i? Julija

2009-01-01

253

An In-vitro Evaluation of Apical Seal Ability of Thermafil Obturation Versus Lateral Condensation  

Directory of Open Access Journals (Sweden)

Full Text Available Statement of Problem: When a tooth is treated endodontically, there are several objectives,which must be met for the root canal therapy to be successful. One of those objectives is the complete obturation of the root canal system.Purpose: The purpose of this study was to evaluate the apical sealability of the Theramfil endodontic obturation technique and compared it with lateral condensation.Materials and Methods: Thirty human maxillary permanent anterior teeth were similarly prepared. Following instrumentation, the roots randomly divided into two experimental groups of ten and two control groups (positive and negative of five each. Ten roots were obturated with Thermafil and ten with lateral condensation. All immersed in Indian ink, then cleared and apical dye penetration was evaluated.Results: Average leakage values were minimum of 1mm to maximum of 2.9mm for lateral condensation and minimum 2mm to maximum 6mm for Thermafil group. There was statistically significant difference between Lateral Condensation and Thermafil obturation techniques (P<0.05.Conclusion: The results of this study indicate that root canals treated by lateral condensation technique leak less than Thermafil ones.

S. Ravanshad

2004-12-01

254

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

Directory of Open Access Journals (Sweden)

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

Clarissa Teles Rodrigues

2012-09-01

255

PWR pressurizer with heaters well which can be obturate and sealing process  

International Nuclear Information System (INIS)

Each heater well is prolongated at the end located outer the pressurizer containment by a sleeve internally tapped which is prolongated at the other end by a guiding and fixation sleeve for welding the heater. The heater well can be obturated by a threaded plug introduce in the tapped part of the sleeve after cutting the welding sleeve and extraction of the heater

1989-07-20

256

Ability of new obturation materials to improve the seal of the root canal system: a review.  

Science.gov (United States)

New obturation biomaterials have been introduced over the past decade to improve the seal of the root canal system. However, it is not clear whether they have really produced a three-dimensional impervious seal that is important for reducing diseases associated with root canal treatment. A review of the literature was performed to identify models that have been employed for evaluating the seal of the root canal system. In vitro and in vivo models are not totally adept at quantifying the seal of root canals obturated with classic materials. Thus, one has to resort to clinical outcomes to examine whether there are real benefits associated with the use of recently introduced materials for obturating root canals. However, there is no simple answer because endodontic treatment outcomes are influenced by a host of other predictors that are more likely to take precedence over the influence of obturation materials. From the perspective of clinical performance, classic root filling materials have stood the test of time. Because many of the recently introduced materials are so new, there is not enough evidence yet to support their ability to improve clinical performance. This emphasizes the need to translate anecdotal information into clinically relevant research data on new biomaterials. PMID:24321349

Li, Guo-hua; Niu, Li-na; Zhang, Wei; Olsen, Mark; De-Deus, Gustavo; Eid, Ashraf A; Chen, Ji-hua; Pashley, David H; Tay, Franklin R

2014-03-01

257

Incidence of post obturation pain following single and multi visit root canal treatment in a teaching hospital of bangladesh.  

Science.gov (United States)

Post obturation pain is the pain of any degree after endodontic treatment. There are different opinions regarding incidence of post obturation pain related to single and multi visit root canal treatment. This prospective study was conducted to evaluate the incidence of post obturation pain in single visit and multi visit root canal treatment and to compare the incidence of pain between the two treatment groups. A total of 120 cases of endodontically involved asymptomatic non vital single rooted teeth were selected for this study. The patients were assigned and divided in to two treatment groups, sixty patients each. In single visit group, all teeth were prepared and filled using the standardized preparation and lateral condensation filling technique. In the multi visit treatment group, at the first appointment, the teeth were prepared, and dressed with calcium hydroxide paste for 7 days. At the second appointment, the teeth were prepared and obturated by using lateral condensation technique. The frequency of post obturation pain was recorded as no pain, slight, moderate and severe pain and evaluated at the day 1 and at the day 7 after obturation. The data were analyzed statistically by using SPSS version-12. P value <0.05 was taken as significant. The study showed that the post obturation pain in the single visit treatment group was more than multi visit treatment group, which is significant (p value <0.044). Out of the 120 patients, 86(71.7%) patients had no pain, 19(15.8%) had slight pain and 15(12.5%) patients had moderate pain at the day 1 after obturation. At the day 7 after obturation, 108(90%) patients had no pain, 9(7.5%) had slight pain and 3(2.5%) patients had moderate pain. No patient noticed severe pain during the follow up period. Older patient had significantly more post obturation pain than the younger patient. There was higher incidence of post obturation pain following the single visit root canal treatment. In multi visit root canal treatment with intra-canal medicaments seems to reduce the post obturation pain. PMID:24858151

Jabeen, S; Khurshiduzzaman, M

2014-04-01

258

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

1974-04-01

259

ULNAR NERVE  

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Objective: To determine the etiology of ulnar nerve compression across the elbow. Design: Retrospective and descriptive. Setting: At AFIRM Rawalpindi. Period: From Jan 2000 to Jan 2004. Material & Methods: 267 cases of Ulnar Nerve Compression at elbow diagnosed after electro-physiological studies were selected. Most of the patients with a variety of complaints were referred to Rehabilitation Medical Department, Rawalpindi (AFIRM) for diagnostic evaluation (NCS/EMG) and management. Results: Ou...

2008-01-01

260

Conduction block in vasculitic neuropathy.  

Science.gov (United States)

We describe a 28-year-old man who developed a mononeuropathy with a conduction block of the median nerve in the forearm, during the acute stage of a polyarteritis nodosa. Sequential studies show progressive disappearance of the conduction block (together with the clinical symptoms), without signs of axonotmesis. PMID:7995304

Magistris, M R; Kohler, A; Estade, M

1994-01-01

 
 
 
 
261

Optic Nerve Drusen  

Science.gov (United States)

... Frequently Asked Questions Español Condiciones Chinese Conditions Optic Nerve Drusen En Español Read in Chinese What are optic nerve drusen? Optic nerve drusen are abnormal globular collections ...

262

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

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

263

An implantable electrical stimulator for phrenic nerve stimulation  

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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...

2012-01-01

264

Nerve grafting in peripheral nerve injuries  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Autologous nerve grafting is the most commnly used operative technique in delayed primary, or secondary nerve repair after the peripheral nerve injuries. The aim of this procedure is to overcome nerve gaps that results from the injury itself, fibrous and elastic retraction forces, resection of the damaged parts of the nerve, position of the articulations and mobilisation of the nerve.In this study we analyse the results of operated patients with transections and lacerations of the peripheral ...

Gruji?i? Danica M.; Samardži? Miroslav M.; Rasuli? Lukas G.; Savi? Dragan S.; Cvrkota Irena S.; Simi? Vesna D.

2003-01-01

265

Implant-supported obturator overdenture for extensive maxillary resection patient: a clinical report.  

Science.gov (United States)

This clinical report presents an implant-retained obturator overdenture solution for a Prosthodontic Diagnostic Index Class IV maxillectomy patient with a large oronasal communication and severe facial asymmetry, loss of upper lip and midfacial support, severe impairment of mastication, deglutition, phonetics, and speech intelligibility. Due to insufficient bone support to provide satisfactory zygomaticus implant anchorage, conventional implants were placed in the body of the left zygomatic arch and in the right maxillary tuberosity. Using a modified impression technique, a cobalt-chromium alloy framework with three overdenture attachments was constructed to retain a complete maxillary obturator. Patient-reported functional and quality of life measure outcomes were dramatically improved after treatment and at the two-year follow-up. PMID:20040025

Leles, Cláudio Rodrigues; Leles, José Luiz Rodrigues; de Paula Souza, Carlos; Martins, Rafael Ragonezi; Mendonça, Elismauro Francisco

2010-04-01

266

[Studies on the pudendal nerve. Part 4. A macroscopical observation of the branches of the pudendal plexus in dogs and cats (author's transl)].  

Science.gov (United States)

The pudendal plexus and its branches of 20 dogs and 20 cats have been observed macroscopicaly. The main findings are summarized as follows: 1) The pudendal plexus in dogs is formed most frequently by the ventral rami of the first, second and third sacral nerves. 2) The bigeminal nerve of dogs and cats is formed respectively by the union of the ventral rami mentioned above. 3) The perineal nerve in dogs arises with one root from the bigeminal nerve and that of cats two roots, of which the main root arises from the points where the bigeminal nerve joins the asciatic nerve and the accessory one from the bigeminal nerve. 4) In dogs and cats the dorsal nerve of the penis or clitoris arises from the main trunk of the perineal nerve (Fig. 5, type IB) at an average rate of 57.5%. 5) In the dogs and cats, the inferior rectal nerve consists of two divisions; a division had the branches which are derived the perineal nerve to supply the skin around the anus and the other branches which arises from the muscular branch of the dorsal nerve of the penis or clitoris to supply the Sphincter ani externus. 6) The muscular branch of dogs and cats which is analogous to that of the perineal nerve in man, arises from the dorsal nerve of the penis or clitoris. 7) In dogs and cats the muscular branch to the Obturator internus is derived from the dorsal nerve of penis or clitoris. 8) The pelvic splanchnic nerve of dogs originates from the ventral rami of the first, second and third sacral nerves and that of cats from the ventral rami of the first and second sacral nerves. 9) In the posterior femoral cutaneous nerve in dogs, as well as in rats and rabbits, the lateral deviation of the origin from the sciatic to the perineal nerve is observed. PMID:1240085

Kanno, Y; Takasaki, S; Kaneshige, T; Nakanishi, T

1975-07-01

267

Rehabilitation of hemimaxillectomy with foldable obturator in restricted mouth opening: a case report.  

