PURPOSE: The ability of the parasacral sciatic nerve block (PSNB) to induce anesthesia of the obturator nerve remains controversial. Our objective was to evaluate the anesthesia of the obturator nerve after a PSNB. METHODS: Forty patients scheduled to undergo knee surgery (anterior cruciate ligament reconstruction) were included in this prospective, randomized, controlled study. Patients were randomized to receive PSNB alone (control group, n = 20) or PSNB in combination with an obturator nerve block (obturator group, n = 20). After evaluation for 30 min, the two groups received a femoral nerve block, and patients were taken to surgery. The obturator nerve blockade was assessed by measurement of adductor strength at baseline (T0) and every 10 min during the 30-min evaluation (T10, T20, and T30). Pain scores after tourniquet inflation and during surgery were compared between the two groups. The requirement for additional intravenous analgesia and/or sedation was also recorded. RESULTS: The two groups had comparable demographic and surgical characteristics. Four patients were excluded from the study because of PSNB or femoral nerve block failure. The adductor strength values were similar between groups at T0 but were significantly lower in the obturator group at T10, T20, and T30 (p obturator group reported less pain than those in the control group (p obturator nerve and emphasizes the need to block this nerve separately to induce adequate analgesia during knee surgery. PMID:22868407

... traditional laproscopy. And now we've identified the obturator nerve. We've identified the location of the ... genitofemoral nerve is and you can see the obturator nerve down below, large iliac vessels just to ...

Because both the saphenous nerve and in part the obturator nerve are traversing the adductor canal of the thigh, we hypothesised that repeated administration of a local anaesthetic (LA) into this aponeurotic space could be a useful option for post-operative analgesia after knee replacement surgery. A systematic search of the literature pertinent to the blockade of the saphenous and/or obturator nerves for pain relief after knee surgery was conducted. Further, pain and opioid requirements were evaluated in eight patients receiving a continuous blockade of the saphenous and obturator nerve (adductor-canal-blockade) after total knee arthroplasty (TKA). Finally, we performed cross-sectional MR scans of the adductor canal after injection of ropivacaine 30ml in one patient. The systematic literature search revealed only one controlled study, where selective blockade of the saphenous nerve was investigated for the purpose of clinical pain relief after knee arthroscopy. We located no studies reporting on saphenous and/or obturator nerve block for pain relief after TKA. Preliminary findings in eight patients demonstrated that a continuous adductor-canal-blockade for 48h after TKA was associated with low mean pain scores at rest and low mean requirements for supplemental morphine. MR scans in one patient demonstrated that 30ml of LA filled the adductor canal, including the distal part, where the posterior branch of the obturator nerve joins the vessels and the saphenous nerve. Continuous adductor-canal-blockade may be a valuable adjunct for post-operative analgesia after major knee surgery. These preliminary results should be confirmed in randomised, controlled trials.

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

Femoral nerve lesions are uncommon, but very distressing at the functional level because of the absence of knee locking mechanism by the quadriceps muscle. We propose here a new neurotization procedure of obturator nerve motor branches to the motor portion of the femoral nerve in the thigh. This study was conducted on five cadavers. The motor portion of the femoral nerve and the motor branches of the obturator nerve, supplying the gracilis and adductor longus muscles, were isolated. The distance between nerve endings and diameter were measured to determine if a direct neurorrhaphy was possible between the femoral nerve and the two united branches of the obturator nerve. The overlap between the two nerve endings was 26 mm on average, and the mean diameter of the two nerve endings was 3.6 mm for the united branches of the obturator nerve and 3.7 mm for the femoral nerve. Thus, a direct suture was possible in all cases. In this anatomical study, access to the femoral nerve and two united branches of the obturator nerve was easy, in contrast to transfer in the pelvis. Moreover, direct suture without tension was possible in all cases. Thus, this transfer is simple and perfectly reproducible and may have a clinical application in proximal femoral nerve injuries. PMID:22821710

BACKGROUND: We evaluated a vertical obturator nerve block (VOB) using a single morphological landmark and no additional distance measurement or obligatory changes of the needle's direction. MATERIALS AND METHOD: A total of 88 cadavers (176 lower limbs), prepared using Thiel's embalming method, were examined. The index finger was placed lateral to the palpable pubic tubercle and the needle inserted laterally to the distal part of the fingernail at the tubercle's level and advanced strictly perpendicular to the table's surface. If bone contact was made, the needle was slightly turned to pass the bone distally. Colored latex (5ml) was then injected. The injection depth was documented, then followed by dissection and nerve exposition. The real skin-nerve distance and the degree of difficulty in orientation and of palpation were measured. Additionally, the dissemination around the nerve or its branches and the intrapelvic spread were documented. RESULTS: The nerve was colored completely in 93.75%, partially in 1.71%, and not colored in 4.54% of cases. The mean injection depth was 3.9cm (±0.7 SD) and real nerve depth was 3.8cm (±0.69 SD). Bone contact necessitating the needle's redirection was found in 20 (11.4%) cases. Easy orientation and palpation of the tubercle was always found. In 40 cases, the latex spread via the obturator canal into the lesser pelvis. CONCLUSION: In this anatomical study, the VOB technique exhibits easy orientation without stimulation or ultrasound guidance. The nerve was located at a constant depth. The injection offered a high percentage of colored nerves. PMID:22951254

In the current anatomic study, special attention was given to the relationship of the posterior division of the obturator nerve to surrounding structures: the obturator canal and the fibromuscular and vascular structures of the medial thigh region. These intimate relationships may, in certain condit...

... they want to do. They actually have decreased physical activity. They end up gaining weight, so it is ... and learn my anatomy again. But as you recall, in the obturator there are some nerves and ...

Abstract Background: The authors used selective peripheral neurotomy (SPN) on the sciatic and obturator nerves to restore the sitting posture and ambulation in bedridden patients suffering from severe proximal lower limb spasticity. Objective: To study the surgical outcome of sciatic and obturator neurotomies. Methods: All patients with refractory hamstring spasticity who encountered SPN on the hamstring nerve were recruited. Obturator neurotomy was undertaken in some individuals. The clinical assessment included Modified Ashworth Scale (MAS), passive range of motion (PROM), sitting competency and ambulatory condition. These parameters were compared between before and after the surgery by using the Wilcoxon signed-rank test. Results: Among the sciatic neurotomy group (n = 15), the mean pre...

Introduction: Recovery after peripheral nerve lesions depends on guiding axons back to their targets. Polysialic acid upregulation by regrowing axons has been proposed recently as necessary for this target selectivity. Methods: We reexamined this proposition using a cross-reinnervation model whereby axons from obturator motor neurons that do not upregulate polysialic acid regenerated into the distal femoral nerve. Our aim was to assess their target selectivity between pathways to muscle and skin. Results: After simple cross-repair, obturator motor neurons showed no pathway preference, but the same repair with a shortened skin pathway resulted in selective targeting of these motor neurons to muscle by a polysialic acid-independent mechanism. Conclusion: The intrinsic molecular differences between motor neuron pools can be overcome by manipulation of their access to different peripheral nerve pathways such that obturator motor neurons preferentially project to a terminal nerve branch to muscle despite not upregulating the expression of polysialic acid. Muscle Nerve, 2012. PMID:23169481

...indicated for infiltration anesthesia, peripheral nerve blocks (e.g., brachial plexus, intercostal retrobular, ulnar, inferior alveolar), and central nerve block (i.e., lumbar or caudal epidural...

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

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 pai...

Cryoneuroablation, also known as cryoanalgesia or cryoneurolysis, is a specialized technique for providing long-term pain relief in interventional pain management settings. Modern cryoanalgesia traces its roots to Cooper et al who developed in 1961, a device that used liquid nitrogen in a hollow tube that was insulated at the tip and achieved a temperature of - 190 degrees C. Lloyd et al proposed that cryoanalgesia was superior to other methods of peripheral nerve destruction, including alcohol neurolysis, phenol neurolysis, or surgical lesions. The application of cold to tissues creates a conduction block, similar to the effect of local anesthetics. Long-term pain relief from nerve freezing occurs because ice crystals create vascular damage to the vasonervorum, which produces severe endoneural edema. Cryoanalgesia disrupts the nerve structure and creates wallerian degeneration, but leaves the myelin sheath and endoneurium intact. Clinical applications of cryoanalgesia extend from its use in craniofacial pain secondary to trigeminal neuralgia, posterior auricular neuralgia, and glossopharyngeal neuralgia; chest wall pain with multiple conditions including post-thoracotomy neuromas, persistent pain after rib fractures, and post herpetic neuralgia in thoracic distribution; abdominal and pelvic pain secondary to ilioinguinal, iliohypogastric, genitofemoral, subgastric neuralgia; pudendal neuralgia; low back pain and lower extremity pain secondary to lumbar facet joint pathology, pseudosciatica, pain involving intraspinous ligament or supragluteal nerve, sacroiliac joint pain, cluneal neuralgia, obturator neuritis, and various types of peripheral neuropathy; and upper extremity pain secondary to suprascapular neuritis and other conditions of peripheral neuritis. This review describes historical concepts, physics and equipment, various clinical aspects, along with technical features, indications and contraindications, with clinical description of multiple conditions amenable to cryoanalgesia in interventional pain management settings. PMID:16880882

Introduction: In peripheral nerve ultrasound, the healthy contralateral side may be used as internal control. Therefore, inherent side-to-side differences must be minimal. The goal of this study was to assess intrastudy, intraobserver, and interobserver reproducibility of ultrasound in comparative side-to-side evaluation of lower limb nerves. Methods: Lower limb nerves of 60 normal subjects were evaluated by 3 radiologists. Bilateral sciatic, tibial, common fibular, sural, lateral femoral cutaneous, femoral, obturator, and saphenous nerves were evaluated. Results: Overall, side-to-side differences were not statistically significant at any level. In the lower limb nerves, in a between-limb comparison, the minimum detectable difference of cross-sectional area ranged from 16.4 mm(2) (sciatic nerve at the level of piriformis muscle) to 0.4 mm(2) (saphenous nerve). Conclusion: In general, the healthy contralateral side can be used as an internal control. Muscle Nerve 46: 717-722, 2012. PMID:23055313

The objective of this study is to study the anatomy of lumbar plexus on human fetuses and to establish its morphometric characteristics and differences compared with adults. Twenty lumbar plexus of 10 human fetal cadavers in different gestational ages and genders were dissected. Lumbar spinal nerves, ganglions, and peripheral nerves were exposed. Normal anatomical structure and variations of lumbar plexus were investigated and morphometric analyses were performed. The diameters of lumbar spinal nerves increased from L1 to L4. The thickest nerve forming the plexus was femoral nerve, the thinnest was ilioinguinal nerve, the longest nerve through posterior abdominal wall was iliohypogastric nerve, and the shortest nerve was femoral nerve. Each plexus had a single furcal nerve and this arose from L4 nerve in all fetuses. No prefix or postfix plexus variation was observed. In two plexuses, L1 nerve was in the form of a single branch. Also, in two plexuses, genitofemoral nerve arose only from L2 nerve. Accessory obturator nerve was observed in four plexuses. According to these findings, the morphological pattern of the lumbar plexus in the fetus was found to be very similar to the lumbar plexus in adults. Clin. Anat. 2012. © 2012 Wiley Periodicals, Inc. PMID:22696243

Tension-free suburethral tapes have revolutionized the surgical treatment of female stress urinary incontinence (SUI). These tapes are inserted by way of a retropubic or transobturator route. The inside-out tension-free vaginal tape transobturator approach, or TVT-Obturator system (TVT-O®, Ethicon Women's Health and Urology, Somerville, NJ), was developed ten years ago with the aim of minimizing the risk of urinary tract injuries associated with retropubic and outside-in transobturator tapes while reproducibly ensuring minimal tissue dissection. Cadaveric studies have shown that the anatomical trajectory of the TVT-O tape is strictly perineal and courses away from neighboring obturator and pudendal neurovascular structures. Several meta-analyses have shown similar SUI cure rates after retropubic and transobturator tape procedures. Yet, the transobturator route may be associated with less voiding dysfunction, blood loss, bladder perforation, and shorter operating time. The original TVT-O procedure was modified with the aim of reducing the incidence of postoperative groin pain as well as the rather theoretical risk of obturator nerve injury. This modified procedure, named TVT-ABBREVO® (Ethicon Women's Health and Urology, Somerville, NJ), utilizes a shortened, 12-cm-long polypropylene tape. In addition, perforation of the obturator membrane with the scissors and guide is avoided in order to reduce the depth of lateral dissection, and consequently, to maximize securing of the tape within the obturator muscular/aponeurotic structures. In a comparative anatomical study, it was indeed observed that the shorter tape traversed less muscular structures (with no or only a minimal amount of tape lying in the adductor muscles) than its original counterpart, while still consistently anchoring in the obturator membrane at a similarly safe distance from the obturator canal. In a single-center randomized clinical trial, after a 3-year minimum follow-up, the modified TVT-O procedure with a shorter tape and reduced dissection was found to be as safe and efficient as the primal procedure for treating female SUI, with less severe and frequent groin pain in the immediate postoperative period. PMID:23109075

The sensory innervation of the face is provided by the three major nerves, emerging from trigeminal nerve: the ophthalmic, maxillary and mandibular nerve. Nerve blocks of the face or head are not widely used in practice in France. However, regional anaesthesia has shown its value in terms of quality of analgesia and perioperative opioid economy in children and adults. Facial peripheral nerve blocks are divided into two categories: superficial trigeminal nerve blocks and deeper blocks such as the mandibular or suprazygomatic maxillary block. The performance of these blocks is simple provided the usual safety rules are followed. As for other peripheral nerve blocks, ultrasound guidance has shown its interest for the realization of facial nerve blocks to identify anatomical structure and to l...

