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1

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

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

?brahim Tekdemir

2011-06-01

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CT-guided obturator nerve block via the posterior approach  

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

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CT-guided obturator nerve block via the posterior approach  

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

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

2006-04-15

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

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

Ayman I Tharwat

2011-02-01

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Efficacy of ultrasound-guided obturator nerve block in transurethral surgery  

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

Thallaj Ahmed

2011-01-01

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

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

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

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

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

2001-06-01

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

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

?ulafi? Slobodan

2008-01-01

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

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

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

2014-01-01

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

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

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

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

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

2014-09-01

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

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

Karl Otto Geier

2003-08-01

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

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

Karl Otto, Geier.

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What Are Nerve Blocks for Headache?  

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... blocks for headache? Print Email What are nerve blocks for headache? ACHE Newsletter Sign up for our ... your e-mail address below. What are nerve blocks for headache? A nerve block is the injection ...

15

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

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

Joern William-Patrick Michael

2011-03-01

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

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

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

2014-02-01

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Electrical nerve stimulation for peripheral nerve block under ultrasound guidance  

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Background: The use of nerve stimulation to identify the ideal injection point for peripheral nerve blocks has been very common in regional anesthesia. However, ultrasound guidance is increasingly being used as an alternative. The ideal injection point is defined for the needle tip to be as close as possible to the nerve. We examined nerve stimulation under ultrasound-guided nerve blocks. Additionally we tried to quantify the effect of D5%-Solution on nerve stimulation. Methods: Afte...

Ocken, Michele

2011-01-01

18

Intraoral second division nerve block.  

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The second division of the trigeminal nerve can be easily blocked by the intraoral route. The technique presented involves entering the greater palatine foramen, traversing the pterygopalatine canal with a needle, and depositing the local anesthetic solution into the superior aspect of the pterygopalatine fossa, where the trunk of the second division lies after the nerve exits the foramen rotundum. The indications, contraindications, technique, and anatomic considerations are presented. This is followed by a discussion of the possible complications as well as their prevention and remedy should they occur. While this is not a new technique, it as been a forgotten one. PMID:284271

Mercuri, L G

1979-02-01

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Iliac compartment block following ilioinguinal iliohypogastric nerve block.  

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Transient femoral nerve palsy is a known complication associated with percutaneous ilioinguinal iliohypogastric nerve block. Excess volume and higher concentrations of local anesthetic have been implicated for transient femoral nerve palsy. We encountered partial iliac compartment block involving lateral cutaneous nerve of the thigh and femoral nerve with a lower concentration (0.25%) of bupivacaine administered in the smallest indicated volume of 0.25 ml.kg-1 using a double-shot technique. PMID:16972842

Shivashanmugam, Thiayagarajan; Kundra, Pankaj; Sudhakar, Subramani

2006-10-01

20

A triplicate obturator foramen.  

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The obturator foramen is a large opening in the hip bone situated below and anterior to the acetabulum. The obturator foramen is enclosed by the obturator membrane, apart from the part above near the obturator groove, where the obturator vessels and nerve pass through. The present study reports multiple openings in the obturator foramen detected incidentally in a left hip bone specimen and discusses its clinical implications. To the best of our knowledge, the occurrence of multiple openings associated with the obturator foramen is rare and has not been reported in any standard textbook of anatomy or in any research study. Anatomical knowledge of the presence of such anomalies may be clinically important for radiologists interpreting skiagrams and surgeons performing operative procedures in the hip region. PMID:16773608

Das, S; Suri, R; Kapur, V

2006-05-01

 
 
 
 
21

Peripheral nerve blocks in pediatric anesthesia  

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

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

2009-01-01

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Peripheral nerve blocks in pediatric anesthesia  

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

Novakovi? Dejan

2009-01-01

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

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Objective. Kilohertz frequency alternating current (KHFAC) waveforms have been shown to provide peripheral nerve conductivity block in many acute and chronic animal models. KHFAC nerve block could be used to address multiple disorders caused by neural over-activity, including blocking pain and spasticity. However, one drawback of KHFAC block is a transient activation of nerve fibers during the initiation of the nerve block, called the onset response. The objective of this study is to evaluate the feasibility of using charge balanced direct current (CBDC) waveforms to temporarily block motor nerve conductivity distally to the KHFAC electrodes to mitigate the block onset-response. Approach. A total of eight animals were used in this study. A set of four animals were used to assess feasibility and reproducibility of a combined KHFAC + CBDC block. A following randomized study, conducted on a second set of four animals, compared the onset response resulting from KHFAC alone and combined KHFAC + CBDC waveforms. To quantify the onset, peak forces and the force-time integral were measured during KHFAC block initiation. Nerve conductivity was monitored throughout the study by comparing muscle twitch forces evoked by supra-maximal stimulation proximal and distal to the block electrodes. Each animal of the randomized study received at least 300 s (range: 318-1563 s) of cumulative dc to investigate the impact of combined KHFAC + CBDC on nerve viability. Main results. The peak onset force was reduced significantly from 20.73 N (range: 18.6-26.5 N) with KHFAC alone to 0.45 N (range: 0.2-0.7 N) with the combined CBDC and KHFAC block waveform (p < 0.001). The area under the force curve was reduced from 6.8 Ns (range: 3.5-21.9 Ns) to 0.54 Ns (range: 0.18-0.86 Ns) (p < 0.01). No change in nerve conductivity was observed after application of the combined KHFAC + CBDC block relative to KHFAC waveforms. Significance. The distal application of CBDC can significantly reduce or even completely prevent the KHFAC onset response without a change in nerve conductivity.

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

2014-10-01

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An elderly woman with obstructed obturator hernia: a less common variety of external abdominal hernia.  

Science.gov (United States)

Obturator hernia is a type of external abdominal hernia. Site of hemiation is the obturator canal, which is the superolateral aspect of the obturator foramen. The herniation sac exits the pelvis near the obturator nerve and vessels. Herniated loops of small bowel extend between the pectineus and obturator muscles. In this report, we present a case of obstructed obturator hernia. PMID:21381527

De Clercq, L; Coenegrachts, K; Feryn, T; Van Couter, A; Vandevoorde, R; Verstraete, K; Rigauts, H

2010-01-01

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Occipital Nerve Block for Surgery on the Posterior Scalp  

Directory of Open Access Journals (Sweden)

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

Saad Mohammad

2013-01-01

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

DEFF Research Database (Denmark)

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

Ehlers, L; Jensen, J M

2012-01-01

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Different clinical electrodes achieve similar electrical nerve conduction block  

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

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

2013-10-01

28

Obturator Hernia  

International Nuclear Information System (INIS)

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

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High frequency electrical conduction block of the pudendal nerve  

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

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

2006-01-01

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The successful use of peripheral nerve blocks for femoral amputation  

DEFF Research Database (Denmark)

We present a case report of four patients with severe cardiac insufficiency where peripheral nerve blocks guided by either nerve stimulation or ultrasonography were the sole anaesthetic for above-knee amputation. The patients were breathing spontaneously and remained haemodynamically stable during surgery. Thus, use of peripheral nerve blocks for femoral amputation in high-risk patients seems to be the technique of choice that can lower perioperative risk Udgivelsesdato: 2009/2

Bech, B.; Melchiors, J.

2009-01-01

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Workflow in interventional radiology: nerve blocks and facet blocks  

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Workflow analysis has the potential to dramatically improve the efficiency and clinical outcomes of medical procedures. In this study, we recorded the workflow for nerve block and facet block procedures in the interventional radiology suite at Georgetown University Hospital in Washington, DC, USA. We employed a custom client/server software architecture developed by the Innovation Center for Computer Assisted Surgery (ICCAS) at the University of Leipzig, Germany. This software runs in an internet browser, and allows the user to record the actions taken by the physician during a procedure. The data recorded during the procedure is stored as an XML document, which can then be further processed. We have successfully gathered data on a number if cases using a tablet PC, and these preliminary results show the feasibility of using this software in an interventional radiology setting. We are currently accruing additional cases and when more data has been collected we will analyze the workflow of these procedures to look for inefficiencies and potential improvements.

Siddoway, Donald; Ingeholm, Mary Lou; Burgert, Oliver; Neumuth, Thomas; Watson, Vance; Cleary, Kevin

2006-03-01

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High frequency electrical conduction block of the pudendal nerve  

Science.gov (United States)

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

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

2006-06-01

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Essential regional nerve blocks for the dermatologist: Part 2.  

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Following on from Part 1 of the series (regional nerve blocks for the face and scalp), we guide the clinician through the anatomy and cutaneous innervation of the digits, wrist and ankle, providing a practical step-by-step guide to regional nerve blockade of these areas. PMID:25394292

Davies, T; Karanovic, S; Shergill, B

2014-12-01

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The effect of age on sciatic nerve block duration.  

Science.gov (United States)

The physiologic changes that occur with advancing age and their effect on the duration of peripheral nerve blocks have yet to be defined. We prospectively studied the duration of sciatic nerve block using mepivacaine in younger and older patients. Eighty ASA physical status I-III patients, aged 18-35 (n = 40) or 55-80 (n = 40) yr, having outpatient knee arthroscopy with a femoral block and a standardized sciatic nerve block were enrolled; 37 in each group completed the study. All patients received a Labat sciatic nerve block using 20 mL of 1.0% mepivacaine with 0.1 mEq/mL sodium bicarbonate and 1:400,000 (2.5 microg/mL) epinephrine and a femoral nerve block. The duration of sensory block (sensation of pinprick, temperature, and vibration), motor block (plantar and dorsi flexion), and complete sensory and motor block in the sciatic nerve distribution of the operative extremity were measured. The time for complete return of both sensory and motor function was longer in the older group, 329 +/- 47 min compared with 306 +/- 46 min (mean +/- sd) in the younger group (P = 0.04). The difference was small under the conditions of this study and would not be perceived clinically. Age also increased the time to return of vibratory sensation (younger = 292 +/- 58 min, older = 257 +/- 50 min; P = 0.007). The other measurements did not differ between groups. We conclude that age may affect peripheral nerve blocks and that more investigation is needed to determine the pharmacologic, physiologic, and chronologic factors behind these findings. PMID:16428567

Hanks, R Kyle; Pietrobon, Ricardo; Nielsen, Karen C; Steele, Susan M; Tucker, Marcy; Warner, David S; King, Kathryn P; Klein, Stephen M

2006-02-01

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

Science.gov (United States)

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

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

2014-01-01

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

DEFF Research Database (Denmark)

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

Nielsen, Zbigniew Jerzy Koscielniak

2008-01-01

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Bowel hematoma following an iliohypogastric-ilioinguinal nerve block.  

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We report a case of a subserosal small bowel hematoma following an ilioinguinal-iliohypogastric nerve block for an appendicectomy in a 6-year-old girl. The bowel hematoma was noted in the wall of the terminal ileum after opening the peritoneum. The hematoma was nonobstructing and the child remained asymptomatic. We discuss the technical aspects of this block. PMID:16918666

Frigon, Chantal; Mai, Ryan; Valois-Gomez, Teresa; Desparmet, Joëlle

2006-09-01

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Ultrasound vs nerve stimulation multiple injection technique for posterior popliteal sciatic nerve block.  

Science.gov (United States)

In this prospective, randomised, observer-blinded study we evaluated whether ultrasound guidance can shorten the onset time of popliteal sciatic nerve block as compared to nerve stimulation with a multiple injection technique. Forty-four ASA I-III patients undergoing posterior popliteal sciatic nerve block with 20 ml of 0.75% ropivacaine were randomly allocated to nerve stimulation or ultrasound guided nerve block. A blinded observer recorded onset of sensory and motor blocks, success rates, the need for fentanyl intra-operatively, the requirement for general anaesthesia, procedure-related pain, patient satisfaction and side-effects. Onset times for sensory and motor blocks were comparable. The success rate was 100% for ultrasound guided vs 82% for nerve stimulation (p = 0.116). Ultrasound guidance reduced needle redirections (p = 0.01), were associated with less procedural pain (p = 0.002) and required less time to perform (p = 0.002). Ultrasound guidance reduced the time needed for block performance and procedural pain. PMID:19453318

Danelli, G; Fanelli, A; Ghisi, D; Moschini, E; Rossi, M; Ortu, A; Baciarello, M; Fanelli, G

2009-06-01

39

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

Science.gov (United States)

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

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

2014-01-01

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A checklist for performing regional nerve blocks.  

Science.gov (United States)

Regional blocks are frequently invasive procedures that create the risk of infection, local anesthetic toxicity, and wrong-site performance. National guidelines have been developed by the Joint Commission and the American Society of Regional Anesthesia and Pain Medicine (ASRA) to reduce the potential for each of these risks. Checklists have been shown to reduce errors and complications in medicine: it seems prudent to incorporate the recommended safety steps into a formalized checklist to be reviewed before performance of a regional block. A task force appointed by the ASRA President reviewed available resources and recommendations and performed a survey of RAPM members at the ASRA annual meeting in May 2013 and proposed a 9-point checklist to fulfill this role. Although it is apparent that local modification will be needed, the basic points and principles should be adopted for the performance of regional blocks. PMID:24718017

Mulroy, Michael F; Weller, Robert S; Liguori, Gregory A

2014-01-01

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

Directory of Open Access Journals (Sweden)

Full Text Available Nerve blocks are common procedures used to remove sensation from a specific region of the body via injection of local anesthetic. Ultrasound-guided nerve blocks are common-place in anesthesia, but require specialized training and advanced bi-manual dexterity. This paper describes a system designed to robotically assist in ultrasound-guided nerve blocks. Robot-assisted nerve blocks could allow for more precise needle placement, and therefore a higher efficacy of blocks. This system is the first step in developing a completely automated nerve block system, which would also require the incorporation of ultrasound image recognition of nerves and other physiological markers.

Joshua Morse

2013-06-01

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Development of Phantom Limb Pain after Femoral Nerve Block  

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Historically, phantom limb pain (PLP) develops in 50–80% of amputees and may arise within days following an amputation for reasons presently not well understood. Our case involves a 29-year-old male with previous surgical amputation who develops PLP after the performance of a femoral nerve block. Although there have been documented cases of reactivation of PLP in amputees after neuraxial technique, there have been no reported events associated with femoral nerve blockade. We base our discussion on the theory that symptoms of phantom limb pain are of neuropathic origin and attempt to elaborate the link between regional anesthesia and PLP. Further investigation and understanding of PLP itself will hopefully uncover a relationship between peripheral nerve blocks targeting an affected limb and the subsequent development of this phenomenon, allowing physicians to take appropriate steps in prevention and treatment. PMID:24872817

Sifonios, Anthony N.; Martinez, Marc E.; Eloy, Jean D.; Kaufman, Andrew G.

2014-01-01

43

PHRENIC NERVE PALSY AFTER SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK  

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

Gupta A K

2009-09-01

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Simulation of spinal nerve blocks for training anesthesiology residents  

Science.gov (United States)

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

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

1998-06-01

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Nerve Conduction Block Using Combined Thermoelectric Cooling and High Frequency Electrical Stimulation  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Conduction block of peripheral nerves is an important technique for many basic and applied neurophysiology studies. To date, there has not been a technique which provides a quickly initiated and reversible “on-demand” conduction block which is both sustainable for long periods of time and does not generate activity in the nerve at the onset of the conduction block. In this study we evaluated the feasibility of a combined method of nerve block which utilizes two well established nerve bloc...

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

2010-01-01

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

Science.gov (United States)

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

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

2012-11-01

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

Directory of Open Access Journals (Sweden)

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

Achir A. Al-Alami

2013-07-01

48

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

DEFF Research Database (Denmark)

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

Rothe, C; Lund, J

2012-01-01

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CT-guided suprascapular nerve blocks: a pilot study  

International Nuclear Information System (INIS)

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

50

Bony spurs projecting in the obturator foramen.  

Science.gov (United States)

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

Singh, R

2012-05-01

51

Long-term use of nerve block catheters in paediatric patients with cancer related pathologic fractures.  

Science.gov (United States)

We report three cases of children with osteosarcoma and pathologic fractures treated with long-term continuous nerve blocks for preoperative pain control. One patient with a left distal femoral diaphysis fracture had a femoral continuous nerve block catheter for 41 days without complications. Another with a fractured left proximal femoral shaft had three femoral continuous nerve block catheters for 33, 26 and 22 days respectively. The third patient, whose right proximal humerus was fractured, had a brachial plexus continuous nerve block catheter for 36 days without complication. In our experience, prolonged use of continuous nerve block is safe and effective in children with pathologic fractures for preoperative pain control. PMID:22813501

Burgoyne, L L; Pereiras, L A; Bertani, L A; Kaddoum, R N; Neel, M; Faughnan, L G; Anghelescu, D L

2012-07-01

52

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

DEFF Research Database (Denmark)

We present a case of a sciatic nerve block performed with the nerve stimulation technique. This technique is normally not used in amputees because detection of a motor response to an electrical stimulation is impossible. In our patient the stimulation provoked a phantom sensation of movement in the non-existing extremity. This sensation was verbally described by the patient and thus used as an alternative to visual identification of motor response. After surgery the patient was pain free. The technique thus presents an alternative method for anesthesia and perioperative pain management in a high-risk group of patients Udgivelsesdato: 2008/2/4

Heiring, C.; Kristensen, Billy

2008-01-01

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Continuous peripheral nerve blocks: a review of the published evidence.  

Science.gov (United States)

A continuous peripheral nerve block, also termed "perineural local anesthetic infusion," involves the percutaneous insertion of a catheter adjacent to a peripheral nerve, followed by local anesthetic administration via the catheter, providing anesthesia/analgesia for multiple days or even months. Continuous peripheral nerve blocks may be provided in the hospital setting, but the use of lightweight, portable pumps permits ambulatory infusion as well. This technique's most common application is providing analgesia after surgical procedures. However, additional indications include treating intractable hiccups; inducing a sympathectomy and vasodilation to increase blood flow after a vascular accident, digit transfer/replantation, or limb salvage; alleviating vasospasm of Raynaud disease; and treating peripheral embolism and chronic pain such as complex regional pain syndrome, phantom limb pain, trigeminal neuralgia, and cancer-induced pain. After trauma, perineural infusion can provide analgesia during transportation to a distant treatment center, or while simply awaiting surgical repair. Catheter insertion may be accomplished using many possible modalities, including nerve stimulation, ultrasound guidance, paresthesia induction, fluoroscopic imaging, and simple tactile perceptions ("facial click"). Either a nonstimulating epidural-type catheter may be used, or a "stimulating catheter" that delivers electrical current to its tip. Administered infusate generally includes exclusively long-acting, dilute, local anesthetic delivered as a bolus only, basal only, or basal-bolus combination. Documented benefits appear to be dependent on successfully improving analgesia, and include decreasing baseline/breakthrough/dynamic pain, supplemental analgesic requirements, opioid-related side effects, and sleep disturbances. In some cases, patient satisfaction and ambulation/functioning may be improved; an accelerated resumption of passive joint range-of-motion realized; and the time until discharge readiness as well as actual discharge from the hospital or rehabilitation center achieved. Lastly, postoperative joint inflammation and inflammatory markers may be decreased. Nearly all benefits occur during the infusion itself, but several randomized controlled trials suggest that in some situations there are prolonged benefits after catheter removal as well. Easily rectified minor complications occur somewhat frequently, but major risks including clinically relevant infection and nerve injury are relatively rare. This article is an evidence-based review of the published literature involving continuous peripheral nerve blocks. PMID:21821511

Ilfeld, Brian M

2011-10-01

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Computerized tomography-guided neurolytic splanchnic nerve block  

International Nuclear Information System (INIS)

Computerized tomography-guided neurolytic splanchnic nerve block is a technique for relieving abdominal cancer pain; the goal is the alcoholic neurolytic interruption of the sensitive structures in retroperitoneal space. Computerized tomography yields accurate anatomical detailing and the course for needle placement and alcohol spread. January, 1993, to July, 1996, twenty-one bilateral splanchnic nerve blocks were performed through the posterior access. Forty-eight hours after alcoholism. 14 patients (66%) had complete pain regression; 52% of the patients needed no analgesics for 6 to 54 days and only 9 patients (42%) needed another low opioid therapy. Complications included hypotension and diarrhea in all cases. One had a cardiac arrest and diet 8 days after the procedure. There were no other complications. The whole procedure usually lasted 60 min (range: 45 to 90 min). Splanchnic nerve neurolysis is a useful treatment in the patients with severe chronic abdominal pain. It is used as a second line treatment when large lesions change celia anatomy and complicate the percutaneous block of the celiac plexus. Endosulfan, Malathion and Methyl parathion, on the metabolic rate of the estuarine clam, Villorita cyprinoides var. cochinensis, have been investigated. The animals exposed to the lower sublethal concentrations of Endosulfan, Malthion and Methyl parathion consumed oxygen at the rate of 1.60, 1.98 and 2.09 ml. 02 g- 1 h-1 respectively, while at the higher concentrations of the pesticides, consumption of oxygen by the animal dropped to nearly half the control value. When compared to Malathion and Methyl parathion. Endosulfan induced animals recorded a greater reduction in her percentage deviation (from control) of oxygen consumption, possibly due to hypoxia induced by the pollutants

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Combination of spinal anesthesia and peripheral nerve block: Case report  

Directory of Open Access Journals (Sweden)

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

Vildan Temel

2010-12-01

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Sciatic nerve blocks for diagnosis of piriformis syndrome  

International Nuclear Information System (INIS)

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

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Anesthetic technique for inferior alveolar nerve block: a new approach  

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

Dafna Geller Palti

2011-02-01

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Anesthetic technique for inferior alveolar nerve block: a new approach  

Scientific Electronic Library Online (English)

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

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

2011-02-01

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Anesthetic technique for inferior alveolar nerve block: a new approach  

Scientific Electronic Library Online (English)

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

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

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Conduction block of whole nerve without onset firing using combined high frequency and direct current  

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This study investigates a novel technique for blocking a nerve using a combination of direct and high frequency alternating currents (HFAC). HFAC can produce a fast acting and reversible conduction block, but cause intense firing at the onset of current delivery. We hypothesized that a direct current (DC) block could be used for a very brief period in combination with HFAC to block the onset firing, and thus establish a nerve conduction block which does not transmit onset response firing to a...