Science.gov (United States)

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. PMID:24431800

Patil, Padmakar S; Rajkumar, K

2013-12-01

268

Tension-free vaginal tape obturator system in the treatment of stress urinary incontinence  

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Surgical approach to the treatment of female stress urinary incontinence has changed significantly since 1995, when Ulmsten first described the procedure providing tension-free support in the middle part of urethra. Although retropubic placement of TVT tapes seemed to meet all the standards of minimally invasive surgical procedures, the occurrence of complications (bleeding, hematomas, and bladder, urethral of intestinal injuries) necessitated a new obturator approach. This study presents a t...

2006-01-01

269

Nerve Racking  

Science.gov (United States)

This lesson describes the function and components of the human nervous system. It helps students understand the purpose of our brain, spinal cord, nerves and the five senses. How the nervous system is affected during spaceflight is also discussed in this lesson.

Integrated Teaching And Learning Program

270

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

271

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

272

Nerve grafting in peripheral nerve injuries  

Directory of Open Access Journals (Sweden)

Full Text Available Autologous nerve grafting is the most commnly used operative technique in delayed primary, or secondary nerve repair after the peripheral nerve injuries. The aim of this procedure is to overcome nerve gaps that results from the injury itself, fibrous and elastic retraction forces, resection of the damaged parts of the nerve, position of the articulations and mobilisation of the nerve.In this study we analyse the results of operated patients with transections and lacerations of the peripheral nerves from 1979 to 2000 year. Gunshot injuries have not been analyzed in this study. The majority of the injuries were in the upper extremity (more than 87% of cases. Donor for nerve transplantation had usually been sural nerve, and only occasionally medial cutaneous nerve of the forearm was used. In about 93% of cases we used interfascicular nerve grafting, and cable nerve grafting was performed in the rest of them. Most of the grafts were 1 do 5 cm long (70% of cases. Functional recovery was achieved in more than 86% of cases, which is similar to the results of the other authors. Follow up period was minimum 2 years. We analyzed the influence of different factors on nerve recovery after the operation: patient’s age, location and the extent (total or partial of nerve injury, the length of the nerve graft, type of the nerve, timing of surgery, presence of multiple nerve injuries and associated osseal and soft tissue injuries of the upper and lower extremities.

Simi? Vesna D.

2003-01-01

273

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

274

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.

275

Anatomical variation of obturator vessels and its practical risk: a case report from an anatomic study Variação anatômica de vasos obturatórios e seu risco prático: relato de caso de um estudo anatômico  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Obturator artery is frequently a branch of anterior division of the internal iliac artery. It has drawn attention of pelvic surgeons, anatomists and radiologists because of the high frequency of variations in its course and origin. The obturator vein is usually described as a tributary of the internal iliac vein. During routine dissection classes to undergraduate medical students we have observed obturator artery arising from external iliac artery, obturator vein draining into external iliac ...

Somayaji Nagabhooshana; Venkata Ramana Vollala; Vincent Rodrigues; Seetharama Bhat; Narendra Pamidi; Stany Wilfred Lobo

2008-01-01

276

Cervical Radiculopathy (Pinched Nerve)  

Science.gov (United States)

... American Academy of Orthopaedic Surgeons. Cervical Radiculopathy (Pinched Nerve) Some people have neck pain that may radiate ... an injury near the root of a spinal nerve. A nerve root injury is sometimes referred to ...

277

Femoral nerve damage (image)  

Science.gov (United States)

The femoral nerve is located in the leg and supplies the muscles that assist help straighten the leg. It supplies sensation ... leg. One risk of damage to the femoral nerve is pelvic fracture. Symptoms of femoral nerve damage ...

278

Optic Nerve Imaging  

Science.gov (United States)

Optic Nerve Imaging email Send this article to a friend by filling out the fields below: Your name: Your ... measurements of nerve fiber damage (or loss). The Nerve Fiber Analyzer (GDx) uses laser light to measure ...

279

Ulnar nerve damage (image)  

Science.gov (United States)

The ulnar nerve originates from the brachial plexus and travels down arm. The nerve is commonly injured at the elbow because of elbow fracture or dislocation. The ulnar nerve is near the surface of the body where ...

280

Effect of gravity and capillarity on human saliva penetration in coronally unsealed obturated root canals  

Science.gov (United States)

Aim The purpose of this study was to evaluate the effect of gravity and capillarity on penetration of human salivary bacteria into the entire length of obturated root canals, and to demonstrate the dye penetration configuration. Materials and methods Fifty single-rooted premolars were decoronated, prepared to a standardized length of 15 mm, instrumented, and randomly divided into two groups (A and B) of 25 teeth each. Each group consisted of experimental (15 samples) and negative and positive controls (five samples each). The experimental groups were obturated with gutta-percha and root canal sealer. The positive control groups were obturated with a single cone of gutta-percha and root canal sealer. The outer surfaces (except for the apical 2 mm) were covered with two layers of nail varnish. An apparatus containing Brain Heart Infusion broth was designed, in which the teeth were placed. The samples in Group A were placed upside down, while Group B was placed normally. The coronal portions of the samples were placed in contact with fresh saliva. The number of days required for bacteria to penetrate the entire length of canals was determined. The samples were then immersed in India ink to determine the dye penetration configuration. Data were analyzed using Student’s t-test. Results The extent of dye penetration was significantly greater in Group B compared to Group A, and they were in a pattern rather than linear form. Conclusions Gravity and capillarity insignificantly affected bacterial leakage. Although gravity and capillarity did not affect bacterial penetration when applied to the coronal access of endodontically treated teeth, it seems that they can promote penetration of India ink into the canal after the bacterial test on the same tooth.

Karamifar, Kasra; Khayat, Akbar; Mogharrabi, Sara; Rajaei, Yasaman; Saghiri, Mohammad Ali

2012-01-01

 
 
 
 
281

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

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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

282

Biocompatibility of root canal obturation materials implanted in rats muscular tissue  

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Full Text Available The purpose of this study was to investigate the biocompatibility of different dental materials for teeth root canal obturation, implanted in rat muscular tissue, by analyzing the type of muscular tissue inflammatory reaction level. In the preparation of Wistar rats M. biceps femoris, three different materials for root canal obturation were implanted: Sealapex (Kerr, Romulus, USA, AH-26 (DE Trey, Zurich, Switzerland and Spongio cement material based on polymethil metacrylate - PMMA (Tomi?, 1981, US patent 4296209. The used control material was sterile wax. The rats were sacrificed 30 and 60 days after implantation and the response of the tissue on implanted material was evaluated with standard histological methods on 6 _m sections stained with hematoxilin and eosin. Implantation of Sealapex in rat muscle tissue produced a strong acute inflammation, infiltration with massive polymorphonuclear and numerous giant cells. Acute inflammation still persisted 60 days after implantation. AH-26 produced a strong reaction around the alien body with predominantly limphocitic infiltration. Giant cells and macrophages contained phagocited pieces of material. After 60 days expressive chronic myositis was present with a mass of giant cells and proliferation of connective tissue. Thirty days later the results of histological investigations suggested that implanted PMMA based material still produced a connective fibrous capsula made of fibroblasts and fibrocytes around the implanted material. In the muscular tissue myositis developed forming granulomatous tissue. After 60 days a capsula was made of mature hyalinisated connective tissue without signs of inflammation in the surrounding muscular tissue. The reaction is similar to the reaction to inert control material, such as sterile wax. These findings suggest biocompatibility of PMMA based material for canal obturation.

Karadži? Branislav

2009-01-01

283

Prolonged peripheral nerve blockade in patients using lithium carbonate.  