Spinal cord or nerve root compression from an epidural metastasis occurs in 5-10% of patients with cancer and in up to 40% of patients with preexisting nonspinal bone metastases. Most metastatic spine diseases arise from the vertebral column, with the posterior half of the vertebral body being the most common initial focus, and/or the paravertebral region, tracking along the spinal nerves to enter the spinal column via the intervertebral foramina. An 82-year-old man diagnosed with sigmoid colon cancer and liver metastases experienced intractable pain described as being like an electric shock on the right T11 dermatome. Imaging studies revealed a huge metastatic mass destroying the right posterior T11 body and pedicle and compressing the right posterior spinal cord and nerve roots. Even after using neuropathic medication and a neural blockade, the extreme paroxysmal pain continued. Considering his elderly, debilitated state and life expectancy, removal of the vertebral metastatic tumor compressing the spinal nerve roots via a single-port, transforaminal, endoscopic approach and percutaneous vertebroplasty (PVP) under monitored anesthetic care (MAC), rather than 3-port endoscopic surgery and corpectomy with or without fusion under general anesthesia with lung deflation, was decided upon and scheduled prior to radiotherapy. A needle was placed into the intervertebral foramen under fluoroscopy in the same manner as a transforaminal epidural block at T11. A guidewire was inserted into the needle after the needle stylet had been removed. An obturator dilator was inserted over the guidewire, and a working sleeve was inserted over the dilator. After the dilator was removed, a spinal endoscope with a 2.7 mm working channel was placed over the guidewire. Careful removal of the tumor emboli during verbal interaction with the patient was performed under MAC using dexmedetomidine, fentanyl, and ketorolac. PVP at T11 was performed through the right osteolytic pedicle. The paroxysmal pain disappeared immediately after the operation without any complications. Removal of a vertebral metastatic tumor compressing the spinal nerve roots via a single-port, transforaminal, endoscopic approach under monitored anesthesia care without lung deflation may be an effective and safe modality for minimally invasive pain management of a single-level spinal tumor metastasis causing intractable radicular pain in patients with cancer who have generalized debilitation. PMID:22828683

A four-year-old female spayed Labrador Retriever, which had undergone bilateral triple pelvic osteotomy (TPO) at the age of eight months, was presented with severe progressive shifting pelvic limb lameness for a duration of three months prior to presentation. The dog had multiple episodes of showing signs of excruciating pain, as well as an inability to rise or ambulate, inappetance, and lethargy. Orthopaedic examination revealed severe bilateral pelvic limb muscular atrophy, and signs of severe pain on abduction of the pelvic limbs, on rectal palpation ventrally, and on palpation of the region of the iliopsoas and pectineus muscles bilaterally. Surgery was indicated to explore the region and to release the pectineus and iliopsoas muscles. During surgery, callus tissue and the free section of pubic bone were found to be impinging on the obturator nerve at the previous TPO pubic osteotomy site bilaterally. On both sides, a 1 to 2 cm segment of pubis and fibrous callus tissue were excised and the obturator nerves were freed from the impingement. Immediately after the surgery, the patient's stance and gait were dramatically improved. The dog could maintain a much broader based stance and make longer strides with the pelvic limbs. At the two month follow-up examination, there were not any signs of lameness noted. Obturator nerve impingement can be a serious potential complication of TPO and may manifest clinically as marked pelvic limb lameness years after surgery. PMID:21938311

Thickening of mesenchyma at the place of the future coxofemoral joint (embryos 10.5--14 mm of parietal-coccygeal length) is defined in the area limited by the lumbar and sacral spinal nerves behind, by the femoral nerve in front and above and by the ischiatic nerve underneath and behind. The femoral head surrounded with anlages of the iliac, pubic and ischiatic bones is defined in 16 mm long embryos. The vascular canal ends blindly or penetrates through the wall of the cotyloid cavity at the place where lately fusion of the iliac and the pubic bones takes place. A special attention is paid, at the embryonic level, to variants of the iliolumbar muscle fixation and to participation of its tendons, in some cases, information of the femoral joint circular zone. The joint capsule, presented as a condensed mesenchyma is defined in prefetuses 18 mm of parietal-coccygeal length. To its inferior fragment, branches of the obturative and the accessory obturative nerves, to its superior fragment--branches of the superior gluteal nerve, to its posterior fragment--branches of the ischiatic nerve, and to its anterior fragment--branches of the femoral nerve grow out. Taking into account the time when these nerves grow into the innervated substrate, they should be considered as the most important for innervating the capsule, it being realized mainly by mixed, or more exactly by the musculo-articular branches. As the branches of the nerves mentioned above penetrate into the capsule thickness, the latter is differentiating into certain layers. Owing to the results obtained, it is possible to conclude that the anlage and further formation of the femoral joint elements is taking place simultaneously with the development and complication of its innervational connections. PMID:7283755

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.

... have been for Doctors to place a palatal obturator. Palatal obturators are a wonderful reconstruction for small defects. However, ... This is an example here of a palatal obturator. It’s certainly time honored. Prosthetic expertise, though, is ...

To elucidate the essential nature of the human obturator externus muscle (OE), the gross anatomy of the anomalous muscle and anomalous fasciculus originating from this muscle as well as the posterior division of the obturator nerve (P) were examined in 73 thighs of 45 Japanese adult cadavers. The investigation of anomalous muscle and anomalous fasciculus was effected by observation of the supernumerary muscular branch and supernumerary muscular twig from the P. The anomalous muscle occurring between the adductor brevis muscle (AB) and adductor minimus muscle (AMi) (37/73 thighs; 50.7%) and the anomalous fasciculus fused to the posterior surface of the AMi (18/73 thighs; 24.7%) were detected. It was demonstrated by the course of the P and the suppling nerve, that the OE was divided into its superior fasciculus (or fasciculi) (SF) and main belly by the P, moreover the anomalous muscle originated from the former and the anomalous fasciculus from the latter. Presumably, in the process of ontogeny, the SF of the original OE retained its original morphology (23/73 thighs; 31.5%), a part of the SF was converted to anomalous muscle (27/73 thighs; 37.0%), the entire SF was converted to anomalous muscle (10/73 thighs; 13.7%), and the entire SF underwent retrogression and disappeared (13/73 thighs; 17.8%). The presence (50/73 thighs; 68.5%) or absence (23/73 thighs; 31.5%) of piercing of the OE by the P seemed to depend upon the circumstances surrounding the morphological change in the SF. The original OE was considered to occur as an OE pierced by the P not possessing any supernumerary muscular branch or twig. Actually, the original OE was con.rmed to occur with a low frequency (15/73 thighs; 20.5%). It was inferred that the original OE readily underwent variation in the process of ontogeny due to the in.uence of the obturator nerve. The segmental composition of the obturator nerve was considered not to be involved in the morphological change in the OE.   

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) 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 (more) 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.

The conventional inferior alveolar nerve block (conventional technique) has potential risks of neural and vascular injuries. We studied a method of inferior alveolar nerve block by injecting a local anesthetic solution into the pterygomandibular space anterior to the mandibular foramen (anterior tec...

Abstract in english OBJECTIVE: This study evaluated in vitro the influence of an eugenol-based sealer (EndoFill) on the retention of stainless steel prefabricated posts cemented with zinc phosphate and resin-based (Panavia F) cements after different periods of root canal obturation, using the pull-out test. MATERIAL AND METHODS: Sixty upper canines were decoronated and the roots were embedded in resin blocks. The specimens were distributed into 3 groups, according to the period elapsed betwe (more) en canal obturation and post cementation: Group I - immediately; Group II - 72 h and Group III - 4 months. The groups were subdivided according to the type of cement used for post cementation: A - zinc phosphate and B - Panavia F. Following the experimental periods, specimens were subjected to pullout test in an Instron machine with application of tensile force at a crosshead speed of 0.5 mm/min until post dislodgement. The maximum forces required for post removal were recorded (kN) and means were subjected to statistical analysis by 2-way ANOVA and Tukey-Kramer test (?=0.001) RESULTS: There were statistically significant differences (p0.05) were found between the three post cementation periods, regardless of the cement. CONCLUSIONS: It was concluded that the eugenol-based sealer influenced the tensile strength of the posts cemented with the resin cement, but had no influence on the time waited between root canal obturation and post space preparation/post cementation.

The present study describes the topography and morphometry of a unilateral ossified sacrotuberous ligament. It aims to discuss its anatomical, radiological and clinical implications. The pudendal nerve, internal pudendal artery, nerve to obturator internus and coccygeal branch of inferior gluteal artery are all-important structures near sacrotuberous ligament. An ossified sacrotuberous ligament may be an important etiological factor in neurovascular compression syndromes and its anatomical knowledge may help in the development of new treatment for this common clinical problem. The ossified sacrotuberous ligament in the present case was 7.6 cm in length and exhibited a characteristic anterior and posterior segment. The base was at the ischial tuberosity and the apex showed numerous small bony protuberances with deep intervening grooves. The ossified STL may be important in differential diagnosis of soft tissue pain and tenderness after trauma. It may be a challenging puzzle for the present day surgeon and radiologist in interpretation of CT-scans and MRI. PMID:19690783

During the past 7 years 30 patients were diagnosed as having either ilioinguinal or genitofemoral entrapment neuralgia. A multidisciplinary approach (surgeon, neurologist, and anesthesiologist), as well as local blocks of the ilioinguinal nerve and/or paravertebral blocks of L-1 and L-2 (genitofemoral nerve), were essential to determine accurately which nerve was specifically involved. Fifteen of the 17 patients (88%) diagnosed as having ilioinguinal neuralgia after previous inguinal herniorrhaphy are pain free after resection of the entrapped portion of the nerve. Thirteen patients were diagnosed as having genitofemoral neuralgia after previous inguinal herniorrhaphy, blunt abdominal trauma, or other surgery. Neurectomy of the genitofemoral nerve proximal to the entrapment controlled the persistent pain in 10 of 13 (77%) of these patients. Ilioinguinal or genitofemoral nerve entrapment neuralgias are rare complications of surgery in the inguinal region. When accurately diagnosed, neurectomy of the specific nerve is highly successful in relieving severe pain and paresthesia without significant morbidity. PMID:3660235

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

We administered combined spinal anesthesia plus bilateral femoral nerve block in two cases undergoing bilateral simultaneous total knee arthroplasty. Although epidural catheters must be removed before anticoagulant treatment can be performed after surgery, femoral nerve block, poses minimal hindrance to anticoagulant therapy. Because femoral nerve block alone cannot provide sufficient postoperative pain relief after total knee arthroplasty, additional sciatic nerve block, spinal anesthesia, opioid administration, or some other means of analgesia is necessary. A combined femoral nerve block plus sciatic nerve block is useful. A large quantity of local anesthetic is required for this purpose, and its application is difficult in bilateral simultaneous surgery. Spinal anesthesia can be used to reduce the quantity of the local anesthetic, and intrathecal morphine can be used to prolong the pain relief. However, intrathecal morphine can cause itching and late respiratory depression. Respiratory depression did not occur in either of the present patients, although case 2 experienced some itching. In conclusion, combined bilateral femoral nerve block with spinal anesthesia poses minimal hindrance to postoperative anticoagulation therapy and enables control of postoperative pain in patients undergoing bilateral simultaneous total knee arthroplasty. PMID:22991813

To evaluate the failure rate, patient acceptance, effective volumes of local anesthetic solution, and incidence of neurologic complications after peripheral nerve block performed using the multiple injection technique with a nerve stimulator, we prospectively studied 3996 patients undergoing combined sciatic-femoral nerve block (n = 2175), axillary blocks (n = 1650), and interscalene blocks (n = 171). The success rate and mean injected volumes of local anesthetic were: 93% with 22.6 +/- 4.5 mL in the axillary, 94% with 24.5 +/- 5.4 mL in the interscalene, and 93% with 28.1 +/- 4.4 mL in the sciatic-femoral nerve blocks. Patients receiving combined sciatic-femoral nerve block showed more discomfort during block placement and worse acceptance of the anesthetic procedure than patients receiving brachial plexus anesthesia. During the first month after surgery, 69 patients (1.7%) developed neurologic dysfunction on the operated limb. Complete recovery required 4-12 wk in all patients but one, who required 25 wk. The only variable showing significant association with the development of postoperative neurologic dysfunction was the tourniquet inflation pressure (400 mm Hg, odds ratio 2.9, 95% confidence intervals 1.6-5.4; P 90% with a volume of <30 mL of local anesthetic solution and an incidence of transient neurologic complication of <2%. Implications: Based on a prospective evaluation of 3996 consecutive peripheral nerve blocks, the multiple injection technique with nerve stimulator allows for up to 94% successful nerve block with <30 mL of local anesthetic solution. Although the data collection regarding neurologic dysfunction was limited, the withdrawal and redirection of the stimulating needle was not associated with an increased incidence of neurologic complications. Sedation/analgesia should be advocated during block placement to improve patient acceptance. PMID:10195536

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.

Objective. The aim of this study was to assess the capability of high-resolution images obtained with a commercially available pelvic phased-array surface coil to demonstrate normal hip anatomy. Design. We retrospectively analyzed the oblique coronal magnetic resonance (MR) images of hips of 36 consecutive patients acquired on a 1.5-T clinical imager using a pelvic phased-array coil as a receiver, a 16-20 cm field of view, and 5 mm slice thickness. Patients. Thirty-six patients were studied, age 15-81 years. There were 20 males and 16 females. Results and conclusions. The articular cartilage, cortex, superior labrum, and iliofemoral ligament were well visualized on proton density weighted fat saturation (PDF) images. The femoral and obturator vessels, obturator nerve, and various muscles were easily seen on T1-weighted images. High-resolution imaging of the hip is achievable in a reasonable amount of time using newer phased-array surface coils and may play an increasing role in the future evaluation of hip disorders. (orig.) With 5 figs., 2 tabs., 26 refs.

... to block your view and it’s going to affect your surgery. Again, the nerve sparing is done ... of the patients, it’s completely spared, which will affect the sexual function and I think it’s important ...

Abdominal Muscles/Ultrasonography; Adult; Ambulatory Surgical Procedures; Anesthetics, Local/Administration & Dosage; Ropivacaine/Administration & Dosage; Ropivacaine/Analogs & Derivatives; Hernia, Inguinal/Surgery; Humans; Nerve Block/Methods; Pain Measurement/Methods; Pain, Postoperative/Prevention & Control; Ultrasonography, Interventional

Presented here is a prospective study assessing the efficacy of decompression of concomitant noncontiguous level (thoracic & lumbar) stenosis in accordance with neurological findings, nerve root blocks, and myelographically proven disease. The objective was to determine the efficacy, clinical outcom...

Abdominal Muscles/Ultrasonography; Adult; Anesthetics, Local/Administration & Dosage; Ropivacaine/Administration & Dosage; Ropivacaine/Analogs & Derivatives; Cesarean Section; Humans; Nerve Block/Methods; Pain Measurement/Methods; Pain, Postoperative/Prevention & Control; Ultrasonography, Interventional

When suspecting proximal injury to the ulnar nerve, it is common to assess the integrity of the small finger flexor digitorum profundus muscle via methods such as isolated blocking exercises, active exercises, and applied resistance. This author describes another method of assessing the integrity of proximal ulnar nerve motor function.-Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor. PMID:22652328

Occipital nerve block has been part of headache medicine for more than half a century, with injection techniques and solutions varying greatly. Most studies have been case series and many show benefit for patients with migraine, cluster headache, and postconcussive headache. A double-blind, controlled trial of cluster headache has demonstrated that injectable steroids with local anesthetics benefit cluster headache patients. A double-blind, controlled trial of nerve blocks in occipital neuralgia, which may have actually been chronic migraine, was positive.

ObjectiveIn patients with prostate cancer, extended pelvic lymph node dissection (ePLND) yields a higher number of lymph node metastases (LNM) than standard pelvic lymph node dissection (PLND) of the obturator fossa only. We describe our laparoscopic technique of extended lymph node dissection and provide the number and locations of positive lymph nodes from our experience.MethodsIn a total of 35 selected patients with clinically localized prostate cancer, laparoscopic ePLND was performed prior to laparoscopic radical prostatectomy. The template included the genitofemoral nerve up to the bifurcation of the common iliac artery and down to the epigastric artery. In the "split and roll" technique the internal and external iliac arteries including the bifurcation and the external iliac vein we...

Abstract Objective- To evaluate the effectiveness of paravertebral lumbar plexus block combined with parasacral sciatic block to anesthetize one hind limb in awake dogs. Study design- Randomized, controlled, blinded experimental study. Animals- Eight healthy mongrel dogs weighing 12.4--4.5-kg and aged 7--2.33-years. Methods- After sedation with medetomidine, dogs received B1: bupivacaine 0.25%, 0.2-mL-kg-1, B2: bupivacaine 0.5%, 0.2-mL-kg-1, B3: bupivacaine 0.25% 0.4-mL-kg-1, P1: NaCl 0.2-mL-kg-1, P2: NaCl 0.4-mL-kg-1. The lumbosacral plexus was blocked through a paravertebral block of the fourth, fifth and sixth lumbar nerves combined with a parasacral block. The relevant nerves were located using a nerve stimulator and injections of each treatment were administered. Degree and durations ...

INTRODUCTION: There are various anaesthetic techniques for ambulatory surgery of carpal tunnel release. The ultrasound-guided nerve blocks offer advantages compared to other techniques. The purpose of this study was to evaluate the efficacy using ultrasound-guided block at the antecubital fossa, as well as to evaluate complications, patient satisfaction and surgeon satisfaction with the block. MATERIALS AND METHODS: Prospective observational study with 32 elective patients for carpal tunnel release in a one-day case unit. An ultrasound-guided block with mepivacaine 1% was performed at the antecubital fossa, aiming for the median, ulnar and the lateral and medial cutaneous nerves of the forearm. The measurements of the anteroposterior and laterolateral diameters of the median and ulnar nerves were recorded, before and after injection. Motor and sensory levels were evaluated for the median and ulnar nerves at 5 and 30min post injection, and compared with the contralateral hand. Pain from the surgical incision time and recovery were recorded, together with complications, and patient and surgeon satisfaction with the block. RESULTS: The antecubital fossa ultrasound-guided block was successful in 93.7% of the patients. No patients needed rescue analgesia in recovery and no complications were recorded. Patient satisfaction was 93.7% and surgeon satisfaction was 97%. CONCLUSIONS: A selective block of the medial, ulnar and medial and lateral cutaneous nerves of the forearm are effective and satisfactory anaesthetic techniques for carpal tunnel release in a one-day case unit. It allows early mobilization, minimises risks and amount of local anaesthetic used. PMID:23177531

Pharyngeal obturator prostheses restore the congenital or acquired defects of the soft palate and allow adequate closure of palatopharyngeal sphincter. Two patients with soft palate defect and subsequent velopharyngeal insufficiency were rehabilitated using pharyngeal obturator prostheses which had ...