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

2011-01-01

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

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Most local anaesthetic blocks are placed blindly, based on a sound knowledge of anatomy. Very often the relationship between the site of deposition of local anaesthetic and the nerve to be blocked is unknown. Large motor neurons may be stimulated with the aid of an electrical current. By observing for muscle twitches, through electrical stimulation of the nerve, a needle can be positioned extremely close to the nerve. The accuracy of local anaesthetic blocks can be improved by this technique....

Joubert, K. E.

2012-01-01

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Development of a mobile ultrasound-guided peripheral nerve block and catheter service.  

Science.gov (United States)

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

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

2011-08-01

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Augmented reality guidance system for peripheral nerve blocks  

Science.gov (United States)

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

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

2010-02-01

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Variant obturator vessels  

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

Nayak SB

2009-10-01

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

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We report two high risk patients undergoing inguinal herniorraphy and testicular biopsy under ultrasound-guided ilioinguinal/iliohypogastric and genitofemoral nerve blocks. The addition of the

Al-alami, Achir A.; Alameddine, Mahmoud S.; Orompurath, Mohammed J.

2013-01-01

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Different Learning Curves for Axillary Brachial Plexus Block: Ultrasound Guidance versus Nerve Stimulation.  

Science.gov (United States)

Little is known about the learning of the skills needed to perform ultrasound- or nerve stimulator-guided peripheral nerve blocks. The aim of this study was to compare the learning curves of residents trained in ultrasound guidance versus residents trained in nerve stimulation for axillary brachial plexus block. Ten residents with no previous experience with using ultrasound received ultrasound training and another ten residents with no previous experience with using nerve stimulation received nerve stimulation training. The novices' learning curves were generated by retrospective data analysis out of our electronic anaesthesia database. Individual success rates were pooled, and the institutional learning curve was calculated using a bootstrapping technique in combination with a Monte Carlo simulation procedure. The skills required to perform successful ultrasound-guided axillary brachial plexus block can be learnt faster and lead to a higher final success rate compared to nerve stimulator-guided axillary brachial plexus block. PMID:21318138

Luyet, C; Schüpfer, G; Wipfli, M; Greif, R; Luginbühl, M; Eichenberger, U

2010-01-01

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

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Full Text Available OBJECTIVES: The efficacy of combined lumbar plexus-sciatic nerve blocks was compared to epidural anesthesia in patients undergoing total knee surgery. PATIENTS AND METHODS: The study included 80 American Society of Anesthesiologists (ASA Physical Status I-III patients (age range 18 to 65 undergoing knee surgery. The patients were randomly divided into one of two groups. Epidural anesthesia was performed in the epidural anesthesia (EA group (n=40, and the lumbar plexus and sciatic nerves were blockedin the lumbar plexus-sciatic nerve blocks (LPSB group (n=40. For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the lumbar plexus-sciatic nerve blocks group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request, and patient and surgeon satisfaction with the anesthetic technique were recorded. RESULTS: One patient in the epidural anesthesia group and three patients in the lumbar plexus-sciatic nerve blocks group required general anesthesia due to failed block. There were no significant differences between the two groups regarding the success of providing adequate anesthesia. Eight patients in the lumbar plexus-sciatic nerve blocks group developed contralateral spread. The onset of sensory-motor block and the time of the first analgesic request were significantly later in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. Although there were no significant differences regarding patient satisfaction with the anesthetic technique between the two groups, surgeon satisfaction was significantly higher in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. CONCLUSION: The lumbar plexus -sciatic nerve blocks provide effective unilateral anesthesia and may offer a beneficial alternative to epidural anesthesia in patients undergoing total knee surgery.

Eyup Horasanli

2010-01-01

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english OBJECTIVES: The efficacy of combined lumbar plexus-sciatic nerve blocks was compared to epidural anesthesia in patients undergoing total knee surgery. PATIENTS AND METHODS: The study included 80 American Society of Anesthesiologists (ASA) Physical Status I-III patients (age range 18 to 65) undergoin [...] g knee surgery. The patients were randomly divided into one of two groups. Epidural anesthesia was performed in the epidural anesthesia (EA) group (n=40), and the lumbar plexus and sciatic nerves were blockedin the lumbar plexus-sciatic nerve blocks (LPSB) group (n=40). For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the lumbar plexus-sciatic nerve blocks group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request, and patient and surgeon satisfaction with the anesthetic technique were recorded. RESULTS: One patient in the epidural anesthesia group and three patients in the lumbar plexus-sciatic nerve blocks group required general anesthesia due to failed block. There were no significant differences between the two groups regarding the success of providing adequate anesthesia. Eight patients in the lumbar plexus-sciatic nerve blocks group developed contralateral spread. The onset of sensory-motor block and the time of the first analgesic request were significantly later in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. Although there were no significant differences regarding patient satisfaction with the anesthetic technique between the two groups, surgeon satisfaction was significantly higher in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. CONCLUSION: The lumbar plexus -sciatic nerve blocks provide effective unilateral anesthesia and may offer a beneficial alternative to epidural anesthesia in patients undergoing total knee surgery.

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

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

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

GUO Xiang-fei

2013-10-01

70

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

Directory of Open Access Journals (Sweden)

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

K.E. Joubert

2012-07-01

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Simulation of local anaesthetic nerve block of the infraorbital nerve within the pterygopalatine fossa: anatomical landmarks defined by computed tomography.  

Science.gov (United States)

To provide anaesthesia of the maxillary cheek teeth, a local block of the infraorbital nerve in the pterygopalatine fossa has been suggested. The aim of this study was to re-examine the anatomy of the pterygopalatine fossa, giving special attention to relevant arteries, veins and nerves; simulate the infiltration of an anaesthetic by injecting a contrast medium; improve the injection technique to avoid puncturing of relevant anatomical structures. Five heads and two living horses were investigated using contrast medium injections and computed tomography (CT). Needles were inserted using two insertion techniques: "Palatine Bone Insertion" (PBI) and "Extraperiorbital Fat Body Insertion" (EFBI). Both techniques are suitable for achieving a consistent distribution of contrast medium around the infraorbital nerve. The periorbita prevents the contrast medium from penetrating into the intraperiorbital compartment. The EFBI-technique is most appropriate for providing a sufficient infraorbital nerve block with a minimised risk of complications. PMID:18371997

Staszyk, Carsten; Bienert, Astrid; Bäumer, Wolfgang; Feige, Karsten; Gasse, Hagen

2008-12-01

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Ultrasound guidance improves a continuous popliteal sciatic nerve block when compared with nerve stimulation  

DEFF Research Database (Denmark)

Continuous sciatic nerve blockade at the popliteal level effectively alleviates postoperative pain after major foot and ankle surgery. No randomized controlled trials have previously compared the success rate of continuous sciatic nerve sensory blockade between ultrasound and nerve stimulation guidance. In the current study, we tested the hypothesis that ultrasound-guided catheter placement improves the success rate of continuous sciatic nerve sensory blockade compared with catheter placement with nerve stimulation guidance.

Bendtsen, Thomas F; Nielsen, Thomas D

2011-01-01

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

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

Ribeiro, J. A.; Sebastia?o, A. M.

1985-01-01

74

The effects of unilateral eighth nerve block on fictive VOR in the turtle.  

Science.gov (United States)

Multiunit activity during horizontal sinusoidal motion was recorded from pairs of oculomotor, trochlear, or abducens nerves of an in vitro turtle brainstem preparation that received inputs from intact semicircular canals. Responses of left oculomotor, right trochlear and right abducens nerves were approximately aligned with leftward head velocity, and that of the respective contralateral nerves were in-phase with rightward velocity. We examined the effect of sectioning or injecting lidocaine (1-2 microL of 0.5%) into the right vestibular nerve. Nerve block caused a striking phase shift in the evoked response of right oculomotor and left trochlear nerves, in which (rightward) control responses were replaced by a smaller-amplitude response to leftward table motion. Such "phase-reversed" responses were poorly defined in abducens nerve recordings. Frequency analysis demonstrated that this activity was advanced in phase relative to post-block responses of the respective contralateral nerves, which were in turn phase-advanced relative to pre-block controls. Phase differences were largest (approximately 10 degrees) at low frequencies (approximately 0.1 Hz) and statistically absent at 1 Hz. The phase-reversed responses were further investigated by eliminating individual canal input from the left labyrinth following right nVIII block, which indicated that the activation of the vertical canal afferents is the source of this activity. PMID:16725122

Jones, Michael S; Ariel, Michael

2006-06-13

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Local anesthesia for transurethral manipulations: is a transrectal periprostatic nerve block effective?  

Science.gov (United States)

Periprostatic nerve block has been reported to be an effective form of anesthesia for prostatic surgery. Recent studies have shown the simplicity and the efficacy of a transrectal approach for periprostatic nerve block. The goal of our study was to evaluate the effect of a transrectal periprostatic nerve block on the discomfort associated with rigid cystoscopy. A total of 73 patients underwent cystoscopy. Group 1 (n = 39) received a transrectal periprostatic lidocaine infiltration prior to the cystoscopy. Group 2 (n = 34) underwent cystoscopy alone. The pain that patients experienced during cystoscopy was assessed on a visual analog scale. The patients in the two groups were very similar in regard to age and size of the prostate. The mean pain score was 3.4 in group 1 and 3.9 in group 2. This difference was not statistically significant. We conclude that nerve block does not seem to reduce the pain associated with transurethral manipulations. PMID:16261365

Müntener, Michael; Fatzer, Markus; Praz, Valentin; Straumann, Urs; Strebel, Räto T; John, Hubert

2005-11-01

76

Cervical foraminal selective nerve root block: a ‘two-needle technique’ with results  

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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 radiculopat...

Kumar, Naresh; Gowda, Veda

2008-01-01

77

Revisiting the anatomy of the ilio-inguinal/iliohypogastric nerve block  

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BACKGROUND : The ilio-inguinal/iliohypogastric nerve block (INB) is one of the most common peripheral nerve block techniques in pediatric anesthesia, which is largely due to the introduction of ultrasound (US) guidance. Despite the benefits of US guidance, the absence of an US machine should not deter the provider from performing INB, considering that many institutions, especially in developing countries, cannot afford to provide ultrasound machines in their anesthesiology d...

Schoor, Albert-neels; Bosman, M. C.; Bosenberg, A. T.

2013-01-01

78

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

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Background:: The effect of ilioinguinal and iliohypogastric (II-IH) nerve block on postoperative pain is well documented when applied before Caesarean section but the efficacy remains unclear when applied after the surgical procedure. Therefore we investigated the effect of II-IH nerve block on postoperative pain and analgesic consumption in patients when applied after Caesarean Section. Methods: Sixty ASA I-II patients, scheduled for elective C/S were included in the study. After gener...

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

2010-01-01

79

Bilateral ultrasound-guided transversus abdominis plane block combined with ilioinguinal-iliohypogastric nerve block for cesarean delivery anesthesia.  

Science.gov (United States)

The ultrasound-guided transversus abdominis plane block and ilioinguinal-iliohypogastric nerve block have been shown to provide pain relief after abdominal surgery. A combination of the 2 blocks may provide acceptable surgical anesthesia for cesarean delivery. We describe 4 women who had contraindications to neuraxial anesthesia, who underwent cesarean delivery with ultrasound-guided bilateral transversus abdominis plane block combined with ilioinguinal-iliohypogastric nerve block using 40 mL 0.5% ropivacaine. Breakthrough pain during the delivery of the fetus was treated with small doses of IV ketamine and propofol. We suggest that this technique may be an alternative to local anesthesia for cesarean delivery in clinical practice. PMID:21467562

Mei, Wei; Jin, Chuangang; Feng, Lin; Zhang, Yi; Luo, Ailin; Zhang, Chuanhan; Tian, Yuke

2011-07-01

80

Effects of median nerve block on radial artery diameter and peak velocity  

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Full Text Available John J Badal, Annie Kiesau, Patrick BoyleUniversity of Arizona, Department of Anesthesiology, Tucson, AZ, USAAbstract: Peripheral artery cannulation is a common procedure but can sometimes be difficult. Our goal was to determine if a median nerve block would increase the diameter and flow of the radial artery. Radial artery diameter and peak velocity was measured using a SonoSite Ultrasound System. Using ultrasound guidance, a median nerve block was performed with lidocaine. Subsequent measurements of the radial artery and peak velocity were again made at 5 minutes post-block and 10 minutes post-block. Mean radial artery diameter measured vertically was 0.23 ± 0.06 cm pre-block, 0.23 ± 0.05 cm at 5 minutes post-block, and 0.23 ± 0.05 cm 10 minutes post-block. Mean radial artery diameter measured horizontally was 0.26 ± 0.05 cm pre-block, 0.27 ± 0.06 cm at 5 minutes post-block, and 0.27 ± 0.08 cm 10 minutes post-block. Peak velocities were 11.3 ± 6.9 cm/s pre-block, increased to 15.0 ± 6.9 cm/s 5 minutes postblock (P = 0.005, and finally increased to 17.7 ± 7.8 cm/s 10 minutes post-block (P = 0.01. This study set out to measure the effects of median nerve blockade on the radial artery. We found a significant increase in peak velocities post-median nerve blockade.Keywords: radial artery, median nerve block, sympathetic

John J Badal

2010-02-01

 
 
 
 
81

Medial antebrachial cutaneous nerve injury after brachial plexus block: two case reports.  

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Medial antebrachial cutaneous (MABC) nerve injury associated with iatrogenic causes has been rarely reported. Local anesthesia may be implicated in the etiology of such injury, but has not been reported. Two patients with numbness and painful paresthesia over the medial aspect of the unilateral forearm were referred for electrodiagnostic study, which revealed MABC nerve lesion in each case. The highly selective nature of the MABC nerve injuries strongly suggested that they were the result of direct nerve injury by an injection needle during previous brachial plexus block procedures. Electrodiagnostic studies can be helpful in evaluating cases of sensory disturbance after local anesthesia. To our knowledge, these are the first documented cases of isolated MABC nerve injury following ultrasound-guided axillary brachial plexus block. PMID:24466530

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

2013-12-01

82

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

Scientific Electronic Library Online (English)

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

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

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

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

Rothe, C; Asghar, S

2011-01-01

84

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

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

Joelle W Boeve

2011-03-01

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

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

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

86

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

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

Kinjo Sakura

2012-03-01

87

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

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BACKGROUND: Postoperative pain relief may be improved by reducing sensitization of nociceptive pathways caused by surgical trauma. Such a reduction may depend on the timing and efficacy of analgesia and the duration of the nociceptive block versus the duration of the nociceptive input. We examined whether a prolonged nerve block administered before a superficial burn injury could reduce local inflammation and late hyperalgesia after recovery from the block. METHODS: The effects of a preemptive saphenous nerve block on primary and secondary hyperalgesia, skin erythema, and blister formation, were compared to the opposite unblocked leg for 12 h after bilateral thermal injuries (15 x 25 mm, 49 degrees C for 5 min) in 20 healthy volunteers. Recovery from the block was identified by return of sensation to cold. RESULTS: Six subjects were excluded because of insufficient initial block (2 subjects) or because the block lasted beyond the study period (4 subjects). The remaining 14 subjects experienced significantly reduced primary (P = 0.005) and secondary hyperplasia (P = 0.01) in the blocked leg after return of cold sensation compared to the unblocked leg. Erythema intensity and blister formation were not significantly affected by the blockade (P = 0.94 and P = 0.07, respectively). CONCLUSIONS: These data suggest that a prolonged, preemptive nerve block reduced late hyperalgesia after thermal injury, whereas the erythema and blister formation were not significantly affected.

Pedersen, J L; Crawford, M E

1996-01-01

88

Anatomical considerations of the neonatal ilio-inguinal/ iliohypogastric nerve block  

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The ilioinguinal/ iliohypogastric nerve block is an effective technique that provides analgesia for a variety of inguinal surgical procedures in children. However, a relatively high failure rate of between 20-30% has been reported. The aim of this study was to determine the exact anatomical position of the ilio-inguinal and iliohypogastric nerves in relation to an easily identifiable bony landmark, the anterior superior iliac spine (ASIS), in neonates. Dissections were performed on a sample o...

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

2009-01-01

89

Anesthetic technique for inferior alveolar nerve block: a new approach  

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BACKGROUND: Effective pain control in Dentistry may be achieved by local anesthetic techniques. The success of the anesthetic technique in mandibular structures depends on the proximity of the needle tip to the mandibular foramen at the moment of anesthetic injection into the pterygomandibular region. Two techniques are available to reach the inferior alveolar nerve where it enters the mandibular canal, namely indirect and direct; these techniques differ in the number of movements required. D...

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

2011-01-01

90

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

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We report the anaesthetic management of two cases involving surgeries on the clavicle, performed under superficial cervical plexus block and selective C5 nerve root block under ultrasound (US) guidance, along with general anaesthesia. Regional analgesia for clavicular surgeries is challenging. Our patients also had significant comorbidities necessitating individualised approach. The first patient had a history of emphysema, obesity, and was allergic to morphine and hydromorphone. The second patient had clavicular arthritis and pain due to previous surgeries. He had a history of smoking, Stevens-Johnson syndrome, along with daily marijuana and prescription opioid use. Both patients had an effective regional block and required minimal supplementation of analgesia, both being discharged on the same day. Interscalene block with its associated risks and complications may not be suitable for every patient. This report highlights the importance of selective regional blockade and also the use of US guidance for an effective and safe block. PMID:25024480

Shanthanna, Harsha

2014-01-01

91

Evaluation of Effect of Pudendal Nerve Block on Post Hemmorrhoidectomy Pain  

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

M.H. Sarmast Shoshtari

2008-10-01

92

Bilateral sciatic nerve block after orthopedic surgery in a pediatric patient  

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

Levent ?ahin

2011-09-01

93

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

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

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

2003-03-01

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

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

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

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

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

Sara Pourshahidi

2008-04-01

95

Staff attitudes to an ultrasound-guided peripheral nerve block room for orthopaedic patients.  

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Ultrasound-guided peripheral nerve blocks have well recognised benefits in orthopaedic patients. Some hospitals, to maximise these benefits, establish dedicated "block rooms" to deliver this service. Orthopaedic surgery makes up a large proportion of our hospitals work load, and many of these patients would benefit from ultrasound-guided peripheral nerve blocks. We analysed the attitudes of key staff in our hospital towards the establishment of a block room. Sixty questionnaires were distributed and 47 (78%) were completed. Orthopaedic surgeons (n = 6) were concerned ultrasound-guided peripheral nerve blocks would delay theatre lists (83%), and cause patients pain (67%) and increased anxiety (67%). Anaesthetists (n = 10) and Nurses (n = 30) were concerned there was insufficient experience in their departments to deliver this service (80% and 77%, respectively). However, 91% of all staff believed funding should be available for a block room. Our survey has identified areas of concern, and deficiencies that we must address before proceeding with the development of such a service. PMID:25282961

Moore, D M; Duggan, M

2014-09-01

96

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

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

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

1995-01-01

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Maxillary nerve block via the greater palatine canal: new look at an old technique.  

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Although not widely used, maxillary nerve block via the greater palatine canal can be remarkably effective. This article is aimed at reviving its use by reviewing the indications, contraindications, and anatomy of the technique. A simplified guide to the technique is offered to place the technique within the armamentarium of the practicing dentist. PMID:8180519

Lepere, A J

1993-01-01

98

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

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

Bærentzen, Finn; Maschmann, Christian

2012-01-01

99

Obturator hernia: A case report and review of the literature?  

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INTRODUCTION An obturator hernia is a rare condition but is associated with the highest mortality of all abdominal wall hernias. Early surgical intervention is often hindered by clinical and radiological diagnostic difficulty. The following case report highlights these diagnostic difficulties, and reviews the current literature on management of such cases. PRESENTATION OF CASE We present the case of an 86-year-old lady who presented with intermittent small bowel obstruction, clear hernial orifices, and right medial thigh pain. Pre-operative CT imaging was suggestive of an obstructed right femoral hernia. However, intra-operatively the femoral canal was clear and an obstructed hernia was found passing through the obturator foramen lying between the pectineus and obturator muscles in the obturator canal. DISCUSSION Obturator hernias are notorious for diagnostic difficulty. Patients often present with intermittent bowel obstruction symptoms due to a high proportion exhibiting Richter's herniation of the bowel. Hernial sacs can irritate the obturator nerve within the canal, manifesting as medial thigh pain, and often no hernial masses can be detected on clinical examination. Increasing speed of diagnosis through early CT imaging has been shown to reduce the morbidity and mortality associated with obturator hernias. However, over-reliance on CT findings should be cautioned, as imaging and operative findings may not always correlate. CONCLUSION A high suspicion for obturator hernia should be maintained when assessing a patient presenting with bowel obstruction particularly where intermittent symptoms or medial thigh pain are present. Rapid clinical and appropriate radiological assessment, followed by early surgery is critical to successful treatment. PMID:23973903

Hodgins, Nicholas; Cieplucha, Krzysztof; Conneally, Padhraic; Ghareeb, Essam

2013-01-01

100

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

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

Melike Sakall?

2010-01-01

 
 
 
 
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Sudden severe postoperative dyspnea following shoulder surgery: Remember inadvertent phrenic nerve block due to interscalene brachial plexus block.  