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Peripheral nerve blocks with local anaesthesia are routinely utilized in oral surgical procedures to achieve anaesthesia at the operative site. A number of local tissue factors as well as systemic conditions and medications may alter the onset, depth and duration of peripheral nerve blocks. This article describes two cases of extremely prolonged anaesthesia in patients treated with chronic oral lithium carbonate who had been administered inferior alveolar, lingual, long buccal, greater palatine and posterior superior alveolar nerve blocks with lidocaine with adrenaline for surgical removal of an upper and a lower third molar tooth. A possible relation with systemic lithium therapy and its probable mode of action are explored. PMID:23810516

Patil, Pavan Manohar

2014-04-01

284

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

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Treacher Collins syndrome has been described as a syndrome involving 1st and 2nd branchial arches, affecting various organs in the craniofacial region. Affected infants report with nasal regurgitation and minimal dietary intake due to cleft palate, consequently show delayed and retarded growth. The situation is further complicated when the repair of the palatal defect is postponed due to delayed milestones. At this juncture, it is of paramount importance to intervene prosthetically and close the defect with the aid of an interim obturator. Herein we describe a simple, yet successful, chairside approach to make an impression of an infant without the aid of any kind of anesthesia. PMID:22346164

Bhandari, Sudhir; Aras, Meena; Bakshi, Sonika

2011-10-01

285

[The use of endobiliary interventions for purulent cholangitis in patients with obturation jaundice].  

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Endobiliary interventions--external cholangiostomy, external-internal drainage, the biliary ducts endoprosthesis--were done in 156 patients with obturational jaundice of various genesis, complicated by purulent cholangitis. The method of the dosed decompression after transcutaneous transhepatic cholangiostomy, which was performed one day before, being applied in 37 patients, was proposed. Application of the method in complex with antibacterial therapy and the extracorporeal detoxication methods had permitted to lower the mortality down to 12.6%, in patients with the abscesses formation cholangitis--to 28.5%. After the stabilization of general status occur 72 patients were operated on. PMID:10857303

Diachenko, V V

2000-01-01

286

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

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

Bhasin Abhilasha

2011-01-01

287

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

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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)

2014-01-01

288

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

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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

289

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  

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

Pedro Aravena Torres

2011-09-01

290

Ischemic and reperfusion injury of rat peripheral nerve  

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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 <10%, and conduction block occurred in the distal portion of the nerve. Nerve blood flow was restored to only 55% and 45% of resting values following 1 and 3 hr, respectively, of ischemia and did not recover even after 2 hr of reperfusion. The blood-nerve barrier was not statistically impaired to the passage of ({sup 14}C)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.

Schmelzer, J.D.; Zochodne, D.W.; Low, P.A. (Mayo Foundation, Rochester, MN (USA))

1989-03-01

291

Rock blocks  

CERN Multimedia

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

Turner, W

2007-01-01

292

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

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

293

Fracture resistance of teeth obturated with Gutta percha and Resilon: An in vitro study  

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Full Text Available Aim: The aim of this study was to evaluate and compare the fracture resistance of endodontically treated teeth filled with gutta percha and Resilon. Materials and Methods: A total of 60 freshly extracted single rooted teeth are selected and their anatomical crown removed at the CEJ. All samples were instrumented with the Step-back technique. Samples were randomly divided into three groups of 20 samples each: Group A obturated by lateral condensation with gutta percha and AH plus sealer, Group B obturated by lateral condensation with Resilon; Group C recieved no filling. Restored teeth were subjected to compressive loading in a universal testing machine. The results of fracture resistance recorded and statistical analysis done. Results: The mean and SD values for the groups are as follows: Group A-536.555 ± 128.816, Group B- 885.943 ± 194.410 and Group C- 591.066 ± 68.97. It was seen that samples of Group B showed the highest fracture resistance followed by Group C. Group A showed the least fracture resistance. Conclusion: The results of this study showed that filling the canals with Resilon increased the in vitro resistance to fracture of endodontically treated single canal teeth when compared with gutta percha.

Baba Suheel

2010-01-01

294

Fracture resistance of teeth obturated with Gutta percha and Resilon: An in vitro study  

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Aim: The aim of this study was to evaluate and compare the fracture resistance of endodontically treated teeth filled with gutta percha and Resilon. Materials and Methods: A total of 60 freshly extracted single rooted teeth are selected and their anatomical crown removed at the CEJ. All samples were instrumented with the Step-back technique. Samples were randomly divided into three groups of 20 samples each: Group A obturated by lateral condensation with gutta percha and AH plus sealer, Group B obturated by lateral condensation with Resilon; Group C recieved no filling. Restored teeth were subjected to compressive loading in a universal testing machine. The results of fracture resistance recorded and statistical analysis done. Results: The mean and SD values for the groups are as follows: Group A-536.555 ± 128.816, Group B- 885.943 ± 194.410 and Group C- 591.066 ± 68.97. It was seen that samples of Group B showed the highest fracture resistance followed by Group C. Group A showed the least fracture resistance. Conclusion: The results of this study showed that filling the canals with Resilon increased the in vitro resistance to fracture of endodontically treated single canal teeth when compared with gutta percha.

Baba, Suheel Manzoor; Grover, Shiban I; Tyagi, Varsha

2010-01-01

295

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

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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.

Ma?gorzata Jaworska

2014-03-01

296

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

Science.gov (United States)

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 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. PMID:24864081

Kierklo, Anna; Tabor, Zbis?aw; Petryniak, Rafa?; Dohnalik, Marek; Jaworska, Ma?gorzata

2014-01-01

297

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

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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

298

Implications of the failure of nerve resection and graft to cure chronic pain produced by nerve lesions.  

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Seven patients had developed pain and abnormal sensitivity in the area supplied by a single nerve which had been injured. They were treated unsuccessfully for periods ranging from 3 to 108 months by conservative methods including neurolysis, local anaesthesia, sympathetic blocks, guanethidine, transcutaneous stimulation and analgesics. All then had the damaged nerve resected and in five cases a sural nerve graft was inserted to bridge the resected gap. The patients were then examined 20 to 72...

Noordenbos, W.; Wall, P. D.

1981-01-01

299

Bilateral variant of sciatic nerve exhibiting intra-pelvic division  

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

Rejeena P Raj, Kunjumon PC, More Anju B

2014-04-01

300

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 | Language: 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 clinical re

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

 
 
 
 
301

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 SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

302

Electrophysiological evidence for the nomenclature of the pudendal nerve and sacral plexus in the male rat.  

Science.gov (United States)

Surgical microscopy and electrophysiological techniques were used to standardize the nomenclature for the pudendal nerve and sacral plexus according to their somatic axonal composition in the male rat. We conclude that the pudendal nerve is the segment running from the L6-S1 trunk to the sacral plexus, carrying efferent fibers to the coccygeus, internal obturator, ventral and dorsal bulbospongiosus, ischiocavernosus, external anal sphincter, and external urethral sphincter muscles, and afferent fibers from the penis, prepuce, scrotum, and ventral-proximal tail. The sacral plexus is the complex formed by the bridge-like structure connecting the pudendal nerve with the lumbosacral trunk, and two nerve branches emerging from it, one innervating the proximal half of the scrotal skin, and the other innervating the muscles at the base of the penis known as the motor branch. These branches are only considered as a part of the sacral plexus because they integrate axons from both the lumbosacral trunk and pudendal nerve. The gross anatomy of the pudendal nerve and sacral plexus has a main organization that was observed in 70% of cases, whereas the remaining 30% occurred in two variants. This nomenclature is appropriate to describe the pudendal nerve and sacral plexus in studies that involve them being lesioned or electrophysiologically analysed. A main additional finding was that two large afferent branches innervate the scrotum, one the proximal half and the other the distal half. As mentioned above, the proximal branch belongs to the sacral plexus, whereas the distal branch belongs to the pudendal nerve because all its axons travel to the cord via this nerve. Since stimulation or even manipulation of the scrotal branches resulted in the secretion of semen containing spermatozoa, it is suggested that scrotal afferents are involved in some way in the ejaculatory process, a topic that deserves further research. PMID:9296560

Pacheco, P; Camacho, M A; García, L I; Hernández, M E; Carrillo, P; Manzo, J

1997-07-25

303

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 SciELO Brazil | Language: Portuguese Abstract in portuguese 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

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

304

Tension-free vaginal tape obturator system in the treatment of stress urinary incontinence.  

Science.gov (United States)

Surgical approach to the treatment of female stress urinary incontinence has changed significantly since 1995, when Ulmsten first described the procedure providing tension-free support in the middle part of urethra. Although retropubic placement of TVT tapes seemed to meet all the standards of minimally invasive surgical procedures, the occurrence of complications (bleeding, hematomas, and bladder, urethral of intestinal injuries) necessitated a new obturator approach. This study presents a transobturator approach to TVT tapes placement (Gynecare, Johnson-Johnson Company) with "inside-out" technique, first shown by De Leval in 2003. During 2005, 6 TVT tapes for stress urinary incontinence treatment were placed at the Clinic of Gynecology and Obstetrics in Novi Sad without any intra or post-operative complications. PMID:17345823

Durdevi?, Srdan

2006-01-01

305

Tension-free vaginal tape obturator system in the treatment of stress urinary incontinence  

Directory of Open Access Journals (Sweden)

Full Text Available Surgical approach to the treatment of female stress urinary incontinence has changed significantly since 1995, when Ulmsten first described the procedure providing tension-free support in the middle part of urethra. Although retropubic placement of TVT tapes seemed to meet all the standards of minimally invasive surgical procedures, the occurrence of complications (bleeding, hematomas, and bladder, urethral of intestinal injuries necessitated a new obturator approach. This study presents a transobturator approach to TVT tapes placement (Gynecare, Johnson-Johnson Company with "inside-out" technique, first shown by De Leval in 2003. During 2005, 6 TVT tapes for stress urinary incontinence treatment were placed at the Clinic of Gynecology and Obstetrics in Novi Sad without any intra or post-operative complications. .