The aim of this study is to evaluate the anesthetic efficacy of mylohyoid and buccal nerve anesthesia at the posterior edentulous mandible versus regional anesthetic block to the inferior alveolar nerve in dental implant surgery. The study was composed of 2 groups. In the first group (group A), 14 voluntary adults (7 female and 7 male) received local infiltrations of 1 mL articaine HCl 4% with epinephrine 1/200,000 to the ipsilateral mylohyoid and buccal nerves. In the second group (group B, control; 9 female and 5 male adults), the inferior alveolar and the buccal nerve blocks were performed. Visual analog scales were obtained from patients to determine the level of pain during incision, drilling, implant placement, and suturing stages of implant surgery. A combination of buccal and mylohyoid nerve block offered an acceptable level of anesthesia. Two patients from group A stopped the ongoing surgery and had extraregional anesthesia by inferior alveolar nerve block. In group B, patients were operated on successfully. Local anesthetic infiltrations of the mylohyoid and the buccal nerve may be considered alternative methods of providing a convenient anesthetic state of the posterior mandibular ridge. PMID:20662675

Chronic pelvic pain refers to noncyclical pain localized to the pelvic region for longer than 6 months. There can be numerous causes for pelvic pain excluding visceral pathology. Familiarity with disorders of peripheral nerve and musculoskeletal structures may assist in diagnosis and therapy. This review focuses on three pelvic pain syndromes mediated by somatic nerves: the “border nerve syndrome” (consisting of the ilioinguinal, iliohypogastric, and genitofemoral nerves), the piriformis syndrome, and pudendal neuralgia. Various approaches have been described to block these nerves, ranging from simple blind techniques to the use of open magnetic resonance imaging facilities. The degree of accuracy and safety of the blocks seem to correlate well with the sophistication of the ...

Background Patient dissatisfaction has been previously associated with motor block in shoulder surgery patients receiving brachial plexus block. For elective minor wrist and hand surgery, we tested whether a regional block accelerating the early return of upper extremity motor function would improve patient satisfaction compared with a long-acting proximal brachial plexus block. Methods A total of 177 patients having elective ‘minor’ wrist and hand surgery under awake regional block randomly received adrenalized infraclavicular lidocaine 2% 10 ml+ropivacaine 0.75% 20 ml (‘long acting’, n=90), or adrenalized infraclavicular lidocaine 1.5% 30 ml+long-acting distal median, radial, and ulnar nerve blocks selected according t...

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

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

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.

Abstract Background. Inguinal hernia repair is associated with a high incidence of chronic postsurgical pain. This pain may be caused by injury to the iliohypogastric, ilioinguinal, or genitofemoral nerves. It is often difficult to identify the specific source of the pain, in part, because these nerves are derived from overlapping nerve roots and closely colocalize in the area of surgery. It is therefore technically difficult to selectively block these nerves individually proximal to the site of surgical injury. In particular, the genitofemoral nerve is retroperitoneal before entering the inguinal canal, a position that puts anterior approaches to the proximal nerve at risk of transgressing into the peritoneum. We report a computed tomography (CT)-guided transpsoas technique to selectively...

Background: During interscalene block (ISB) placement, ultrasound guidance (USG) enables the practitioner to measure the spread of local anesthetic around the nerve trunks or roots, and to adjust the needle position in order to optimize diffusion. Moreover, USG helps determine the best injection level, i.e. the point from which diffusion gives the most complete brachial plexus block. The aim of this study was to compare C5 and C6 level injections and to determine which level allows the best diffusion. Methods: Sixty randomized patients scheduled for shoulder surgery were divided into two groups. In group C5, injection was directed toward C5 while in group C6, the C6 nerve root was targeted. Block performance time was recorded. The onset of motor and sensory block of each nerve distribution...

Obturator hernia of the fallopian tube is extremely rare. Multidetector computed tomography of a 43-year-old nulliparous woman with sudden onset lower right abdominal pain showed a low-density mass in the right obturator canal suspected of being an obturator hernia of the uterine adnexa. She was diagnosed as having an incarcerated obturator hernia of the fallopian tube at operation and treated with prosthetic mesh. Obturator hernia of the fallopian tube is very rare, and all cases reported in the literature were localized on the right side, perhaps due to the lesser mobility of the left than the right fallopian tube. PMID:22990633

Abstract in portuguese As lesões do plexo lombar são incomuns e as descrições dos acessos cirúrgicos são derivadas de vias de acesso à coluna vertebral. MÉTODO: A via extraperitoneal anterolateral foi realizada em seis cadáveres para o acesso ao plexo lombar. Eventuais dificuldades na dissecção foram relatadas. RESULTADOS: Tal acesso permitiu a exposição dos elementos distais do plexo lombar, mas uma extensão cranial da incisão foi necessária para a exposição do nervo iliohipo (more) gástrico. Para a exposição dos nervos genitofemoral e obturador houve a necessidade da ligadura de vasos originados da artéria ilíaca comum em 2 casos. As raízes foram identificadas somente após dissecção e ligadura dos vasos lombares. CONCLUSÃO: O acesso anterolateral extraperitoneal permite uma exposição adequada dos nervos terminais do plexo lombar lateralmente ao músculo psoas maior. Uma extensão cranial da incisão pode ser necessária para exposição do nervo iliohipogástrico. A exposição das raízes implica em maior risco de lesão vascular. Abstract in english Lesions of lumbar plexus are uncommon and descriptions of surgical access are derived from vertebral spine approaches. METHOD: The extraperitoneal anterolateral approach to the lumbar plexus was performed in six adult fresh cadavers. The difficulties on dissection were related. RESULTS: An exposure of all distal elements of lumbar plexus was possible, but a cranial extension of the incision was needed to reach the iliohypogastric nerve in all cases. Ligation of vessels de (more) rived from common iliac artery was necessary for genitofemoral and obturator nerves exposure in two cases. The most proximal part of the lumbar roots could be identified only after dissection and clipping of most lumbar vessels. CONCLUSION: The extraperitoneal anterolateral approach allows appropriate exposure of terminal nerves of lumbar plexus laterallly to psoas major muscle. Cranial extension of the cutaneous incision may be necessary for exposure of iliohypogastric nerve. Roots exposure increases the risk of vascular damage.

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 vía de abordaje alternativa para el bloqueo del nervio obturador. Resultados: Mediante este abordaje, que simplifica, en posición de litotomía, el bloqueo nervioso del obtura (more) dor, 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 been 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.

In the present study, the efficacy of a nerve stimulator in performing brachial plexus block (BPB) in dogs was investigated. The nerve blocking effects of bupivacaine and ropivacaine for BPB were also compared. Twelve beagles were allocated to groups based on the following treatments: conventional BPB with 0.5% bupivacaine (0.5% BupiM group) or BPB with 0.5% bupivacaine, 0.5% ropivacaine or 0.75% ropivacaine and a nerve stimulator (the 0.5% BupiS, 0.5% RopiS and 0.75% RopiS groups, respectively). After BPB, nerve blocking effects were assessed based on sensory blockade in several cutaneous areas and knuckling. The ratio of full block (blockade in all cutaneous areas) for 0.5% BupiM was 25%, and that for 0.5% BupiS was significantly higher, 75% (p<0.05). For the 0.5% BupiS, 0.5% RopiS and 0.75% RopiS groups, the average duration of full block was 387, 184 and 275 min, respectively, and the average duration of knuckling was 703, 460 and 421 min, respectively. The duration of full block and knuckling for the two ropivacaine groups was shorter compared with that of the 0.5% BupiS group. In conclusion, when using bupivacaine and ropivacaine for BPB in dogs, it is worth noting that there are differences in onset time and duration and that effective perioperative analgesia can be achieved depending on the intended use.   

PurposeThe aim of this study was to evaluate the distribution and absorption of local anesthetic solutions in inferior alveolar nerve block using magnetic resonance imaging. Materials and MethodsForty healthy volunteers were divided into 4 groups and injected with 1.5 mL for inferior alveolar nerve block and 0.3 mL for lingual nerve block. The solutions used for the different groups were 2% lidocaine, 2% lidocaine with 0.125 mg/mL epinephrine, 4% articaine with 0.006 mg/mL epinephrine, and 4% articaine with 0.012 mg/mL epinephrine. All subjects had axial T2-weighted and fat-suppressed images at 0, 60, and 120 minutes after injection. The localization, area, and intensity (signal characteristics) of the solutions were analyzed and onset and duration times of the anesthesia were recorded. Re...

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

Testicular atrophy can be prevented by limiting dissection trauma to the spermatic cord, specifically, leaving the distal part of the indirect inguinal hernia sacs in situ; never dissecting beyond the pubic tubercle; and using the properitoneal space when it is advisable, as in recurrent hernias, to avoid dissection of the spermatic cord altogether. Chronic residual neuralgia may be debilitating and difficult to manage. The involved nerve may be identified by local anesthetic nerve blocks. Neurectomy of the ilioinguinal, iliohypogastric, and genitofemoral nerves may cure the neuralgia. PMID:8497804

We have previously reported that exposure to microwave fields (a specific absorption rate of 10 W/kg at 2.45-GHz continuous wave) would consistently lower the survival time of isolated frog sciatic nerves stimulated at high repetition rates (50 pulse pairs per second, ppps). The time course of the loss of excitability of the exposed nerve (as compared to its unexposed contralateral mate) is reminiscent of that seen when the active transport of sodium (Na) and potassium (K) is blocked by certain agents--such as the cardiac glycoside ouabain. To assess the role that these microwaves may have in interfering with or counteracting active transport, we performed a series of experiments in which the active Na-K pump was substantially blocked by ouabain prior to microwave exposure. The paired nerves were soaked for 5 min in a high concentration (10(-3) g/liter) of ouabain to achieve the fastest and most complete blockage of the Na-K pump prior to stimulation at 50 ppps. The ''rundown time course'' was, as expected, accelerated in all ouabain-treated nerves, but the microwave-exposed nerves showed no additional shortening of survival time. The experiments were repeated at a slower stimulation rate (5 ppps) so that the survival time of the nerves more closely approximated that of nerves not treated with ouabain (1 to 2 h versus 30 min or less for ouabain-treated nerves stimulated at 50 ppps). Results of these lower stimulation rates also showed that there was no significant difference in the survival time of ouabain-treated exposed and control nerves. These results lend support to the view that the relative loss of excitability in microwave-exposed nerves is related to an interference with or counteraction of the Na-K pump.

Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution. PMID:22428971

Study Objective: To determine whether bilateral iliohypogastric and ilioinguinal (IHII) peripheral nerve blocks, given in conjunction with neuraxial morphine, reduce postcesarean analgesic requirements and side effects, resulting in improved maternal satisfaction. Design: Randomized, prospective, double-blinded, placebo-controlled study. Setting: Labor and delivery suite at Johns Hopkins Hospital. Patients: 34 women scheduled for elective cesarean delivery. Interventions: Patients were randomized to receive IHII nerve blocks bilaterally, with either total 24 mL of 0.5% bupivacaine or normal saline, following cesarean delivery via Pfannensteil incision with a standard intrathecal dose of 12 mg of 0.75% bupivacaine with 10 g of fentanyl and 200 g of preservative-free morphine. Measurements: ...

(Headache 2010;50:869-881) Epidural blood patch is an effective treatment with a low complication rate. It is also an invasive method that can cause permanent neurological sequelae such as early and late back pain, radiculopathy, spinal-subdural hematoma, spinal-epiarachnoid hematoma, intrathecal hematoma, arachnoiditis, and infection. We report a case in which a postdural puncture headache resolved within 2 minutes of a greater occipital nerve block, a minimally invasive and easy procedure with a low complication rate. This case report suggests that a greater occipital nerve block may be a successful alternative treatment for patients with post-dural puncture headache. PMID:20353435

Purpose While infraorbital nerve blocks have demonstrated analgesic benefits for pediatric nasal and facial plastic surgery, no studies to date have explored the effect of this regional anesthetic technique on adult postoperative recovery. We designed this study to test the hypothesis that infraorbital nerve blocks combined with a standardized general anesthetic decrease the duration of recovery following outpatient nasal surgery. Methods At a tertiary care university hospital, healthy adult subjects scheduled for outpatient nasal surgery were randomly assigned to receive bilateral infraorbital injections with either 0.5% bupivacaine (Group IOB) or normal saline (Group NS) using an intraoral technique immediately following induction of general anesthesia. All subjects underwent a standardi...

The sweet potato hornworm, Agrius convolvuli, possesses a pair of anterior cardiac nerves innervating the dorsal vessel. The anterior cardiac nerves branch off the visceral nerve that arises posteriorly from the frontal ganglion. Heartbeat reversal from anterograde heartbeat to posterograde heartbeat is triggered by the anterior cardiac nerves. Application of octopamine (OA) during the anterograde heartbeat phase reverses the anterograde heartbeat to the posterograde heartbeat, while application of OA during the phase of posterograde heartbeat accelerates heartbeat. The heartbeat reversal from anterograde heartbeat to posterograde heartbeat evoked by stimuli applied to the visceral nerve is blocked by application of the octopaminergic antagonists, phentolamine and chlorpromazine. The results suggest that OA may be a neurotransmitter for the anterior cardiac nerve. The alary muscle of the second segment receives excitatory innervation from the posterior cardiac nerve and from the nerve which extends from the second abdominal ganglion. Activation of the alary muscle results in acceleration of posterograde heartbeat. Other neurotransmitters, besides OA, may take part in the resultant acceleration. PMID:12443920

The only named branch of the inferior alveolar nerve (IAN) before it enters the mandibular foramen is the mylohyoid nerve. However, several variations have been reported in the literature. In this study, a recurrent variant branch of the IAN arising just below the origin of the mylohyoid nerve was investigated in adult Indian cadavers allotted for dissection to the first year dental students of Government Dental College, Ahmedabad (India). The dissection was performed by the lateral approach to the infratemporal fossa. The nerve was found in 12 of 35 sides (34.3%) and 8 of 18 cadavers (44.4%). Thus, in our study it was not a rare variation of the IAN, where in most cases it innervated the lateral pterygoid muscle. In some cases, it terminated in the lateral pterygoid muscle. In others, it penetrated the muscle to join the anterior or posterior division of the mandibular nerve or its branches; thus, the variant nerve in such cases might be regarded as an additional root of the IAN. Because the concerned primordia of the nerves and muscles migrate extensively during development and growth, alternative routes of migration may bring about variants like the one under study. The variant appeared to be unique in some of its features. It may be a source of neuropathic and referred pain. Failure of the conventional inferior alveolar nerve block anesthesia and the peripheral neurectomy used for the treatment of trigeminal neuralgia may be partly due to the presence of this variation. PMID:22302685

We have now used CT to evaluate the cavernous sinuses, especially the 3rd, 4th, 5th, and 6th cranial nerves. adjacent to them. Twenty cases, presumably all having sellar or parasellar lesions, were examined by means of thin-slice (2-4 mm) axial and coronal (including both direct and reconstructed methods) CT studies. Moreover, three blocks of the sellar region obtained from adult cadavers were examined beforehand by CT scan, and the courses of the respective paracavernous cranial nerves were confirmed by microsurgical dissection. As a result, the following conclusions were obtained. 1. It was valuable to perform a post-enhanced direct coronal study for the definite identification of the paracavernous cranial nerves (3rd to 6th cranial nerves). 2. Also valuable was a magnified CT film of the parasellar regions, which made the identification of the parasellar cranial nerves clearer. 3. In the clinical cases showing a normal shape of the cavernous sinuses on CT, each cranial nerve was evaluated. In the axial studies (almost 10 to 15 degrees anterior to Reid's basal line), the frequencies of the identification of the 3rd, 5th, and 6th cranial nerves were 76%, 97% (as to the Gasserian ganglion), and 21% respectively. None of the 4th cranial nerve was visualized in the cases examined. On the other hand, the frequencies of the identification of the 3rd, 5th, and 6th cranial nerves were 83%, 86%, and 21% respectively in the direct coronal studies and 62%, 57%, and 4% in those of the reconstructed films. The visualization of each cranial nerve in the direct coronal study was better than when the reconstructed method was used. Finally, a schematic presentation of the cranial nerves adjacent to the cavernous sinuses was made in the axial and coronal projections.