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Advanced imaging techniques, improved operative techniques, and instrumentation combined with better patient awareness and expectations have resulted in an exponential increase in upper limb surgical procedures during recent times. Surgical teams expect superior analgesia and regional blocks have matched these expectations quite often resulting in improved patient satisfaction and early rehabilitation to achieve best results. Ultrasound-guided interscalene brachial plexus block (ISB) is commonly used to provide analgesia for procedures involving shoulder girdle. We report a case of symptomatic hemi-diaphragmatic paresis (HDP) due to the phrenic nerve block following ISB for arthroscopic sub-acromial decompression of the shoulder presenting as severe postoperative dyspnea. There is strong evidence of HDP following ISB in anesthetic literature, but not reported in related surgical specialties such as orthopedics. We wish to inform upper-limb surgeons and educate junior doctors and other ancillary staff working in upper-limb units to be aware of this serious but reversible complication. PMID:25114416

Jariwala, Arpit; Kumar, B C Raju Pavan; Coventry, David M

2014-04-01

102

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

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

103

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

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

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

2013-02-15

104

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

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

Taner Çiftçi

2011-12-01

105

Maxillary nerve block anaesthesia via the greater palatine canal: a modified technique and case reports.  

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A modification of the technique of maxillary nerve block (via the greater palatine canal) is discussed. This technique has been employed in the Exodontia and Oral Surgery Clinics of the United Dental Hospital of Sydney for more than 40 years. Clinical experience in that time has shown that once the greater palatine canal has been negotiated successfully, the palatal canal approach to the maxillary nerve is safe and reliable. The value of being able to anaesthetize the maxillary nerve and its branches is illustrated by the presentation of two clinical cases where local anaesthesia was achieved and the extractions performed in patients who would otherwise have required a general anaesthetic for the procedures. PMID:2029227

Wong, J D; Sved, A M

1991-02-01

106

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

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

107

Development of an ultrasound-guided technique for pudendal nerve block in cat cadavers.  

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The objective of this prospective experimental cadaveric study was to develop an ultrasound-guided technique to perform an anaesthetic pudendal nerve block in male cats. Fifteen fresh cadavers were used for this trial. A detailed anatomical dissection was performed on one cat in order to scrutinise the pudendal nerve and its ramifications. In a second step, the cadavers of six cats were used to test three different ultrasonographic approaches to the pudendal nerve: the deep dorso-lateral, the superficial dorso-lateral and the median transperineal. Although none of the approaches allowed direct ultrasonographical identification of the pudendal nerve branches, the deep dorso-lateral was found to be the most advantageous one in terms of practicability and ability to identify useful and reliable landmarks. Based on these findings, the deep dorso-lateral approach was selected as technique of choice for tracer injections (0.1 ml 1% methylene blue injected bilaterally) in six cat cadavers distinct from those used for the ultrasonographical study. Anatomical dissection revealed a homogeneous spread of the tracer around the pudendal nerve sensory branches in all six cadavers. Finally, computed tomography was performed in two additional cadavers after injection of 0.3 ml/kg (0.15 ml/kg per each injection sites, left and right) contrast medium through the deep dorso-lateral approach in order to obtain a model of volume distribution applicable to local anaesthetics. Our findings in cat cadavers indicate that ultrasound-guided pudendal nerve block is feasible and could be proposed to provide peri-operative analgesia in clinical patients undergoing perineal urethrostomy. PMID:23599255

Adami, Chiara; Angeli, Giovanni; Haenssgen, Kati; Stoffel, Michael H; Spadavecchia, Claudia

2013-10-01

108

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

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

T.V.S Gopal

2014-06-01

109

Needle stylet with integrated optical fibers for spectroscopic contrast during peripheral nerve blocks  

Science.gov (United States)

The effectiveness of peripheral nerve blocks is highly dependent on the accuracy at which the needle tip is navigated to the target injection site. Even when electrical stimulation is utilized in combination with ultrasound guidance, determining the proximity of the needle tip to the target region close to the nerve can be challenging. Optical reflectance spectroscopy could provide additional information about tissues that is complementary to these navigation methods. We demonstrate a novel needle stylet for acquiring spectra from tissue at the tip of a commercial 20-gauge needle. The stylet has integrated optical fibers that deliver broadband light to tissue and receive scattered light. Two spectrometers resolve the light that is received from tissue across the wavelength range of 500-1600 nm. In our pilot study, measurements are acquired from a postmortem dissection of the brachial plexus of a swine. Clear differences are observed between spectra acquired from nerves and those acquired from adjacent tissue structures. We conclude that spectra acquired with the stylet have the potential to increase the accuracy with which peripheral nerve blocks are performed.

Desjardins, Adrien E.; van der Voort, Marjolein; Roggeveen, Stefan; Lucassen, Gerald; Bierhoff, Walter; Hendriks, Benno H. W.; Brynolf, Marcus; Holmström, Björn

2011-07-01

110

Transition from nerve blocks to periarticular injections and emerging techniques in total joint arthroplasty.  

Science.gov (United States)

The emergence of procedure-specific multimodal pain management regimens that provide effective control of postoperative pain, while markedly reducing the amount of opioid medication required, has been one of the most important advances in hip and knee replacement in recent years. When peripheral nerve blockade first became widely available for inclusion in multimodal regimens, it was viewed as a revolution in the management of postoperative pain. This approach, however, is costly and has some important limitations, including an increased incidence of falls. For many patients, peripheral nerve blocks can now be replaced by a periarticular injection with EXPAREL® (bupivacaine liposome injectable suspension), an extended-release anesthetic infiltrated by the surgeon as part of a multimodal pain regimen. EXPAREL® offers some important clinical and administrative benefits over nerve blocks. Preliminary data from a pilot study comparing the relative effectiveness of EXPAREL® versus sciatic nerve blockade has shown a noticeable reduction in average pain scores at rest with EXPAREL® following both hip and knee arthroplasty, as well as a reduction in the 6- to 12-hour pain score following hip arthroplasty. There was also a significant reduction in opioid use with EXPAREL®, as well as a $411 reduction in the cost of total knee arthroplasty and a $348 reduction in the cost of total hip arthroplasty. PMID:25303457

Springer, Bryan D

2014-10-01

111

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

Directory of Open Access Journals (Sweden)

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

Arissara Iamaroon

2010-03-01

112

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

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

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

2012-01-01

113

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

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

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

1991-01-01

114

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

Science.gov (United States)

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

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

2010-12-01

115

The comparison of combined femoral-sciatic nerve block with spinal anesthesia at lower extremity surgery  

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Full Text Available Introduction: In this study, we aimed to compare the spinal anesthesia technique with combined femoral-sciatic block technique in patients undergoing lower limb surgery. Methods: In this study, after obtaining the approval of the Dicle University Faculty of Medicine Ethics Committee, scheduled for elective lower extremity surgery, the ASA 1-2 groups, between the ages of 18-65, 60 patients were enrolled. Study was planned as a prospective, randomized and controlled. Patients were randomly divided into 2 groups as the spinal anesthesia (Group S and combined sciatic-femoral nerve block (Group CSF to be. Results: Demographic data similar between the groups (p> 0.05. The implementation period of the technique was long in the Group CSF compared with in the Group S (p <0.001. Surgery delivery time was shorter in the Group S compared with in the Group CSF (p <0.001. The time of motor block occurrence was longer in the Group CSF compared with in the Group S (p <0.001. The duration of motor block was long in the Group CSF compared with in the Group S (p <0.001. Conclusion: The each of two methods is safe and effective in lower extremity orthopedic surgery, but the application of peripheral nerve block to provide the long-term advantages such as postoperative analgesia and reducing postoperative analgesic consumption. J Clin Exp Invest 2014; 5 (2: 443-446

Selim Almaz

2014-06-01

116

Ultrasonographic-guided ilioinguinal/iliohypogastric nerve block in pediatric anesthesia: what is the optimal volume?  

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Recently, our study group demonstrated the usefulness of ultrasonographic guidance in ilioinguinal/iliohypogastric nerve blocks in children. As a consequence, we designed a follow-up study to evaluate the optimal volume of local anesthetic for this regional anesthetic technique. Using a modified step-up-step-down approach, with 10 children in each study group, a starting dose of 0.2 mL/kg of 0.25% levobupivacaine was administered to perform an ilioinguinal/iliohypogastric nerve block under ultrasonographic guidance. After each group of 10 patients, the results were analyzed, and if all blocks were successful, the volume of local anesthetic was decreased by 50%, and a further 10 patients were enrolled into the study. Failure to achieve a 100% success rate within a group subjected patients to an automatic increase of half the previous volume reduction to be used in the subsequent group. Using 0.2 and 0.1 mL/kg of 0.25% levobupivacaine, the success rate was 100%. With a volume of 0.05 mL/kg of 0.25% levobupivacaine, 4 of 10 children received additional analgesia because of an inadequate block. Therefore, according to the protocol, the amount was increased to 0.075 mL/kg of 0.25% levobupivacaine, where the success rate was again 100%. We conclude that ultrasonographic guidance for ilioinguinal/iliohypogastric nerve blocks in children allowed a reduction of the volume of local anesthetic to 0.075 mL/kg. PMID:16717308

Willschke, H; Bösenberg, A; Marhofer, P; Johnston, S; Kettner, S; Eichenberger, U; Wanzel, O; Kapral, S

2006-06-01

117

[Case of two-stage carotid artery stenting managed with ultrasound-guided carotid sinus nerve block].  

Science.gov (United States)

We report the use of ultrasound-guided carotid sinus nerve block for circulatory management during two-stage carotid artery stenting (CAS) in a patient with symptomatic carotid stenosis complicated with decreased cerebral perfusion reserve. The patient was a 70-year-old man with symptoms of ocular ischemia and markedly decreased perfusion of the left cerebral hemisphere observed in single photon emission computed tomography. Ultrasound-guided carotid sinus nerve block was conducted to prevent CAS perioperative circulatory fluctuations caused by carotid sinus reaction (CSR). We did not observe any hemodynamic instability during CAS. There were no complications associated with the nerve block. Although further research is required, the present findings suggest that ultrasoundguided carotid sinus nerve block may safely and effectively prevent CSR in CAS. PMID:23772540

Morita, Yoshihito; Hara, Atsuko; Yamaguchi, Keisuke; Yamamoto, Munetaka; Ootshi, Hidenori; Iseki, Masako; Inada, Eiichi

2013-05-01

118

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

Scientific Electronic Library Online (English)

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

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

119

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

Directory of Open Access Journals (Sweden)

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

A.M. Sousa

2012-02-01

120

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

Scientific Electronic Library Online (English)

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

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

2012-02-01

 
 
 
 
121

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

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

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

2000-01-01

122

Nerve Blocks  

Science.gov (United States)

... located in the examining room. Fluoroscopy, which converts x-rays into video images, is used to watch and guide progress of the procedure. The video is produced by the x-ray machine and a detector that is suspended ...

123

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

DEFF Research Database (Denmark)

The myelinated nerve fibre is formed by an axon and Schwann cells or oligodendrocytes that sheath the axon by winding around it in tight myelin layers. Repetitive stimulation of a fibre is known to result in accumulation of extracellular potassium ions, especially between the axon and the myelin. Uptake of potassium leads to Schwann cell swelling and myelin restructuring that impacts the electrical properties of the myelin. In order to further understand the dynamic interaction that takes place between the myelin and the axon, we have modelled submyelin potassium accumulation and related changes in myelin resistance during prolonged high-frequency stimulation. We predict that potassium-mediated decrease in myelin resistance leads to a functional excitation block with various patterns of altered spike trains. The patterns are found to depend on stimulation frequency and amplitude and to range from no block (less than 100 Hz) to a complete block (greater than 500 Hz). The transitional patterns include intermittent periodic block with interleaved spiking and non-spiking intervals of different relative duration as well as an unstable regime with chaotic switching between the spiking and non-spiking states. Intermittent conduction blocks are accompanied by oscillations of extracellular potassium. The mechanism of conductance block based on myelin restructuring complements the already known and modelled block via hyperpolarization mediated by the axonal sodium pump and potassium depolarization.

Brazhe, Alexey; Maksimov, G. V.

2011-01-01

124

The Role of Slow Potassium Current in Nerve Conduction Block Induced by High-Frequency Biphasic Electrical Current  

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The role of slow potassium current in nerve conduction block induced by high-frequency biphasic electrical current was analyzed using a lumped circuit model of a myelinated axon based on Schwarz-Reid-Bostock (SRB) model. The results indicate that nerve conduction block at stimulation frequencies above 4 kHz is due to constant activation of both fast and slow potassium channels, but the block at stimulation frequencies below 4 kHz could be due to either anodal or cathodal DC block depending on...

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

2009-01-01

125

Comparison of Treatment Methods in Lumbar Spinal Stenosis for Geriatric Patient: Nerve Block Versus Radiofrequency Neurotomy Versus Spinal Surgery  

Science.gov (United States)

Objective The incidence of spinal treatment, including nerve block, radiofrequency neurotomy, instrumented fusions, is increasing, and progressively involves patients of age 65 and older. Treatment of the geriatric patients is often a difficult challenge for the spine surgeon. General health, sociofamilial and mental condition of the patients as well as the treatment techniques and postoperative management are to be accurately evaluated and planned. We tried to compare three treatment methods of spinal stenosis for geriatric patient in single institution. Methods The cases of treatment methods in spinal stenosis over than 65 years old were analyzed. The numbers of patients were 371 underwent nerve block, radiofrequency neurotomy, instrumented fusions from January 2009 to December 2012 (nerve block: 253, radiofrequency neurotomy: 56, instrumented fusions: 62). The authors reviewed medical records, operative findings and postoperative clinical results, retrospectively. Simple X-ray were evaluated and clinical outcome was measured by Odom's criteria at 1 month after procedures. Results We were observed excellent and good results in 162 (64%) patients with nerve block, 40 (71%) patient with radIofrequency neurotomy, 46 (74%) patient with spinal surgery. Poor results were 20 (8%) patients in nerve block, 2 (3%) patients in radiofrequency neurotomy, 3 (5%) patient in spinal surgery. Conclusion We reviewed literatures and analyzed three treatment methods of spinal stenosis for geriatric patients. Although the long term outcome of surgical treatment was most favorable, radiofrequency neurotomy and nerve block can be considered for the secondary management of elderly lumbar spinals stenosis patients. PMID:25346752

Park, Chang Kyu; Kim, Min Ki; Park, Bong Jin; Choi, Seok Geun; Lim, Young Jin; Kim, Tae Sung

2014-01-01

126

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

Science.gov (United States)

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

Lee, Shuying; Tan, Josephine Swee Kim

2013-11-01

127

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

Science.gov (United States)

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

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

2014-07-01

128

Effects of intercostal nerve blocks on pulmonary mechanics in healthy men.  

Science.gov (United States)

Bilateral block of the 5th through the 11th intercostal nerves was induced in 16 healthy men. In eight of the men, bupivacaine 0.25% was used and in the other eight, etidocaine 0.5%. Before and after induction of the block flow/volume curves, maximal airway pressures, and pulmonary compliance, were recorded, and helium spirometry and multiple and single breath nitrogen wash-outs were performed. There were no differences between the results in the two groups, and the material was therefore pooled. Total lung capacity was decreased by 4%. There was no increase in residual volume, though the maximal expiratory airway pressure decreased by 7%. There was an 8% decrease in functional residual capacity. Pulmonary recoil appeared to be unchanged, as also did the effort-independent peak expiratory flow rates. According to the pulmonary nitrogen clearance index, the overall pulmonary time constant did not alter, while the slope of the alveolar plateau in the single breath nitrogen wash-out test increased by 9%. The significance of the latter finding is unclear, but it is concluded that the nerve block had no obvious effects on pulmonary mechanics, the changes observed rather being attributable to effects on the chest wall. PMID:7246031

Jakobson, S; Fridriksson, H; Hedenström, H; Ivarsson, I

1980-12-01

129

Anatomical Study of The Sacum for Transsacral Block of Sacral Nerves  

Directory of Open Access Journals (Sweden)

Full Text Available Inroduction: For transsacral block of sacral nerves in analgesia and anesthesia of the rectal, anal or urethral region the dorsal sacral foramina are used.To find solution of this by identifying additional anatomical landmarks and measurements of dorsal sacral foramina for transsacral nerve block. Materials & Method: Total 100 complete and undamaged adult, dry sacrums were measured with a vernier caliper (accurate to 0.1 mm. Dorsal sacral foramina of the sacrum were taken as points. Calculations and analyses were expressed as mean (SD, median and range using Open Office 3.2.0 spreadsheet version for Linux (Ubuntu 10.04. Results: The average distance between the two superolateral sacral crests was 60.61 (SD 6.71 mm. Distance between dorsal sacral foramina vertical right side 1st to 2nd 14.05 (SD 2.35mm, 2nd to 3rd 12.33 (SD 1.84mm, 3rd to 4th 11.26 (SD 2.35mm and vertical left side 1st to 2nd 14.18 (SD 2.61mm, 2nd to 3rd 12.18 (SD 1.95mm, 3rd to 4th 10.78 (SD2.42mm. Transverse distance between dorsal sacral foramina 1st to 1st 34.72 (SD 3.97mm, 2nd to 2nd 29.43 (SD 3.51mm, 3rd to 3rd 25.58 (SD 3.46mm, 4th to 4th 24.63 (SD 3.22mm. Conclusion: Measurements of dorsal sacral foramina can be used for transsacral nerve block. [Natl J of Med Res 2012; 2(4.000: 501-503

D S Patil

2012-08-01

130

Development and validation of an equine nerve block simulator to supplement practical skills training in undergraduate veterinary students.  

Science.gov (United States)

Lameness is the most common presenting complaint in equine practice. Performing diagnostic nerve blocks is an integral part of any lameness work-up, and is therefore an essential skill for equine practitioners. However, the opportunities for veterinary students to practice this skill are limited. The aim of this study was to design and validate an equine nerve block simulator. It was hypothesised that the simulator would improve students' ability and enhance their confidence in performing nerve blocks. A simulator was built using an equine forelimb skeleton and building foam. Wire wool targets were placed under the foam in the positions corresponding to the anatomical location of the most palmar digital, abaxial and low four-point nerve blocks and attached to an electrical circuit. The circuit became complete when the operator placed a needle in the correct position and immediate audible feedback with a buzzer was provided. To validate the simulator, it was compared with two established teaching methods: cadaver training and theoretical training with a hand-out. Cadaver-trained students achieved the best results (73 per cent correct blocks), compared with simulator-trained students (71 per cent correct blocks), and a hand-out trained group (58 per cent correct blocks). Feedback obtained with a questionnaire showed that students enjoyed simulator training more, and that they felt more confident in performing diagnostic nerve blocks than the other two groups. The equine nerve block simulator provides a safe, cost-effective method to supplement the teaching of diagnostic analgesia to undergraduate veterinary students. PMID:23486507

Gunning, P; Smith, A; Fox, V; Bolt, D M; Lowe, J; Sinclair, C; Witte, T H; Weller, R

2013-04-27

131

A technique for anodally blocking large nerve fibres through chronically implanted electrodes.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

If a spinal root of a baboon or rhesus monkey is trapped in an initially loose-fitting silicone rubber channel containing two or more platinum electrodes, electrical pulses sent through these electrodes can stimulate nerve fibres close to the cathode and block the resulting impulses close to the anode. We show (1) how anodal break excitation and excitation of fibres outside the silicone rubber channel can be avoided; (2) that an implant 26 months old behaves like a recent one; (3) that in a r...

Brindley, G. S.; Craggs, M. D.

1980-01-01

132

Maxillary nerve block: a case report and review of the intraoral technique.  

Science.gov (United States)

Maxillary nerve blockade is not commonly used by general practitioners due to a lack of experience with the techniques involved and the fear of iatrogenic damage. Nevertheless, it represents an excellent method of producing profound anesthesia in the maxilla, with definite indications in selected instances. The anatomy and techniques associated with the maxillary block, as well as the indications, contraindications and complications are reviewed, and the use of the greater palatine foramen approach to treat a patient with a facial abscess is described. PMID:7736334

Nish, I A; Pynn, B R; Holmes, H I; Young, E R

1995-04-01

133

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

Directory of Open Access Journals (Sweden)

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

Krutika B Rupera

2013-06-01

134

Emergence and distribution of the ilioinguinal nerve in the inguinal region: applications to the ilioinguinal anaesthetic block (about 100 dissections).  

Science.gov (United States)

The variations in the emergence and distribution of the ilioinguinal nerve are the cause of the failures of the ilioinguinal block and the difficulties at interpreting the ilioinguinal nerve syndrome. In order to identify its variations and set reliable anatomical landmarks for performing the ilioinguinal block, we dissected 100 inguinal regions of 51 adult corpses. The nerve was absent in seven cases and double in one case. The ilioinguinal nerve emerged from the internal oblique muscle, passing at 1 +/- 0.8 cm of the inguinal ligament and 3.33 +/- 2 cm of the ventral cranial iliac spine. It appeared behind the inguinal ligament and/or the ventral cranial iliac spine in 19 cases and presented a common trunk with the iliohypogastric nerve in 13 cases. In 47 cases, the nerve appeared in the form of a single trunk. Sixteen modes of division and eight types of predominantly anterior scrotal topographic distribution could be noted. These results show the high variability of the emergence and the sensory distribution of the ilioinguinal nerve. They enable us to propose techniques for ilioinguinal block performance using more accurate anatomical landmarks formed by the inguinal ligament and the ventral cranial iliac spine and a better diagnostic approach of ilioinguinal neuropathies. PMID:19707710

Ndiaye, Assane; Diop, M; Ndoye, J M; Ndiaye, Aï; Mané, L; Nazarian, S; Dia, A

2010-01-01

135

Dental obturation materials  

Science.gov (United States)

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

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

2006-10-01

136

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

DEFF Research Database (Denmark)

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

Lange, K H W; Jansen, T

2011-01-01

137

Cervical foraminal selective nerve root block: a 'two-needle technique' with results.  

