Comparison of the analgesic effect of an adductor canal block using a new suture-method catheter vs. standard perineural catheter vs. single-injection: a randomised,blinded, controlled study

We performed a randomised, blinded, controlled study with adult patients scheduled for primary total knee arthroplasty under spinal anaesthesia. The aim was to investigate the analgesic effects of adductor canal block using catheter-based repeated boluses, either through a new suture-method catheter or a standard perineural catheter, compared with a single-injection technique. All patients received an adductor canal block after surgery with an initial bolus of 20 ml ropivacaine 0.75%, followed by 20 ml of ropivacaine 0.2% every 8 h in the standard and suture-method catheter groups, and sham boluses for the single-injection group. The primary outcome measure was total opioid consumption (intravenous morphine equivalents) from the end of surgery until 12:00 on postoperative day 2. Secondary outcomes were pain, muscle strength and ambulation. We randomly assigned (1:1:1) and analysed 153 patients. Total opioid consumption was median (IQR [range]) 24 (11–37 [0–148]) mg in the suture-method group, 38 (17–51 [0–123]) mg in the standard catheter group and 37 (14–57 [0–158]) mg in the single-injection group (p = 0.049). Differences were not statistically significant after Bonferroni correction (α = 0.05/3). There were no differences between groups on postoperative day 1. On postoperative day 2, there were no differences between catheter groups, but muscle strength and ambulation were improved compared with the single-injection group. We conclude that providing repeated boluses via a catheter did not decrease opioid consumption or pain compared with a single injection, but improved muscle strength and ambulation on postoperative day 2. The two types of catheters were similar.     

Multimodal periarticular injection vs continuous femoral nerve block after total knee arthroplasty: a prospective, crossover, randomized clinical trial

This study compares the efficacy of pain control using continuous femoral nerve block (FNB) and multimodal periarticular soft tissue injection. This is a randomized, crossover, clinical trial. Sixteen patients having bilateral osteoarthritis of the knee scheduled for staged total knee arthroplasty were randomized to receive either FNB (0.2% ropivacaine), via indwelling catheter for 72 hours, or multimodal periarticular soft tissue injection in the first stage. In the second stage, they received the opposite treatment. The primary outcome measure was morphine consumption by patient-controlled analgesia in the first 72 hours postoperatively. Cumulative morphine consumption as well as rest pain and motion pain in the first 72 hours was comparable between the 2 groups. The functional outcomes did not differ significantly. We conclude that multimodal periarticular soft tissue injection provides comparable analgesia to continuous FNB after total knee arthroplasty.     

Femoral nerve injury as a complication of pelvic surgery

Femoral nerve injury is a rare complication of pelvic surgery but may lead to medicolegal actions. The common cause is the use of a long‐bladed self‐retaining pelvic retractor. The injury is not well recognised in coloproctology practice and this brief article is to draw attention to this complication.     

Ilioinguinal and iliohypogastric nerve block revisited: single shot versus double shot technique for hernia repair in children

BACKGROUND: We attempted to determine the efficacy of a one plane ilioinguinal and iliohypogastric nerve block with a single shot and double shot techniques. METHODS: In a randomized single blind study, 90 children, aged 2-12 years, received a single shot (SS) or a double shot (DS) technique for ilioinguinal and iliohypogastric (IG-IH) nerve block for inguinal hernia repair. In the SS group, 0.25 ml x kg(-1) of 0.25% bupivacaine was given one fingerbreadth medial to the anterior superior iliac spine under the external oblique aponeurosis. In the DS group, one-third of the total dose of bupivacaine was given as for the SS group. The remaining two-thirds was deposited 0.5 cm above and lateral to the mid-inguinal point deep to the external oblique aponeurosis. RESULTS: The success rates of both techniques were similar, at 72%, although the presence of local anaesthetic in the inguinal canal was significantly higher with the DS technique. The incidence of femoral nerve block was 4.5% with the SS and 9% with the DS technique (P > 0.05). Parental satisfaction with postoperative pain relief was high, at 94%. CONCLUSIONS: The DS technique, while technically more difficult, does not improve the success rate of the IG-IH nerve block compared with the SS technique.     