It is generally accepted that the endothelium regulates vascular tone independent of the activity of the sympathetic nervous system. Here, we tested the hypothesis that the activation of sympathetic nerves engages the endothelium to oppose vasoconstriction. Local inositol 1,4,5-trisphosphate (IP(3))-mediated Ca(2+) signals ("pulsars") in or near endothelial projections to vascular smooth muscle (VSM) were measured in an en face mouse mesenteric artery preparation. Electrical field stimulation of sympathetic nerves induced an increase in endothelial cell (EC) Ca(2+) pulsars, recruiting new pulsar sites without affecting activity at existing sites. This increase in Ca(2+) pulsars was blocked by bath application of the ?-adrenergic receptor antagonist prazosin or by TTX but was unaffected by directly picospritzing the ?-adrenergic receptor agonist phenylephrine onto the vascular endothelium, indicating that nerve-derived norepinephrine acted through ?-adrenergic receptors on smooth muscle cells. Moreover, EC Ca(2+) signaling was not blocked by inhibitors of purinergic receptors, ryanodine receptors, or voltage-dependent Ca(2+) channels, suggesting a role for IP(3), rather than Ca(2+), in VSM-to-endothelium communication. Block of intermediate-conductance Ca(2+)-sensitive K(+) channels, which have been shown to colocalize with IP(3) receptors in endothelial projections to VSM, enhanced nerve-evoked constriction. Collectively, our results support the concept of a transcellular negative feedback module whereby sympathetic nerve stimulation elevates EC Ca(2+) signals to oppose vasoconstriction. PMID:22140050

Anaesthesia of the external ear canal (external acoustic meatus) is usually performed by blocking both the great and internal auricular nerves by regional infiltration. However, exact landmarks for blocking the internal auricular nerve to accomplish effective anaesthesia have not been described yet. In this study, detailed anatomical dissection of the equine external ear canal and its nerve supply was carried out on fifteen cadaver heads. Tissue samples of the dissected nerves were taken from two cadaver heads processed and were evaluated microscopically. Prior to the dissection, the region of interest was evaluated ultrasonographically, and injection of a local anaesthetic was simulated with an injection of methylene blue on ten cadaver heads. The tympanic membranes of three cadaver heads were obtained by microdissection and processed for microscopic evaluation. The entrance point of the internal auricular nerve, which is a branch of the facial nerve, into the ear canal is formed by the styloid process of the auricular cartilage. Using ultrasound, the styloid process presented as a thin hyperechoic line 2.17-2.97 cm deep, based on the skin surface. Landmarks for performing a complete and reliable anaesthesia of the external ear canal were established, and the simulated anaesthesia with methylene blue injection was evaluated as successful in all ten cases. Additionally, the histological composition of the equine tympanic membrane is described and illustrated. PMID:22432970

Abstract in portuguese O objetivo deste trabalho foi analisar a morfologia dos cimentos Sealapex, Apexit, Sealer 26 (cimentos a base de hidróxido de cálcio) e Ketac Endo (cimento de ionômero de vidro), através da microscopia de força atômica, verificando-se as características de suas partículas após a obturação dos canais radiculares e após um período de seis meses de contato com o plasma sanguíneo humano. Utilizaram-se 16 dentes unirradiculares humanos extraídos e incluídos em (more) blocos de resina após o preparo biomecânico. As raízes foram divididas em quatro grupos de quatro raízes cada e os canais radiculares obturados pela técnica de condensação lateral passiva com os cimentos em estudo. Verificou-se que o cimento Apexit foi o que mais sofreu desintegração após seis meses de imersão em plasma sanguíneo humano, seguido pelo Ketac Endo e Sealapex. Dentre todos os cimentos estudados, o Sealer 26 mostrou-se o mais uniforme e com a menor desintegração. Abstract in english The aim of this study was to analyze the high resolution morphological characteristics of Sealapex, Apexit, Sealer 26 (calcium hydroxide cements) and Ketac Endo (glass ionomer cement), using atomic force microscopy (AFM), immediately after root canal obturation and six months after it, keeping the roots stored in human blood plasma. The AFM evaluation used 16 single-rooted human teeth embedded in resin blocks after biomechanical preparation. The samples were divided into (more) four groups (four roots each) and the passive lateral condensation filling technique was used in the obturation of the canals with the mentioned sealers. Apexit suffered the highest degree of disintegration after the six-month storage in human blood plasma, followed by Ketac Endo and Sealapex. Sealer 26 was the most uniform cement and suffered the least disintegration.

Regional cerebral blood flow was studied in the cat, with and without trigeminal ganglion stimulation, by the intravenous injection of the tracer ({sup 14}C)iodoantipyrine and subsequent regional brain dissection. Electrical activation of the trigeminal ganglion led to a selective increase in regional blood flow in the frontal and parietal cortex that was bilateral without change in the posterior cortex, deep cerebral nuclei, white matter, or brain stem. Unilateral intracranial section of the facial nerve blocked the response in the ipsilateral frontal and parietal cortex, whereas bilateral facial nerve section blocked the contralateral frontal cortical response. The contralateral parietal cortical increase in blood flow was not affected by facial nerve section and may thus represent the result of metabolic activation of sensory cortex.

Chronic pain and tenderness in the groin, labia majora, and medial thigh can be caused by neuropathy of the genitofemoral nerve. Differentiation from ilioinguinal neuralgia by diagnostic blocks is crucial to selecting proper treatment. Three women with genitofemoral neuralgia underwent laparoscopic examination and treatment, thus avoiding laparotomy and flank incision. PMID:9050733

Bretylium and guanethidine produced a block of neuromuscular transmission in the rat phrenic nerve diaphragm and cat sciatic gastrocnemius preparations, but had a potentiating effect on acetylcholine-induced contracture of the frog rectus. On the sciatic gastrocnemius preparation of the cat the comp...

The potencies of saxitoxin (STX) and of five structurally related toxins were determined by their ability to block impulses at equilibrium in frog sciatic nerve. The order of potency, with values relative to STX potency in parentheses, was: neo-STX (4.5) greater than gonyautoxin (GTX) III (1.4) grea...

The actions of tetrodotoxin (TTX) and saxitoxin (STX) in normal water and in deuterium oxide (D2O) have been studied in frog myelinated nerve. Substitution of D2O for H2O in normal Ringer's solution has no effect on the potency of TTX in blocking action potentials but increases the potency of STX by...

A sustained-release DepoFoam injection formulation of bupivacaine (EXPAREL, 15?mg/mL) is currently being investigated for postsurgical analgesia via peripheral nerve block (PNB). Single-dose toxicology studies of EXPAREL (9, 18, and 30?mg/kg), bupivacaine solution (Bsol, 9?mg/kg), and saline injecte...

Nerve growth factor (NGF) leads to neuronal differentiation of PC12 cells and promotes their survival in serum-free medium. Past studies have shown that purine analogues block some of the effects of NGF but not others and thus that they can be used to dissect the mechanistic pathways of its action. ...

1. The aims of this study were first, to examine whether deficits in nerve conduction in streptozotocin-diabetic rats could be reversed by a 10% dietary supplement of evening primrose oil. Second, to determine the time-course of reversal, and third, to assess whether the effects could be blocked by ...

Bilateral cleft lip and palate may occasionally be associated with complex congenital cyanotic heart disease. An infant with common atrium and single ventricle with infundibular pulmonary stenosis (Blalock-Taussig shunt done recently) presented for lip repair surgery. Balanced general anesthesia was administered using sevoflurane along with a regional nerve block to maintain optimal pulmonary and systemic vascular resistance. PMID:22869953

This study describes the effects of Bothrops marajoensis venom (Marajó lancehead) on isolated neuromuscular preparations of chick biventer cervicis (CBC) and mouse phrenic nerve-diaphragm (PND). At low concentrations (1µg/ml for CBC and 5µg/ml for PND), the venom exhibited a neuromuscular blocking w...

During blocks of the ulnar nerve induced by inflating a sphygmomanometer cuff round the arm, the strengths of the movements of ulnar deviation of the individual fingers and adduction of the thumb were measured by means of a pressure transducer. No statistically significant differences were found bet...

Repetitive peripheral stimulation is associated with an enhancement of the intensity of corticomotor responses. We analysed the effects of hemicerebellectomy on the modulation of cortical motor output associated with repetitive electrical stimulation of the sciatic nerve in the rat. Hemicerebellectomy blocked the enhancement of the corticomotor response. The cerebellum is a key player in this form of short-term plasticity. PMID:11927777

We studied the spread of local anesthetic solution in the inferior alveolar nerve block by the injection of local anesthetic solution into the pterygomandibular space anterior to the mandibular foramen (anterior technique). Seventeen volunteers were injected with 1.8 mL of a mixture containing lidoc...

The authors, using a crossover design, randomly administered, in a single-blind manner, 3 sets of injections: an inferior alveolar nerve block (IANB) plus a mock buccal and a mock lingual infiltration of the mandibular first molar, an IANB plus a buccal infiltration and a mock lingual infiltration o...

To determine whether a repeated intraosseous (IO) injection would increase or prolong pulpal anesthesia, we measured the degree of anesthesia obtained by a repeated IO injection given 30 min following a combination inferior alveolar nerve block/intraosseous injection (IAN/IO) in mandibular second pr...

The purpose of this study was to compare the anesthetic efficacy of 2 bupivacaine solutions. Twenty-two volunteers randomly received in a crossover, double-blinded manner 2 inferior alveolar nerve blocks with 1.8 mL of racemic bupivacaine and a mixture of 75% levobupivacaine and 25% dextrobupivacain...

A sustained-release DepoFoam injection formulation of bupivacaine (EXPAREL, 15?mg/mL) is currently being investigated for postsurgical analgesia via peripheral nerve block (PNB). Single-dose toxicology studies of EXPAREL (9, 18, and 30?mg/kg), bupivacaine solution (Bsol, 9?mg/kg), and saline injected around the brachial plexus nerve bundle were performed in rabbits and dogs. The endpoints included clinical pathology, pharmacokinetics, and histopathology evaluation on Day 3 and Day 15 (2/sex/group/period). EXPAREL resulted in a nearly 4-fold lower C(max) versus Bsol at the same dose. EXPAREL was well tolerated at doses up to 30?mg/kg. The only EXPAREL-related effect seen was minimal to mild granulomatous inflammation of adipose tissue around nerve roots (8 of 24 rabbits and 7 of 24 dogs) in the brachial plexus sites. The results indicate that EXPAREL was well tolerated in these models and did not produce nerve damage after PNB in rabbits and dogs. PMID:22363842

Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: O clássico bloqueio "3 em 1" por via anterior tem suscitado divergências quanto ao envolvimento anestésico de seus três nervos participantes, o femoral, o cutâneo lateral da coxa e o obturador. O objetivo deste estudo é verificar o desfecho do bloqueio "3 em 1" por via anterior, através das técnicas: injeção única (G1), cateteres curtos (G2) e cateteres longos (G3). Os bloqueios "3 em 1", clinicamente identificados como completos ou s (more) uperdimensionados foram, adicionalmente, investigados por meio de rádio imagem. MÉTODO: A identificação do espaço subfascial ilíaco nos bloqueios "3 em 1" com injeção única ou com cateteres foi feita pela perda de resistência ao ar. Em vários eventos dolorosos, o volume anestésico administrado variou entre 30 e 40 ml e a introdução cranial dos cateteres foi até 18 cm no espaço subfascial ilíaco. Quando a pesquisa clínica apontava envolvimento do nervo obturador ou de outro nervo adicional ao bloqueio "3 em 1", complementava-se a investigação com estudo radiográfico e tomodensiométrico com o propósito de estabelecer correspondência com a anatomia pélvica. RESULTADOS: O envolvimento dos nervos fêmoro cutâneo lateral e obturador não foram constantes, ao contrário do nervo femoral. No estudo, nenhum bloqueio "3 em 1" completo com injeção única (G1) se manifestou, e sim um bloqueio "2 em 1", com a participação eventual do ramo femoral do nervo genitofemoral (bloqueio "2,5 em 1"). Contudo, quando foram utilizados cateteres curtos (G2), obteve-se bloqueio "3 em 1" em apenas um paciente, ao passo que com cateteres longos (G3) introduzidos no sentido cefálico até 18 cm no espaço subfascial ilíaco, três bloqueios "3 em 1" superdimensionados foram registrados, pelo envolvimento adicional dos nervos fibular comum em dois pacientes e o nervo tibial em um paciente. CONCLUSÕES: Apesar da pequena amostra, com injeção única (G1), sempre se obteve um bloqueio "2 em 1" ou "2,5 em 1", sem a participação do nervo obturador. Com cateter curto (G2), o bloqueio "3 em 1" foi classificado como completo em 6,6% dos casos (um paciente). Porém, com cateter longo (G3), o resultado tende a ser mais previsível em relação aos outros grupos, especialmente quando o cateter alcança o espaço paravertebral lombossacral, resultando num bloqueio "3 em 1" completo em 20% dos casos (três pacientes) ou, raramente, num bloqueio "3 em 1" superdimensionado em 13,2% dos casos (dois pacientes). Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El clásico bloqueo "3 en 1" por vía anterior ha suscitado divergencias cuanto al envolvimiento anestésico de sus tres participantes, el nervio femoral, el nervio cutáneo lateral del muslo y el nervio obturador. El objetivo de este estudio es verificar el resultado del bloqueo "3 en 1" por vía anterior, a través de las técnicas: inyección única (G1), catéteres cortos (G2) y catéteres largos (G3). Los bloqueos "3 en 1", clínicamente id (more) entificados como completos o superdimensionados fueron, adicionalmente, investigados por medio de radio imagen. MÉTODO: La identificación del espacio subfascial ilíaco en los bloqueos "3 en 1" con inyección única o con catéteres fue hecha por la pérdida de resistencia al aire. En varios eventos dolorosos, el volumen anestésico administrado varió entre 30 y 40 ml y la introducción cranial de los catéteres fue hasta 18 cm en el espacio subfascial ilíaco. Cuando la pesquisa clínica apuntaba envolvimiento del nervio obturador o de otro nervio adicional al bloqueo "3 en 1", se complementava la investigación con estudio radiográfico y tomodensiométrico con el propósito de establecer correspondencia con la anatomía pélvica. RESULTADOS: El envolvimiento de los nervios femoro cutáneo lateral y obturador no fueron constantes, al contrario del nervio femoral. En el estudio, ningún bloqueo "3 en 1" completo con inyección única (G1) se manifestó, y si un bloqueo "2 en 1", con la participación eventual del nervio genitofemoral (bloqueo "2,5 en 1"), uno de los ramos del nervio femoral. Todavía, cuando fueron utilizados catéteres cortos (G2), se obteve bloqueo "3 en 1" en apenas un paciente, al paso que con catéteres largos (G3) introducidos en el sentido cefálico até 18 cm en el espacio subfascial ilíaco, tres bloqueos "3 en 1" superdimensionados fueron registrados, por el envolvimiento adicional de los nervios fibular común en dos pacientes y el nervio tibial en un paciente. CONCLUSIONES: A pesar de la pequeña muestra, con inyección única (G1), siempre se obtuvo un bloqueo "2 en 1" ó "2,5 en 1", sin la participación del nervio obturador. Con catéter corto (G2), el bloqueo "3 en 1" fue clasificado como completo en 6,6% de los casos (un paciente). Mas, con catéter largo (G3), el resultado tiende a ser más previsible en relación a los otros grupos, especialmente cuando el catéter alcanza el espacio paravertebral lombosacral, resultando en un bloqueo "3 en 1" completo en 20% de los casos (tres pacientes) o, raramente, en un bloqueo "3 en 1" superdimensionado en 13,2% de los casos (dos pacientes). Abstract in english BACKGROUND AND OBJECTIVES: Classic anterior 3-in-1 blockade has been questioned as to the anesthetic involvement of its three participant nerves: femoral, lateral cutaneous of thigh and obturator. This study aimed at evaluating the outcome of anterior 3-in-1 blockade through: single injection (G1), short catheters (G2) and long catheters (G3). 3-in-1 blockades identified as total or overdimensioned were additionally investigated by radio images. METHODS: The identificatio (more) n of iliac subfascial space in 3-in-1 blockades with single injection or catheters has been made by loss of resistance to air. In several painful events, anesthetic volume has varied 30 to 40 mL and cranial catheters introduction was up to 18 cm in the iliac subfascial space. When clinical research would point to the involvement of the obturator nerve or other nerve additional to 3-in-1 blockade, investigation was complemented by radiographic or TC-Scan studies aiming at establishing correspondence with pelvic anatomy. RESULTS: The involvement of lateral cutaneous of thigh and obturator nerves has not been constant, as opposed to the femoral nerve. No total 3-in-1 blockade with single injection (G1) was observed in our study, but rather 2-in-1, with eventual participation of the femoral branch of the genitofemoral nerve (2.5-in-1 blockade). However, when short catheters were used (G2), there has been 3-in-1 blockade in just one patient, while with long catheters (G3) introduced in the cephalad direction until 18 cm in the iliac subfascial space, three overdimensioned 3-in-1 blockades were recorded, with the additional involvement of common fibular nerve in two patients and tibial nerve in one patient. CONCLUSIONS: In spite of the small sample size, single injection (G1) has always provided 2-in-1 or 2.5-in-1 blockade without the participation of the obturator nerve. With short catheters (G2) 3-in-1 blockade was classified as total in 6.6% of cases (one patient). With long catheters (G3), however, results seem to be more predictable as compared to the other groups, especially when the catheter reaches the lumbosacral paravertebral space, resulting in total 3-in-1 blockade in 20% of cases (3 patients) or more uncommonly, in overdimensioned 3-in-1 blockade in 13.2% of cases (2 patients).