Science.gov (United States)

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 and 12 months after the procedure. Thirty patients were included in the final analysis. Average pre-operative VAS score was 7.4 (range 5-10), which improved to 2.2 (range 0-7) at 6 weeks and 2.0 (range 0-4) at 1 year and the mean NDI score prior to intervention was 66.9 (range 44-84), which improved to 31.7 (range 18-66) at 6 weeks and 31.1 (range 16-48) at 1 year. The improvements were statistically significant. Patients with involvement of C6 or C7 nerve roots responded slightly better at 6 weeks with regards to VAS improvement. Mean duration of radiation exposure during the procedure was 27.8 s (range 10-90 s). Only minor complications were noted-transient dizziness in two and transient nystagmus in one patient. Our 'two-needle technique' is a new, safe and effective non-surgical treatment for cervical radiculopathy. PMID:18204941

Kumar, Naresh; Gowda, Veda

2008-04-01

138

Continuous Femoral Nerve Blocks: Varying Local Anesthetic Delivery Method (Bolus versus Basal) to Minimize Quadriceps Motor Block while Maintaining Sensory Block  

Science.gov (United States)

Background Whether the method of local anesthetic administration for continuous femoral nerve blocks —basal infusion versus repeated hourly bolus doses —influences block effects remains unknown. Methods Bilateral femoral perineural catheters were inserted in volunteers (n = 11). Ropivacaine 0.1% was administered through both catheters concurrently: a 6-h continuous 5 ml/h basal infusion on one side and 6 hourly bolus doses on the contralateral side. The primary endpoint was the maximum voluntary isometric contraction (MVIC) of the quadriceps femoris muscle at Hour 6. Secondary end points included quadriceps MVIC at other time points, hip adductor MVIC, and cutaneous sensation 2 cm medial to the distal quadriceps tendon in the 22 h following local anesthetic administration initiation. Results Quadriceps MVIC for limbs receiving 0.1% ropivacaine as a basal infusion declined by a mean (SD) of 84% (19) compared with 83% (24) for limbs receiving 0.1% ropivacaine as repeated bolus doses between baseline and Hour 6 (paired t test P = 0.91). Intrasubject comparisons (left vs. right) reflected a lack of difference as well: the mean basal-bolus difference in quadriceps MVIC at Hour 6 was ?1.1% (95% CI ?22.0 to 19.8%). The similarity did not reach our a priori threshold for concluding equivalence, which was the 95% CI falling within ± 20%. There were similar minimal differences in the secondary endpoints during local anesthetic administration. Conclusions This study did not find evidence to support the hypothesis that varying the method of local anesthetic administration —basal infusion versus repeated bolus doses —influences continuous femoral nerve block effects to a clinically significant degree. PMID:21394001

Charous, Matthew T.; Madison, Sarah J.; Suresh, J.; Sandhu, NavParkash S.; Loland, Vanessa J.; Mariano, Edward R.; Donohue, Michael C.; Dutton, Pascual H.; Ferguson, Eliza J.; Ilfeld, Brian M.

2011-01-01

139

Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy.  

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It has been suggested that use of peripheral nerve blocks (PNBs) may have some potential benefits in the outpatient setting. There have been no studies specifically comparing PNBs performed with short-acting local anesthetics with general anesthesia (GA) in patients undergoing outpatient knee surgery. We hypothesized that a combination of lumbar plexus and sciatic blocks using a short-acting local anesthetic will result in shorter time-to-discharge-home as compared with GA. Patients scheduled to undergo knee arthroscopy were randomized to receive a GA (midazolam, fentanyl, propofol, N(2)O/O(2)/desflurane via laryngeal mask airway) or lumbar plexus/sciatic block (PNBs; 2-chloroprocaine). Patients given GA also received an intraarticular injection of 20 mL 0.25% bupivacaine for postoperative pain control. Patients in the PNB group were given midazolam (up to 4 mg) and alfentanil (500-750 microg) before block placement and propofol 30-50 microg . kg(-1) . min(-1) for intraoperative sedation. Relevant perioperative times, postanesthesia care unit bypass rate, severity of pain, and incidence of complications were compared between the two groups. Fifty patients were enrolled in the study; 25 patients each received GA or PNBs. Total operating room time did not differ significantly between the 2 groups (97 +/- 37 versus 91 +/- 42 min). Seventy-two percent of patients receiving PNB met criteria enabling them to bypass Phase I postanesthesia care unit compared with only 24% of those receiving GA (P outpatient knee arthroscopy. PMID:15781509

Hadzic, Admir; Karaca, Pelin Emine; Hobeika, Paul; Unis, George; Dermksian, Jeffrey; Yufa, Marina; Claudio, Richard; Vloka, Jerry D; Santos, Alan C; Thys, Daniel M

2005-04-01

140

Persistent groin pain following a trans-obturator sling procedure for stress urinary incontinence: a diagnostic and therapeutic challenge.  

Science.gov (United States)

Groin pain after a tension-free vaginal tape-obturator (TVT-O) procedure can occur but mostly disappears within 4 weeks. Persistent groin pain is extremely rare and there is a paucity of literature on how to diagnose and manage this adverse event. We present two cases with severe persistent groin pain after uncomplicated TVT-O, in which magnetic resonance imaging and electromyography did not reveal the cause. We concluded that the tape entrapped or cut through peripheral branches of the obturator nerve. We removed as much of the tape as possible in both cases. Removal partially relieved the pain although sensory loss of the obturator nerve persisted 1 year after surgery. In case of abnormal post-operative groin pain, soon removal of the tape enhances the chance that damage to the obturator nerve is reversible, although it is important to counsel patients with similar pathology that recovery can take long and may be only partial. PMID:18769847

Hazewinkel, Menke H; Hinoul, Piet; Roovers, Jan-Paul

2009-03-01

 
 
 
 
141

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

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

Tantry Thrivikrama

2010-01-01

142

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

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

Koshy Rachel

2010-01-01

143

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

LENUS (Irish Health Repository)

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

Mehmood, Shehzad

2012-01-31

144

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

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

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

2010-11-15

145

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

International Nuclear Information System (INIS)

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

146

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

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

Ezirganli, Seref; Kazancioglu, Hakki Oguz

2013-11-01

147

Is ilioinguinal/iliohypogastric nerve block always totally safe in children?  

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We report a case of accidental puncture of the small bowel during an ilioinguinal/iliohypogastric nerve block procedure for hernia repair. The diagnosis was made a few days later during a laparoscopic exploration owing to the progressive onset of clinical and radiological intestinal obstruction. A large, obstructing subserosal haematoma was found without any apparent perforation of the mucosa, and the damaged loop was resected. Such a complication has already been reported once in the literature after use of a long bevel needle for the puncture. This case is the first reported using an atraumatic short bevel needle. We discuss the technical aspects of the procedure and underline the fact that regional anaesthesia in children is never totally risk free. PMID:12562490

Amory, C; Mariscal, A; Guyot, E; Chauvet, P; Leon, A; Poli-Merol, M L

2003-02-01

148

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

International Nuclear Information System (INIS)

t all stimulating times t > 2.63, P 0.05). After the block with NS or lidocaine, hypotension had lasted for 17 minutes in group C1 (All t > 1.98, P 0.05). Conclusion: Mono-side carotid sinus nerve block has no significant influence on hemodynamics of normal rabbits, but has reliable preventional and therapeutic role on hemodynamics instability caused by carotid sinus stimulation

149

Influence of Frequency and Temperature on the Mechanisms of Nerve Conduction Block Induced by High-Frequency Biphasic Electrical Current  

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The influences of stimulation frequency and temperature on mechanisms of nerve conduction block induced by high-frequency biphasic electrical current were investigated using a lumped circuit model of the myelinated axon based on Schwarz and Eikhof (SE) equations. The simulation analysis showed that a temperature-frequency relationship was determined by the axonal membrane dynamics (i.e. how fast the ion channels can open or close.). At a certain temperature, the axonal conduction block always...

Wang, Jicheng; Shen, Bing; Roppolo, James R.; Groat, William C.; Tai, Changfeng

2008-01-01

150

Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials.  

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The effect of adding clonidine to local anesthetics for nerve or plexus blocks remains unclear. The authors searched for randomized placebo-controlled trials testing the impact of adding clonidine to local anesthetics for peripheral single-injection nerve or plexus blocks in adults undergoing any surgery (except eye) without general anesthesia. Twenty trials (1,054 patients, 573 received clonidine) published 1992-2006 tested plexus (14 brachial, 1 cervical) and nerve blocks (2 sciatic/femoral, 1 midhumeral, 1 ilioinguinal/iliohypogastric, 1 ankle). Clonidine doses ranged from 30 to 300 microg; most patients received 150 microg. Clonidine prolonged the duration of postoperative analgesia (weighted mean difference 122 min; 95% confidence interval [CI] 74-169), sensory block (weighted mean difference 74 min; 95% CI 37-111), and motor block (weighted mean difference 141 min; 95% CI 82-199). In a subgroup of patients receiving an axillary plexus block, these effects were independent of whether clonidine was added to an intermediate or a long-acting local anesthetic. Clonidine increased the risk of arterial hypotension (odds ratio 3.61; 95% CI 1.52-8.55; number-needed-to-harm 11), orthostatic hypotension or fainting (odds ratio 5.07; 95% CI 1.20-21.4; number-needed-to-harm 10), bradycardia (odds ratio 3.09; 95% CI 1.10-8.64; number-needed-to-harm 13), and sedation (odds ratio 2.28; 95% CI 1.15-4.51; number-needed-to-harm 5). There was a lack of evidence of dose-responsiveness for beneficial or harmful effects. Clonidine added to intermediate or long-acting local anesthetics for single-shot peripheral nerve or plexus blocks prolongs duration of analgesia and motor block by about 2 h. The increased risk of hypotension, fainting, and sedation may limit its usefulness. Dose-responsiveness remains unclear. PMID:19602964

Pöpping, Daniel M; Elia, Nadia; Marret, Emmanuel; Wenk, Manuel; Tramèr, Martin R

2009-08-01

151

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

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

Lahori Vikram

2011-01-01

152

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

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

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

2014-07-18

153

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

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

Fu-Chao Liu

2005-06-01

154

Effects Of Oral Carbamazepine With 2% Lidocaine On Maxillary And Mandibular Nerve Blocks In Trigeminal Neuralgia  

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Full Text Available Purpose: We evaluated the therapeutic efficacy of associating the oral administration ofcarbamazepine with 2% lidocaine for maxillary and mandibular nerve blocks in acute and long-term pain relief of trigeminal neuralgia in this retrospective study.Methods: A total of 13 patients (9 men and 4 women, with trigeminal neuralgia aged between34 and 91 years (Mean age 53±13.39, and who applied to our hospitals Pain Unit between July2007-July 2009 were included in this study. The records of 13 patients suffering pain due totrigeminal neuralgia were examined; pain free periods, treatment success, side effects, andrecurrence were recorded.Results: At the end of a 5-week treatment period, pain relapses ceased in all patients. Themajority of patients benefited remarkably from the treatment after week three. Pain recurred inone patient after one month and in two patients after six months. No relapse was observed inthe other 10 patients during the 12-month follow-up period. Conclusion: Pain episodes in trigeminal neuralgia cases may be controlled by maxillary andmandibular blocks applied with oral carbamazepine and 2% lidocaine. Favorable results areobtained in both the short and long–term, and notable increases are observed in the comfort andquality of life of patients.

Mehmet BAYKAL, Metin KAPLAN

2010-11-01

155

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

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

Pyylampi Ville

2011-10-01

156

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

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

157

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

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

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

2012-09-15

158

MORPHOLOGICAL STUDY OF OBTURATOR ARTERY  

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

Pavan P Havaldar

2014-06-01

159

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

DEFF Research Database (Denmark)

We present a case with an ultrasound-guided (USG) placement of a perineural catheter beneath the transverse scapular ligament in the scapular notch to provide a continuous block of the suprascapular nerve (SSN). The patient suffered from a severe and very painful adhesive capsulitis of the left shoulder secondary to an operation in the same shoulder conducted 20 weeks previously for impingement syndrome and a superior labral anterior-posterior tear. Following a new operation with capsular release, the placement of a continuous nerve block catheter subsequently allowed for nearly pain-free low impact passive and guided active mobilization by the performing physiotherapist for three consecutive weeks. This case and a short topical review on the use of SSN block in painful shoulder conditions highlight the possibility of a USG continuous nerve block of the SSN as sufficient pain management in the immediate post-operative period following capsular release of the shoulder. Findings in other painful shoulder conditions and suggestions for future studies are discussed in the text.

Neimann, Jens Dupont BØrglum; Bartholdy, Anne

2011-01-01

160

An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block.  

Science.gov (United States)

The purpose of this study was to evaluate, with the electric pulp tester, the anesthetic efficacy of 1.8 ml of 2% lidocaine with 1:100,000 epinephrine, 3.6 ml of 2% lidocaine with 1:200,000 epinephrine, and 1.8 ml of 4% lidocaine with 1:100,000 epinephrine in human inferior alveolar nerve block. Thirty subjects randomly received each of the solutions at three successive appointments. The first molar, canine, lateral incisor, and contralateral canine were tested with the pulp tester at various time intervals up to 55 min. Complete anesthesia was defined as an 80/80 reading with the pulp tester. No significant differences in anesthetic success or failure were found among the three solutions. Potential anesthetic problems (failure, noncontinuous anesthesia, slow onset, and short duration) occurred in 43 to 57% of the molars, in 43 to 60% of the canines, and in 57 to 80% of the lateral incisors. Complete anesthesia in the mandible is a meaningful clinical problem. PMID:2607268

Vreeland, D L; Reader, A; Beck, M; Meyers, W; Weaver, J

1989-01-01

 
 
 
 
161

Duration of action of bupivacaine hydrochloride used for palatal sensory nerve block in infant pigs.  

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Bupivacaine hydrochloride is frequently used in veterinary dental procedures to reduce the amount of general anesthesia needed and to reduce post-procedural pain. The aim of this study was to develop a novel method to test local anesthetic duration in mammals. Six infant pigs were placed under deep/surgical anesthesia with 3 % isoflurane and oxygen while 0.5 ml of 0.5% bupivacaine hydrochloride was injected to block the two greater palatine and the nasopalatine nerves. They were then maintained under light anesthesia with 0.5-1.0% isoflurane. Beginning 15-minutes after the injection, 7 sites in the oral cavity were stimulated using a pointed dental waxing instrument, including 3 sites on the hard palate. The response, or lack of response, to the stimulus was recorded on video and in written record The bupivacaine hydrochloride injections lasted 1 to 3-hours before the animals responded to the sensory stimulation with a reflexive movement This study provides evidence that bupivacaine used to anesthetize the hard palate has a relatively short and variable duration of action far below what is expected based on its pharmacokinetic properties. PMID:25185333

Holman, Shaina Devi; Gierbolini-Norat, Estela M; Lukasik, Stacey L; Campbell-Malone, Regina; Ding, Peng; German, Rebecca Z

2014-01-01

162

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

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

A GHAFOURI

2001-09-01

163

Self-consistent analyses for potential conduction block in nerves by an ultrashort high-intensity electric pulse  

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Simulation studies are presented that probe the possibility of using high-field (>100kV/cm) , short-duration (˜50ns) electrical pulses for nonthermal and reversible cessation of biological electrical signaling pathways. This would have obvious applications in neurophysiology, clinical research, neuromuscular stimulation therapies, and even nonlethal bioweapons development. The concept is based on the creation of a sufficiently high density of pores on the nerve membrane by an electric pulse. This modulates membrane conductance and presents an effective “electrical short” to an incident voltage wave traveling across a nerve. Net blocking of action potential propagation can then result. A continuum approach based on the Smoluchowski equation is used to treat electroporation. This is self-consistently coupled with a distributed circuit representation of the nerve dynamics. Our results indicate that poration at a single neural segment would be sufficient to produce an observable, yet reversible, effect.

Joshi, R. P.; Mishra, A.; Hu, Q.; Schoenbach, K. H.; Pakhomov, A.

2007-06-01

164

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

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

Manal el Gohary

2009-01-01

165

Temporary pupillary dilatation and ptosis: complications of PSA nerve block: a case report and review of literature  

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Lidocaine, an amide local anesthetic is administered regularly for the minor oral and dental surgical procedures. In this article, ophthalmic complications arising from Posterior superior nerve block are discussed and a case report which had dilatation of pupil and ptosis of eye lids is presented. A review of literature is done regarding the ophthalmic complications. The precautions one needs to take during the administration of Local Anesthesia (LA) especially Posterior Superior Alveolar ner...

Prakasm, Michael; Managutti, Anil; Dolas, R. S.; Agrawal, M. G.

2009-01-01

166

Bispectral index monitoring of propofol sedation during ultrasound guided nerve block for inguinal herniorraphy: A randomized prospective study  

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Background: Patient's awareness can be reduced during ultrasound guided nerve block for inguinal herniorraphy with propofol sedation. The study was aimed to evaluate the clinical efficacy of direct visualization of anatomy of inguinal region by ultrasound and benefits of bispectral index (BIS) monitoring. Materials and Methods: After approval, 40 adult male consented patients of ASA grade I-III of 18-58 years with body mass index iliohypogastric nerves (ILHN and ILIN) block between the internal oblique and transversus abdominis muscles with 20 mL of 0.75% ropivacaine. The propofol infusion rate for sedation in patients of group I (non-BIS) was managed clinically and in patients of group II (BIS) was managed with BIS index of 65-75. Any surgical or anesthetic complications were recorded. The two groups were compared by evaluating the propofol consumption during surgery. Results: Ultrasonographic visualization of the ILHN and ILIN was possible in all patients and inguinal herniorraphy was performed uneventfully. The mean dose of propofol required for sedation was 5.45 mg/kg/h in patients of group I (non-BIS) while 4.92 mg/kg/h in patients of group II (BIS). The mean propofol consumption was not statistically significant (P = 0.12). All patients were hemodynamically stable and there was no respiratory depression during propofol sedation. Conclusion: Ultrasonography has facilitated the clinically effective nerve block for inguinal herniorraphy and BIS monitoring has ensured amnesia and faster emergence.

Gupta, Kumkum; Gupta, Prashant K.; Rastogi, Bhawna; Jain, Manish; Kumar, Lokesh; Singh, Ivesh

2013-01-01

167

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

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

S. Ponnambala Namasivayam

2014-02-01

168

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

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Abstract Objective To determine the impact of pre-operative and intra-operative ilioinguinal and iliohypogastric nerve block on post-operative analgesic utilization and length of stay (LOS). Methods We conducted a prospective randomized double-blind placebo controlled trial to assess effectiveness of ilioinguinal-iliohypogastric nerve block (IINB) on post-operative morphine consumption in female study patients (n = 60). Patients undergoing laparotomy vi...

Saltzman Steven L; Ehleben Carole M; Hosford Sarah L; Dominique El-Khawand H; Ghulmiyyah Labib M; Wehbe Salim A; Sills Eric

2008-01-01

169

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

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

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

170

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

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

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

2012-05-01

171

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

Scientific Electronic Library Online (English)

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

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

2013-07-01

172

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

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

Liu JL

2014-05-01

173

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

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

Liu JL

2014-02-01

174

Pyomyositis of Obturator Muscles: Unusual Late Presentation  

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

Prasad Channappa Soraganvi

2013-04-01

175

Obturator hernia: diagnosis through medical imaging  

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

176

Obturator hernia: diagnosis through medical imaging  

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

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

1995-08-01

177

Complications associated with maxillary nerve block anaesthesia via the greater palatine canal.  

Science.gov (United States)

This paper documents the type, frequency and duration of complications associated with regional anaesthesia of the maxillary nerve via the greater palatine canal in a series of 101 patients treated in the Oral Surgery Department, United Dental Hospital of Sydney. PMID:1444954

Sved, A M; Wong, J D; Donkor, P; Horan, J; Rix, L; Curtin, J; Vickers, R

1992-10-01

178

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

Scientific Electronic Library Online (English)

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

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

2013-06-01

179

Quasi-trapezoidal pulses to selectively block the activation of intrinsic laryngeal muscles during vagal nerve stimulation  

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The stimulation of the vagus nerve has been used as an anti-epileptic treatment for over a decade, and its use for depression and chronic heart failure is currently under investigation. Co-activation of the intrinsic laryngeal muscles may limit the clinical use of vagal stimulation, especially in the case of prolonged activation. To prevent this, the use of a selective stimulation paradigm has been tested in seven acute pig experiments. Quasi-trapezoidal pulses successfully blocked the population of the largest and fastest vagal myelinated fibers being responsible for the co-activation. The first response in the vagus compound action potential was reduced by 75 ± 22% (mean ± SD) and the co-activated muscle action potential by 67 ± 25%. The vagal bradycardic effects remained unchanged during the selective block, confirming the leading role of thin nerve fibers for the vagal control of the heart. Quasi-trapezoidal pulses may be an alternative to rectangular pulses in clinical vagal stimulation when the co-activation of laryngeal muscles must be avoided.

Tosato, M.; Yoshida, K.; Toft, E.; Struijk, J. J.

2007-09-01

180

A randomised controlled trial of the effect of regional nerve blocks on immediate post-tonsillectomy pain in adult patients.  

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Post-operative pain is the main cause of morbidity following tonsillectomy. The efficacy of glossopharyngeal and lesser palatine nerve blocks in controlling postoperative pain in adult patients was investigated prospectively. Patients 16 years and older admitted for elective tonsillectomy were randomised to one of three groups to receive a pre-incisional oropharyngeal injection of 0.5% bupivicaine, a 'dummy' injection of saline or no injection. Dissection tonsillectomy and general anaesthetic techniques were standardized. Postoperative pain was monitored for 24 h. ANOVA, chi2 and Fisher's exact test were used for intergroup comparisons. Ninety-two patients (72 women and 20 men), mean age 22 years were studied. Twenty-nine patients received 0.5% bupivicaine, 30 saline and 33 no pre-incisional injection. The overall mean pain scores of 2.1, 1.9 and 1.9 in the bupivicaine, saline and no injection groups were similar. Glossopharyngeal and lesser palatine 0.5% bupivicaine nerve blocks are not effective in reducing early post-tonsillectomy pain. PMID:11012656

El-Hakim, H; Nunez, D A; Saleh, H A; MacLeod, D M; Gardiner, Q

2000-10-01

 
 
 
 
181

Femoral nerve blocks in fractures of femur: variation in the current UK practice and a review of the literature.  