髂腰肌外伤性血肿合并股神经麻痹1例

1病例资料患者,男,19岁,因左腹股沟处肿痛,伴伸髋伸膝无力20 d入院。入院前20 d激烈运动时过度外展后伸髋关节后出现左腹股沟处肿痛,左腰部酸痛,未经特殊处理;伤后次日左腹股沟处肿块略有增大,左下肢无力,且左大腿前侧和小     

股外侧皮神经卡压综合征的诊治

目的 探讨股外侧皮神经卡综合征的诊断与治疗方法。方法 采用皮层体感诱发电位协助诊断，并行局部封闭治疗，无效者行手术治疗。结果 8例均经保守局部封闭治疗，5例缓解；3例疗效不佳行手术治疗，术后效果良好。结论 对股外侧皮神经卡压综合征的诊断，皮层体感诱发电位检测具有一定帮助作用，保守治疗及手术治疗均有一定疗效。     

Femoral and Sciatic Neuropathies After Total hip Arthroplasty

Six patients with peripheral nerve lesions after total hip replacements were reviewed. the incidence of peripheral nerve lesions was six out of 825, i.e. 0.7 per cent. the neuropathies, four sciatic, one femoral and one combined femoral and sciatic, were due to damage by the reamer in one case, haemorrhage in two, whereas the cause was unknown in three patients. After conservative treatment and 1–5 years follow-up the recovery was classified as good in three, fair in one and poor in two patients.     

Femoral and lateral femoral cutaneous nerve block for muscle biopsies in children

Retrospective chart review (1978–1993) of 179 children less than age 18 (10.0 ± 3.8 SD yrs) undergoing muscle biopsy for determination of susceptibility to malignant hyperthermia provided data. One hundred and forty-six patients received femoral and lateral femoral cutaneous nerve blocks as their primary anaesthetic. We examined age, weight, duration of surgery, time to discharge from hospital, choice and dosage of local anaesthetics, choice and dosage of sedation, postoperative pain medications, and complications. All children receiving this form of anaesthesia remained outpatients. Between 1978 and 1985 procaine (10 mg·kg^-1) with hyaluronidase or 2-chloroprocaine (12 mg·kg^-1) provided nerve blockade; after 1985, lignocaine (6.8 mg·kg^-1), or a combination of lignocaine or mepivacaine and 2-chloroprocaine, were the preferred agents. More recently the combination of 2-chloroprocaine and bupivacaine has been popular. Three patients required admission to the recovery room postoperatively, due to heavy sedation. Forty-three children (29%) received pain medication during recovery. Femoral and lateral femoral cutaneous block anaesthesia with light to moderate sedation is well tolerated in children undergoing anterior thigh procedures.     

Anatomic variability of the lateral femoral cutaneous nerve: Value of 3T MRI in identifying anomaly for surgical intervention

The anatomic variability of the lateral femoral cutaneous nerve (LFC) creates diagnostic as well as therapeutic problems. A case is reported in which a woman with complaints of pain in the anterior and lateral thigh was referred for evaluation. Symptoms arose after an abdominal hysterectomy. Her symptoms were the territory of the LFC and not of the L2/L3 dermatome. She had a Tinel sign that was positive for the LFC skin territory, but this was located over the anterior superior iliac spine (ASIS), instead of medial to it. For this reason, a 3‐Tesla MR neurography imaging was obtained. This showed the LFC as crossing over the ASIS, instead of being located either within or beneath the inguinal ligament. MRI imaging facilitated successful surgical treatment. This is the first report of the MR neurography and intraoperative appearance of this least common anatomic course for the LFC.     

Lower limb blocks for children

Femoral and lateral cutaneous nerve of the thigh blocks have been performed in a group of 50 children; the method has not previously been described in paediatric practice. The technique was judged to have been successful in 48 (96%) of the children. There were no early or late complications. It is concluded that these blocks are easy to perform, even in small children and infants, and that they can produce reliable postoperative analgesia for a variety of orthopaedic and plastic procedures.     

Pseudotumor formation following large-diameter metal-on-metal total hip arthroplasty—Report of two cases and literature review

Pseudotumor after metal-on-metal total hip arthroplasty is an increasingly frequent complication in Taiwan. Orthopedic surgeons should be aware of this complication and follow up their patients regularly so that the disease can be detected early and properly managed. We report two cases of this complication. Case 1 exhibited cystic change with fluid accumulation, and in Case 2 a semisolid mass was found. In Case 1, a high inclination angle of the cup (at 65°) was noted. In Case 2, the cup was placed at a normal inclination angle, but it was too anteverted (31°). The histopathological studies revealed that the cystic pseudotumor had more diffuse lymphocyte infiltration and perivascular lymphocyte cuffing with eosinophil and plasma cells. The semisolid mass of Case 2 had less lymphocyte infiltration. Both cases had metal debris with foreign body granuloma. In patients with residual groin pain and a palpable mass after surgery, the possibility of pseudotumor formation should be considered. Various imaging techniques, such as ultrasound, computed tomography scan, and magnetic resonance imaging, can be used to confirm the presence of such lesions. Revision with nonmetal-on-metal articulation is suggested to relieve the symptoms.     