The ultrasound-guided transversus abdominis plane (TAP) block is used to treat postoperative pain after abdominal surgery. Abdominal wall sensory nerves are anaesthetised by injecting local anaesthetics into the neurofascial plane between the internal oblique and the transversus abdominis muscles. Sensory assessment of a TAP block may guide the decision on the extent of the block. The purpose of this study was to investigate if the dermatomal extent of sensory blockade after injection of 20 ml 0.5% ropivacaine bilaterally into the TAP can be assessed using cold and pinprick sensation.

Infraclavicular approach to the brachial plexus provides adequate anesthesia of the entire arm. Local anesthetics can be deposited over cords and branches of brachial plexus above the formation of musculocutaneous and axillary nerves. The approach can also easily block ulnar segment of medial cord and intercostobrachial nerve, which helps preventing tourniquet pain. However, distance to the plexus is deeper than the other approaches so that current blind method using anatomical landmarks requires anesthesiologists' delicate manipulation and experience. Through ultrasonography, the location of subclavian artery, as an anatomical landmark, can be easily identified. It is then very easy and safe to perform infraclavicular brachial plexus block. Our new method showed 89% (n = 9) successful rate. The time for the block was 4.2 +/- 1.5 min and there was an average of 3.2 +/- 0.6 needle penetrations. Thirty three percent (n = 3) had subclavian artery been punctured without formation of hematoma clinically. No patient had clinical postoperative pneumothorax. PMID:7934690

APS12-2, a non-competitive acetylcholinesterase inhibitor, is one of the synthetic analogs of polymeric alkylpyridinium salts (poly-APS) isolated from the marine sponge Reniera sarai. In the present work the effects of APS12-2 were studied on isolated mouse phrenic nerve-hemidiaphragm muscle preparations, using twitch tension measurements and electrophysiological recordings. APS12-2 in a concentration-dependent manner blocked nerve-evoked isometric muscle contraction (IC50=0.74mM), without affecting directly-elicited twitch tension up to 2.72mM. The compound (0.007-3.40mM) decreased the amplitude of miniature endplate potentials until a complete block by concentrations higher than 0.68mM, without affecting their frequency. Full size endplate potentials, recorded after blocking voltage-gate...

We describe an unusual sports injury in a young man, a combination of obturator hip dislocation with an ipsilateral anterior cruciate ligament injury. Traumatic non?prosthetic hip dislocations, particularly obturator hip dislocations, are extremely rare sports injuries and have not previously been r...

Experience with 29 000 cases in which the oesophageal obturator airway has been used in cardiopulmonary resuscitation indicates its safety, efficacy, and ease of use. Blood gases, fractional inspired oxygen, and pH were measured in 18 patients given both the oesophageal obturator airway and the endo...

Genitofemoral neuritis, which occurs when the neurolytic solution spreads into the psoas muscle, is the most common complication after neurolytic lumbar sympathetic block. We developed a transdiscal approach for neurolytic lumbar sympathetic block to reduce the danger of genitofemoral neuritis by making a sympathectomy without penetration of the psoas muscle, through which the genitofemoral nerve passes. We attempted transdiscal lumbar sympathetic block in 14 patients for whom the last previous lumbar sympathetic block performed by using the conventional paravertebral method was unsuccessful. Under fluoroscopic guidance, the needle was inserted transdiscally at L2-3 and/or L3-4 and was advanced until its tip pierced the anterior longitudinal ligament. Radiography and computed tomography revealed that the injected contrast media spread along the anterolateral surface of the vertebral column without any flow into the psoas muscle. Alcohol was injected successfully in all patients. During the 1-mo follow-up period, no patients had any symptom of genitofemoral neuritis. Thirteen patients who had been suffering from lower extremity pain achieved partial or complete pain relief. One patient with plantar hyperhidrosis achieved persistent anhidrosis. These results suggest that the transdiscal approach can be a technical option for neurolytic lumbar sympathetic block. Implications: Neurolytic lumbar sympathetic block was performed with the needle advanced through the intervertebral disc. With this technique, the risk of genitofemoral neuritis, the most common complication after neurolytic lumbar sympathetic block, was reduced because the needle does not penetrate the psoas muscle, through which the genitofemoral nerve passes. PMID:9390600

CONTEXT: Contrasting findings have been published regarding the role of magnesium sulphate used as an additive to local anaesthetics in peripheral nerve blocks. OBJECTIVE: To clarify the effect of magnesium sulphate on nerve excitability. SETTING: C and A? compound action potentials were recorded extracellularly in vitro in saphenous nerves from adult rats. ANIMALS: Saphenous nerves (n?=?30) from male Wistar rats (n?=?19), 12 to 16 weeks old. INTERVENTION: Primary sensory afferents were tested with a computerised threshold tracking program (QTRAC) with a supramaximal 1?ms current pulse either alone or after 300?ms of conditioning polarising ramp currents in the presence and absence of 10?mmol?l magnesium sulphate, 80??mol?l lidocaine and a combination of both. MAIN OUTCOME MEASURES: Changes in current thresholds to elicit compound action potential amplitudes of 40% of the maximal response. RESULTS: Magnesium sulphate increased excitability thresholds to a greater extent in A? fibres than in C fibres. It enhanced the effects of lidocaine in both A? fibres [mixture 0.470?mA (SD 0.105) versus lidocaine 0.358?mA (SD 0.080), P?voltage-gated sodium channels. They also may help to explain the conflicting reports regarding the clinical effects of magnesium sulphate as an additive to lidocaine in peripheral nerve blocks. PMID:23138572

Local cooling (LC) causes a cutaneous vasoconstriction (VC). In this study, we tested whether there is a mechanism that links LC to VC nerve function via sensory nerves. Six subjects participated. Local skin and body temperatures were controlled with Peltier probe holders and water-perfused suits, respectively. Skin blood flow at four forearm sites was monitored by laser-Doppler flowmetry with the following treatments: untreated control, pretreatment with local anesthesia (LA) blocking sensory nerve function, pretreatment with bretylium tosylate (BT) blocking VC nerve function, and pretreatment with both LA and BT. Local skin temperature was slowly reduced from 34 to 29 degrees C at all four sites. Both sites treated with LA produced an increase in cutaneous vascular conductance (CVC) early in the LC process (64 +/- 55%, LA only; 42 +/- 14% LA plus BT; P 0.05). As cooling continued, there were significant reductions in CVC at all sites (P < 0.05). At control and LA-only sites, CVC decreased by 39 +/- 4 and 46 +/- 8% of the original baseline values, which were significantly (P < 0.05) more than the reductions in CVC at the sites treated with BT and BT plus LA (-26 +/- 8 and -22 +/- 6%). Because LA affected only the short-term response to LC, either alone or in the presence of BT, we conclude that sensory nerves are involved early in the VC response to LC, but not for either adrenergic or nonadrenergic VC with longer term LC. PMID:17468334

A prevascular femoral hernia is a rare type of femoral hernia in which the neck lies anterior to the femoral vessels. Obturator hernias are unusual herniations through the obturator foramen. There are no reports in the literature of coexisting prevascular and obturator hernias. Although obturator hernias have been treated successfully by laparoscopic techniques, there are no published reports of prevascular hernias treated in this way. We report the first case in the literature of a patient with a prevascular femoral hernia treated successfully by laparoscopic preperitoneal mesh repair in a rare case associated with ipsilateral obturator and classic femoral hernias. Prevascular femoral hernias are rare, potentially difficult to treat and are ideally suited to investigation and repair by laparoscopic means. PMID:23047414

OBJECTIVE: The objective of the study was to evaluate the anatomic relationships of anchor points of single-incision midurethral slings with 2 common placement trajectories. STUDY DESIGN: In 30 female pelvic halves, a probe was introduced through a suburethral tunnel following 45(°) and 90(°) angle trajectories. The corresponding anchor points were tagged. Distances to the obturator canal, accessory obturator vessels, dorsal vein of clitoris, and external iliac vein were recorded. RESULTS: Both suburethral tunnel trajectories and their respective anchor points remained caudad to the obturator internus muscle in 100% of dissections. The closest distance between either anchor point to the obturator canal was 1.6 cm. The closest distance from the 45(°) and 90(°) anchor points to the accessory obturator vessels was 1.6 and 1.5 cm, respectively. CONCLUSION: The anchor points of single-incision midurethral slings are in close proximity to vascular structures that could be injured with inadvertent entry into the retropubic space. PMID:23099191

Despite recent advances in surgical technique for inguinal hernia repair, chronic groin pain following the surgical repair of an inguinal hernia is not uncommon. Injury to the ilioinguinal, iliohypogastric, or genitofemoral nerves is the most common etiology. Specific risk factors that increase the likelihood of developing chronic groin pain have been identified. Ultrasound-guided peripheral nerve blocks may play an important role in the diagnosis and treatment of chronic groin pain. As in many pain syndromes, early diagnosis and early treatment are crucial. Evidence-based management of chronic groin pain is poorly studied, although cryotherapy and neuromodulation techniques show potential efficacy.

Abstract In patients with aggressive tumors resistant to conventional pain treatment, regional anaesthesia frequently becomes an alternative therapy. Cervical paravertebral nerve block among several access options to the brachial plexus is barely ever used. We present a case with severe shoulder and upper extremity pain owing to an expanding Pancoast tumor exhibiting compression upon the brachial plexus. Continuous intrathecal morphine infusion and adjuvant treatment was not sufficient to render the patient pain free. With the addition of paravertebral nerve blockade the patient's pain improved substantially, however without impacting his longevity.

Neuropeptide Y (NPY) is colocalized with norepinephrine and coreleased from adrenergic nerves. NPY reportedly can influence vascular neuroeffector transmission in both negative and positive directions. Mechanisms by which NPY effects are exerted and their relative contribution may vary between different blood vessels. Therefore, we investigated effects of NPY on adrenergic neurotransmission in ring segments of the rat tail artery by measuring isometric force development and [3H]norepinephrine release. NPY (1-100 nM) potentiated responses to transmural nerve stimulation (3 Hz, six pulses) by more than 300% but produced no direct contractile effects. NPY potentiated responses to longer transmural nerve stimulation trains (30-100 pulses) or to exogenous norepinephrine by only 30%. NPY had no effect on [3H]norepinephrine overflow with either short (six pulses) or long (30 pulses) stimulation trains. Contractile responses to transmural nerve stimulation were completely blocked by prazosin (10(-7) M) both in the absence and presence of NPY. Since the impact of an increased rate of contraction on the contractile response achieved would be greater with short stimulation trains, the effect of NPY on contraction rate was analyzed. NPY increased the rate of contraction to both norepinephrine and transmural nerve stimulation. It is hypothesized that NPY increases the early (phasic) component of the contractile response by preferentially influencing release of intracellular calcium stores. These findings suggest that the effects of NPY will be more profound on phasic rather than sustained patterns of nerve traffic. PMID:2600818

We have investigated nerve growth factor-dependent neurite growth from adult sensory neurons using the compartmented culture system. The requirement of both TrkA and the p75 neurotrophin receptors in neurite growth was examined using several experimental interventions. Inhibition of TrkA activation using K252a resulted in a total block of distal neurite extension into nerve growth factor-containing compartments. Brain-derived neurotrophic factor and the anti-p75 monoclonal antibody MC192 have been shown to interfere with the binding of nerve growth factor to p75. Brain-derived neurotrophic factor, which binds p75 but not TrkA, competes with nerve growth factorforp75, while the anti-p75 antibody MC192 has been shown to decrease the interaction of nerve growth factor with TrkA. The addition of brain-derived neurotophic factor to nerve growth factor-containing distal compartments inhibited, but did not totally block, distal neurite extension. MC192, on the other hand, totally inhibited nerve growth factor-dependent neurite growth. To test whether MC192 and brain-derived neurotrophic factor might be influencing Trk activation, TrkA phosphorylation was examined biochemically. Both compounds were found to attenuate nerve growth factor-induced Trk phosphorylation, although neither inhibited the activation completely. The possibility that MC192 or brain-derived neurotrophic factor might activate p75 signaling directly (and potentially antagonize TrkA signaling) was also investigated. This was assessed by quantitating the activation and nuclear translocation of the transcription factor NFkB using immunocytochemistry. Only treatment with the anti-p75 antibody MC192 resulted in prolonged and significant increase in the number of neurons displaying nuclear staining for NFkB. Our results demonstrate that both TrkA and p75 play a role in neurite growth response to nerve growth factor, and further suggest that any alteration in optimal TrkA-p75 interactions, or direct activation of p75 at the expense of TrkA, results in an inhibition of nerve growth factor-dependent neurite growth in adult sensory neurons. PMID:10430489

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.

Regional anesthetic blocks are performed on patients who will undergo surgery of the hand. In this study, thermal and oxygenation imaging techniques were applied to observe the region affected by the peripheral block as a fast objective, non-contact, method compared to the standard pinpricks or cold sensation tests. The temperature images were acquired with an IR thermal camera (FLIR ThermoCam SC640). The data were recorded and analyzed with the ThermaCamTM Researcher software. Images at selected wavelengths were obtained with a CCD camera combined with a Liquid Crystal Tunable Filter (420-730 nm). The concentration changes of oxygenated and deoxygenated hemoglobin in the dermis of the skin were calculated using the modified Lambert Beer equation. In 10 patients an anesthetic block was placed by administering 20-30 ml Ropivacaine 7,5 mg/ml around the plexus brachialis. The anesthetic block of the axillary, ulnar, median and radial nerve causes dilatation of the blood vessels inducing an increase of blood flow and, consequently, an increase of the skin temperature and skin oxygenation in the lower arm. Both imaging methods showed distinct oxygenation and temperature differences at the surface of the skin of the hand with a good correlation with the areas with the nerve blocks. For oxygenation imaging a CCD camera with LED light source of selected wavelengths might be a relative inexpensive method to observe the effectiveness of regional blocks.