Science.gov (United States)

Fractures of the femur are common orthopaedic emergencies presenting to emergency departments (ED). Femoral nerve block (FNB) is a fast, safe and effective means of providing pain relief to these patients. With the aim to analysing the variation in current practice of giving FNB in patients with fractured femur in the UK, we carried out a telephonic national survey. Out of 252 EDs contacted, 230 departments participated in the survey (91% response rate). The survey showed that 74% EDs in the UK had access to ultrasound, but only 10% EDs gave FNB regularly under ultrasound guidance. In total, 46% of EDs gave FNB by blind technique. Therefore, ultrasound-guided FNB is an underutilised method of providing pain relief for fractured femur patients. The main reasons for not using ultrasound for FNB were: lack of training, participants' confidence in giving an effective and safe FNB block blindly and time constraints. The literature review suggests that ultrasound-guided FNB has a faster onset of action, is more effective and safer than the FNB given with nerve stimulator (NS) or blindly, and probably needs lower local anaesthetic dose. The use of NS for FNB in ED might not be practical because of the likelihood of the pain resulting from the movement of the affected limb due to the contraction of the muscles caused by nerve stimulation and because of additional training needed in using NS. The studies comparing FNB given using ultrasound or NS, or given blindly, have been done in the perioperative settings. To date, there has been no randomised controlled trial in ED setting comparing FNB given blindly or under ultrasound guidance. Such a study might have provided a good evidence for modifying the current practice of blind FNB. PMID:23444420

Mittal, Rajnish; Vermani, Era

2014-02-01

182

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

Science.gov (United States)

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

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

2014-01-01

183

Herniography off femoral, obturator and perineal hernias  

Energy Technology Data Exchange (ETDEWEB)

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.

Ekberg, O.; Nordblom, I.; Fork, F.T.; Gullmo, A.

1985-08-01

184

Herniography off femoral, obturator and perineal hernias  

International Nuclear Information System (INIS)

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

185

The furcal nerve revisited  

Directory of Open Access Journals (Sweden)

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

Nanjundappa S. Harshavardhana

2014-08-01

186

The furcal nerve revisited.  

Science.gov (United States)

Atypical sciatica and discrepancy between clinical presentation and imaging findings is a dilemma for treating surgeon in management of lumbar disc herniation. It also constitutes ground for failed back surgery and potential litigations thereof. Furcal nerve (Furcal = forked) is an independent nerve with its own ventral and dorsal branches (rootlets) and forms a link nerve that connects lumbar and sacral plexus. Its fibers branch out to be part of femoral and obturator nerves in-addition to the lumbosacral trunk. It is most commonly found at L4 level and is the most common cause of atypical presentation of radiculopathy/sciatica. Very little is published about the furcal nerve and many are unaware of its existence. This article summarizes all the existing evidence about furcal nerve in English literature in an attempt to create awareness and offer insight about this unique entity to fellow colleagues/professionals involved in spine care. PMID:25317309

Harshavardhana, Nanjundappa S; Dabke, Harshad V

2014-08-01

187

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

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

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

2010-01-01

188

[Long-term block of thoracic vegetative nerve trunks in combined treatment of acute intestinal obstruction].  

Science.gov (United States)

Results of treatment of acute intestinal obstruction with long-term block of the left thoracic sympathetic trunk, paraaortal and paraesophageal vegetative plexuses, vagus and posterior bronchial plexuses are analyzed. Compared with long-term epidural block this method permits one to reduce 2 times the rate of postoperative complications and lethality, to shorten the hospital stay by 5 days. Long-term block of thoracic vegetative nervous trunks provide manipulations out of structures of the spinal column and permits to influence directly both parts of the vegetative nervous system. PMID:12501465

Kuznetsov, I A

2002-01-01

189

Continuous Femoral Versus Posterior Lumbar Plexus Nerve Blocks for Analgesia After Hip Arthroplasty: A Randomized, Controlled Study  

Science.gov (United States)

BACKGROUND Hip arthroplasty frequently requires potent postoperative analgesia, often provided with an epidural or posterior lumbar plexus local anesthetic infusion. However, American Society of Regional Anesthesia guidelines now recommend against epidural and continuous posterior lumbar plexus blocks during administration of various perioperative anticoagulants often administered after hip arthroplasty. A continuous femoral nerve block is a possible analgesic alternative, but whether it provides comparable analgesia to a continuous posterior lumbar plexus block after hip arthroplasty remains unclear. We therefore tested the hypothesis that differing the catheter insertion site (femoral versus posterior lumbar plexus) after hip arthroplasty has no impact on postoperative analgesia. METHODS Preoperatively, subjects undergoing hip arthroplasty were randomly assigned to receive either a femoral or posterior lumbar plexus stimulating catheter inserted 5 to 15 cm or 0 to 1 cm past the needletip, respectively. Postoperatively, patients received perineural ropivacaine, 0.2% (basal 6 mL/hour, bolus 4 mL, 30 min lockout) for at least two days. The primary end point was the average daily pain scores as measured with a numeric rating scale (0–10) recorded in the 24-h period beginning at 07:30 the morning after surgery, excluding twice-daily physical therapy sessions. Secondary end points included pain during physical therapy, ambulatory distance, and supplemental analgesic requirements during the same 24-h period, as well as satisfaction with analgesia during hospitalization. RESULTS The mean (SD) pain scores for subjects receiving a femoral infusion (n = 25) were 3.6 (1.8) versus 3.5 (1.8) for patients receiving a posterior lumbar plexus infusion (n = 22) resulting in a group difference of 0.1 (95% confidence interval ?0.9 to 1.2; P = 0.78). Because the confidence interval was within a prespecified ?1.6 to 1.6 range, we conclude that the effect of the two analgesic techniques on postoperative pain was equivalent. Similarly, we detected no differences between the two treatments with respect to the secondary end points, with one exception: subjects with a femoral catheter ambulated a median (10th–90th percentiles) 2 (0–17) m the morning after surgery, compared with 11 (0–31) m for subjects with a posterior lumbar plexus catheter (data nonparametric; P = 0.02). CONCLUSIONS After hip arthroplasty, a continuous femoral nerve block is an acceptable analgesic alternative to a continuous posterior lumbar plexus block when using a stimulating perineural catheter. However, early ambulatory ability suffers with a femoral infusion. PMID:21467563

Ilfeld, Brian M.; Mariano, Edward R.; Madison, Sarah J.; Loland, Vanessa J.; Sandhu, NavParkash S.; Suresh, Preetham J.; Bishop, Michael L.; Kim, T. Edward; Donohue, Michael C.; Kulidjian, Anna A.; Ball, Scott T.

2011-01-01

190

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

Directory of Open Access Journals (Sweden)

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

C. A. Caputi

2011-03-01

191

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

Directory of Open Access Journals (Sweden)

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

M Toghae

2012-08-01

192

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

DEFF Research Database (Denmark)

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

Simonsen, O H; Gorst-Rasmussen, Anders

2011-01-01

193

[Combined sciatic/3-in-1 block in routine surgical care].  

Science.gov (United States)

For decades it has been known that the combined sciatic and femoral nerve block could be used for operations on the leg. Nevertheless, it is used in very few hospitals as a routine method for surgical anesthesia and only few publications exist in this area. To highlight some practical aspects, we have produced a retrospective study of 660 cases of femoral and sciatic nerve blocks used exclusively for operating purposes. For all blocks we used a nerve stimulator. For the sciatic nerve we normally used the posterior approach. The femoral nerve was blocked in the "3 in 1" method of Winnie to include the obturator and lateral femoral cutaneous nerves as well. All patients had been premedicated (Table 3). In 67% we used bupivacaine 0.5%, in 29% prilocaine 1%, in 4% mixed agents, and in 5 cases mepivacaine 1.5%. We added epinephrine 1:400,000 in all cases except those with cardiac contraindications. The maximal dose was 80 ml or 9.76 mg/kg prilocaine and 105 ml or 7.72 mg/kg bupivacaine. Both doses were tolerated without complications. Applying strict criteria (Fig. 1 + 2), the overall failure rate was 17.7% (Table 1): depending on the anesthesiologist administering the block 7.1%-27.8% (Fig. 3) and on the type of operation 4.6%-42.3% (Table 2). The most important factor influencing the failure rate was the anesthesiologist. The individual failure rate of the first 30 blocks of each anesthesiologist (V30) was nearly equal to the overall individual failure rate (Fig. 3). The form and time of premedication and the extent of sedation did not influence the results.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2825250

Dennig, L; Billich, R; Bührle, E

1987-10-01

194

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

Science.gov (United States)

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

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

2012-06-01

195

Diagnosis and treatment of obturator hernia  

Energy Technology Data Exchange (ETDEWEB)

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

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

2002-09-01

196

Diagnosis and treatment of obturator hernia  

International Nuclear Information System (INIS)

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

197

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

DEFF Research Database (Denmark)

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

Bischoff, Joakim Mutahi; Koscielniak-Nielsen, Zbigniew J

2012-01-01

198

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

International Nuclear Information System (INIS)

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

199

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

Gp, Dureja; Toshniwal Gokul; Sunder Rani A

2008-01-01

200

MR Imaging Features of Obturator Internus Bursa of the Hip  

International Nuclear Information System (INIS)

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

 
 
 
 
201

MR Imaging Features of Obturator Internus Bursa of the Hip  

Energy Technology Data Exchange (ETDEWEB)

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

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

2008-08-15

202

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

Scientific Electronic Library Online (English)

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

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

203

Increase in flexor but not extensor corticospinal motor outputs following ischemic nerve block.  

Science.gov (United States)

Human motor cortex is capable of rapid and long-lasting reorganization, evident globally, as shifts in body part representations, and at the level of individual muscles as changes in corticospinal excitability. Representational shifts provide an overview of how various body parts reorganize relative to each other but do not tell us whether all muscles in a given body part reorganize in the same manner and to the same extent. Transcranial magnetic stimulation (TMS) provides information about individual muscles and can therefore inform us about the uniformity of plastic changes within a body part. We used TMS to investigate changes in corticospinal excitability of forearm flexors and extensors after inflation of a tourniquet around the wrist. Motor evoked potential (MEP) amplitudes and input/output (I/O) curves were obtained from wrist flexors and extensors simultaneously before and during block. TMS was delivered to the optimal site for eliciting MEPs in flexors in experiment 1, extensors in experiment 2, and both flexors and extensors in experiment 3. In all experiments flexor MEP amplitude increased during block while extensor MEP amplitude showed no systematic change, and the slope of flexor but not extensor I/O curves increased. Flexor H-reflex amplitude normalized to maximal M wave showed negligible changes during block, suggesting that the increase in corticospinal excitability in the flexors cannot be completely explained by increased excitability at the spinal cord level. These findings show that forearm flexors and extensors differ in their potential for plastic changes, highlight the importance of investigating how experimentally induced plasticity affects anatomically close, but functionally distinct, muscle groups, and suggest that rehabilitation interventions aiming to alter cortical organization should consider the differential sensitivity of various muscle groups to plasticity processes. PMID:22457455

Vallence, Ann-Maree; Hammond, Geoffrey R; Reilly, Karen T

2012-06-01

204

Bloqueios nervosos guiados por ultra-som / Ultrasound-guided nerve blocks / Bloqueos nerviosos guiados por ultrasonido  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: As técnicas de bloqueios nervosos guiados por ultra-som são baseadas na visualização direta das estruturas nervosas, da agulha de bloqueio e das estruturas anatômicas adjacentes. Desta maneira, é possível depositar a solução de anestésico local precisamente em torno dos ne [...] rvos e acompanhar a sua dispersão em tempo real, obtendo-se, assim, um bloqueio mais eficaz, de menor latência, menor dependência de referências anatômicas, menor volume de solução anestésica e maior segurança. CONTEÚDO: O artigo revisa os aspectos relativos aos mecanismos físicos para formação de imagens, a anatomia ultra-sonográfica do neuroeixo e dos plexos braquial e lombossacral, os equipamentos e materiais empregados nos bloqueios, os ajustes do aparelho de ultra-som para melhorar as imagens, os planos de visualização das agulhas de bloqueio e as técnicas e o treinamento em bloqueios guiados por ultra-som. CONCLUSÕES: Os passos para se obter sucesso em anestesia regional incluem a identificação exata da posição dos nervos, a localização precisa da agulha, sem lesões nas estruturas adjacentes e, finalmente, a injeção cuidadosa de anestésico local junto aos nervos. Embora a neuroestimulação forneça grande auxílio na identificação dos nervos, esta não consegue, isoladamente, preencher todas essas exigências. Por isso, acredita-se que os bloqueios guiados por ultra-som serão a técnica de eleição para anestesia regional num futuro não muito distante. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: Las técnicas de bloqueos nerviosos guiados por ultrasonido se basan en la visualización directa de las estructuras nerviosas, de la aguja de bloqueo y de las estructuras anatómicas adyacentes. De esa manera, se puede depositar la solución de anestésico local precisamente e [...] n torno de los nervios y acompañar su dispersión en tiempo real, obteniéndose así, un bloqueo más eficaz, de menor latencia, menor dependencia de referencias anatómicas, menor volumenn de solución anestésica y una mayor seguridad. CONCLUSION: El artículo revisa los aspectos relativos a los mecanismos físicos para la formación de imágenes, la anatomía ultra sonográfica del neuro eje y de los plexos braquial y lumbo sacral, los equipos y materiales empleados en los bloqueos, los ajustes del aparato de ultrasonido para mejorar las imágenes, los planos de visualización de las agujas de bloqueo y las técnicas y el entrenamiento en bloqueos guiados por ultrasonido. CONCLUSIONES: Los pasos para obtener el éxito en anestesia regional incluyen la identificación exacta de la posición de los nervios, la localización precisa de la aguja, sin lesiones en las estructuras adyacentes y, finalmente, la inyección cuidadosa de anestésico local junto a los nervios. Aunque la neuro estimulación sea de gran ayuda en la identificación de los nervios, ella no logra, aisladamente, rellenar todas esas exigencias. A causa de eso, se cree que los bloqueos guiados por ultrasonido serán la técnica de elección para la anestesia regional en un futuro no muy distante. Abstract in english BACKGROUND AND OBJECTIVES: Ultrasound-guided nerve blocks are based on the direct visualization of nerve structures, needle, and adjacent anatomic structures. Thus, it is possible to place the local anesthetic precisely around the nerves and follow its dispersion in real time, obtaining, therefore, [...] more effective blockades, reduced dependency on anatomic references, decreased anesthetic volume, and increased safety. CONTENTS: The aim of this paper was to review the physical mechanisms of image formation, ultrasound anatomy of the neuro axis and of the brachial and lumbosacral plexuses, equipment and materials used in the blockades, settings of the ultrasound equipment to improve the image, planes of visualization of the needles, the techniques, and training in ultrasound-guided nerve blocks. CONCLUSIONS: The steps for a successful reg

Pablo Escovedo, Helayel; Diogo Brüggemann da, Conceição; Getúlio Rodrigues de, Oliveira Filho.

205

Anatomy of greater palatine foramen and canal and pterygopalatine fossa in Thais: considerations for maxillary nerve block.  

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This study aims to investigate the anatomy of the greater palatine foramen (GPF), greater palatine canal (GPC) and pterygopalatine fossa (PPF) with special reference to the blockage of the maxillary nerve. A correlation between the length of GPC and PPF and the heights of the orbit and the maxilla was also studied using simple linear regression analysis. The morphology of the GPF, GPC and PPF as well as heights of the orbit and the maxilla were assessed in 105 Thai skulls. The thickness of the mucosa over the GPF was also measured from the dissection of 55 cadavers. The results showed that most GPF appeared as an oval foramen located at the palatal aspect of the upper third molar. The GPF was 16.2+/-1.3 mm lateral to the median sagittal plane of the hard palate, 2.1+/-1.3 mm anterior to the posterior border of the hard palate and 5.1+/-1.3 mm from the greatest concavity of the distolateral margin of the hard palate. The mean length of GPC and PPF was 29.7+/-4.2 mm. The mean angles of the GPC in relation to the hard palate and the vertical plane were 57.9+/-5.8 degrees and 6.7+/-5.2 degrees , respectively. In attempting to insert a needle to reach the foramen rotundum through the GPF, 31.7% passed into the orbit while 8.7% passed into the brain. The mean thickness of the mucosa over GPF was 6.7+/-2.3 mm. Two models for estimating the depth of needle injection in maxillary nerve block have been developed as follows: Length of GPC and PPF=19.038+0.314 (orbital height) and length of GPC and PPF=21.204+0.187 (maxillary height). The calculated length combined with the mucosal thickness was the estimated depth of needle injection. In conclusion, our results concerning the GPF, GPC and PPF will provide the useful reference for clinicians to anesthetize the maxillary nerve with a greater degree of success. PMID:16228112

Methathrathip, D; Apinhasmit, W; Chompoopong, S; Lertsirithong, A; Ariyawatkul, T; Sangvichien, S

2005-12-01

206

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

LENUS (Irish Health Repository)

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

Mannion, Stephen

2012-02-03

207

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

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

Szucs Szilard

2012-06-01

208

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

LENUS (Irish Health Repository)

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

Szucs, Szilard

2012-06-27

209

Ultrasound-guided pudendal nerve block in cats undergoing perineal urethrostomy: a prospective, randomised, investigator-blind, placebo-controlled clinical trial.  

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The objective of this study was to evaluate the clinical usefulness, in terms of analgesic efficacy and safety, of ultrasound-guided pudendal nerve block performed with bupivacaine in cats undergoing perineal urethrostomy. Eighteen client-owned male cats scheduled for perineal urethrostomy were enrolled in the study and assigned to one of two treatment groups. The pudendal nerve block was performed under general anaesthesia, as described elsewhere, with 0.3 ml/kg of either saline (group C) or 0.5% bupivacaine (group B) - the total injection volume being split equally between the two sites of injection (left and right). Intra-operatively, assessment of nociception was based on the rescue analgesics requirement, as well as on the evaluation of changes in physiological parameters in comparison with the baseline values. Postoperative pain assessment was performed using three different pain scales at recovery and then 1, 2 and 3 h after recovery. Cats in group B showed lower heart rates and required fewer analgesics during surgery than group C. Postoperatively, group B had lower pain scores and needed less rescue buprenorphine than group C. Iatrogenic block-related complications were not observed. In conclusion, the ultrasound-guided pudendal nerve block can be considered clinically useful in feline medicine as it provides reliable analgesia in cats undergoing perineal urethrostomy. PMID:24174501

Adami, Chiara; Dayer, Thomas; Spadavecchia, Claudia; Angeli, Giovanni

2014-04-01

210

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

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

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

2014-06-01

211

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

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

2008-01-01

212

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

International Nuclear Information System (INIS)

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

213

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

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

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

2010-01-01

214

Inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen: radiographic study of local anesthetic spread in the pterygomandibular space.  

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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 lidocaine and contrast medium utilizing the anterior technique. The course of spread was traced by fluoroscopy in the sagittal plane, and the distribution area was evaluated by lateral cephalograms and ...

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

2000-01-01

215

Anesthetic Efficacy of Combinations of 0.5 M Mannitol and Lidocaine With Epinephrine in Inferior Alveolar Nerve Blocks: A Prospective Randomized, Single-Blind Study  

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The purpose of this prospective, randomized, single-blind study was to determine the anesthetic efficacy of lidocaine with epinephrine compared to lidocaine with epinephrine plus 0.5 M mannitol in inferior alveolar nerve (IAN) blocks. Forty subjects randomly received an IAN block in 3 separate appointments spaced at least 1 week apart using the following formulations: a 1.8 mL solution of 36 mg lidocaine with 18 µg epinephrine (control solution); a 2.84 mL solution of 36 mg lidocaine ...

Wolf, Ronald; Reader, Al; Drum, Melissa; Nusstein, John; Beck, Mike

2011-01-01

216

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

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

V. Domingo

2004-05-01

217

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

Scientific Electronic Library Online (English)

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

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

218

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

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

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

2014-05-01

219

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

Scientific Electronic Library Online (English)

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

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

220

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

Scientific Electronic Library Online (English)

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

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

2013-09-01

 
 
 
 
221

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

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Study Design: A randomized, double-blind, controlled trial. Objective: To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks with or without steroids in managing chronic low back pain of facet joint origin. Summary of Background Data: Lumbar facet joints have been shown as the source of chronic pain in 21% to 41% of low back patients with an average prevalence of 31% utilizing controlled comparative local anesthetic blocks. Intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin. Methods: The study included 120 patients with 60 patients in each group with local anesthetic alone or local anesthetic and steroids. The inclusion criteria was based upon a positive response to diagnostic controlled, comparative local anesthetic lumbar facet joint blocks. Outcome measures included the numeric rating scale (NRS), Oswestry Disability Index (ODI), opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months. Results: Significant improvement with significant pain relief of ? 50% and functional improvement of ? 40% were observed in 85% in Group 1, and 90% in Group II, at 2-year follow-up. The patients in the study experienced significant pain relief for 82 to 84 weeks of 104 weeks, requiring approximately 5 to 6 treatments with an average relief of 19 weeks per episode of treatment. Conclusions: Therapeutic lumbar facet joint nerve blocks, with or without steroids, may provide a management option for chronic function-limiting low back pain of facet joint origin. PMID:20567613

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

2010-01-01

222

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

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

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

2010-01-01

223

Nerve terminals form but fail to mature when postsynaptic differentiation is blocked: in vivo analysis using mammalian nerve-muscle chimeras.  