?ur?evi? Sr?an

2006-01-01

306

Prolonged nerve blockade in a patient treated with lithium  

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Full Text Available Amit Lehavi, Boris Shenderey, Yeshayahu (Shai KatzDepartment of Anesthesiology, Rambam Health Care Campus, Haifa, IsraelAbstract: We report a case of a patient, chronically treated with oral lithium, who presented with an extremely prolonged (42-hour duration of sensory and motor paralysis following an uneventful infraclavicular block for hand surgery that was performed under ultrasound guidance using bupivacaine and lidocaine. Due to its direct effect on nerve conduction of action potential, we propose that lithium may have had a role in the unusually prolonged duration of a peripheral nerve block.Keywords: nerve blockade, lithium, duration, anesthesia

Lehavi A

2012-04-01

307

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

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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

308

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

309

Communication between radial nerve and medial cutaneous nerve of forearm  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Radial nerve is usually a branch of the posterior cord of the brachial plexus. It innervates triceps, anconeous, brachialis, brachioradialis, extensor carpi radialis longus muscles and gives the posterior cutaneous nerve of the arm, lower lateral cutaneous nerve of arm, posterior cutaneous nerve of forearm; without exhibiting any communication with the medial cutaneous nerve of forearm or any other nerve. We report communication between the radial nerve and medial cutaneous nerve of forearm o...

Marathe, Rr; Mankar, Sr; Joshi, M.; Sontakke, Ya

2010-01-01

310

Insight into the function of the obturator internus muscle in humans: Observations with development and validation of an electromyography recording technique.  

Science.gov (United States)

There are no direct recordings of obturator internus muscle activity in humans because of difficult access for electromyography (EMG) electrodes. Functions attributed to this muscle are based on speculation and include hip external rotation/abduction, and a role in stabilization as an "adjustable ligament" of the hip. Here we present (1) a technique to insert intramuscular EMG electrodes into obturator internus plus (2) the results of an investigation of obturator internus activity relative to that of nearby hip muscles during voluntary hip efforts in two hip positions and a weight-bearing task. Fine-wire electrodes were inserted with ultrasound guidance into obturator internus, gluteus maximus, piriformis and quadratus femoris in ten participants. Participants performed ramped and maximal isometric hip efforts (open kinetic chain) into flexion/extension, abduction/adduction, and internal/external rotation, and hip rotation to end range in standing. Analysis of the relationship between activity of the obturator internus and the other hip muscles provided evidence of limited contamination of the recordings with crosstalk. Obturator internus EMG amplitude was greatest during hip extension, then external rotation then abduction, with minimal to no activation in other directions. Obturator internus EMG was more commonly the first muscle active during abduction and external rotation than other muscles. This study describes a viable and valid technique to record obturator internus EMG and provides the first evidence of its activation during simple functions. The observation of specificity of activation to certain force directions questions the hypothesis of a general role in hip stabilisation regardless of force direction. PMID:24788026

Hodges, Paul W; McLean, Linda; Hodder, Joanne

2014-08-01

311

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

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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

312

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

313

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 ...

314

Microvascular Cranial Nerve Palsy  

Science.gov (United States)

... Cranial Nerve Palsy? Tweet Microvascular cranial nerve palsy (MCNP) is a neurological condition involving the small blood ... affects the muscles that move the eyes. With MCNP, there is a blockage of blood flow to ...

315

Radial nerve dysfunction (image)  

Science.gov (United States)

The radial nerve travels down the arm and supplies movement to the triceps muscle at the back of the upper arm. ... the wrist and hand. The usual causes of nerve dysfunction are direct trauma, prolonged pressure on the ...

316

Degenerative Nerve Diseases  

Science.gov (United States)

Degenerative nerve diseases affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Many ... viruses. Sometimes the cause is not known. Degenerative nerve diseases include Alzheimer's disease Amyotrophic lateral sclerosis Friedreich's ...

317

Ulnar nerve palsy due to axillary crutch.  

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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

318

Does the sciatic nerve approach influence thigh tourniquet tolerance during below-knee surgery?  

Science.gov (United States)

In this prospective, randomized, blinded study we assessed thigh tourniquet tolerance when a Labat's or a posterior popliteal approach of the sciatic nerve was used for below-knee surgery. One-hundred-twenty patients were divided into two groups of 60. A posterior popliteal (Group 1) or a Labat's (Group 2) sciatic nerve block was performed with 25 mL 1% mepivacaine + epinephrine 1:200,000. In both groups, a femoral nerve block was achieved. Patient comfort during block performance, sensory block, success rate, and thigh tourniquet tolerance were recorded. Performance of the block was significantly more comfortable in Group 1 than in Group 2 (P posterior femoral cutaneous nerve in 91% of the patients, Labat's approach of the sciatic nerve provides no better thigh tourniquet tolerance than the popliteal approach. The popliteal approach is as efficient but more comfortable for the patient and is the preferred technique for below-knee surgery. PMID:15845716

Fuzier, Régis; Hoffreumont, Pierre; Bringuier-Branchereau, Sophie; Capdevila, Xavier; Singelyn, François

2005-05-01

319

Engineering peripheral nerve repair.  

Science.gov (United States)

Current approaches for treating peripheral nerve injury have resulted in promising, yet insufficient functional recovery compared to the clinical standard of care, autologous nerve grafts. In order to design a construct that can match the regenerative potential of the autograft, all facets of nerve tissue must be incorporated in a combinatorial therapy. Engineered biomaterial scaffolds in the future will have to promote enhanced regeneration and appropriate reinnervation by targeting the highly sensitive response of regenerating nerves to their surrounding microenvironment. PMID:23790730

Marquardt, Laura M; Sakiyama-Elbert, Shelly E

2013-10-01

320

Laryngeal nerve damage  

Science.gov (United States)

Laryngeal nerve damage is injury to one or both of the nerves that are attached to the voice box. ... Injury to the laryngeal nerves is uncommon. It it does occur, it can be from: A complication of neck or chest surgery (especially thyroid, lung, ...

 
 
 
 
321

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

322

Fracture resistance of teeth obturated with Gutta percha and Resilon: An in vitro study  

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Aim: The aim of this study was to evaluate and compare the fracture resistance of endodontically treated teeth filled with gutta percha and Resilon. Materials and Methods: A total of 60 freshly extracted single rooted teeth are selected and their anatomical crown removed at the CEJ. All samples were instrumented with the Step-back technique. Samples were randomly divided into three groups of 20 samples each: Group A obturated by lateral condensation with gutta percha and AH pl...

2010-01-01

323

Paravertebral blocks.  

Science.gov (United States)

PVB remains an underused block. It is easy to perform reliable and effective blocks for a wide variety of applications both for acute or chronic pain. As evidence continues to be published showing the advantages of PVB versus traditional methods of pain control, it is hoped that PVB will become part of the standard repertoire of blocks used in teaching hospitals and in private practice. PMID:22227423

Greengrass, Roy A; Duclas, Reynold

2012-01-01

324

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.

325

Infraclavicular brachial plexus blocks. Comparison of neonatal and adult anatomy  

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The infraclavicular (IC) block has been designed to effectively block all the cords and branches of the (BP). However, the majority of paediatric research available uses techniques designed employing adult samples. Although the success rates of these procedures are acceptable, a nerve stimulator is used to identify the BP. Even with the aid of nerve stimulators, no regional anaesthetic technique can be considered safe and consistent until the anatomy has been examined. This study aims to desc...

Schoor, A.; Bosman, M. C.; Bosenberg, A. T.

2009-01-01

326

Distribution of Sciatic nerve in Hamstring muscles  

Directory of Open Access Journals (Sweden)

Full Text Available Regarding the importance of sciatic nerve distribution in replacement of anal sphincter and sciatic nerve block we decided to study this matter for the first time in Iran. In this way 100 cadavers (88% male and 12% female were dissected and studied by loop microscope. The results shows that primarily, according to the first branch derived from sciatic; there would be 4 main Groups. If this samples were rgarded according to the second branch of the nerve, then there would be 6 accessory groups added. So, in group A the first branch was related to proximal part of semimembranosus, in group B the branch was recorded as normal variations based on the above mentioned patterns.