Sections Brain, Spinal Cord, and Nerve Disorders Chapters Cranial Nerve Disorders Internuclear Ophthalmoplegia Internuclear ophthalmoplegia is impairment of ... nerve cells (centers or nuclei) that the 3rd cranial nerve (oculomotor nerve) and the 6th cranial nerve (abducens ...

Abstract Objective To develop a technique for placing continuous peripheral nerve block (CPNB) catheters adjacent to palmar nerves in horses and to evaluate the effect of low-volume local anesthetic (LA) infusion on nociception in the distal equine thoracic limb. Study design In vitro and in vivo laboratory investigation. Study material and animals Forty-two thoracic limbs from 22 equine cadavers and five horses. Methods Thoracic limb specimens were dissected to find landmarks for catheter insertion adjacent to medial and lateral palmar nerves. Based on the anatomy of the proximal metacarpus, a technique for placing palmar CPNB catheters was developed and the potential for catheter dislodgement studied in vitro by fluoroscopic visualization during passive carpal flexion and dye injection f...

OBJECTIVE -- To quantify the effects of acute electrical stimulation frequency and amplitude at the dorsal nerve of the penis (DNP), pudendal nerve (PN) and S1 sacral nerve (S1) on isovolumetric reflex bladder contractions and maximum cystometric capacity in anaesthetized male cats. MATERIALS AND METHODS -- Experiments were conducted in 14 adult male cats anaesthetized with -chloralose. -- The effects of stimulation on the pressure - time integral of reflex bladder contractions were evaluated using a randomized block design with the following factors randomized: stimulation intensity (0.8, 1, or 2 the threshold for evoking a reflex electromyogram response in the external anal sphincter [T]), frequency (2-Hz, 5-Hz, 7.5-Hz, 10-Hz, 15-Hz, 20-Hz, or 33-Hz) and location (PN, S1 or DNP). -- The ...

Abstract in english Schwann cells produce and release trophic factors that induce the regeneration and survival of neurons following lesions in the peripheral nerves. In the present study we examined the in vitro ability of developing rat retinal cells to respond to factors released from fragments of sciatic nerve. Treatment of neonatal rat retinal cells with sciatic-conditioned medium (SCM) for 48 h induced an increase of 92.5 ± 8.8% (N = 7 for each group) in the amount of total protein. S (more) CM increased cell adhesion, neuronal survival and glial cell proliferation as evaluated by morphological criteria. This effect was completely blocked by 2.5 µM chelerythrine chloride, an inhibitor of protein kinase C (PKC). These data indicate that PKC activation is involved in the effect of SCM on retinal cells and demonstrate that fragments of sciatic nerve release trophic factors having a remarkable effect on neonatal rat retinal cells in culture.

Diseases of the thyroid are common and surgical treatment is often the preferred option. Thyroid surgery is becoming subspecialised and falls within the repertoire of maxillofacial, and head and neck surgeons. Multidisciplinary management of most patients with diseases of the thyroid is key to providing the best care particularly for those with malignancies and retrosternal extension. To reduce postoperative complications a meticulous search for, and protection of the recurrent laryngeal nerve and parathyroid glands, with an incision along the skin crease in the lower neck, which can be extended for neck dissection, are paramount. Recent advances in thyroid surgery include ultrasound-guided cervical plexus block, use of the Harmonic Scalpel(®) (Ethicon Endo-Surgery, Inc., USA), intraoperative nerve stimulation to monitor the recurrent laryngeal nerve, use of TissuePatch™ 3 (Tissuemed Ltd., Leeds, UK) adhesive sealant, and minimal access surgery. PMID:22192610

Multifocal motor neuropathy (MMN) is characterized by slowly progressive, predominantly distal, asymmetric limb weakness and partial conduction blocks (CB) of motor axons. Cranial nerve involvement and respiratory failure are uncommon. We report two patients who exhibited unilateral hypoglossal and abducens palsy as presenting signs. Other remarkable features were autonomic instability and respiratory failure due to bilateral phrenic nerve involvement. Treatment with intravenous (IV) immunoglobulin (Ig) resulted in an improvement. Patient 2, who showed IgM reactivity against ganglioside GM1, has been receiving maintenance therapy with IVIg for 7years. We speculate that cranial weakness of our patients could be due to CB similar to those detected in the motor nerves of the extremities.

Cervicocephalic artery dissections occurring during dental care have exceptionally been reported. We describe a case of internal carotid artery dissection, presenting as hypoglossal nerve palsy, occurring immediately after difficult inferior alveolar nerve anesthetic block for third inferior molar dental care. Carotid dissection was successfully treated with anticoagulation therapy while hypoglossal nerve palsy recovered with carotid dissection shrinkage. The etiopathogenetic mechanisms of this singular form of internal carotid artery dissection are discussed. The possibility of internal carotid artery dissection development during oral or dental procedure, specifically in cases of possible trivial intraoperative internal carotid artery injury, severe local periodontal infection, or prolonged cervical hyperextension should be considered. Every possible prophylactic measure should be taken (eg, sedating the patient during oral or dental procedures, aggressive preoperative management of general and local periodontal chronic infections, avoiding prolonged perioperative neck hyperextention) to prevent this very rare but potentially life-threatening complication. PMID:22914855

An experimental investigation has been undertaken to improve understanding of the role of the obturator and detonations in the subdetonative ram accelerator starting process. Ram accelerator start experiments were conducted with various obturator geometries to determine the obturator dynamics and assess its effect on the outcome of a start attempt. The obturator rapidly decelerates upon entrance and then moves backwards. Reversal of direction occurs more rapidly after propellant ignition, for less massive obturators, and solid geometries. Perforated geometries and decreasing obturator mass are less conducive to igniting a given propellant, as evidenced by the flowfield and start attempt outcome data presented. Wave unstarts were observed to occur with and without detonations, indicating more than one mechanism responsible for this type of start failure. Piston-initiated detonation experiments were conducted by firing the obturators without the ram accelerator projectile. The piston experiments identified the detonation limits for a wide range of propellants, but were found to not always be indicative of the upper Mach number at which a ram accelerator can be successfully started. In some instances a successful start or wave fall-off would occur at Mach numbers above which a piston alone detonated the propellant. Thus, the projectile can play a mitigating role in detonation initiation and use of piston detonation limits to quantitatively define a detonation wave unstart limit was not realized.

Chronic pelvic pain can present in various pain syndromes. In particular, interventional procedure plays an important diagnostic and therapeutic role in 3 types of pelvic pain syndromes: pudendal neuralgia, piriformis syndrome, and "border nerve" syndrome (ilioinguinal, iliohypogastric, and genitofemoral nerve neuropathy). The objective of this review is to discuss the ultrasound-guided approach of the interventional procedures commonly used for these 3 specific chronic pelvic pain syndromes. Piriformis syndrome is an uncommon cause of buttock and leg pain. Some treatment options include the injection of the piriformis muscle with local anesthetic and steroids or the injection of botulinum toxin. Various techniques for piriformis muscle injection have been described. CT scan and EMG-guidance are not widely available to interventional physicians, while fluoroscopy exposes the performers to radiation risk. Ultrasound allows direct visualization and real-time injection of the piriformis muscle. Chronic neuropathic pain arising from the lesion or dysfunction of the ilioinguinal nerve, iliohypograstric nerve, and genitofemoral nerve can be diagnosed and treated by injection to the invloved nerves. However, the existing techniques are confusing and contradictory. Ultrasonography allows visualization of the nerves or the structures important in the identification of the nerves and provides the opportunities for real-time injections. Pudendal neuralgia commonly presents as chronic debilitating pain in the penis, scrotum, labia, perineum, or anorectal region. A pudendal nerve block is crucial for the diagnosis and treatment of pudendal neuralgia. The pudendal nerve is located between the sacrospinous and sacrotuberous ligaments at the level of ischial spine. Ultrasonography, but not the conventional fluoroscopy, allows visualization of the nerve and the surrounding landmark structures. Ultrasound-guided techniques offer many advantages over the conventional techniques. The ultrasound machine is portable and is more readily available to the pain specialist. It prevents patients and healthcare professionals from the exposure to radiation during the procedure. Because it allows the visualization of a wide variety of tissues, it potentially improves the accuracy of the needle placement, as exemplified by various interventional procedures in the pelvic regions aforementioned. PMID:18354713

Introduction: Several peripheral nerve block techniques (PNB) are performed for hand surgery. Their tolerance by patients or their efficacy are poorly described. We evaluated them for blocks at the wrist and at the brachial canal. Patients and methods: Cohort of outpatients undergoing open carpal tunnel release under PNB with arm tourniquet. Various anaesthetic protocols existed in our staff. The primary end points were a moderate to severe pain (greater than 3/10 on a numerical rating scale) felt during needle puncture, nerve stimulation, mepivacaine injection, at the surgical site (intraoperatively) or at the arm tourniquet, an intraoperative lidocaine supplementation, the occurrence of vasovagal events. For each primary end point, a logistic regression analyzed: the effects of gender, a...

In a recently developed in vitro analog of appetitive classical conditioning of feeding in "Aplysia," the unconditioned stimulus (US) was electrical stimulation of the esophageal nerve (En). This nerve is rich in dopamine (DA)-containing processes, which suggests that DA mediates reinforcement during appetitive conditioning. To test this possibility, methylergonovine was used to antagonize DA receptors. Methylergonovine (1 nM) blocked the pairing-specific increase in fictive feeding that is usually induced by in vitro classical conditioning. The present results and previous observation that methylergonovine also blocks the effects of contingent reinforcement in an in vitro analog of appetitive operant conditioning suggest that DA mediates reinforcement for appetitive associative conditioning of feeding in "Aplysia." (Contains 3 figures.)

Abstract Introduction.- Dorsal penile nerve block (DPNB) has been previously shown to provide effective analgesia for penile surgeries. To date, few studies have examined the role of DPNB prior to inflatable penile prosthesis (IPP) implantation. Aim.- The purpose of this study was to assess the efficacy of local penile nerve block prior to IPP implantation for postoperative pain control. Main Outcome Measures.- The primary outcome was postoperative pain rated using the visual analog scale (VAS). Secondary outcome measures included total narcotic usage during hospitalization. Methods.- Institutional Review Board approval was obtained. Patients with erectile dysfunction scheduled for IPP implantation were approached for study participation. Patients were excluded if they had a previous IPP s...

Several techniques have been described for selective nerve root blocks. We describe a novel ?two-needle technique?, performed through the postero-lateral route with the patient in lateral position under C-arm guidance. The aim of the current study is to highlight the effectiveness and safety of cervical selective nerve root block for radiculopathy using this technique. We present results of a retrospective 2-year follow-up study of 33 injections carried out on 33 patients with radiculopathy due to cervical disc disease and or foraminal stenosis using this procedure. Patients with myelopathy, gross motor weakness and any other pathology were excluded. The outcome was measured comparing ?Visual Analogue Score? (VAS) and ?Neck Disability Index? (NDI) before the procedure with those at 6?weeks...

Abstract Objective. To present a case of complex regional pain syndrome (CRPS) type II with sympathetic dysfunction and trophic changes in the orofacial region, which was partially responsive to intravenous ketamine. Patient. The patient was a 68-year-old man who suffered from inveterate pain with trophic changes of the right face and tongue and vasomotor dysfunction on the right side of the face after ipsilateral trigeminal nerve block. Allodynia and hyperalgesia were observed on the affected side of the face. Pain initially improved after sympathetic nerve block, but similar pain returned that was unresponsive to the same procedure. Repeated intravenous administration of low-dose ketamine preceded by intravenous midazolam alleviated the pain, but trophic changes of the tongue persisted. ...

The purpose of this study was to evaluate the effect of submucous tramadol as adjuvant of mepivacaine with epinephrine in inferior alveolar nerve block. A double-blind, randomized, placebo-controlled, crossover clinical trial was conducted. Twenty healthy young volunteers were randomized into two treatment sequences using a series of random numbers. Sequence 1: Group A, 2% mepivacaine with 1:100,000 epinephrine plus submucous tramadol 50mg (1mL of saline) and one week later Group B, 2% mepivacaine with 1:100,000 epinephrine plus submucous placebo (1mL of saline). Sequence 2: Group B and one week later Group A. All treatments were administered 1min after that patient informed anesthesia of lower lip. We evaluated the duration of anesthesia of lower lip, anesthetic efficacy, and local and systemic adverse events. Anesthetic efficacy was better in group receiving submucous tramadol during the first 2h compared with group receiving submucous placebo (Pinferior alveolar nerve block. PMID:21555171

IntroductionThere is a decrease in the anesthetic efficacy of inferior alveolar nerve blocks in patients with irreversible pulpitis. It was hypothesized that the increasing the volume of anesthetic solution may improve the success rates of dental pulp anesthesia in patients with pulpal pain. MethodsFifty-five adult volunteers, actively experiencing pain, participated in this prospective, randomized, single-blind study. The patients were divided into 2 groups on a random basis and received an inferior alveolar nerve block with either 1.8 mL or 3.6 mL of 2% lidocaine with 1:200,000 epinephrine. Endodontic access preparation was initiated after 15 minutes of the initial IANB. Pain during treatment was recorded using the Heft-Parker visual analog scale (HP VAS). The primary outcome measure, an...

The effect of tetanus toxin on neuropeptide hormone release from isolated nerve endings of the neural lobe of rat pituitaries (neurosecretosomes) was measured in a perfusion system. Tetanus toxin inhibited depolarization-evoked release of oxytocin and vasopressin in a time- and dose-dependent manner. At 1 microgram/ml, tetanus toxin blocked stimulated release by 85%. Tetanus toxin that was preincubated with a neutralizing monoclonal antibody or heated to 100 degrees C had no effect on hormone release. The ionophores A23187 and ionomycin were potent stimulators of hormone release in control nerve endings, but were not able to overcome the effect of tetanus toxin in intoxicated nerve endings. 8-Bromo-cyclic GMP, which has been reported to reverse the action of tetanus toxin in PC12 cells, had no effect on the action of tetanus toxin in neurosecretosomes. Neurosecretosomes are the first system in which tetanus toxin has been shown to block release from peptidergic nerve terminals. They appear to be a valuable invitro system for studying the biochemical mechanism of tetanus toxin action.

In conventional percutaneous disc surgery, introducing instruments into disc space starts by inserting a guide needle into the triangular working zone. However, landing the guide needle tip on the annular window is a challenging step in endoscopic discectomy. Surgeons tend to repeat the needling procedure to reach an optimal position on the annular target. Obturator guiding technique is a modification of standard endoscopic lumbar discectomy, in which, obturator is used to access triangular working zone instead of a guide needle. Obturator guiding technique provides more vivid feedback and easy manipulation. This technique decreases the steps of inserting instruments and takes safer route from the peritoneum.

Objectives: The obturator prosthesis is a valid aid in rehabilitation. It is normally used to correct small-to-medium defects of the palate left by surgical excision of tumors involving the oral cavity and part of the respiratory tract. Our aim was to implement a similar protocol for patients with osteonecrosis of the jaw (ONJ). Materials and methods: This report describes the treatment of a patient with ONJ using self-molding thermoplastic material applied on an obturator. Results and conclusions: Placement of an obturator with thermoplastic material allowed us to restore the patient's general health, which had been poor, and it also had positive effects on phonation.

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.