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To better understand the role of the postsynaptic cell in the differentiation of presynaptic terminals, we transplanted muscles that lacked postsynaptic differentiation from mutant mice into normal adult immunocompatible hosts and attached the host nerve to the grafts. Host motor axons innervated wild-type grafted muscle fibers and established normal appearing chimeric neuromuscular junctions. By repeated in vivo imaging, we found that these synapses were stably maintained. Results were different when nerves entered transplanted muscles derived from mice lacking muscle-specific receptor tyrosine kinase (MuSK) or rapsyn, muscle-specific components required for postsynaptic differentiation. Initial steps in presynaptic differentiation (e.g., formation of rudimentary arbors and vesicle clustering at terminals) occurred when wild-type neurites contacted MuSK- or rapsyn deficient muscle fibers, either in vivo or in vitro. However, wild-type terminals contacting MuSK or rapsyn mutant muscle fibers were unable to mature, even when the chimeras were maintained for up to 7 months. Moreover, in contrast to the stability of wild-type synapses, wild-type nerve terminals in mutant muscles underwent continuous remodeling. These results suggest that postsynaptic cells supply two types of signals to motor axons: ones that initiate presynaptic differentiation and others that stabilize the immature contacts so that they can mature. Normal postsynaptic differentiation appears to be dispensable for initial stages of presynaptic differentiation but required for presynaptic maturation. PMID:10934257

Nguyen, Q T; Son, Y J; Sanes, J R; Lichtman, J W

2000-08-15

224

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

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

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

2014-04-01

225

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

LENUS (Irish Health Repository)

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

Long, Ronan M

2012-01-31

226

Electrochemical microleakage assessment of three different root canal obturation techniques.  

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This study compared microleakage of lateral condensation, Thermafil and multiphase gutta-percha obturation technique using an electrochemical test system. The mean leakage current of three obturation techniques compared with that of positive samples. It was found that, the multiphase gutta-percha showed the least mean leakage current followed by Thermafil and lateral condensation techniques. PMID:9588165

Ibrahim, R M; Kataia M A-el-R

1994-07-01

227

Single-cone obturation technique: a literature review  

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

Lidiane de Castro Pinto

2012-12-01

228

Laparoscopic repair of coexisting prevascular and obturator hernias.  

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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

Bunting, David M; Finlay, Ian G

2012-10-01

229

Combined epidural anesthesia and ultrasound guided peripheral nerve block for wound revision in a patient with peripartum cardiomyopathy -A case report-.  

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Peripartum cardiomyopathy (PPCM) is a rare complication that occurs between the late stage of pregnancy and six months after delivery. PPCM presents as symptoms of left ventricular dysfunction and it can be fatal unless treated promptly. Furthermore, anesthesia and surgery in such patients is a large challenge to anesthesiologists. First and foremost, the maintenance of stable hemodynamics is a major concern. We report a case of combined lumbar epidural anesthesia and both ilioinguinal and iliohypogastric nerve block under ultrasound guided for a wound revision in a 37-year-old woman diagnosed with PPCM after an emergency cesarean section. PMID:21179300

Gong, Tai Kyung; Kim, Seong Su

2010-11-01

230

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

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

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

1999-09-01

231

The Efficacy and Safety of Continuous Popliteal Sciatic Nerve Block for the Relief of Pain Associated with Critical Limb Ischemia: A Retrospective Study  

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Full Text Available Background: Patients with critical limb ischemia (CLI often suffer from severe pain. A continuous peripheral nerve block has been shown to provide effective analgesia for patients having lower limb surgery. We have been administering continuous sciatic nerve block (CSNB for patients with CLI whose pain could not be relieved by other analgesic tools. The aim of this retrospective study was to investigate the efficacy and safety of CSNB for patients with CLI. Method: We retrospectively investigated 99 patients who received CSNB for the relief of severe pain in the lower limb associated with CLI. Patient demographics, neurological history, complications, and subjective evaluation of the effectiveness of CSNB were investigated from their clinical records. The distal tips of 108 catheters were cultured. Result: One hundred and seventy-two catheters were placed in 99 patients. More than 90% of the patients enjoyed considerable relief of severe pain. The analgesic effect of CSNB was greater in patients with older age and hemodialysis. Thirty-one catheters had positive bacterial colonization. However, no severe infectious complication was found. There was no relationship between the co-existence of diabetes and positive bacterial colonization. We encountered a patient with ASO and diabetes who suffered from persistent motor weakness and hypesthesia even after 3 months of CSNB placement. Conclusions: CSNB provided good pain control for patients with severe pain caused by CLI. Although catheters were frequently found to be colonized, infection at the catheter site was self-limiting even in patients with diabetes.

Atsushi Hashimoto

2013-12-01

232

[Use of ilio-inguinal iliohypogastric nerve block for herniorraphy: a prospective study in a 35-case series at the Lome University Hospital Center in Togo].  

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The purpose of this prospective-descriptive study was to evaluate the quality of anaesthesia and analgesic effect achieved by ilio-inguinal iliohypogastric nerve block (IINB) in patients undergoing herniorraphy. Study was carried out over a 6-month period in the Anaesthesia Intensive Care Department of the Lomé University Hospital Centre in Togo. All patients indicated for unilateral herniorraphy were enrolled. A total of 35 patients underwent herniorraphy with IINB. Mean patient age was 32 years. Farmers accounted for 57% of the population. Men accounted for 86.7%. The anaesthesia classification was ASA I or II in 88.6% of cases. Complete sensory block was obtained within 15 minutes after induction in 71.43% of cases. Additional sedation using ketamine and/or fentanyl was used in 51.43% of cases. Conversion from IINB to general anaesthesia was necessary in three cases including 2 due to extension of the surgical incision and one for the surgeon's convenience. The mean duration of the procedure was 70 minutes. Intraoperative complications included nausea in one case, dizziness in 2 cases, and bitterness in mouth in 3 cases. Postoperatively, extension to the femoral nerve was observed in 2 cases. Five patients presented a visual analogue pain scale (VAS) > or = 4 within 18 hours after the procedure. This study shows that IINB is a useful alternative to general anaesthesia for herniorraphy. Specific training is necessary to allow more widespread use. PMID:18478775

Ouro-Bang'Na Maman, A F; Kangni, N; Mouzou, T; Djibril, M A; Tomta, K; Chobli, M

2008-02-01

233

Perineural Dexmedetomidine Added to Ropivacaine Causes a Dose-dependent Increase in the Duration of Thermal Antinociception in Sciatic Nerve Block in Rat  

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Background The present study was designed to test the hypothesis that dexmedetomidine added to ropivacaine would increase the duration of antinociception to a thermal stimulus in a dose-dependent fashion in a rat model of sciatic nerve blockade. Methods Fifty adult Sprague Dawley rats (10 rats/group) received unilateral sciatic nerve blocks with 0.2 ml of 0.5% ropivacaine or 0.2 ml of 0.5% ropivacaine plus dexmedetomidine (2.7 ?M [0.5 ?g/kg], 11.7 ?M [2 ?g/kg], 34.1 ?M [6 ?g/kg], or 120.6 ?M [20 ?g/kg]) in a randomized, blinded fashion. Time to paw withdrawal latency to a thermal stimulus for both paws and an assessment of motor function were measured every 30 min after the nerve block until a return to baseline. Results Dexmedetomidine added to ropivacaine increased the duration of dense sensory blockade and time for return to normal sensory function in a dose-dependent fashion (p < 0.005). There was a significant time (p < 0.005), dose (p < 0.005), and time by dose effect (p < 0.005) on paw withdrawal latencies of the operative paws. There were no significant differences in paw withdrawal latencies of the control paws, indicating little systemic effect of the dexmedetomidine. The duration of motor blockade was also increased with dexmedetomidine. High-dose dexmedetomidine (120.6 ?M) was not neurotoxic. Conclusion This is the first study showing that dexmedetomidine added to ropivacaine increases the duration of sensory blockade in a dose-dependent fashion in rat. The findings are an essential first step encouraging future efficacy studies in humans. PMID:19858875

Brummett, Chad M.; Padda, Amrita K.; Amodeo, Francesco S.; Welch, Kathleen B.; Lydic, Ralph

2009-01-01

234

Variability in the origin of the obturator artery  

Scientific Electronic Library Online (English)

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

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

235

Variability in the origin of the obturator artery  

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

Mangala M. Pai

2009-01-01

236

The role of retraction in direct nerve injury in total hip replacement  

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Objectives Acetabular retractors have been implicated in damage to the femoral and obturator nerves during total hip replacement. The aim of this study was to determine the anatomical relationship between retractor placement and these nerves. Methods A posterior approach to the hip was carried out in six fresh cadaveric half pelves. Large Hohmann acetabular retractors were placed anteriorly, over the acetabular lip, and inferiorly, and their relationship to the femoral and obturator nerves was examined. Results If contact with bone was not maintained during retractor placement, the tip of the anterior retractor had the potential to compress the femoral nerve by passing superficial to the iliopsoas. If pressure was removed from the anterior retractor, the tip pivoted on the anterior acetabular lip, and passed superficial to the iliopsoas, overlying and compressing the femoral nerve, when pressure was reapplied. The inferior retractor pierced the obturator membrane in all specimens medial to the obturator nerve, with subsequent retraction causing the tip to move laterally, making contact with the nerve. Conclusion Iliopsoas can only offer protection to the femoral nerve if the retractor passes deep to the muscle bulk. The anterior retractor should be reinserted if pressure is removed intra-operatively. Vigorous movement of the inferior retractor should be avoided. Cite this article: Bone Joint Res 2014;3:212–6. PMID:24973358

McConaghie, F. A.; Payne, A. P.; Kinninmonth, A. W. G.

2014-01-01

237

Trans-obturator Tape in surgical treatment of urinary incontinence  

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

Ashrafi M

2008-06-01

238

Morphological examination of the obturator notch and canal in cervidae.  

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

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

2014-05-01

239

Lack of correlation between obturation limits and apical leakage  

Scientific Electronic Library Online (English)

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

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

2013-07-01

240

Lack of correlation between obturation limits and apical leakage  

Scientific Electronic Library Online (English)

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

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

 
 
 
 
241

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

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Full Text Available This prospective double blinded study was designed to compare the effect of magnesium or fentanyl addition to ropivacaine in continuous femoral nerve block in patients undergoing elective total knee replacement under general anesthesia. Sixty patients undergoing elective TKR under general anesthesia, were randomly allocated into three equal groups, Group (R: given 30 mL Ropivacaine 0.2%. Group (R+F: given 30 mL Ropivacaine 0.2% and 4 ?g mL-1 fentanyl. Group (R+M: given 30 mL Ropivacaine 0.2% and 50 mg mL-1 of magnesium sulphate, through femoral catheter. The following parameters were evaluated: (1 demographic data of the patients and duration of the surgery, (2 intraoperative and postoperative hemodynamics, (3 intraoperative fentanyl requirements, (4 the severity of postoperative pain for 24 h, (5 time to first request of analgesia and (6 amount of postoperative morphine consumed in 0-6, 6-12, 12-18, 18-24 and 0-24 h, postoperatively. There were no difference among the three groups as regards the demographic data, the duration of the surgery, the pre and postoperative hemodynamics, the total intraoperative fentanyl consumption and the VAS during the 1st postoperative hour. The postoperative pain showed significant lower values in groups (R+F and (R+M compared to group (R when measured at 6, 12, 18 and 24 postoperative hours. The time for the first postoperative request for analgesia was statistically longer in the (R+M group and (R+F group compared with group (R. The postoperative morphine consumption was statistically lower in groups (R+F and (R+M compared to group (R but insignificant between groups (R+F and (R+M. The admixture of magnesium sulphate or fentanyl to ropivacaine for continuous femoral nerve block provided a significant prolongation of postoperative analgesia than ropivacaine alone.

Md. Ashraf Abd Elmawgoud

2008-01-01

242

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

Scientific Electronic Library Online (English)

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

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

243

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

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

Marcos Rassi Fernandes

2012-08-01

244

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

Scientific Electronic Library Online (English)

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

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

2012-08-01

245

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

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

Saltzman Steven L

2008-11-01

246

Ultrasound-guided bilateral paravertebral continuous nerve blocks for a mildly coagulopathic patient undergoing exploratory laparotomy for bowel resection.  

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Regional anesthesia techniques commonly utilized in post-operative pain management are often considered contraindicated in coagulopathic patients. We report on successful postoperative pain control utilizing peripheral nerve blockade after exploratory laparotomy with small bowel resection in a mildly coagulopathic patient. In our case, complicated by abnormal PT, PTT and INR, a thromboelastogram (TEG) was performed before the procedure and found to be normal. An ultrasound-guided bilateral paravertebral blockade with continuous paravertebral catheters was then performed in this pediatric patient without complications. The patient expressed satisfaction with his pain control. More studies are needed to evaluate the validity of TEG in the prediction of bleeding risk and the safety of this regional technique in a mildly coagulopathic patients. PMID:21241416

Visoiu, Mihaela; Yang, Charles

2011-04-01

247

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

Scientific Electronic Library Online (English)

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

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

2012-02-01

248

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

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

Marcos Rassi Fernandes

2012-02-01

249

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

Scientific Electronic Library Online (English)

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

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

250

Nerve growth factor blocks thapsigargin-induced apoptosis at the level of the mitochondrion via regulation of Bim.  

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This study examined how the neurotrophin, nerve growth factor (NGF), protects PC12 cells against endoplasmic reticulum (ER) stress-induced apoptosis. ER stress was induced using thapsigargin (TG) that inhibits the sarcoplasmic/ER Ca2+-ATPase pump (SERCA) and depletes ER Ca2+ stores. NGF pre-treatment inhibited translocation of Bax to the mitochondria, loss of mitochondrial transmembrane potential, cytochrome c release, activation of caspases (-3, -7 and -9) and apoptosis induction by TG. Notably, TG also caused a marked induction of BimEL mRNA and protein, and knockdown of Bim with siRNA protected cells against TG-induced apoptosis. NGF delayed the induction and increased the phosphorylation of BimEL. NGF-mediated protection was dependent on phosphatidylinositol-3 kinase (PI3K) signalling since all above apoptotic events, including expression and phosphorylation status of BimEL protein, could be reverted by the PI3K inhibitor LY294002. In contrast, NGF had no effect on the TG-mediated induction of the unfolded protein response (increased expression of Grp78, GADD34, splicing of XBP1 mRNA) or ER stress-associated pro-apoptotic responses (induction of C/EBP homologous protein [CHOP], induction and processing of caspase-12). These data indicate that NGF-mediated protection against ER stress-induced apoptosis occurs at the level of the mitochondria by regulating induction and activation of Bim and mitochondrial translocation of Bax. PMID:18266951

Szegezdi, E; Herbert, K Reed; Kavanagh, E T; Samali, A; Gorman, A M

2008-12-01

251

Evaluation of root canal obturation using gas permeability method  

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Full Text Available Introduction. Prognosis of root canal treatment is highly dependent on the quality of endodontic space obturation. The main task of successful root canal treatment is to achieve adequate reparation processes in the apical periodontium. The aim of this study was to evaluate the quality of root canal obturation using the method of gas (argon penetration through three different endodontic materials. Material and Methods. Thirty recently extracted human single-rooted teeth after root canal instrumentation were divided into three identical groups and obturated with three different endodontic materials: group I - GuttaFlow (RSA, Germany, group II - AH Plus (DeTray, Germany, group III - Acroseal (Septodont, France. The quality of root canal obturation was evaluated using the method of gas permeability. Results. The best results were obtained with GuttaFlow. The average penetration rate of argon was 186.7 seconds. Slightly higher gas porosity had AH Plus, 179.9 seconds, while the highest gas permeability was observed after the application of Acroseal, 178.5 seconds. However, there was no statistically significant difference in gas penetration among these endodontic materials (p>0.05. Conclusion. All three endodontic materials showed gas permeability in a given time interval. The best quality of obturation was achieved with GuttaFlow, while the lowest quality was obtained with Acroseal.

Matovi? Ivan

2013-01-01

252

A review of 12 cases of obturator hernia  

International Nuclear Information System (INIS)

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

253

Strategy of diagnosis and treatment for obturator hernia  

International Nuclear Information System (INIS)

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

254

The effect of continuous popliteal sciatic nerve block on unplanned postoperative visits and readmissions after foot surgery - a randomised, controlled study comparing day-care and inpatient management.  

Science.gov (United States)

Regional anaesthesia has been shown to have several advantages over general anaesthesia in reducing the need for, and hence cost of, unscheduled outpatient visits or readmission to hospital. However, the benefit has not been evaluated in a direct comparison between day-care patients and inpatients. We randomly allocated 120 patients undergoing unilateral foot surgery to either inpatient (two-day postoperative stay) or day-care management under continuous regional anaesthesia, and compared the impact on unscheduled postoperative outpatient visits, readmissions to hospital and the associated costs. The operations were performed under popliteal sciatic nerve block. A perineural catheter was inserted before surgery and removed from all patients on the third postoperative day. We found no significant difference in the incidence of outpatient visits (3.3% day-care vs 5.0% inpatient, p = 0.640), readmissions (6.7% day-care vs 3.3% inpatient, p = 0.395) or complications between the two groups. Costs were also significantly lower in the day-care group (net difference €8011 (£6684; $10 986) per patient, p < 0.001). We conclude that continuous regional anaesthesia allows foot surgery to be performed as a day-care procedure more cheaply than in inpatients, without an increase in clinical complications. PMID:24905687

Saporito, A; Sturini, E; Borgeat, A; Aguirre, J

2014-11-01

255

Success rate of 10th semester dental students of Tehran University of Medical students in infra alveolar nerve block injection technique  

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Full Text Available "nBackground and Aim: Inducing anesthesia is one of the important tasks in dentistry. Among various techniques for injection, the Inferior Alveolar Nerve Block (IANB technique is one of the most practical and prevalent methods. However, according to some proofs in reference books, the success rate for this technique is some how low. Therefore the success rate of IANB performed by 10th-semester undergraduare students from Faculty of Dentistry of Tehran University of Medical Sciences was assessed in this study. "nMaterials and Methods: In this cross-sectional study from patients referring to oral and maxillofacial surgery ward, 20 patients with predefined conditions were selected. For each of them, two IANB injections were done in two separated days; one by a student and the other by an attend (or resident of maxillofacial surgery ward. Success or failure of each injection was examined by Pin Prick test. In this study, the non-parametric Willcoxon test was used. "nResults: In this study, the success rate of IANB was 70% and 90%, respectively for students and attends (or resident. "nConclusion: Significant statistically difference was seen between the two groups, we hope that through further practical education, this differences rsduce in following similar studies.

Hoseinitodashki H.

2009-03-01

256

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

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

A. Martínez Navas

2009-02-01

257

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

Scientific Electronic Library Online (English)

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

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

2009-02-01

258

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

LENUS (Irish Health Repository)

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

Mannion, Stephen

2012-02-03

259

Stress analysis in oral obturator prostheses: imaging photoelastic  

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

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

2013-06-01

260

Resection of soft tissue tumors extending through the obturator ring.  

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Pelvic soft tissue sarcomas are rare tumors often presenting larger than other soft tissue sarcomas and can extend into the thigh through various anatomic routes. Surgical resection is the main modality of curative treatment. En bloc tumor excision with wide, negative margins may reduce the risk of local recurrence. Soft tissue sarcomas extending through the obturator foramen create unique challenges to operative management. This case report describes 2 cases of lipomatous lesions that extend through the obturator foramen, presenting as dumbbell-shaped lesions with large intra- and extrapelvis portions. One possible surgical approach performed in both patients is detailed with long-term follow-up. Postoperatively, 1 incidence of infection was reported. Functional outcomes were acceptable, with full restoration of ambulation without assistive devices in both cases and no hernia observed. Oncologic outcomes included locoregional recurrence in 1 patient at 24 months outside the radiation field. The ideal primary treatment for all localized soft tissue sarcomas, including those extending through the obturator foramen, is resection. However, the unique subgroup of obturator ring soft tissue sarcomas has undefined outcomes and complications. The authors' goal was to achieve en bloc resection with wide negative margins while preserving ipsilateral limb function. The surgical approach described in this case study offers a description of feasibility and discussion of theoretical and observed complications. PMID:24025018

Starks, Alexandria; Guo, Lifei; Abraham, John A

2013-09-01

 
 
 
 
261

High division of sciatic nerve  

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

Tripti Shrivastava

2014-04-01

262

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

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

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

263

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

Scientific Electronic Library Online (English)

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

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

2012-04-01

264

Mineral trioxide aggregate obturation: a review and case series.  

Science.gov (United States)

Mineral trioxide aggregate (MTA) has emerged as a reliable bioactive material with extended applications in endodontics that include the obturation of the root canal space. This article examines the literature supporting MTA as a canal filling material, suggests methods for its delivery and placement, and presents clinical cases that demonstrate its effectiveness in resolving apical periodontitis under a variety of circumstances. Case reports are presented documenting clinical outcomes after the application of MTA that include retreatment, obturation combined with root-end resection, apexification, internal resorption, dens in dente, and in conventional endodontic therapy. The review introduces clinicians to an alternative treatment strategy that might improve the healing outcomes for patients presenting with complex and challenging endodontic conditions. PMID:19482173

Bogen, George; Kuttler, Sergio

2009-06-01

265

The adjustable tension-free vaginal tape--obturator.  

Science.gov (United States)

A 59-year-old woman presented with stress urinary incontinence, had adjustment of tension-free vaginal tape-obturator (TVT-O) performed using a method that does not require lateral dissection, after a failed TVT-O. Despite having TVT-O tape erosion, she has remained continent for a period of 24 months. The case demonstrates an effective and simple method of TVT-O tape readjustment. PMID:20352194

Harharah, Lubna; Lee, Lih Charn; Han, How Chuan

2010-06-01

266

Comparative evaluation of sealing ability of different obturation materials  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Introduction Root canal filling materials are intended to prevent microleakage and passing of microorganisms and their toxins along the root canal space and into the periradicular tissues. Objective Objective of this in vitro study was to evaluate and compare apical leakage of root canals obturated using a modified warm vertical condensation technique and different materials. Methods Sixty-five extracted single-root teeth were prepared according to the crown-down/ step-back technique. Each ca...