"Khaleghi R

2000-09-01

327

Robot-Assisted Laparoscopic Prostatectomy  

Medline Plus

Full Text Available ... dorsal venous complex. This is a complex of veins that can be quite problematic open. 00:15: ... are the obturator vessels. Here are the obturator vein, obturator artery, and this is the obturator nerve. ...

328

Block persistence  

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We define a block persistence probability $p_l(t)$ as the probability that the order parameter integrated on a block of linear size $l$ has never changed sign since the initial time in a phase ordering process at finite temperature Tblocks, where \\theta_0 is the global (magnetization) persistence exponent and f(x) decays with the local (single spin) exponent \\theta for large x. This scal...

Cueille, Stephane; Sire, Clement

1998-01-01

329

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

Science.gov (United States)

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

Erdem, Arzu Pinar; Sepet, Elif

2008-10-01

330

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

Scientific Electronic Library Online (English)

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

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

331

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)

1986-01-01

332

In Vitro Comparison of Apical Leakage in Root Canals Obturated with 0.04 and 0.02 Tapered Gutta-Percha  

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Full Text Available INTRODUCTION: Gutta-percha is the most commonly used material for root canal obturation; it has been recently manufactured with different tapers. The aim of this in vitro study was to compare microleakage of canals obturated with standard gutta-percha (0.02 taper or the new 0.04 taper gutta-percha master cone using the cold lateral condensation technique. MATERIALS AND METHODS: Forty-four extracted single rooted teeth were selected. The crowns were removed and all the canals were prepared using RaCe rotary files. The teeth were then divided into experimental (n=2 and control (n=2 groups. In the first study group, the teeth were obturated with 0.02 taper gutta-percha master cone and lateral condensation. In the second study group, the canals were obturated by 0.04 tapered master cones and the same obturation method. The degree of leakage was measured using fluid filtration method. Data were analyzed statistically by student t-test. RESULTS: There was no significant difference between the mean microleakage of two experimental groups (P=0.558. CONCLUSION: Lateral condensation technique using 0.04 tapered master cones can provide an effective apical seal similar to 0.02 gutta-percha cones.

Maryam Bidar

2010-11-01

333

Microsurgical procedures for peripheral nerve lesions: Choice of anesthesia  

Directory of Open Access Journals (Sweden)

Full Text Available Microsurgical procedures on peripheral nerve lesions have their own specifics. Those are: duration and extent of operation, and need to change body position during operation. General endotracheal anesthesia has been used for operations on brachial plexus lesions with neural transpher; on peripheral nerve lesions with sural nerve autotransplantations; on all extracranial lesions (facial n. and lesion hypoglossal n.; for lesions of plexus lumbalis and sciatic nerve. These operations are requesting turning of patient on the lateral or ventral position or they are performed on head and neck. Because operation and anesthesia last longer, general ET anesthesia is more suitable for neurosurgens and anesthesiologist's interventions. Regional anesthesia, i.e. neural plexus block, is suitable for operations on upper extremity. Then we perform brachial plexus block with more approaches. There has been frequently in use axillary approach which is easier to perform, has minimum of complications and is suitable for procedures at cubital region, forearm and hand.

Stoši? Mila M.

2003-01-01

334

Obturation and holding-back device for a leaktight closing plug of a steam generator tube  

International Nuclear Information System (INIS)

The device comprises a threaded rod which can screwing in a bore tapped in the core and solidary at one end at a blocking element. This blocking element as an external diameter superior at the diameter of the rod and is engaged in the extremity of the plug opposite at the closing end with means for blocking in rotation or/and in translation the blocking device

1989-06-23

335

Ulnar nerve palsy due to axillary crutch.  

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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...

2001-01-01

336

Transverse cervical nerve: implications for dental anesthesia.  

Science.gov (United States)

The inferior alveolar nerve block (IANB) has the highest failure incidence of any dental anesthetic technique. Many authors have outlined potential reasons for these failures in permanent lower molars, including accessory innervations from the mylohyoid and mental foramen. However, the potential accessory innervation of posterior mandibular teeth from the transverse cervical nerve (TCN), a branch of ventral rami from the C2-C3 spinal nerves from the cervical plexus (CP), has been difficult to assess as a result of the small size and thickness of the mandibular accessory foramina and nerve branches, as well as due to the dissection technique performed. The goal of this study was to identify and trace the CP branches from fresh human cadaver tissue samples using the Sihler's technique. Two fresh human cadaver samples were used. Samples were fixed in neutralized formalin, macerated in potassium hydroxide, decalcified in acetic acid, stained in Ehrlich's hematoxylin, destained in acetic acid, and cleared in glycerin. Both specimens skin was dissected. The Sihler's technique delineated all nerves three dimensionally and helped to disclose structures of small size and thickness. The TCN from the CP, stained in blue, innervated the posterior mandible in one of the two samples. These results confirmed that the CP may supply accessory innervation to the inferior border of the posterior mandible through the TCN. These findings illustrate variations of anatomy that may account for IANB failures in posterior mandibular teeth and allows for clinical decisions for implementing supplemental anesthetic techniques. PMID:23362053

Lin, K; Uzbelger Feldman, D; Barbe, M F

2013-09-01

337

Vagus Nerve Stimulation (VNS Therapy)  

Medline Plus

Full Text Available ... down to the vagus nerve and wrap these electrodes around the nerve and then connect them underneath ... re going to see later, where the tiny electrodes are actually wrapped around this nerve. Now, here’s ...

338

Prolonged nerve blockade delays the onset of neuropathic pain.  

Science.gov (United States)

Aberrant neuronal activity in injured peripheral nerves is believed to be an important factor in the development of neuropathic pain. Pharmacological blockade of that activity has been shown to mitigate the onset of associated molecular events in the nervous system. However, results in preventing onset of pain behaviors by providing prolonged nerve blockade have been mixed. Furthermore, the experimental techniques used to date to provide that blockade were limited in clinical potential in that they would require surgical implantation. To address these issues, we have used liposomes (SDLs) containing saxitoxin (STX), a site 1 sodium channel blocker, and the glucocorticoid agonist dexamethasone to provide nerve blocks lasting ~1 wk from a single injection. This formulation is easily injected percutaneously. Animals undergoing spared nerve injury (SNI) developed mechanical allodynia in 1 wk; nerve blockade with a single dose of SDLs (duration of block 6.9 ± 1.2 d) delayed the onset of allodynia by 2 d. Treatment with three sequential SDL injections resulting in a nerve block duration of 18.1 ± 3.4 d delayed the onset of allodynia by 1 mo. This very prolonged blockade decreased activation of astrocytes in the lumbar dorsal horn of the spinal cord due to SNI. Changes in expression of injury-related genes due to SNI in the dorsal root ganglia were not affected by SDLs. These findings suggest that formulations of this kind, which could be easy to apply clinically, can mitigate the development of neuropathic pain. PMID:23045676

Shankarappa, Sahadev A; Tsui, Jonathan H; Kim, Kristine N; Reznor, Gally; Dohlman, Jenny C; Langer, Robert; Kohane, Daniel S

2012-10-23

339

Acquired medullated nerve fibres.  

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Myelination of nerve fibres normally stops at the lamina cribrosa. When it does proceed beyond the lamina cribrosa, it is believed to do so shortly after birth. A patient is recorded in whom medullated nerve fibres developed in the retina during adult life.

Baarsma, G. S.

1980-01-01

340

[Peripheral facial nerve palsy].  

Science.gov (United States)

There are different etiological factors concerning the acute peripheral facial nerve palsy. In the majority of the cases, however, no etiological factor can be found. These cases are called idiopathic facial palsy or Bells palsy. Perhaps local anaesthetics could play a role as an etiological factor. By means of a case-report this form of facial nerve palsy will be discussed. PMID:11908448

Nauta, J M; Timmenga, N M; Cats, H

1993-04-01

 
 
 
 
341

Starting with ultrasonography decreases popliteal block performance time in inexperienced hands: a prospective randomized study  

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Full Text Available Abstract Background The widespread of hallux valgus surgery in a day care setting enhanced the role of regional anaesthesia in the last few years. Sciatic nerve block at popliteal fossa has been shown to provide safe and effective analgesia. Our purpose was to compare the success rate and performance time of popliteal block during resident’s training for regional anaesthesia by using nerve stimulation (NS or combined nerve stimulation and ultrasound (NS + US. Methods 70 adult patients undergoing hallux valgus surgery were randomly assigned to receive sciatic nerve block at popliteal fossa with US+NS or NS alone with a double injection technique for peroneal and tibial branches, respectively. Two residents experienced with nerve stimulator performed the procedures after a learning phase concerning ultrasonography. A local anaesthetic solution, containing 10 mL of 0.75% ropivacaine and 10 mL of 2% lidocaine was used: 12 mL were infiltrated close the tibial nerve, and 8mL were infiltrated close the common peroneal nerve. Block success rate, sensory block onset time, block performance time were evaluated. Recourse to general anaesthesia was considered as failure. Results No differences were detected in success rate and onset time of sensory block between the two groups (P > 0.05. The time to block tibial nerve and the overall block time were significantly faster in US+NS group (P Conclusions Ultrasound guidance for popliteal nerve block resulted in similar success rate with a faster procedure time when compared with nerve stimulator, thus providing a possible effect on resident education and operating room efficiency.