IntroductionSuccess of inferior alveolar nerve (IAN) block decreases in patients with irreversible pulpitis. The purpose of this study was to evaluate the effect of preoperative administration of alprazolam on the success of the IAN block for teeth with irreversible pulpitis. MethodsSixty patients with irreversible pulpitis of a mandibular molar were selected for this prospective, randomized, double-blind, placebo-controlled study. The patients received identical capsules of either 0.5 mg of alprazolam or placebo 45 minutes before the administration of a conventional IAN block. Access cavity preparation was initiated 15 minutes after the IAN block injection. Lip numbness was recorded for all the patients. Success was defined as no or mild pain on the basis of visual analogue scale recordin...

Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst. PMID:3343608

Lumbar sympathetic block (LSB) is used in the management of sympathetically maintained pain states. Complications of LSB may include infection, injury of spinal cord or somatic nerve, kidney trauma, hypotension, paraplegia and genitofemoral neuralgia. We present a case of a 53-year-old woman who had undergone LSB for the relief of reflex sympathetic dystrophy and subsequently a disrupted right proximal ureter. She was treated with ureteroureterostomy and an indwelling ureteral stent. PMID:19230175

Lumbar sympathetic block (LSB) is used in the management of sympathetically maintained pain states. Complications of LSB may include infection, injury of spinal cord or somatic nerve, kidney trauma, hypotension, paraplegia and genitofemoral neuralgia. We present a case of a 53-year-old woman who had undergone LSB for the relief of reflex sympathetic dystrophy and subsequently a disrupted right proximal ureter. She was treated with ureteroureterostomy and an indwelling ureteral stent.

Minimally invasive techniques for the treatment of some spinal diseases are percutaneous treatments, proposed before classic surgery. By using imaging guidance, one can significantly increase accuracy and decrease complication rates. This review report physiopathology and discusses indications, methods, complications and results of performing these techniques on the spine, including different level (cervical, thoracic, lumbar and sacroiliac) and different kind of treatments (nerve block, disc treatment and bone treatment). Finally the present article also reviews current literature on the controversial issues involved. PMID:16129245

Patients may experience significant pain after hip arthroscopy. Two patients who experienced severe pain after arthroscopic hip surgery, despite receiving multimodal pharmacologic therapy, are presented. In both cases, ultrasound-guided femoral nerve block provided excellent analgesia. However, during ultrasound, significant anatomic changes were noted in the inguinal region. In this report, we describe anatomic changes in the inguinal region that are visible with ultrasound after hip arthroscopy.

PURPOSE: Infraorbital nerve block is used for intraoperative and postoperative analgesia in nasal and oral surgery procedures, as well as in the chronic pain settings. Ultrasound guidance has not been described in the literature. The aim of the study was to assess the quality of ultrasound imaging of the infraorbital foramen and develop an "in-plane" technique of the block using a skull model. METHODS: The infraorbital foramina were assessed on five skull models immersed in the water bath. Ultrasound-guided simulation of an in-plane infraorbital nerve block was then performed. Slightly curved needle was placed close to the foramina and its visibility was recorded. Success rate and time to locate infraorbital foramina, success rate and time to insert the needle close to the foramina under ultrasound and correlation between the ultrasound and caliper measurements were evaluated and recorded. Data for the left and right foramen were compared. RESULTS: The infraorbital foramina were successfully located using ultrasound in all 20 cases. Simulation of infraorbital nerve block was also successful in all measurements. The time difference between locating or simulating blockade of the left and right infraorbital foramina was not statistically significant. Correlation between ultrasound measurement and direct measurement using a caliper was satisfactory for the distances between the inferior orbital rim and the inferior margin of the infraorbital foramen but poor for the distances between the lower rim of the orbit and the superior margin of the foramen. CONCLUSIONS: This experimental study suggests that the infraorbital foramen is easily located using ultrasound and an "in-plane" ultrasound-guided technique for infraorbital nerve blockade is feasible on the model. PMID:23129265

Background Use of an infraclavicular block is appropriate for surgery of the upper limb. However, it does not consistently block the entire brachial plexus. The aim of this study was to investigate whether increasing the dose of ropivacaine could enhance the success rate, onset time, and efficacy of the sensory and motor block during the use of a vertical infraclavicular block using neurostimulation in upper limb surgery. Methods Two hundreds and ten patients were prospectively randomized into three groups: Group 1 (30 ml of 0.5% ropivacaine; n = 70), Group 2 (40 ml of 0.5% ropivacaine; n = 70), and Group 3 (40 ml of 0.75% ropivacaine; n = 70). Patients in each group received a vertical infraclavicular block using neurostimulation and obtained a distal motor response of the ulnar or median nerve. Recorded outcome measures included block success rate, onset time, sensory and motor blocks, and adverse events. Results No differences were found in the block success rate among the three groups (92.8%, 97.1%, and 94.2% for Groups 1, 2, and, 3, respectively; P = 0.346). There were no significant differences in onset time (P = 0.225) among groups, nor was there enhancement in the sensory block, but the motor block was enhanced. Local anesthetic toxicity was observed in five female patients from group 3 (P = 0.006). Conclusions Although the efficacy of the motor block was significantly improved, success rate, onset time, and efficacy of sensory block were not enhanced significantly among groups despite differences in volume and volume/concentration of the local anesthetic. PMID:18685942

The ability of the lectin, ricinus communis agglutinin I (ricin120), to undergo retrograde axonal transport and cause degeneration of neuronal cell bodies has been frequently exploited to establish the origin of peripheral axons. Since this cytotoxic action of ricin results from its inactivation of ribosomes, the retrogradely transported lectin was employed in the present study to inhibit protein synthesis in dorsal root ganglion (DRG) neurons whose axons project into the lumbar nerve trunk of bullfrog tadpoles. The procedure was developed to examine, during tadpole metamorphosis, the ratio of fast-transported radiolabeled protein accumulating at the proximal side of a nerve trunk ligature to the total newly synthesized protein in the cell bodies of origin. The relatively small diameter and fragility of the developing lumbar nerve trunks necessitated introduction of ricin by bath application to the cut nerve end rather than by intraneural injection. Consistent uptake of ricin was achieved by pretreatment with the phospholipase A2 inhibitor, mepacrine, that blocks resealing of severed nerve fibers. Optimal time and dosage of ricin were established by determining the maximal achievable inhibition of [35S]methionine into DRG protein. In stage XVI tadpoles, maximal inhibition of approximately to 65% was observed after 16 h incubation in 2.5 mg/ml ricin. As evidence that neuronal protein synthesis was effectively suppressed, there was no detectable anterograde axonal transport of [35S]protein subsequent to ricin treatment.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7534363

To assess the clinical potential and limitations of magnetic resonance imaging (MRI) in degenerative lumbar spinal diseases, the findings of MR imaging were compared with those of myelography and CT. The subjects were 80 patients with intervertebral disc herniation (46), spondylosis (28), degenerative spondylolisthesis (5), and spondylolysis (one). There was a good correlation between sagittal MRI (T1-weighted images) and myelography in measuring the anteroposterior diameter and the compression rate of the injured dural canal in all disease categories. However, MRI was inferior, irrespective of sagittal and coronal images, to myelography in detecting blocking of the dural canal and intradural findings such as redundant nerve roots. MRI was inferior to selective nerve root infiltration in visualizing the compression of the nerve root, irrespective of diseases; however, there was no difference in abnormal findings of the running of nerve root between the two modalities. Transverse MRI was superior to CT in visualizing the nerve root. Thus, MRI alone is insufficient for the diagnosis of degenerative lumbar spinal diseases, and the other modalities should be supplementary for pathophysiological understanding of these diseases. (N.K.).

Neuromuscular blocking agents have generally been avoided during intraoperative neurophysiological monitoring (IOM) where muscle responses to nerve stimulation or transcranial stimulation are monitored. However, a variety of studies and clinical experience indicate partial neuromuscular blockade is compatible with monitoring in some patients. This review presents these experiences after reviewing the currently used agents and the methods used to assess the blockade. A review was conducted of the published literature regarding neuromuscular blockade during IOM. A variety of articles have been published that give insight into the use of partial pharmacological paralysis during monitoring. Responses have been recorded from facial muscles, vocalis muscles, and peripheral nerve muscles from transcranial or neural stimulation with neuromuscular blockade measured in the muscle tested or in the thenar muscles from ulnar nerve stimulation. Preconditioning of the nervous system with tetanic or sensory stimulation has been used. In patients without neuromuscular pathology intraoperative monitoring using peripheral muscle responses from neural stimulation is possible with partial neuromuscular blockade. Monitoring of muscle responses from cranial nerve stimulation may require a higher degree of stimulation and less neuromuscular blockade. The role of tetanic or sensory conditioning of the nervous system is not fully characterized. The impact of neuromuscular pathology or the effect of partial blockade on monitoring muscle responses from spontaneous neural activity or mechanical nerve stimulation has not been described. PMID:23015366

Effects of substance P (SP) and selective tachykinin agonists on neurotransmission at guinea-pig intracardiac ganglia were studied in vitro. Voltage responses of neurons to superfused tachykinins and nerve stimulation were measured using intracellular microelectrodes. Predominant effects of SP (1 ?M) were to cause slow depolarization and enable synaptic transmission at low intensities of nerve stimulation. Augmented response to nerve stimulation occurred with 29 of 40 intracardiac neurons (approx. 73%). SP inhibited synaptic transmission at 23% of intracardiac neurons but also caused slow depolarization. Activation of NK3 receptors with 100 nM [MePhe7]neurokinin B caused slow depolarization, enhanced the response of many intracardiac neurons to low intensity nerve stimulation or local application of acetylcholine, and triggered action potentials independent of other stimuli in 6 of 42 neurons. The NK1 agonist [Sar9,Met(O2)11]SP had similar actions but was less effective and did not trigger action potentials independently. Neither selective agonist inhibited cholinergic neurotransmission. We conclude that SP can function as a positive or negative neuromodulator at intracardiac ganglion cells, which could be either efferent neurons or interneurons. Potentiation occurs primarily through NK3 receptors and may enable neuronal responses with less preganglionic nerve activity. Inhibition of neurotransmission by SP is most likely explained by the known blocking action of this peptide at ganglionic nicotine receptors.   

Cigarette smoking and nicotine enhance parotid saliva secretion, however, the underlying mechanism is unclear. To address the mechanism of nicotine-induced salivation and to explore the possibility that nicotinic receptor agonists act as sialogogues, we investigated the effects of nicotinic receptor agonists on salivary secretion in vivo and on intracellular Ca²+ concentration in digested parotid acini in vitro in rats. In urethane-anesthetized rats, intravenous administration of nicotinic receptor agonists, nicotine and cytisine, at 3 ?mol/kg increased whole saliva output accompanied by a pressor response with nicotine, but not with cytisine. Using Ca²+-imaging system on digested parotid acini in which autonomic nerve terminals were kept intact, nicotine and cytisine dose-dependently increased intracellular Ca²+ concentration at ?M level. This was not observed in single acinar cells containing no nerve terminal. The nicotine-induced Ca²+ response was largely blocked by a muscarinic receptor antagonist and partly blocked by an adrenergic receptor antagonist. Furthermore, the same nicotine-induced Ca²+ response was blocked by mecamylamine, a relatively selective nicotinic antagonist for ?3?4 subtype receptor, but not by other selective antagonists, dihydro-?-erythroidine for ?4-containing receptor and methyllycaconitine for ?7 nicotinic receptors. These results suggest that nicotinic agonists-induced salivation is due to a release of acetylcholine and noradrenaline from autonomic nerve terminals through activation of ?3?4 nicotinic receptor subtype. In addition, considering the blood pressure response and development of addiction with nicotine, cytisine may be a better therapeutic candidate to serve as a sialogogue for xerostomia patients. PMID:21300575

... obturator made which is a piece of plastic that can fit and close the hole, it’s a little ... palate. And then there are always corrective actions that can be done either through speech therapy, strengthening the ...

Nasal septal perforation may present with various symptoms: epistaxis, crusting, secondary infection, whistling and nasal obstruction. Perforation may be treated by conservative pharmacological treatment or closed by surgical approach. A useful alternative is mechanical obturation, achieved insertin...

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.

Two cases of arterial variation are described in which the obturator, inferior epigastric and medial circumflex femoral arteries arose from a common trunk from the external iliac artery. A possible ontogenetic explanation is provided.

The purpose of this study was to investigate how patients with maxillofacial defects evaluate their quality of life after maxillectomy and prosthodontic therapy with obturator prostheses. 43 patients were included in the study (25 female, 18 male). 31 (72%) patients completed a standardized questionnaire of 143 items and then answered additional questions in a standardized interview. Global quality of life after prosthodontic therapy with obturator prostheses was 64% (?22.9) on average. Functioning of the obturator prosthesis, impairment of ingestion, speech and appearance, the extent of therapy, and the existance of pain had significant impact on the quality of life (p < 0.005). Orofacial rehabilitation of patients with maxillofacial defects using obturator protheses is an appropriate tre...

IntroductionThere have been varied results from studies comparing postendodontic fracture resistance between teeth obturated with Resilon or gutta-percha. This study was performed to evaluate the fracture resistance of roots obturated by using Resilon (RealSeal sy-stem) or gutta-percha (with AH Plus sealer). MethodsEighty extracted human mandibular single-rooted premolars stored in 10% formalin were used in the study. They were prepared by using a crown-down technique, debrided with NaOCl, ethylenediaminetetraacetic acid, and sterile water and divided into 4 groups. Obturation was performed by using the lateral condensation method. The negative control group consisted of unfilled specimens, and the positive control group consisted of those obturated with flowable, dual-cure composite resin...

This study evaluated the leakage following in vitro gutta percha obturation of 60 root canals using 3 techniques, both with and without use of sealer. The techniques were: lateral condensation; warm (vertical) condensation; and the new mechanical compacti...

Object Transcranial MR-guided focused ultrasound surgery (MRgFUS) is evolving as a treatment modality in neurosurgery. Until now, the trigeminal nerve was believed to be beyond the treatment envelope of existing high-frequency transcranial MRgFUS systems. In this study, the authors explore the feasibility of targeting the trigeminal nerve in a cadaveric model with temperature assessments using computer simulations and an in vitro skull phantom model fitted with thermocouples. Methods Six trigeminal nerves from 4 unpreserved cadavers were targeted in the first experiment. Preprocedural CT scanning of the head was performed to allow for a skull correction algorithm. Three-Tesla, volumetric, FIESTA MRI sequences were performed to delineate the trigeminal nerve and any vascular structures of the cisternal segment. The cadaver was positioned in a focused ultrasound transducer (650-kHz system, ExAblate Neuro, InSightec) so that the focus of the transducer was centered at the proximal trigeminal nerve, allowing for targeting of the root entry zone (REZ) and the cisternal segment. Real-time, 2D thermometry was performed during the 10- to 30-second sonication procedures. Post hoc MR thermometry was performed on a computer workstation at the conclusion of the procedure to analyze temperature effects at neuroanatomical areas of interest. Finally, the region of the trigeminal nerve was targeted in a gel phantom encased within a human cranium, and temperature changes in regions of interest in the skull base were measured using thermocouples. Results The trigeminal nerves were clearly identified in all cadavers for accurate targeting. Sequential sonications of 25-1500 W for 10-30 seconds were successfully performed along the length of the trigeminal nerve starting at the REZ. Real-time MR thermometry confirmed the temperature increase as a narrow focus of heating by a mean of 10°C. Postprocedural thermometry calculations and thermocouple experiments in a phantom skull were performed and confirmed minimal heating of adjacent structures including the skull base, cranial nerves, and cerebral vessels. For targeting, inclusion of no-pass regions through the petrous bone decreased collateral heating in the internal acoustic canal from 16.7°C without blocking to 5.7°C with blocking. Temperature at the REZ target decreased by 3.7°C with blocking. Similarly, for midcisternal targeting, collateral heating at the internal acoustic canal was improved from a 16.3°C increase to a 4.9°C increase. Blocking decreased the target temperature increase by 4.4°C for the same power settings. Conclusions This study demonstrates focal heating of up to 18°C in a cadaveric trigeminal nerve at the REZ and along the cisternal segment with transcranial MRgFUS. Significant heating of the skull base and surrounding neural structures did not occur with implementation of no-pass regions. However, in vivo studies are necessary to confirm the safety and efficacy of this potentially new, noninvasive treatment. PMID:23157185

... Abducens palsy; Lateral rectus palsy; Vith nerve palsy; Cranial nerve VI palsy ... mononeuropathy VI is damage to the sixth cranial (skull) nerve. This nerve, also called the abducens nerve helps ...