Melih Irena; Jakovljevi? Ankica; Popovi? Milica; Peši? Dragana

2010-01-01

267

Nerve biopsy  

Science.gov (United States)

Biopsy - nerve ... A nerve biopsy is most often done on a nerve in the ankle, forearm, or along a rib. The health care ... feel a prick and a mild sting. The biopsy site will be sore for a few days ...

268

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

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

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

2013-09-01

269

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: Vários são os métodos de localização do nervo femoral no espaço perivascular na região inguinal sendo o mais comum o do estimulador de nervo periférico. O objetivo deste estudo foi o de avaliar a necessidade do bloqueio do nervo femoral com o método do estimulador de nervo [...] periférico, comparando-o com o método da perda de resistência tanto pela técnica de injeção única como pela técnica com catéteres. MÉTODO: Foram realizados 60 bloqueios do nervo femoral divididos em quatro grupos homogêneos (GA, GB, GC e GD). Trinta bloqueios representaram dois grupos pela técnica de injeção única, quinze com agulha descartável 21G (GA) e quinze com agulha isolada adaptada ao estimulador de nervo periférico (GC) e os restantes trinta bloqueios divididos em quinze bloqueios com cateter venoso (GB) e quinze com cateter longo Contiplex® (GD). Todos os bloqueios do nervo femoral foram realizados no espaço perivascular inguinal. O espaço perifemoral foi identificado após a segunda perda de resistência ao ar (fascia ilíaca) (GA e GC), e com 0,3 a 0,4 mA com o estimulador de nervo periférico (GB e GD). Foram avaliados os seguintes parâmetros: tempo para a realização do bloqueio; presença ou ausência de parestesias ou disestesias; dificuldade de punção e falhas. RESULTADOS: Não foram relatadas parestesias nem disestesias. Duas falhas resultaram no grupo A (p Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: Varios son los métodos de localización del nervio femoral en el espacio perivascular en la región inguinal siendo el más común el del estimulador de nervio periférico. El objetivo de este estudio fue el de evaluar la necesidad del bloqueo del nervio femoral con el método d [...] el estimulador del nervio periférico, comparándose con el método de la pérdida de resistencia tanto por la técnica de inyección única como por la técnica con catéteres. MÉTODO: Fueron realizados sesenta bloqueos del nervio femoral divididos en cuatro grupos homogéneos (GA, GB, GC y GD). Treinta bloqueos representaron dos grupos por la técnica de inyección única, quince con aguja desechable 21G (GA) y quince con aguja aislada adaptada al estimulador de nervio periférico (GC) y los restantes treinta bloqueos divididos en quince bloqueos con catéter venoso (GB) y quince con catéter largo Contiplex® (GD). Todos los bloqueos del nervio femoral fueron realizados en el espacio perivascular inguinal. El espacio perifemoral fue identificado después de la segunda pérdida de resistencia al aire (fascia ilíaca) (GA y GC), y con 0,3 a 0,4 mA con el estimulador de nervio periférico (GB y GD). Fueron evaluados los siguientes parámetros: tiempo para la realización del bloqueo; tiempo de duración del bloqueo; si hubo o no parestesias o disestesias; se hubo o no dificultad de punción y fallas. RESULTADOS: No fueron relatadas parestesias ni disestesias. Dos fallas resultaron en el grupo A (p Abstract in english BACKGROUND AND OBJECTIVES: There are several methods to locate the femoral nerve in the perivascular inguinal space, being the most common the use of a peripheral nerve stimulator. This study aimed at evaluating femoral nerve block performed with peripheral nerve stimulator as compared to the loss o [...] f resistance to air technique, both by single injection or with catheter insertion. METHODS: Sixty patients undergoing femoral nerve blocks were divided in four homogeneous groups (GA, GB, GC, GD). Thirty blocks were performed with single injection technique: 15 with disposable 21G needle (GA) and 15 with insulated needle adapted to the peripheral nerve stimulator (GC). The remaining 30 blocks were divided in 15 blocks performed with intravenous catheter (GB) and 15 with long Contiplex® catheter (GD). All femoral nerve blocks were performed in the perivascular inguinal space. Perifemoral space was identified after the second loss of resistance to air (iliac fascia, GA and GC), and with 0.3 to 0.

Karl Otto, Geier.

2003-06-01

270

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

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Block anesthesia of maxillary nerve 9BAMN) is achieved by depositing anesthesia through greater palatine canal into the pterygopalatine fossa. Authors differ in the amount of anesthesia to be administered and the rate of complications (diplopia and hematomas), Coronado et al., (2008), measured the size of the pterygopalatine fossa finding an average of 1.2 ml, suggesting that amount of anesthesia for BAMN. The aim of this study is to compare the effectiveness of low doses of 1.2 ml (LD)versus...

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

2011-01-01

271

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

Scientific Electronic Library Online (English)

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

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

2014-03-01

272

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

Scientific Electronic Library Online (English)

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

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

273

Bilateral eventration of sciatic nerve.  

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

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

2010-01-01

274

Strangulated intestinal obstruction secondary to a typical obturator hernia: a case report with literature review.  

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Obturator hernia is a rare pelvic hernia with incidence of 1%. It's a significant cause of intestinal obstruction in emaciated elderly women. Delayed diagnosis and surgical intervention contributed to its relatively high morbidity and mortality. We present a typical case of obturator hernia with positive Howship-Romberg sign and Hannington-Kiff sign. The diagnosis was confirmed by spiral CT preoperatively. During the emergency laparotomy, the incarcerated intestine was reduced and removed. Obturator foramen was repaired by simple suture. The patient recovered uneventfully and no recurrence occurred during the follow-up. The obturator hernia should be included in the differential diagnosis if clinically suspected. Early diagnosis and prompt surgical treatment are essential to reduce the morbidity and mortality associated with obturator hernia. PMID:22408570

Cai, Xiaoyan; Song, Xiangyang; Cai, Xiujun

2012-01-01

275

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

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

Xiaoyan Cai, Xiangyang Song, Xiujun Cai

2012-01-01

276

Strangulated obturator hernia - an unusual presentation of intestinal obstruction.  

LENUS (Irish Health Repository)

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

Zeeshan, Saqib

2012-01-31

277

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

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

Mirilas, Petros; Skandalakis, John E

2010-03-01

278

ANESTHETIC EFFICACY OF COMBINATION OF TWO PERCENT LIDOCAINE WITH 1:80,000 EPINEPHRINE AND 0.5 MOL/L MANNITOL FOR INFERIOR ALVEOLAR NERVE BLOCKS IN PATIENTS WITH SYMPTOMATIC IRREVERSIBLE PULPITIS: AN IN VIVO STUDY  

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Full Text Available The purpose of this prospective randomized single blind study was to determine the anesthetic efficacy of combination of 2 % Lidocaine with 1 : 80,000 Epinephrine and 0.5 mol / L Mannitol in Inferior Alveolar Nerve (IAN Blocks in patients with symptomatic irreversible pulpitis. 60 subjects randomly received IAN Blocks using the following two anesthetic formulations: one formulation comprised of 2.5 ml of 2 % Lidocaine with 1 : 80,000 Epinephrine and the other formulation comprised of 1.6 ml of 2 % Lidocaine with 1 : 80,000 Epinephrine and 0.9 ml of 0.5 mol / L Mannitol. The pain response of the patient was recorded on endodontic access and initial instrumentation using the Heft-Parker Visual Analogue Scale. From the statistical analysis obtained following this study the addition of 0.5 mol / L Mannitol to lidocaine with epinephrine formulations significantly improved effectiveness in achieving a greater percentage of total pulpal anesthesias compared with a lidocaine formulation without Mannitol for IAN blocks. There is a significant improvement in the efficacy of IAN blocks when 2 % Lidocaine with 1 : 80,000 Epinephrine is administered in combination with 0.5 mol / L Mannitol. Based on the results of this study we can conclude that this combination of local anesthetic should be used on a regular basis to obtain successful anesthesia. However there is a need for more research as there are very few studies done on this aspect.

Thimmaiah. P. B.

2013-08-01

279

Comparison of three obturation techniques with regard to bacterial leakage  

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

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

2013-09-01

280

Effect of new obturating materials on vertical root fracture resistance of endodontically treated teeth.  

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The aim of this study was to compare vertical forces at fracture of teeth obturated with different materials. Single-rooted teeth were divided into five groups. The first group served as a negative control. The remaining four groups were shaped using ProTaper rotary files (Dentsply Maillefer, Ballaigues, Switzerland). The second group was obturated with gutta percha and a zinc oxide sealer. The third group was obturated with EndoRez points and EndoRez sealer (both from Ultradent, South Jordan, UT). The fourth group was obturated with Resilon (Pentron Clinical Technologies, Wallingford, CT) and RealSeal sealer (Pentron Clinical Technologies). The fifth group was obturated with Guttaflow (Colténe/Whaledent, Altstätten, Switzerland). Roots were then fixed into a universal testing machine and loaded with a spreader until fracture. It was found that forces at fracture were statistically significantly higher in the Resilon and EndoRez groups. It was concluded that obturation of roots with resin-based obturation materials (Resilon and EndoRez) increased the resistance of root canal filled teeth to vertical root fracture. PMID:17509416

Hammad, Mohammad; Qualtrough, Alison; Silikas, Nick

2007-06-01

 
 
 
 
281

Tacrolimus reduces scar formation and promotes sciatic nerve regeneration?  

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A sciatic nerve transection and repair model was established in Sprague-Dawley rats by transecting the tendon of obturator internus muscle in the greater sciatic foramen and suturing with nylon sutures. The models were treated with tacrolimus gavage (4 mg/kg per day) for 0, 2, 4 and 6 weeks. Specimens were harvested at 6 weeks of intragastric administration. Masson staining revealed that the collagen fiber content and scar area in the nerve anastomosis of the sciatic nerve injury rats were significantly reduced after tacrolimus administration. Hematoxylin-eosin staining showed that tacrolimus significantly increased myelinated nerve fiber density, average axon diameter and myelin sheath thickness. Intragastric administration of tacrolimus also led to a significant increase in the recovery rate of gastrocnemius muscle wet weight and the sciatic functional index after sciatic nerve injury. The above indices were most significantly improved at 6 weeks after of tacrolimus gavage. The myelinated nerve fiber density in the nerve anastomosis and the sciatic nerve functions had a significant negative correlation with the scar area, as detected by Spearman’s rank correlation analysis. These findings indicate that tacrolimus can promote peripheral nerve regeneration and accelerate the recovery of neurological function through the reduction of scar formation.

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

2012-01-01

282

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

Scientific Electronic Library Online (English)

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

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

2014-07-01

283

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

Scientific Electronic Library Online (English)

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

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

284

The Role of Nasendoscopy in the Fabrication of a Palatopharyngeal Obturator - A Case Report  

Science.gov (United States)

Defects confined to the hard palate can be managed with relative ease because it is a static shelf creating oro- nasal separation. Since the soft palate is a dynamic separator between the oral and nasal cavities, defects involving the soft palate require careful consideration. Instrumental visualization methods can aid the fabrication of obturators in patients with such defects and prevent problems of under or over obturation. This case report presents the prosthodontic management of a patient with a Veau class II cleft palate using a palatopharyngeal obturator in order to re-establish normal functions of deglutition and speech. Nasendoscopy was used as an adjunctive procedure to assess velopharyngeal function with the prosthesis.

Aras, Meena A.; Chitre, Vidya; Rajagopal, Praveen

2014-01-01

285

Who Is at Risk for Heart Block?  

Science.gov (United States)

... Is at Risk for Heart Block? Explore Heart Block What Is... Electrical System & EKG Results Types Causes Who Is at ... are at higher risk for first-degree heart block caused by an overly active vagus nerve. You have one vagus nerve on each side ...

286

Femoral nerve block using ropivacaine 0.025%, 0.05% and 0.1%: effects on the rehabilitation programme following total knee arthroplasty: a pilot study.  

Science.gov (United States)

Femoral nerve blockade is recommended for analgesia following total knee arthroplasty. Following implementation of this type of postoperative analgesia in our hospital we found that active mobilization the day after surgery, may be difficult due to insufficient quadriceps muscle strength. We therefore designed a pilot study comparing the effect of ropivacaine 0.1%, 0.05% or 0.025% on the patient's postoperative rehabilitation and analgesia. Three groups of 12 patients received bolus doses of ropivacaine via their femoral nerve catheters for postoperative analgesia. The ability to actively mobilize, quadriceps muscle strength, pain VAS-scores and patient's satisfaction were measured during in the first three postoperative days. There were no significant differences in the patient's ability to actively mobilize and the pain VAS-scores. The overall satisfaction of the patients with the pain treatment was significantly better (p = 0.049) in the 0.1% compared with the 0.025% group. This pilot-study demonstrated no advantage associated with the use of a ropivacaine concentration less than 0.1%. PMID:18540926

Paauwe, J J; Thomassen, B J; Weterings, J; van Rossum, E; Ausems, M E

2008-09-01

287

Can low dose spinal anesthesia combined with ultrasound guided bilateral ilioinguinal-iliohypogastric nerve blocks avoid use of additional epidural catheter in high risk obstetric cases? Our experience from two cases.  

Science.gov (United States)

Critical obstetric cases associated with cardiac pathology may pose real challenge for anaesthesiologist during Caesarean section. Meticulous perioperative care and suitable selection of anaesthesia technique are the key to successful outcome. Single shot spinal anaesthesia is not used any more because of serious haemodynamic consequence. Progressive and controlled epidural local anaesthetic injection is mostly used in such cases. But recently combined spinal epidural anaesthesia and continuous spinal anaesthesia are suggested due to better precise control of haemodynamics and quicker onset. However, institution of such complex technique may require time which may not be feasible in emergency situations. Use of bilateral ilioinguinal-iliohypogastric nerve block along with low dose spinal anaesthesia may obviate the need of additional epidural catheter in such complicated cases. We hereby present our experience from two cases. PMID:24605418

Bhakta, P; Sharma, P K; Date, R R; Mohammad, A K

2013-01-01

288

[Tactics of preoperative infusion therapy in obturation jaundice].  

Science.gov (United States)

The influence of the infusion therapy content on a hepatic function of bile outflow (HFBO), a bilirubin content and the enzymes activity in obturation jaundice in 139 patients was studied up. In 54 patients (the first group) a Ringer solution and 10% solution of glucose in 1:1 ratio were applied; in 37 patients (the second group) - a sterofundin-G-5 solution; in 48 patients (the third group) - remaxol in a dose of 800 ml/day. Application of sterofundin-G-5 and remaxol as a component of infusion therapy have promoted a bile outflow intensity enhancement in early postoperative period in comparison with such while Ringer solution and 10% solution of glucose application. Remaxol more effectively have eliminated a hyperbilirubinemia, enzymemia and a HFBO disorder, than sterofundin-G-5. PMID:22295543

Iakovlev, A Iu; Semenov, V B; Emel'ianov, N V; Mokrov, K V; Akulenko, S V; Zarechnova, N V

2011-10-01

289

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

Science.gov (United States)

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

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

2014-06-01

290

Comparative evaluation of sealing ability of different obturation materials  

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

Melih Irena

2010-01-01

291

Terminal nerve: cranial nerve zero  

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

Jorge Eduardo Duque Parra

2006-12-01

292

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

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

E. M. Rickes

2012-04-01

293

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

Scientific Electronic Library Online (English)

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

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

294

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

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

Jovanovic Mirko

2011-01-01

295

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

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

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

296

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

Scientific Electronic Library Online (English)

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

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

2014-01-01

297

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

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

Affonso H. Zugliani

2007-10-01

298

Laparoscopic trans-peritoneal hernioplasty (TAPP) is useful for obturator hernias: report of a Case.  

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A 71-year-old female presented to our hospital due to pain from the right hip joint to the lower abdomen. The pain had suddenly appeared and spontaneously disappeared more than 10 times during the past 2 years. She had visited many hospitals, but remained undiagnosed. The patient underwent a computed tomography (CT) scan of the pelvis, and a soft tissue shadow was seen between the external obturator and pectineal muscles. She was diagnosed with a right obturator hernia and underwent elective repair by laparoscopic trans-peritoneal hernioplasty (TAPP). 1 year has passed since the surgery, without any recurrence of the abdominal pain. Obturator hernias are rare, and most cases are found as incarcerated hernias. It is rare to find an obturator hernia without intestinal obstruction, or with the recurrent pain as in our case. We herein report a case in which an obturator hernia was undiagnosed and intermittent pain was experienced for 2 years prior to TAPP, which appears to have successfully treated the hernia. PMID:23975587

Otowa, Yasunori; Kanemitsu, Kiyonori; Sumi, Yasuo; Nakamura, Tetsu; Suzuki, Satoshi; Kuroda, Daisuke; Kakeji, Yoshihiro

2014-11-01

299

Mental nerve neuropathy following dental extraction.  

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Mental nerve neuropathy (MNN), colloquially referred to as numb chin syndrome, is an uncommon neurologic condition that may arise secondary to multiple local and systemic etiologies, and may mimic other pain conditions affecting the mandible. Early recognition of mental nerve neuropathy in conjunction with accurate etiologic identification is crucial, as early pain management may prevent the transition from an acute to a chronic pain condition. In this article, we will describe the clinical courses of 2 patients who presented to the pain clinic with chronic painful numbness in the mental nerve sensory distribution following dental extraction. After a period of failed conservative medical management and repetitive successful nerve blocks at the mental foramen, we decided to proceed with radiofrequency nerve ablation. In both cases, performance of radiofrequency nerve ablation demonstrated a significant decrease in pain. Within interventional pain medicine, nerve blocks are often utilized to assist with pain generator identification, and resultantly also play an integral role in treatment planning. For instance, nerve blocks are often utilized to establish accurate identification of nerve tissue viability, a preliminary role essential for the determination of whether to proceed with an ablative peripheral nerve procedure. In this article, we will additionally review these important usages of nerve blocks within interventional pain medicine. The objective of our article is to help clinicians identify and properly manage early stage mental nerve neuropathy. Moreover, we aim to advance general medical knowledge of this important pain medicine topic. During the process of preparing this article we reviewed all existing pertinent medical literature related to MNN. PMID:24850119

Elahi, Foad; Manolitsis, Nicholas; Ranganath, Yatish S; Reddy, Chandan

2014-01-01

300

Nerve conduction  

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... individual nerve fibers (neurons). Neurons consist of dendrites, axon, and cell body. The dendrites are the tree- ... genetic information in the form of DNA. The axon transmits signals away from the cell body to ...

 
 
 
 
301

Comparison of obturator prosthesis fabricated using different techniques and its effect on the management of a hemipalatomaxillectomy patient.  

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Odontogenic tumours involving the maxilla or mandible are usually treated with surgical resection. To prevent recurrence, extensive surgical intervention might be carried out leaving the patient with anatomical defects. However, rehabilitation of such patients with an obturator can improve function, facial form and social acceptance. In this case, we have evaluated the different designs and techniques of fabrication of an obturator prosthesis used for the rehabilitation of a hemipalatomaxillectomy patient. A 40-year-old man presented with a loose fitting obturator prosthesis. He had undergone hemipalatomaxillectomy for the treatment of an ameloblastoma 2?years earlier and had been using an obturator prosthesis since then. Hollow-bulb obturator prostheses were fabricated using two different methods, the lost salt and open lid techniques. The obturator prosthesis fabricated with the lost salt technique weighed less than the patient's old obturator. But the obturator fabricated using the open lid technique did not only considerably reduce the weight of the prosthesis but also improved health, function, aesthetics, phonetics and quality of life in this hemipalatomaxillectomy patient. PMID:25188927

Badadare, Mokshada M; Patil, Sanjayagouda B; Bhat, Sudhakara; Tambe, Abhijit

2014-01-01

302

The role of nasendoscopy in the fabrication of a palatopharyngeal obturator - a case report.  

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Defects confined to the hard palate can be managed with relative ease because it is a static shelf creating oro- nasal separation. Since the soft palate is a dynamic separator between the oral and nasal cavities, defects involving the soft palate require careful consideration. Instrumental visualization methods can aid the fabrication of obturators in patients with such defects and prevent problems of under or over obturation. This case report presents the prosthodontic management of a patient with a Veau class II cleft palate using a palatopharyngeal obturator in order to re-establish normal functions of deglutition and speech. Nasendoscopy was used as an adjunctive procedure to assess velopharyngeal function with the prosthesis. PMID:25302273

Amin, Bhavya M; Aras, Meena A; Chitre, Vidya; Rajagopal, Praveen

2014-08-01

303

Traumatic obturator hip dislocation in a 9-year-old boy.  

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Traumatic hip dislocation is a rare but potentially devastating injury in a child. Although most hip dislocations are posterior, other variants have been described. An anterior dislocation in the pediatric population is uncommon and, to our knowledge, this is the first case of anterior-inferior (obturator) dislocation (ie, the femoral head lies in the obturator foramen), to be reported in the English-language literature. In this article, we describe the case of a young boy with a traumatic obturator hip dislocation treated conservatively with closed reduction and followed closely for 1 year. The patient did not develop any sequelae throughout the follow-up year. This case report, along with a review of the literature, will help guide clinicians in the care of patients with this rare injury. PMID:24078972

Avery, Daniel M; Carolan, Gregory F

2013-09-01

304

Examination of Articulation in Patient Using Obturator by Means of Computer Planning  

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Full Text Available Background and Aims: Approximately 5% of cancers involve structures of oral cavity. Partial resection of maxilla (maxillectomy may be performed in these cases. Maxillectomy often results in significant functional disabilities such as inability in mastication, deglutition and speech with adverse impact on psychological statusand social life of patients. Obturator prosthesis is a prosthodontic treatment to separate nasal and oral cavities and restore the critical above mentioned functions. The assessment of speech is considered to examine speech function restored by the treatment. The purpose of this study was to evaluate the speech in patients with resected maxilla who have been treated by obturator prosthesis from a pool of related patients in the Prosthodotnics department ofdental faculty, Tehran University of Medical Sciences. The evaluation was performed with computer software using sentence intelligibility (SI test. Materials and Methods: This cross sectional study was conducted on 10 subjects (23-66 years referred to the Prosthodontics department of the faculty and received an obturator. After primary examination of the prosthesis,the patients completed SI test in an acoustic room under guidance of a speech therapist. The performed tests were analyzed by the speech therapist. In addition, the SI with and without the prosthesis was evaluate by lay audience. The statistical analyses were performed using Wilcoxon-signed rank test and Weighted Kappa. Results: Significant differences were found between SI tests with and without the obturators (P<0.001. Two of 10 patients showed problems in speech function using obturator. Conclusion: Within the limitations of the present study, obturators had significant effect on improvement of the speech outcomes of examined patients. Improvement of the quality of life could be predicted.