Cataldo Rita

2012-12-01

342

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

343

Blocking Conceptualization  

Directory of Open Access Journals (Sweden)

Full Text Available My purpose in this chapter is to go into some detail on the various blocks to conceptualization that the reader can and should be wary of so he/she can either avoid them, deal with them adequately to do a GT study, or submit to them humbly for greater gains for the moment. They are authoritative blocks, preconceptions, inability to adequately conceptualize, the initial confusion and regression, multiversion view of GT, QDA requirement blocks, data collection overload, data coding overload, peer reviews, dealing with jargonizing GT, and being a novice both in experience and in scholarship with GT. Obviously these are related in many ways and I have dealt with them a bit in above chapters on helping coding. My goal here is to put them into relief for focused attention and thought so they can be avoided or handled.

Barney G. Glaser, Ph.D., Hon. Ph.D.

2011-03-01

344

Uso de obturadores en cirugía oral y maxilofacial: Presentación de cinco casos clínicos / Use of obturators in oral and maxillofacial surgery: A report of five cases  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Los defectos creados en el maxilar, principalmente tras cirugía resectiva de tumores malignos, traumatismo o defectos congénitos, deben ser corregidos con el fin de recuperar los consecuentes déficits en el habla, la deglución, la masticación y la estética. Para ello contamos con dos amplias posibil [...] idades: reconstrucción quirúrgica o colocación de un obturador protésico maxilar. En este artículo llevamos a cabo una revisión de la literatura reciente y clásica sobre obturadores palatinos, ilustrándola mediante 5 casos clínicos con esta opción terapéutica. Hemos encontrado descritas una amplia variedad de modificaciones para los distintos tipos de obturadores, como la fabricación de aletas nasales, colocación de obturadores de forma inmediata tras la cirugía, el hecho de ahuecar el aditamento obturador, etc. En nuestra práctica hemos observado una serie de ventajas en la colocación de este tipo de prótesis de forma posquirúrgica diferida y en estrecha colaboración con su médico responsable. Abstract in english Defects created in the maxillary bone, principally after surgical resection of malignant tumors, trauma or congenital defects, must be corrected to eliminate the resulting speech, swallowing, and chewing defects and restore the cosmetic appearance. Two major options available are surgical reconstruc [...] tion or the placement of a maxillary obturator prosthesis. The recent and classic literature on palatal obturators is reviewed and five clinical cases treated with a palatal obturator are reported. A large variety of modifications have been reported for different types of obturators, such as nasal wings, immediate postoperative obturator prosthesis placement, etc. In the authors' experience, deferred postoperative obturator placement in close collaboration with the responsible doctor has advantages.

R.T., Velázquez-Cayón; R., Flores-Ruiz; D., Torres-Lagares; S., González-Guerrero; D., González-Padilla; J.L., Gutiérrez-Perez.

345

Peripheral nerve surgery.  

Science.gov (United States)

In treating the three main surgical problems of peripheral nerves--nerve sheath tumors, entrapment neuropathies, and acute nerve injuries--the overriding consideration is the preservation and restoration of neurologic function. Because of this, certain other principles may need to be compromised. These include achieving a gross total excision of benign tumors, employing conservative therapy as long as a disease process is not clearly progressing, and delaying repair of a nerve transection until the skin wound has healed. Only three pathophysiologic processes need be considered: neurapraxia (focal segmental dymyelination), axonotmesis (wallerian degeneration caused by a lesion that does not disrupt fascicles of nerve fibers), and neurotmesis (wallerian degeneration caused by a lesion that interrupts fascicles). With nerve sheath tumors and entrapment neuropathies, the goal is minimize the extent to which neurapraxia progresses to axonotmesis. The compressive force is relieved without carrying out internal neurolysis, a procedure that is poorly tolerated, presumably because a degree of nerve ischemia exists with any long-standing compression. When the nerve has sustained blunt trauma (through acute compression, percussion, or traction), the result can be a total loss of function and an extensive neuroma-in-continuity (scarring within the nerve). However, the neural pathophysiology may amount to nothing more than axonotmesis. Although this lesion, in time, leads to full and spontaneous recovery, it must be differentiated from the neuroma-in-continuity that contains disrupted fascicles requiring surgery. Finally, with open nerve transection, the priority is to match the fascicles of the proximal stump with those of the distal stump, a goal that is best achieved if primary neurorrhaphy is carried out. PMID:2991727

McQuarrie, I G

1985-05-01

346

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

347

Anterior Interosseous Nerve Syndrome  

Directory of Open Access Journals (Sweden)

Full Text Available Lesion of the interosseous anterior nerve, which is the largest branch of the median nerve in the forearm, is very rare and often occurs due to compression of nerves between the two heads of the pronator teres muscle, following a trauma or idiopathically. We present a 45-year-old patient who developed pain in his right forearm, hand muscle weakness and hyperextension of the thumb and forefinger after physical work (he had carried heavy boxes on his forearms. The diagnosis of compressive neuropathy was based on electromyoneurographic examination. The patient underwent physical therapy and after 3 months his clinical and electrophysiological findings were improved.

Zoran Vukojevic

2011-06-01

348

Interscalene block: a comparison between electrostimulation and ultrasound-guided techniques  

Digital Repository Infrastructure Vision for European Research (DRIVER)

In order to compare conventional interscalene brachial plexus block (ISBPB) using surface landmarks and nerve stimulation to ultrasound-guided blocks for shoulder surgery, 60 patients, 33 males and 27 females, ranging in age between 16 - 85 years were included in this prospective study and randomized into 2 matched groups, 30 patients each. Group A using nerve stimulator (NS) alone and group B guided by 2-dimensional ultrasound (US) as well. Prilocaine 1 % was used for the block while ropivac...

Salem, Mohamed Hamed

2009-01-01

349

Oval in males and triangular in females? A quantitative evaluation of sexual dimorphism in the human obturator foramen.  

Science.gov (United States)

Among the numerous pelvic traits presenting sex differences, the obturator foramen is classically described as being oval in males and triangular in females. However, no demonstrations or detailed studies seem available in the literature. The purpose of this work was to study quantitatively this trait using Fourier analysis, because this methodological approach is particularly well adapted for discrimination between different simple shapes. Using this approach, an outline can be characterized by a series of harmonics (1 to n), each defined by two Fourier descriptors: amplitude (C(n)), describing the relative importance of the harmonic contribution to the original shape, and phase (Phi(n)), representing the orientation of the harmonic contribution. The material consisted of 104 three-dimensional CT reconstructions of adult pelves (52 males and 52 females). After size normalization, the outlines of the 104 left obturator foramens were studied. Significant differences were demonstrated with, in total, 84.6% of individuals presenting a correct inferred sex. The most discriminating descriptors were the phase of the second harmonic (C(2),) related to the oval (or elliptic) aspect and thus the elongation of the shape, and the amplitude of the third harmonic (Phi(3)), describing the triangularity of the shape. Because the trend for an outline to be more or less oval or triangular is difficult to visually assess and because there is an infinite number of transitional shapes, only a precise quantitative approach such as Fourier analysis allows for unambiguous characterization and statistical analysis. PMID:19927366

Bierry, Guillaume; Le Minor, Jean-Marie; Schmittbuhl, Mathieu

2010-04-01

350

[Nerve injuries and posttraumatic therapy].  

Science.gov (United States)

Peripheral nerve injuries are a common clinical problem and can represent a major challenge, especially after trauma. In order to achieve optimal therapy, an early and adequate diagnosis with subsequent therapy is critical for functional preservation and restoration. Especially after complete severance of a peripheral nerve, the surgical techniques for nerve coaptation are an important prerequisite for peripheral nerve regeneration. The importance and necessity of adequate nerve coaptation and nerve transplantation are presented in detail. In addition, the types of primary and secondary nerve reconstruction procedures are described as well as the optimal time point of nerve repair. This article provides a comprehensive overview of the possibilities for diagnosis and intervention after nerve injury, additionally including an algorithm for surgical intervention. Furthermore, possible pitfalls and factors for improving the functional outcome are presented to optimize results with trauma-related nerve injury. PMID:24903504

Radtke, C; Vogt, P M

2014-06-01

351

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

352

Diabetic Nerve Problems  

Science.gov (United States)

... at the wrong times. This damage is called diabetic neuropathy. Over half of people with diabetes get ... you change positions quickly Your doctor will diagnose diabetic neuropathy with a physical exam and nerve tests. ...

353

Bilateral suprascapular nerve entrapment.  