Femoral nerve compression after migration of bone cement to the groin after hip arthroplasty

Although often a benign complication of total hip arthroplasty, cement extrusion can cause nerve, vessel, and organ compression. We report the case of a 70-year-old male patient in whom an extruded cement mass migrated anteriorly and compressed the femoral nerve and impinged on the femoral artery producing acute, severe groin pain with neuralgia 9 years postoperatively. Paresthesia of the anterior and medial thigh was found on examination. Radiographic, ultrasound, and computed tomographic studies confirmed a 6 × 1.5-cm mass of bone cement in the right groin compressing the femoral nerve that was removed successfully at surgery. Six months postoperatively, the patient's pain had resolved, but hyperesthesia of the medial thigh remained.     

Involvement of the lateral femoral cutaneous nerve as source of persistent pain after total hip arthroplasty

This report describes a situation in which the lateral femoral cutaneous (LFC) nerve was the source of incisional pain in a patient after a total hip arthroplasty. The painful scar was denervated by an approach that resected just the posterior branch of the LFC nerve. This was done through an incision near the anterior superior iliac crest, avoiding any potential exposure of the implant. One of the 3 patients reported here had a coexisting meralgia paresthetica that was treated by the same operative approach. The orthopedic surgeon should include the LFC nerve as an origin of persistent pain after total hip arthroplasty.     

Diagnosis and management of "an apparent mechanical" femoral mononeuropathy: a case study

This report describes an apparent case of femoral nerve mononeuropathy in a 58-year-old equestrian due to mechanical stress. A woman presented at a chiropractic office complaining of right buttock pain radiating to the right groin and knee. A treatment plan, consisting of chiropractic adjustments in addition to stretching and myofascial therapy, was initiated. The goal was to reduce pain and inflammation in the sacroiliac articulation by restoring normal biomechanical function. A rehabilitation program to alleviate tension in the musculature was initiated to reduce mechanical stresses exerted on the femoral nerve. The patient received five treatments over a period of three weeks and became asymptomatic. Even though peripheral nerve entrapment is an uncommon condition, clinicians must not overlook the possibility of a femoral mononeuropathy as it can produce a complex presentation and lead to ineffective patient management.     

股外侧皮神经卡压综合征诊治21例

自1998年9月至2001年11月,对24例患者采用皮层体感诱发电位检测辅助诊断股外侧皮神经(lateral femoral cu-tanous nerve,LFCN)卡压综合征,16例保守治疗,8例保守无效者行手术治疗,疗效满意.其中资料完整者21例,报告如下.     

Advanced Age,Obesity and Continuous Femoral Nerve Blockade are Independent Risk Factors for Inpatient Falls After Primary Total Knee Arthroplasty

We asked whether femoral nerve blockade (FNB) was an independent risk factor for inpatient post-operative falls after total knee arthroplasty (TKA). Data on 2197 primary TKAs were collected from our institution between 2003 and 2010. Patient demographics, type and duration of blocks were considered predictors of falls in a logistic regression model. Among 60 (2.7%) falls, the odds ratio was 1.04 (1.0–1.07; p = 0.008) for each 1 year of increased age above the mean (66 years), 2.4 (1.3–4.5; p = 0.005) for BMI > 30 kg/m² and 4.4 (1.04–18.2; p = 0.04) for continuous FNB. Single-shot FNB did not increase risk. No fall resulted in operative morbidity. The use of continuous FNB should be cautioned, especially in patients with other risk factors such as obesity and advanced age.     

Paravascular lumbar plexus block: block extension after femoral nerve stimulation and injection of 20 vs. 40 ml mepivacaine 10 mg/ml

The goal of this prospective randomized study was to assess the extension of the "three-in-one" paravascular lumbar plexus block after femoral nerve stimulation and injection of 20 vs. 40 ml mepivacaine 10 mg/ml. Three-in-one blocks were achieved in 12 of 39 (31%) patients given 20 ml of 1% mepivacine (group 1), and 17 of 41 (41%) patients given 40 ml (Group 2) of the same solution (n.s). The level of successful blockade at each nerve did not differ between groups: The femoral nerve was blocked in 92% vs. 93% of patients in groups 1 and 2, respectively; the obturator nerve in 62% vs. 78%; and the lateral cutaneous femoral nerve in 41% vs. 44%. We conclude that femoral nerve stimulation is effective in faciliating blockade in the femoral nerve but not the obturator or lateral cutanous femoral nerve with the tested solution and volumes, and therefore not particularly effective for achieving complete 3-in-l blockade. Whithin the clinically relevant range of 20–40 ml, the volume of mepivacaine 10 mg/ml does not appear to influence the extent of blockade.