We tested the hypothesis that a reduction in sympathetic tone to exercising forearm muscle would increase blood flow, reduce muscle acidosis, and attenuate reflex responses. Subjects performed a progressive, four-stage rhythmic handgrip protocol before and after forearm bier block with bretylium as forearm blood flow (Doppler) and metabolic (venous effluent metabolite concentration and (31)P-NMR indexes) and autonomic reflex responses (heart rate, blood pressure, and sympathetic nerve traffic) were measured. Bretylium inhibits the release of norepinephrine at the neurovascular junction. Bier block increased blood flow as well as oxygen consumption in the exercising forearm (P bretylium bier block. The results support the conclusion that sympathetic stimulation to muscle during exercise not only limits muscle blood flow but also appears to limit anaerobiosis and H(+) release, presumably through a preferential recruitment of oxidative fibers.

Background The dorsal nerve block of the penis during circumcision has not been standardized and the effectiveness of the block can be changeable. The aim of this study was to determine which technique is more suitable for blocking sensory innervations of penis. Methods This prospective study was done on adults who voluntarily applied to be circumcised. Patients were randomized into three distinctive groups; first, just circular infiltration; second, circular plus dorsal penile infiltration; and third, circular plus ventral upward infiltration. Sensation was tested using pinprick sensory testing before and after infiltration. The total duration of the procedure was recorded. Results In total, 89 adult uncircumcised men were included into the study. The average age of men was 21.4 (min: 20;...

It could append that patient pain relief in palliative care is not achieved despite the use of opioids and the multimodal approach. Therefore, regional techniques are used in the palliative care unit of the Limoges University Hospital since four years. Patients and methods: From October 2006 to September 2010, every patient under regional technique was followed with a specific form. The items collected were demographic characteristics, underlying disease, and associated treatments. The efficacy of regional techniques on pain was scored. Results: Sixty-three patients, 39 males and 24 females, mean age 59 years, were treated by 104 regional procedures. There were 49 neuroaxial analgesia (40 spinal and nine epidural), 39 peripheral nerve blocks including 25 iliofascial blocks and 16 blocks fo...

IntroductionThe purpose of these 2 prospective, randomized, single-blind studies was to determine the anesthetic efficacy of lidocaine with epinephrine compared with a combination lidocaine with epinephrine plus 0.5 mol/L mannitol for inferior alveolar nerve (IAN) blocks in patients experiencing symptomatic irreversible pulpitis. MethodsIn study one, 55 emergency patients randomly received IAN blocks by using a 3.18-mL formulation containing 63.6 mg of lidocaine with 31.8 mg epinephrine or a 5-mL formulation containing 63.6 mg of lidocaine with 31.8 mg epinephrine (3.18 mL) plus 1.82 mL of 0.5 mol/L mannitol. In study two, 51 emergency patients randomly received IAN blocks by using a 1.9-mL formulation containing 76.4 mg of lidocaine with 36 mg epinephrine or a 3-mL formulation containing ...

Ptychodiscus brevis, which causes Florida red tide, produces Ptychodiscus brevis toxin (PBTX) known to contain neurotoxins and to induce rhinorrhea, tearing, and cough in normal humans and wheezing in asthmatic subjects. It was previously reported (J Allergy Clin Immunol 69:418, 1982; 73:824, 1984) that PBTX causes canine tracheal smooth muscle contraction via stimulation of sodium channels in the axons of parasympathetic postganglionic nerves and the release of acetylcholine from these nerve endings. This was postulated to be an asthma-triggering mechanism. In this article the toxins were evaluated to determine if they also stimulate sodium channels on adrenergic nerve endings and release norepinephrine. Rat vas deferens was selected as the experimental tissue. Both PBTX and norepinephrine contracted rat vas deferens. Prazosin 10(-6) mol/L blocked the response to PBTX (3 micrograms/ml) (88.3% to 27.3% contraction [n = 6; p less than 0.001]) and the response to norepinephrine (EC50 was shifted from 1.67 X 10(-6) mol/L to 1.25 X 10(-4) mol/L in the presence of prazosin 10(-6) mol/L [n = 6; p less than 0.001]). Phentolamine 10(-6) mol/L also blocked both PBTX and norepinephrine. Tetrodotoxin 10(-7) mol/L, a sodium channel blocker, completely blocked the response to PBTX but not to norepinephrine. The response to PBTX was significantly reduced from 1.53 gm of tension in controls to 0.29 gm of tension (n = 6; p = 0.002) in tissues obtained from rats pretreated with reserpine (2 mg/kg per day for 2 days, injected intraperitoneally). Verapamil 10(-5) mol/L blocked the PBTX response, and PBTX caused no contraction in calcium-free media.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:4040140

The aim of this work was to explain the reasons of two unsuccessful blocks of sciatic nerve even if anaesthetic solution was injected through insulated needle on elicited twitch. The clinical cases were two outpatients undergoing diagnostic arthroscopy of knee under anaesthetic block of sciatic and femoral nerves. In both patients, the muscular twitch appeared when the ischiatic bone was kept in unexpected touch with needle tip. In spite of the attempt to locate correctly the needle (the touch with bone means that the nerve is not in front of the needle tip), the injection of anaesthetic solution was unsuccessful. In clinical environment, when electroinsulated needles gathered total amount of administered current on the needle tip, it was not possible to elicit a twitch just at the moment of touch of the needle with the bone. Referred events disagree with some experimental works performed out of clinical environment, which found that total amount of administered current through an insulated needle gathers always in front of the tip. Our clinical observations seems to confirm an electrolocation mistake called "electrical shadow". The ability of sheathed needles to work as occasional capacitor due to the alternation of two conductor layers (needle shaft and tissue) and of a dielectric (coating material) can explain some missing electrolocations, as the appearance of electric fields within dielectric needle sheathing. PMID:10479843

Objective. To investigate the use of MR imaging in the characterization of denervated muscle of the shoulder correlated with electrophysiologic studies.Design and patients. We studied with MR imaging five patients who presented with shoulder weakness and pain and who underwent electrophysiologic studies. On MR imaging the distribution of muscle edema and fatty infiltration was recorded, as was the presence of masses impinging on a regional nerve.Results. Acute/subacute denervation was best seen on T2-weighted fast spin-echo images with fat saturation, showing increased SI related to neurogenic edema. Chronic denervation was best seen on T1-weighted spin-echo images, demonstrating loss of muscle bulk and diffuse areas of increased signal intensity within the muscle. Three patients showed MR imaging and electrophysiologic findings of Parsonage Turner syndrome. One patient demonstrated an arteriovenous malformation within the spinoglenoid notch, impinging on the suprascapular nerve with associated atrophy of the infraspinatus muscle. The fifth patient demonstrated fatty atrophy of the teres minor muscle caused by compression by a cyst of the axillary nerve and electrophysiologic findings of an incomplete axillary nerve block.Conclusion. MR imaging is useful in detecting and characterizing denervation atrophy and neurogenic edema in shoulder muscles. MR imaging can provide additional information to electrophysiologic studies by estimating the age (acute/chronic) and identifying morphologic causes for shoulder pain and atrophy. (orig.)

Adenosine triphosphate is released into the synaptic cleft of the neuromuscular junction during normal synaptic transmission, and in much greater quantities following injury and ischaemia. There is much data to suggest roles for presynaptic P2 receptors but little to demonstrate which specific receptor subunits are present. Here we show P2X7 receptor subunits on presynaptic motor nerve terminals from birth, but no evidence for P2X1, P2X2, P2X3, P2X4, P2X5 or P2X6 receptor subunits. Further, P2X receptor subunits are present as multimeric, membrane-inserted receptors. A selective agonist, 2'-3'-O-(4-benzoylbenzoyl)-adenosine 5'-triphosphate (BzATP: 100 microM), triggers vesicle release from motor nerve terminals, which is blocked by P2X7RS-specific concentrations of periodate oxidised ATP (OxATP: 100 microM) and brilliant blue G (BBG: 1 microM), but not by suramin (100 microM). Vesicle release is enhanced in the absence of extracellular divalent cations and occurs through activation of the ion channel and not any associated large pore, as we failed to label nerve terminals with large membrane-impermeant molecules after addition of BzATP. We conclude that a P2X7-like receptor is present at mouse motor nerve terminals, and that their activation promotes vesicle release. PMID:15713258

There is no data about whether botulinum neurotoxin inhibits the parasympathetic ganglionic neurotransmission in the heart, although botulinum toxin as a clinical drug inhibits the release of acetylcholine at the neuromuscular junction. Therefore, we investigated whether botulinum toxin (type A) injected into the sinoatrial (SA) fat pad inhibits decreases in heart rate induced by stimulation of the preganglionic parasympathetic nerves in the heart of the anesthetized dog. Stimulation of the parasympathetic nerves in the SA fat pad (SAP stimulation) prolonged the atrial interval but not the atrioventricular (AV) interval, and cervical vagus nerve stimulation (CV stimulation) prolonged both atrial and AV intervals. After botulinum toxin (20 or 25 mouse units) was injected into the SA fat pad, it gradually inhibited the prolongation of the atrial interval evoked by SAP and CV stimulations but not the prolongation of the AV interval evoked by CV stimulation. Conditioning successive stimulation of the cervical vagus nerves accelerated the inhibition by botulinum toxin of the chronotropic response to CV stimulation. These results indicate that selective injection of botulinum toxin into the SA fat pad blocks bradycardia mediated by parasympathetic ganglionic activation in the dog heart.   

Abstract in portuguese A artéria obturatória é muitas vezes um ramo da divisão anterior da artéria ilíaca interna. Ela tem chamado atenção de cirurgiões pélvicos, anatomistas e radiologistas devido à alta freqüência de variações em seu trajeto e origem. A veia obturatória é geralmente descrita como uma tributária de veia ilíaca interna. Durante aulas de dissecação para estudantes de medicina, observamos a artéria obturatória surgindo a partir da artéria ilíaca externa, (more) veia obturatória drenando para a veia ilíaca externa, veia comunicante entre a veia obturatória e a veia ilíaca externa e artéria epigástrica inferior surgindo a partir da artéria obturatória. Os vasos obturatórios anômalos e a artéria epigástrica inferior no presente caso podem se encontrar em situação perigosa em cirurgias pélvicas que exigem dissecação ou suturas ao longo da borda pélvica. Discutem-se as causas de desenvolvimento e a significância clínica das variações. Abstract in english 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 (more) into external iliac vein, communicating vein between obturator vein and external iliac vein and inferior epigastric artery arising from the obturator artery. The anomalous obturator vessels and inferior epigastric artery in the present case may be in a dangerous situation in pelvic surgeries that require dissection or suturing along the pelvic rim. Developmental reasons and clinical significances of the variations are discussed.

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

Objective: The composite effects of organophosphorus (OP)-cholinesterase (ChE) inhibitors and oximes on the actions of nondepolarizing neuromuscular blockers in acute OP-ChE inhibitor intoxication have not been evaluated in detail. We investigated the effects of paraoxon (Pox) (an OP-ChE inhibitor) and pralidoxime (PAM) (an oxime) on the nondepolarizing neuromuscular blocking action of rocuronium. Methods: Isometric twitch tensions of rat left phrenic nerve-hemidiaphragm preparations elicited by indirect (phrenic nerve) supramaximal stimulation at 0.1 Hz were evaluated. Analysis of variance with post hoc testing was used for statistical comparison, and P 50], 9.84 [9.64-10.04] mM, mean [95% confidence interval]) and all pretreated diaphragms (P 50, 15.48 [15.24-15.72] mM). The rightward sh...

Objective: Lumbar spinal stenosis (LSS) is a chronic degenerative disease with pain in the back, buttocks and legs aggrevated by walking and relieved after rest without associated vascular disease of lower extremities observed in patients between 50 and 60years. Several studies, using different methods indicated an association between slowing or blocking of root-nerve conduction and LSS. None of the previous research had applied the more conceivable methods such as recording the cauda equina potentials from the lumbar level or stimulating the spinal roots within the canal using either leg nerves or muscles. In this study, electrical lumbar laminar stimulation was used to demonstrate prolongation of cauda equina motor conduction time in lumbar spinal stenosis. Methods: Twenty-one LSS patien...

This study tests the null hypothesis that there is no difference between sciatic nerve block (SNB) and periarticular anesthetic infiltration (PI) as adjuncts to femoral nerve blockade (FNB) in total knee arthroplasty in terms of postoperative opioid requirements. Fifty-two patients undergoing total knee arthroplasty were randomized to receive either (a) combined FNB-SNB or (b) combined FNB-PI. Average morphine consumption in the first 24 (20 vs 23 mg) and 48 hours (26 vs 33 mg) showed no significant difference. Visual Analogue Scale scores, knee flexion (60^o vs 67.5^o) and extension lag (0^o vs 5^o) were comparable. Anesthetic time, surgical time, and length of hospital stay (5.5 vs 6 days) were similar. This study showed no significant difference between the 2 groups. The PI offers a pra...

The ultrasound-guided superficial cervical plexus (SCP) block may be useful for providers in emergency care settings who care for patients with injuries to the ear, neck, and clavicular region, including clavicle fractures and acromioclavicular dislocations. The SCP originates from the anterior rami of the C1-C4 spinal nerves and gives rise to 4 terminal branches-greater auricular, lesser occipital, transverse cervical, and suprascapular nerves-that provide sensory innervation to the skin and superficial structures of the anterolateral neck and sections of the ear and shoulder. Here we describe an ultrasound-guided technique for blockade of the SCP that is potentially well suited to emergency care settings. We present the first case description of its successful use to manage pain for a pa...

Poisoning via organophosphorus (OP) nerve agents occurs when the OP binds and inhibits the enzyme acetylcholinesterase (AChE). This enzyme is responsible for the metabolism of the neurotransmitter acetylcholine (ACh) which transmits signals between nerves and several key somatic regions. When AChE is inhibited, the signal initiated by ACh is not properly terminated. Excessive levels of ACh result in a cholinergic crisis, and in severe cases can lead to death. Current treatments for OP poisoning involve the administration of atropine, which blocks ACh receptors, and oximes, which reactivate AChE after inhibition. Efforts to improve the safety, efficacy, and broad spectrum utility of these treatments are ongoing and usually require the use of appropriate animal model systems. For OP poisonin...

Polymersomes are nanosized vesicles formed from amphiphilic block copolymers, and have been identified as potential drug delivery vehicles to the inner ear. The aim of this study was to provide targeting to specific cells within the inner ear by functionalizing the polymersome surface with Tet1 peptide sequence. Tet1 peptide specifically binds to the trisialoganglioside clostridial toxin receptor on neurons and was expected to target the polymersomes toward the cochlear nerve. The Tet1 functionalized PEG-b-PCL polymersomes were administered using routine drug delivery routes: transtympanic injection and cochleostomy. Delivery via cochleostomy of Tet1 functionalized polymersomes resulted in cochlear nerve targeting; in contrast this was not seen after transtympanic injection. PMID:22403485

Abstract Cocaine was brought to Europe after the discovery of America. In the 19th century, the active component of coca leaves, named cocaine, was extracted and several researchers started experimenting with the substance, describing many physiological and pathological effects of its action. The first scholar to practically demonstrate the possibility of using cocaine solution in medicine, mostly ophthalmology, was Carl Koller. Following this remarkable achievement cocaine became the substance most frequently applied for different types of anaesthesia. Halsted and Hall reported the first successful nerve block of the interior dental nerve with 4% cocaine solution. In 1892, Schleich published the results of his studies in which he used a 0.1-0.2% solution of cocaine hydrochloride intra- an...