Science.gov (United States)

Bilateral suprascapular nerve entrapment syndrome is very rare. It presents with shoulder pain, weakness and atrophy of the supraspinatus and infraspinatus muscles. We present a twenty-year old man having a history of bilateral shoulder pain associated with weakness. Electromyographic studies revealed signs of a lesion that caused a neupraxic state of the left suprascapular nerve, moderate axonal loss of the right suprascapular nerve and denervation of the right suprascapular muscle. The patient was treated with physical and medical therapy. Due to worsening of the symptoms, a surgical operation was performed by the excision of the transverse scapular ligaments bilaterally. His pain, weakness and atrophy had diminished on examination six weeks later. Suprascapular nerve entrapment should be considered in patients with shoulder pain, particularly those with weakness and atrophy of the supraspinatus and infraspinatus muscles. PMID:15004884

Aydin, Teoman; Ozaras, Nihal; Tetik, Sevgi; Emel, Erhan; Seyithanoglu, Hakan

2004-02-29

354

Experience with Nerve Allograft Transplantation  

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Nerve allograft transplantation should be used for the repair of devastating peripheral nerve injuries that cannot be reconstructed through traditional means such as autologous nerve grafting or nerve transfer procedures. The risks of required systemic immunosuppression, although only temporary for nerve allograft recipients, preclude widespread use of this treatment modality. Translational research has led to several advancements in this field including the use of preoperative allograft cold...

Fox, Ida K.; Mackinnon, Susan E.

2007-01-01

355

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 | Language: Portuguese 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

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

356

Lower cranial nerves.  

Science.gov (United States)

Imaging evaluation of cranial neuropathies requires thorough knowledge of the anatomic, physiologic, and pathologic features of the cranial nerves, as well as detailed clinical information, which is necessary for tailoring the examinations, locating the abnormalities, and interpreting the imaging findings. This article provides clinical, anatomic, and radiological information on lower (7th to 12th) cranial nerves, along with high-resolution magnetic resonance images as a guide for optimal imaging technique, so as to improve the diagnosis of cranial neuropathy. PMID:24210311

Soldatos, Theodoros; Batra, Kiran; Blitz, Ari M; Chhabra, Avneesh

2014-02-01

357

Another simplicial nerve  

CERN Document Server

As it was pointed out by Sergey Mozgovoy to the author, the standard simplicial nerve used in [H1] does not satify some of the announced properties. This has some desctructive consequences on a few claims concerning the category sCat of simplicial categories. In this note we give a new definition of simplical nerve and present some more details to rehabilitate the author's papers on formal deformation theory.

Hinich, V

2007-01-01

358

Obturator externus bursa: prevalence of communication with the hip joint and associated intra-articular findings in 200 consecutive hip MR arthrograms  

Energy Technology Data Exchange (ETDEWEB)

The purpose of the study was to demonstrate the prevalence of communication between the hip joint and the obturator externus bursa on hip MR arthrography. Following institutional review board approval, 200 hip MR arthrograms in 196 subjects were independently reviewed by two musculoskeletal radiologists. Discrepancies were resolved by adjudication. The presence or absence of communication between the hip joint and the obturator externus bursa was recorded. Associated lesions involving the acetabular labrum and articular cartilage were recorded. The obturator externus bursa was shown to communicate with the hip joint in 11 of the 200 (5.5%) hip MR arthrograms. Of these, six were in men and five were in women. The age range was 15-63 years with a mean age of 34 years. All 11 patients had labral tears. Eight of the 11 had cartilage lesions. The obturator externus bursa can be seen to communicate with the hip joint in 5.5% of hip MR arthrograms. Associated labral and cartilage lesions are common. (orig.)

Kassarjian, Ara [Corades, S.L., Majadahonda-Madrid (Spain); Massachusetts General Hospital, Division of Musculoksleletal Radiology, Boston, MA (United States); Llopis, Eva [Hospital de la Ribera, Department of Radiology, Alzira (Valencia) (Spain); Schwartz, Richard B. [Longwood MRI Specialists, Brookline, MA (United States); Bencardino, Jenny T. [NYU Department of Radiology, New York, NY (United States)

2009-11-15

359

Evaluation and management of peripheral nerve injury.  

Science.gov (United States)

Common etiologies of acute traumatic peripheral nerve injury (TPNI) include penetrating injury, crush, stretch, and ischemia. Management of TPNI requires familiarity with the relevant anatomy, pathology, pathophysiology, and the surgical principles, approaches and concerns. Surgical repair of TPNI is done at varying time intervals after the injury, and there are a number of considerations in deciding whether and when to operate. In neurapraxia, the compound muscle and nerve action potentials on stimulating distal to the lesion are maintained indefinitely; stimulation above the lesion reveals partial or complete conduction block. The picture in axonotmesis and neurotmesis depends on the time since injury. The optimal timing for an electrodiagnostic study depends upon the clinical question being asked. Although conventional teaching usually holds that an electrodiagnostic study should not be done until about 3 weeks after the injury, in fact a great deal of important information can be obtained by studies done in the first week. Proximal nerve injuries are problematic because the long distance makes it difficult to reinnervate distal muscles before irreversible changes occur. Decision making regarding exploration must occur more quickly, and exploration using intraoperative nerve action potential recording to guide the choice of surgical procedure is often useful. PMID:18482862

Campbell, William W

2008-09-01

360

Tissue pressure threshold for peripheral nerve viability.  

Science.gov (United States)

To investigate the pressure threshold for peripheral nerve dysfunction in compression syndromes (carpal tunnel and compartment syndromes), carpal canal pressure was elevated to 40, 50, 60, and 70 mm Hg in normal volunteers. Motor and sensory latencies and amplitudes of the median nerve were evaluated before compression, after 30-240 minutes of compression, and during the postcompression recovery phase. Although some functional loss occurred at 40 mm Hg, motor and sensory responses were completely blocked at a threshold tissue fluid pressure of 50 mm Hg, measured by the wick catheter. In one subject in whom diastolic blood pressure was significantly higher than in other subjects, the threshold pressure was raised slightly. The Semmes-Weinstein monofilament test and the 256-cycle vibratory test were more sensitive than two-point discrimination tests for evaluating peripheral nerve function in this compression model. These results indicate that between 40 mm Hg and 50 mm Hg there exists a critical pressure threshold at which peripheral nerve is acutely jeopardized. Compartment decompression may not be indicated when interstitial pressures are below this level. PMID:6883862

Gelberman, R H; Szabo, R M; Williamson, R V; Hargens, A R; Yaru, N C; Minteer-Convery, M A

1983-09-01

 
 
 
 
361

Dynamics and sensitivity analysis of high frequency conduction block  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The local delivery of extracellular high frequency stimulation (HFS) has been shown to be a fast acting and quickly reversible method of blocking neural conduction, and is currently being pursued for several clinical indications. However, the mechanism for this type of nerve block remains unclear. In this study, we investigate two hypotheses: 1) That depolarizing currents promote conduction block via inactivation of sodium channels, and 2) that the gating dynamics of the fast sodium channel a...

Ackermann, D. Michael; Bhadra, Niloy; Gerges, Meana; Thomas, Peter J.

2011-01-01

362

Anatomical Variations in Formation and Branching Pattern of the Femoral Nerve in Iliac Fossa: A Study in 64 Human Lumbar Plexuses  

Directory of Open Access Journals (Sweden)

Full Text Available Femoral nerve is used for nerve block in several surgeries and is vulnerable to compression in tight ilio-psoascompartment. The knowledge of origin and variations of femoral nerve in iliac fossa is important for anatomists, anesthetistsand surgeons to prevent iatrogenic femoral nerve palsy.We dissected 32 human cadavers to study the anatomy of the femoral nerve. We dissected the lumbar plexusbilaterally; dissected the psoas major muscle to see formation of the femoral nerve. We measured the length of the femoralnerve from its formation to inguinal ligament; and recorded variations of the femoral nerve with digital photography.The average length of the femoral nerve was 144 mm. Anatomical variations of the femoral nerve were found in25% lumbar plexuses. These variations included abnormally long L2 root, early division of the femoral nerve, origin oflateral cutaneous nerve of thigh from the femoral nerve, origin of nerve to pectineus from the femoral nerve in iliac fossa,splitting of the femoral nerve into two slips by psoas major or accessory slips of iliacus muscle.The aim of this study was to highlight variations in branching pattern of the femoral nerve in iliac fossa forappropriate exposure of the femoral nerve.

Rajesh B Astik,

2011-07-01

363

Mechanical injury of peripheral nerves. Fine structure and dysfunction.  