Somaieh Allahiary

2013-02-01

305

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

Scientific Electronic Library Online (English)

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

Luciana P., Iglesias; Frederico O.C., Silva; Bruno G., Vasconcelos; Lucas A., Ribeiro; Nairana F., Hodniki; Lara R., Gomes; Maria A., Miglino; Alan P. F. de, Melo.

2012-07-01

306

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

Scientific Electronic Library Online (English)

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

Luciana P., Iglesias; Frederico O.C., Silva; Bruno G., Vasconcelos; Lucas A., Ribeiro; Nairana F., Hodniki; Lara R., Gomes; Maria A., Miglino; Alan P. F. de, Melo.

307

Modified snap-on attachment with 'O-ring' for two piece hollow bulb obturator.  

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Restoration of near normal functions in patients who have been treated with hemimaxillectomy is generally difficult, in view of the restriction in mouth opening following healing of large surgical wound. Further, the extent and nature of the surgical defect differ from patient to patient. Thus, design of an obturator needs to be patient oriented. In this report, we describe a novel snap-on attachment with O-ring in a conventional two piece hollow bulb obturator for a 70-year-old male treated for carcinoma of the left maxilla and sinus. PMID:24047848

Gunasekar, C; Nasser, K S Gamal Abdul; Sabarigirinathan, C; Kumar, K Ram

2013-01-01

308

Laparoscopic repair of obturator bladder hernia: a case report and review of the literature.  

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Hernias through the obturator foramen are rare and are difficult to diagnose. They usually appear in elderly women, have an atypical presentation, and are associated with high mortality. The most frequently compromised organ is the small bowel. Hernias that involve the small bowel are often associated with intestinal obstruction and secondary necrosis. Several techniques and approaches have been described for management. We present a case of bladder hernia through the obturator foramen that we repaired laparoscopically by placing a mesh plug, a management option we find safe, fast, and effective. PMID:18211207

Velásquez-López, Juan G; Gil, Federico Gaviria; Jaramillo, Federico Escobar

2008-02-01

309

Evaluation of obturator foramen suggests no differences between sexes in young bovines.  

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Among the numerous bovine pelvic traits displaying sex differences, no detailed studies of bovine obturator foramen are available in the veterinary literature. The purpose of this work was to study quantitatively this structure using lineal biometrics, shape indexes and Fourier analysis. The material consisted of 60 hemicoxae belonging to young bovines of approximately 1 year of age. Although significant differences were found in area, perimeter and length of obturator foramen, none of the analyses used were able to differentiate between sexes and thus cannot be used as a natural trait for determining sex, at least in young bovines. PMID:22835213

Parés-Casanova, P M

2013-04-01

310

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

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

Patrícia Falcão Pitombo

2013-02-01

311

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

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

Davidovi? Lazar B.

2002-01-01

312

Evaluation of root canal obturation: a three-dimensional in vitro study.  

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The aim of the study was to measure percentage of volume of voids and gaps in root canals obturated with different obturation materials by using micro-computed tomography (micro-CT). Forty-eight single-rooted teeth were collected and decoronated, and root canals were prepared by using rotary files. The roots were randomly allocated into 4 groups, and each group was obturated by using cold lateral compaction with a different material (gutta-percha and TubliSeal sealer, EndoRez points and EndoRez sealer, RealSeal points and RealSeal sealer, and a gutta-percha point and GuttaFlow sealer). Roots were scanned with micro-CT, and volume measurements for voids and gaps in the obturated roots were carried out by using specialized CT software. Percentage of gaps and voids was calculated. Statistical analysis showed that gutta-percha exhibited an overall significantly lower percentage (1.02%) of voids and gaps. The present study showed that none of the root canal filled teeth were gap-free. Roots filled with gutta-percha showed less voids and gaps than roots filled with the remaining filling materials. PMID:19345801

Hammad, Mohammad; Qualtrough, Alison; Silikas, Nick

2009-04-01

313

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

Science.gov (United States)

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

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

2014-03-01

314

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

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

S. Ravanshad

2004-12-01

315

Stress analysis in oral obturator prostheses over parallel and tilted implants: photoelastic imaging.  

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This study aimed to evaluate the stress distribution through the photoelastic method in implant-retained palatal obturators prostheses. Two photoelastic models with bucco-sinusal communication were fabricated, one model without implants and another with two parallel implants and one tilted in the molar region. A conventional obturator prosthesis and five implant-retained obturators dentures with different attachment systems were fabricated: OR, three individualized O-rings; BC, bar clip; BOC, implants splinted by bars associated with two O-rings positioned at the center of the bar; OD, implants splinted by bars associated with two O-rings positioned in distal cantilever; and BOD, implants splinted by bars with clips associated with two O-rings positioned in distal cantilever. Each assembly (model/attachment system/prosthesis) was positioned in a circular polariscope and a load of 100 N was applied on each implant. The results were obtained by observing the photographic record of the tensions in the photoelastic models resulting from the application of load. It can be observed that a larger amount of stress fringes on BC system. It was concluded that the attachment system has a direct influence on the stress distribution of implant-retained obturator prostheses, with the three individualized O-rings exhibiting the lowest stress values, and tilted implants presented a biomechanical behavior similar to parallel implants. PMID:24129983

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

2013-10-01

316

Surgical approach to a large dumbbell-shaped pelvic lipoma extending through the obturator foramen.  

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Lipomas are the most commonly occurring mesenchymal tumors. We report a technique used to manage a patient with a large dumbbell-shaped pelvic lipoma passing through the obturator foramen. Using the combined expertise of an orthopedic and pelvic surgeon, successful and safe removal of this benign dumbbell-shaped pelvic lipoma was achieved. PMID:17676261

Dozois, E J; Malireddy, K K; Sim, F H; Wenger, D E

2007-09-01

317

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

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

Clarissa Teles Rodrigues

2012-09-01

318

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

Scientific Electronic Library Online (English)

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

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

2013-06-01

319

Relationship between cup position and obturator externus muscle in total hip arthroplasty  

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Full Text Available Abstract Background It is often challenging to find the causes for postoperative pain syndromes after total hip replacement, since they can be very allotropic. One possible cause is the muscular impingement syndrome. The most commonly known impingement syndrome is the psoas impingement. Another recently described impingement syndrome is the obturator externus muscle impingement. The aim of this study is to analyze pathological conditions of the Obturator externus and to show possible causes. Methods 40 patients who had undergone a total hip replacement were subjected to clinical and MRI examinations 12 months after the surgery. The Harris Hip Score (HHS was used to analyze pain and function. Additionally, a satisfaction score and a pain score (VAS were determined. The MRI allowed for the assessment of the spatial relation between the obturator externus muscle and the acetabulum. Also measured were the acetabular inclination angle as well as the volume and cross-sectional area of the obturator externus muscle. Results The patients were assigned to 3 groups in accordance with their MRI results. Group 1 patients (n = 18 showed no contact between the obturator externus and the acetabulum. Group 2 (n = 13 showed contact, and group 3 (n = 9 an additional clear displacement of the muscle in its course. It was not possible to establish a connection between the imaging findings, the HHS, the VAS, and patient satisfaction. What was striking, however, was a significant difference between the median inclination angle in group 1 (40° ± 5.4° and group 3 (49° ± 4.7° (p Conclusion Contact between the obturator externus muscle and the caudal acetabula border occurs frequently, but is only rarely accompanied by a painful muscular impingement. The position of the acetabula must be seen as one of the main risk factors for contact between the acetabula border and the obturator. The hip replacement process must provide for sufficient osseous coverage of the caudal acetabula border. Furthermore, the retention of the transverse ligament may serve as protective cover for the incisura acetabuli.

Perka Carsten

2010-07-01

320

Nerve grafting in peripheral nerve injuries  

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

Simi? Vesna D.

2003-01-01

 
 
 
 
321

Flank hernia secondary to phenol nerve block.  

LENUS (Irish Health Repository)

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

Al-Hilli, Z

2010-09-01

322

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

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

Luis Henrique Cangiani

2008-04-01

323

Graduating dental students' ability to produce quality root canal fillings using single- or multiple-cone obturation techniques.  

Science.gov (United States)

The primary purposes of this study were to compare the quality (length and density) and efficiency (time to completion) of obturation when single- or multiple-cone obturation techniques were used by graduating dental school students on previously instrumented single-canalled teeth using simulated clinical conditions in vitro. Five students took part in the study, each of whom obturated thirty-six teeth using six obturation techniques. The multiple-cone techniques included lateral condensation of gutta-percha, the technique the students had used in their laboratory and clinical courses, and two similar variations: lateral condensation of Epiphany and mechanical lateral condensation of gutta-percha. These three methods were compared to three single-cone techniques: Thermafil, Activ GP, and GuttaFlow. The students had no experience with single-cone techniques except for a brief introduction and demonstration. All obturations were timed, and post-obturation radiographs were taken in the clinical and proximal views (CV and PV). The radiographs were read by two endodontic faculty members who were blinded to technique, student, and fellow faculty member's results. Data were also separated by operator experience with individual techniques: the first three obturations/techniques were compared to the final three obturations/techniques. Data were analyzed using chi-square tests. The quality produced or time required rarely differed within multiple-cone or single-cone groups, but statistical differences did occur between the two groups. Multiple-cone obturation was more likely to produce adequate length (p=0.0042), density in the CV (p=0.0056), and density in the PV (p=0.0003). Conversely, the single-cone techniques were significantly faster (mean 350 seconds) than the multiple-cone techniques (mean 464 seconds) (p=0.0020). Quality did not improve significantly with the experienced groups versus the inexperienced with any of the six techniques, but the mean time for obturation decreased from 449 seconds to 362 seconds. These preliminary findings suggest that further training and experience are needed to improve the quality of obturation produced when single-cone techniques are used. Further research is needed to determine how much training and/or experience will be needed. PMID:19491347

Gound, Tom G; Sather, James P; Kong, Tae S; Makkawy, Hany A; Marx, David B

2009-06-01

324

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

Science.gov (United States)

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

325

Improved technique for CT-guided celiac ganglia block  

International Nuclear Information System (INIS)

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

326

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

Introduction: For a successful root canal treatment, canal must be obturated apically, coronally and laterally to prevent microleakage and canal reinfection. Cold lateral condensation is the most popular method of canal obturation; an easy method with a controlled filling. Cold lateral technique disadvantages are presence of void, possible vertical root fracture, and absence of a homogenous and condensed filling. In some techniques like One-step, heat is used to soften gutta-percha for better...

AR - Farhad; Gh, Javadi

2006-01-01

327

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

Scientific Electronic Library Online (English)

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

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

328

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

Scientific Electronic Library Online (English)

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

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

2011-09-01

329

Removal of a vertebral metastatic tumor compressing the spinal nerve roots via a single-port, transforaminal, endoscopic approach under monitored anesthesia care.  

Science.gov (United States)

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

Joo, Young-Chan; Ok, Whoi-Kyung; Baik, Seong-Hoon; Kim, Hae-Jin; Kwon, Oh-Sun; Kim, Kyung-Hoon

2012-01-01

330

Neuromodulation of the suprascapular nerve.  

Science.gov (United States)

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

Elahi, Foad; Reddy, Chandan G

2014-12-01

331

Ischemic and reperfusion injury of rat peripheral nerve  

International Nuclear Information System (INIS)

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

332

Balanced force, crown-down preparation, and inject-R Fill obturation.  

Science.gov (United States)

The balanced force concept proposes that instruments are guided by the canal structure when rotational motion is used. Changing the direction of rotation controls the probability that instruments will become overstressed and controls the cutting of structure to give an efficient result. Crown-down progression of the cleaning and shaping is possible as a result of predetermined preparations and use of a recent modified tip file design, the Flex-R file. Preparation time is minimized, while cleaning is enhanced by the crown-down approach. After cleaning and shaping, the intracanal aseptic state must be preserved by obturation. System B condensation followed by Inject-R Fill, back-filling is described as an efficient method to accomplish this obturation. PMID:10202467

Roane, J B

1998-11-01

333

Avulsed immature permanent central incisors obturated with mineral trioxide aggregate: a case report.  

Science.gov (United States)

The endodontic management of immature permanent incisors in young children can be challenging. This case reported an avulsed immature maxillary central incisors that underwent complete endodontic obturation using mineral trioxide aggregate. A 10-year-old male who suffered a fall injury avulsed both his central incisors. The revascularization process was not possible due to patient compliance and geographic reasons. Mineral trioxide aggregate was utilized as a novel endodontic treatment. After one year post-injury, the teeth remained symptom-free, the clinical and radiographic follow-up showed evidence of healthy periodontium. How to cite this article: Al-Kahtani A. Avulsed Immature Permanent Central Incisors Obturated With Mineral Trioxide Aggregate: A Case Report. J Int Oral Health 2013; 5(3):88-96. PMID:24155609

Al-Kahtani, Ahmed

2013-06-01

334

Fabricating an obturator using rapid prototyping to design the framework: a case report.  

Science.gov (United States)

Congenital or acquired maxillary defects cause various esthetic and functional problems. Maxillary deficiency can be prosthetically restored with an obturator. Computer-aided design/computer-assisted manufacture technology, which had been used exclusively in fixed prosthodontics, is now being more widely used in other fields, including removable prosthodontics, after the introduction of software and availability of a comprehensive solution for designing and manufacturing a removable partial denture (RPD). The rapid prototyping (RP) technique enables precise fabrication of the RPD framework in a shorter time period compared to conventional methods. This case report describes the fabrication of an obturator using the RP technique in a patient who underwent hemimaxillectomy of the soft palate. PMID:25191886

Kim, Min-Soo; Lee, Jeong-Yol; Shin, Sang-Wan

2014-01-01

335

Locked overlapping dislocation of the pubic symphysis into the obturator foramen: a case report.  

Science.gov (United States)

A 20-year-old man sustained an overlapping dislocation of the pubic symphysis following a low velocity side-to-side compression injury. Such injuries are rare in the literature. This case, where the pubis was locked into the obturator foramen, may be the first of its kind to be reported. The pubic symphysis was successfully reduced by levering, with difficulty, the locked pubic body out of the left obturator foramen. As the reduction was unstable, the pubic symphysis was fixed with 2 reconstruction plates. The patient was able to mobilise fully after 3 months and returned to work. At 18 months' follow-up he was able to void urine normally after urethral repair. PMID:16914789

Sreesobh, K V; Sageer, A M; Raffic, M

2006-08-01

336

Locked pubic symphysis into the obturator foramen: a rare case presentation and literature review.  

Science.gov (United States)

Locked pubic symphysis is a rare form of pelvic injury. It occasionally occurs after a lateral compression injury of the pelvis. We described an overlapping pubic symphysis dislocation that was locked into the contralateral obturator foramen. To the best of our knowledge, there are about seventeen similar cases reported in the literature. The pubic symphysis was finally reduced by means of a superior pubic ramus osteotomy to unlock the incarcerated pubic body out of the contralateral obturator foramen. As the reduction was unstable, the pubic symphysis was fixed with a reconstruction plate. The patient recovered completely and returned to normal activities within 4months. At 1year's follow-up she reported no discomfort in the pubic symphysis region and was able to void urine normally. PMID:23270720

Li, K H; Sun, B H; Zhu, Y; Long, H T

2013-02-01

337

Optic Nerve Pit  

Science.gov (United States)

... Asked Questions Español Condiciones Chinese Conditions Optic Nerve Pit What is optic nerve pit? An optic nerve pit is a small pocket ... be seen in both eyes. How is optic pit diagnosed? If the pit is not affecting vision, ...

338

Nerve conduction velocity  

Science.gov (United States)

Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve. ... normal body temperature. Being too cold slows nerve conduction. Tell your doctor if you have a cardiac ...

339

Silicone obturators and the bacterial flora in symptomatic nasal septal perforations  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

Hulterstro?m, Anna Karin

2012-01-01

340

A new technique of impression making for an obturator in cleft lip and palate patient  

Directory of Open Access Journals (Sweden)

Full Text Available Cleft lip and palate is a birth defect occurring in the orofacial region. One of the immediate problems to be addressed in a newborn with this defect would be to aid in suckling and swallowing. Here we present a case of a 5-day-old infant with unilateral cleft lip and palate for whom feeding obturator was made by using a simplified impression technique to facilitate feeding.

Ravichandra K

2010-01-01

 
 
 
 
341

Nerve conduits for peripheral nerve surgery.  

Science.gov (United States)

Autologous nerve grafts are the current criterion standard for repair of peripheral nerve injuries when the transected nerve ends are not amenable to primary end-to-end tensionless neurorrhaphy. However, donor-site morbidities such as neuroma formation and permanent loss of function have led to tremendous interest in developing an alternative to this technique. Artificial nerve conduits have therefore emerged as an alternative to autologous nerve grafting for the repair of short peripheral nerve defects of less than 30 mm; however, they do not yet surpass autologous nerve grafts clinically. A thorough understanding of the complex biological reactions that take place during peripheral nerve regeneration will allow researchers to develop a nerve conduit with physical and biological properties similar to those of an autologous nerve graft that supports regeneration over long nerve gaps and in large-diameter nerves. In this article, the authors assess the currently available nerve conduits, summarize research in the field of developing these conduits, and establish areas within this field in which further research would prove most beneficial. PMID:24867724

Pabari, Amit; Lloyd-Hughes, Hawys; Seifalian, Alexander M; Mosahebi, Ash

2014-06-01

342

Obturator approach in the surgical treatment of stress urinary incontinence using tension - free transvaginal tape  

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Full Text Available The study reviews the surgical treatment results of urinary stress incontinence in the group of 51 female patients, in whom the tension-free transvaginal tape was placed beneath the middle part of urethra using obturator approach during the period from 2005 to 2009. The method of surgery applied in all patients was obturator approach (”inside-out” method sec. de Leval, using a synthetic tension-free transvaginal prolen tape. After the sub-urethral tunnel had been created by scissors, the obturator membrane was perforated, then the placement of wing guides followed, through which helical needles with synthetic tape were brought to the skin. The following complications were observed in 8 (15.7% patients: erosion of tape in 2 (3.9%, urine retention in 2 (3.9%, bleeding from the site of incision in 1 (1.9% and transitory leg pain in 3 (5.8% cases. Two years after the surgery, 43 (84.3% patients were dry, 4 (7.8% patients showed a significant improvement, while the recurrence was recorded in 4 (7.8% operated patients.

?ur?evi? Sr?an

2012-01-01

343

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

Science.gov (United States)

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

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

2014-04-01

344

[A case of obturator hernia with overlooked Howship-Romberg sign and treated as sciatica].  

Science.gov (United States)

We report a case of a patient with incarcerated obturator hernia who presented with right thigh pain. An 88-year-old woman who had experienced right thigh pain for the previous 3 years was given a diagnosis of sciatica at the orthopedic department. In July 2009, she was hospitalized with the chief complaint of appetite loss. The day after admission she experienced increased right thigh pain and lower abdominal pain. Abdominal ultrasonography revealed a keyboard sign. Based on this finding, we diagnosed an ileus, which was alleviated by the insertion of an ileus tube. However, after the removal of the ileus tube, her right thigh pain recurred. Therefore, a diagnosis of hernia was considered. Contrast-enhanced computed tomography revealed an incarcerated bowel in the region between the pectineus muscle and muscle obturator. Laparotomy showed that the ileal part located about 15 cm from the terminal ileum was incarcerated in the right foramen obturatum; therefore, ileal resection and end-to-end anastomosis were performed. After the operation, her intestinal obstruction symptoms and right pain disappeared. If right pain and ileus symptoms of unknown cause occur in elderly persons, obturator hernia should be considered. PMID:21778635

Katoh, Takeaki; Kawamoto, Ryuichi; Kusunoki, Tomo

2011-01-01

345

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

Directory of Open Access Journals (Sweden)

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

Pedro Aravena Torres

2011-09-01

346

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

Science.gov (United States)

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

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

2014-01-01

347

Comparison of laterally condensed, vertically compacted thermoplasticized, cold free-flow GP obturations - A volumetric analysis using spiral CT  

Directory of Open Access Journals (Sweden)

Full Text Available Aim/Objective: To compare the laterally condensed gutta-percha, vertically compacted thermoplastized gutta-percha (E and Q Plus system and cold free-flow gutta-percha (GuttaFlow. This is a volumetric analysis using spiral CT, an in vitro study. Materials and Methods: Access cavities were prepared in 60 single rooted anterior teeth; cleaning and shaping was done and obturated with three of the different techniques: group A: cold lateral; group B: vertically compacted thermoplasticized and group C: cold free-flow obturation techniques. Volume analysis was done using spiral computed tomography (CT. The percentage difference was calculated and statistically analyzed using one-way ANOVA and post hoc multiple comparison Tukey HSD tests. Results: There were statistical significant differences between group A (0.183cm 3 and group B (0.136cm 3 ; group A (0.183cm 3 and group C (0.128cm 3 . But there was no statistical significance between group B (0.136cm 3 and group C (0.128cm 3 . Conclusion: Within the limitations of this in vitro study it can be concluded that cold free-flow obturation technique showed the highest volume of obturation, followed by the vertically condensed thermoplasticized technique. The least volume of obturation was observed in cold lateral condensation technique.

Kandaswamy Deivanayagam

2009-01-01

348