Science.gov (United States)

In summary we have examined the morphology of the normal peripheral nerve, presented the types of mechanical nerve injury and associated histopathology, and discussed possible mechanisms responsible for symptoms of pain, paresthesiae, and weakness associated with these lesions. Neurapraxia consists of intussusception of axon and myelin through the nodes of Ranvier resulting in prolonged nerve conduction block. Axonotmesis and neurotmesis describe more severe disruptions of nerve fiber architecture, are difficult to distinguish electrophysiologically, and have poorer prognoses for functional regenerative repair. Chronic entrapment lesions consist of telescoping myelin internodes and tapering of the sheaths with bulbous polarization of internodes away from the site of injury. Both acute and chronic lesions chiefly involve large myelinated fibers and both may create neuralgia, although the mechanism by which this occurs is poorly understood. Presently, increasing evidence suggests ectopic impulse generators and ephaptic transmission may be responsible for sensorimotor phenomena in these lesions. PMID:6323088

Castaldo, J E; Ochoa, J L

1984-01-01

364

Nerve injuries sustained during warfare: part I--Epidemiology.  

Science.gov (United States)

We describe 261 peripheral nerve injuries sustained in war by 100 consecutive service men and women injured in Iraq and Afghanistan. Their mean age was 26.5 years (18.1 to 42.6), the median interval between injury and first review was 4.2 months (mean 8.4 months (0.36 to 48.49)) and median follow-up was 28.4 months (mean 20.5 months (1.3 to 64.2)). The nerve lesions were predominantly focal prolonged conduction block/neurapraxia in 116 (45%), axonotmesis in 92 (35%) and neurotmesis in 53 (20%) and were evenly distributed between the upper and the lower limbs. Explosions accounted for 164 (63%): 213 (82%) nerve injuries were associated with open wounds. Two or more main nerves were injured in 70 patients. The ulnar, common peroneal and tibial nerves were most commonly injured. In 69 patients there was a vascular injury, fracture, or both at the level of the nerve lesion. Major tissue loss was present in 50 patients: amputation of at least one limb was needed in 18. A total of 36 patients continued in severe neuropathic pain. This paper outlines the methods used in the assessment of these injuries and provides information about the depth and distribution of the nerve lesions, their associated injuries and neuropathic pain syndromes. PMID:22434470

Birch, R; Misra, P; Stewart, M P M; Eardley, W G P; Ramasamy, A; Brown, K; Shenoy, R; Anand, P; Clasper, J; Dunn, R; Etherington, J

2012-04-01

365

[Characteristics of sciatic nerve regeneration in limb blood supply disturbance].  

Science.gov (United States)

The submitted work is devoted to a problem of influence of the regional hemodynamic disturbances on nerve regeneration following its full anatomic breakdown and neuroraphy. In a chronic experiment on 30 white rats, an arterial ischemia was reproduced by ligation of the main femoral arteries: common and deep femoral (12 animals), while venous hypertension was reproduced by ligation of the main veins: common, deep femoral and big hypodermic veins (12 animals). In the second stage of the operation a sciatic nerve of the same limb was dissected and its pieces were connected by perineural seam. In the control group 6 animals were subjected to the operation with the subsequent imposition of the perineural seam on the sciatic nerve. In 7, 14, 30, 60, 90 days after operation the tissue block from a zone of neural anastomosis was deleted. Proximal and distal stumps of the operated nerve, reclaiming neuroma and hematomicrocirculating channels of the nerve were investigated by perfusion, histologic and electron-microscopic methods. It is established that the regional ischemia caused by trauma of the main arteries of the limb resulted in inhibition of regenerative processes in the operated nerve, and restoration of arterial blood circulation is essential for stimulation of these processes. Regional venous hypertension is not the critical factor for regeneration of a peripheral nerve after its anatomic breakdown and microsurgical neuroraphy. PMID:16108229

Honcharuk, O O; Tsymbaliuk, V I; Kostyns'ky?, H B

2005-01-01

366

Ultrasound-guided ulnar nerve catheter placement in the forearm for postoperative pain relief and physiotherapy.  

Science.gov (United States)

Consistent identification of peripheral nerves as well as placement of catheters for post-operative pain relief is possible with the aid of ultrasound. By blocking a single nerve rather than the entire extremity, pain can be eliminated without impairing motor function of the entire extremity, providing greater patient comfort. This report describes a case in which ultrasound-guided ulnar nerve catheter placement was performed in the forearm for post-operative pain relief following arthrolysis and tenolysis of the fifth finger. The ulnar nerve catheter allowed for excellent pain relief and completely painless physiotherapy without impairing motor function of the operated finger. PMID:19032570

Lurf, M; Leixnering, M

2009-02-01

367

COMMUNICATION BETWEEN RADIAL AND ULNAR NERVE AT A HIGH HUMERAL LEVEL  

Directory of Open Access Journals (Sweden)

Full Text Available Various communications between the different branches of brachial plexus have been reported by many authors but the communication between the radial and ulnar nerve; the branches of posterior and medial cords of brachial plexus in the arm is very rare. It features the communicating ramus travelling from proximal radial nerve and distal ulnar nerve at a high humeral level in the right arm of a 56 year old male cadaver. Knowledge of such variations may be of importance in the evaluation of certain entrapment phenomenon of ulnar nerve or unexplained sensory loss after trauma or surgical interventions in that particular area is also of clinical significance in anaesthetic blocks.

Monika Lalit

2014-06-01

368

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

369

Ultrasound-guided peripheral and truncal blocks in pediatric patients  

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Ultrasound has added a feather in the cap of the anesthesiologists as real-time nerve localization and drug deposition around the nerve structure under real-time guidance is now a reality, as the saying “seeing is believing” has been proven true with the advent of ultrasound in anesthesia. Pediatric patients are a unique group regarding their anatomical and physiological features in comparison with adults; regional blocks in adults with the anatomical landmark and surface marking are almo...

2011-01-01

370

Pleural effusion and atelectasis during continuous interscalene brachial plexus block -A case report-  

Digital Repository Infrastructure Vision for European Research (DRIVER)

An interscalene brachial plexus block is an effective means of providing anesthesia-analgesia for shoulder surgery. However, it has a multitude of potential side effects such as phrenic nerve block. We report a case of a patient who developed atelectasis of the lung, and pleural effusion manifested as chest discomfort during a continuous interscalene brachial plexus block for postoperative analgesia.

Yang, Chun Woo; Jung, Sung Mee; Cho, Choon Kyu; Kwon, Hee Uk; Kang, Po Soon; Lim, Young Su; Oh, Jin Young; Yi, Jin Woong

2010-01-01

371

THE SELECTIVITY OF DRUGS BLOCKING GANGLIONIC TRANSMISSION IN THE RAT.  

Science.gov (United States)

By comparing the effects on ganglionic transmission and on the pre- and post-ganglionic nerves in the isolated superior cervical ganglion preparation of the rat, the selectivity of several drugs was assessed quantitatively. Hexamethonium, tetraethylammonium, nicotine and tubocurarine blocked transmission in concentrations which did not affect nervous conduction and were considered to be highly selective in action. Atropine, amylobarbitone and paraldehyde depressed nervous conduction appreciably in ganglion-blocking doses, but not enough to account wholly for the block in transmission and they were therefore considered as being moderately selective. The ganglion blocking actions of mephenesin, procaine, methylpentynol, methylpentynol carbamate and benactyzine were nonspecific, showing general depression of neuronal activity. Ganglion block with bretylium was nonselective in its site of depression of the postganglionic neurone in concentrations which only partly depressed the preganglionic nerve. PMID:14228129

QUILLIAM, J P; SHAND, D G

1964-10-01

372

The role of microsurgery in nerve repair and nerve grafting.  

Science.gov (United States)

Advances in the field of microsurgery have improved the results after peripheral nerve surgery and have extended the types of nerve repair that can be accomplished. Innovative techniques using microsurgical dissection, such as nerve transfers and end-to-side repairs are direct consequences of these advances. PMID:17478254

Dvali, Linda; Mackinnon, Susan

2007-02-01

373

Vagus Nerve Stimulation (VNS Therapy)  

Medline Plus

Full Text Available ... itself. He has the nerve with a small red piece of tubing around the nerve. He’s holding ... that can help us identify what kind of syndrome they have, perhaps, what kind of seizures. There ...

374

Vagus Nerve Stimulation (VNS Therapy)  

Medline Plus

Full Text Available VAGUS NERVE STIMULATOR IMPLANTATION LEBONHEUR CHILDREN’S MEDICAL CENTER, MEMPHIS, TN Broadcast October 28, 2004 NARRATOR Approximately 1% ... of epilepsy. You are about to see a vagus nerve stimulation, a safe and effective treatment for ...

375

Vagus Nerve Stimulation (VNS Therapy)  

Science.gov (United States)

VAGUS NERVE STIMULATOR IMPLANTATION LEBONHEUR CHILDREN’S MEDICAL CENTER, MEMPHIS, TN Broadcast October 28, 2004 NARRATOR Approximately 1% ... of epilepsy. You are about to see a vagus nerve stimulation, a safe and effective treatment for ...

376

Vagus Nerve Stimulation (VNS Therapy)  

Medline Plus

Full Text Available ... of a vagus nerve stimulator for epilepsy. My name is Dr. Stephanie Einhaus and I am a ... an implantation of a vagus nerve stimulator. My name is Dr. Stephanie Einhaus and we’ve enjoyed ...