Bloqueos de extremidad inferior / Lower extremity blocks

Lower limb blocks are described with emphasis on distribution according to sensitive distribution and its sonoanatomy.

Se describen los bloqueos de la extremidad inferior haciendo énfasis en la distribución de acuerdo a distribución sensitiva y a su sonoanatomia.

Application of ultrasound-guided fascia iliaca compartment block combined with sacral plexus block in elderly patients undergoing total hip arthroplasty via posterolateral approach / 临床麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided fascia iliaca compartment block combined with sacral plexus block in elderly patients undergoing posterolateral approach total hip arthroplasty (THA).Methods Sixty patients,24 males and 36 females,aged 65-90 years,ASA physical status Ⅱ or Ⅲ,undergoing THA via posterolateral approach were randomized into two groups with 30 cases in each group.Group SA received unilateral hypobaric spinal anesthesia with 2.0-2.5 ml local anesthetics (2 ml of 0.5% bupivacaine mixed 1 ml of sterile water for injection).Group NB received ultrasound-guided fas-cia iliaca compartment block (50 ml of 0.4% ropivacaine)combined with sacral plexus block (20 ml of 0.5% ropivacaine).The onset time and success time of sensory and motor block were evaluated.The visual analogue scale (VAS)at entring into the operating room (T0 ),1 min before positioning change (T1 ),posi-tioning change (T2 ),skin incision (T3 ),30 min after skin incision (T4 ),end of surgery (T5 ),24 h post-operatively (T6 ).The use of dopamine and atropine and incidence of complications were recorded. Results Compared with group SA,the onset time and success time of sensory and motor nerve block of group NB were longer (P <0.05).The VAS decreased at T1 ,T2 ,T6 and increased at T3 ,T5 in group NB (P <0.05).The use of dopamine in group NB (6.7%)was less than that in group SA (26.7%).Head-ache,nausea, vomiting, urinary retention were significantly decreased in group NB (P < 0.05 ). Conclusion Ultrasound-guided fascia iliaca compartment block combined with sacral plexus block re-lieves the pain caused by positioning changes.This technique may be used in elderly patients undergo-ing THA via posterolateral approach with less use of vasoactive drugs,better postoperative analgesic effects,fewer complications and higher degree of patient satisfaction.

Mechanism and clinical value of sacral plexus perfusion in rachi lumbocrural pain / 中国生化药物杂志

Objective To investigate the mechanism and clinical value of sacral plexus perfusion method in the treatment of rachi lumbocrural pain.Methods 80 cases of patients with rachi lumbocrural pain in our hospital from May 2014 to May 2016 were selected, they were randomly divided into sacral plexus perfusion method treatment group ( study group) and infrared short medium long frequency therapeutic instrument combined with acupuncture and massage therapy group (control group) two groups, 40 cases in each group.The main clinical symptoms scores, main clinical signs scores, thoracolumbar spine flexion, VAS scores, clinical efficacy of the two groups were statistically analyzed.Results The low back pain, cold limbs, numbness, leg redicular pain scores of the study group were significantly lower, the difference was statistically significant (P<0.05), the both sides L3 transverse tip tenderness scores, VAS score were significantly lower, the difference was statistically significant (P<0.05), the thoracolumbar flexion was significantly higher, the difference was statistically significant (P<0.05), the total treatment efficiency 92.5%(37/40) was significantly higher than the control group 67.5%(27/40), the difference was statistically significant (P<0.05).Conclusion The clinical value of sacral plexus perfusion method in the treatment of rachi lumbocrural pain is higher than infrared short medium long frequency therapeutic instrument combined with acupuncture and massage therapy, it can more effectively improve the clinical symptoms and signs, relieve the pain, enhance the thoracolumbar flexion and total treatment efficiency of patients.

The value of Turbo inversion recovery magnitude (TIRM) magnetic resonance neurography for sacral plexus injury / 中华显微外科杂志

Objective To evaluate the capability of Turbo inversion recovery magnitude (TIRM) magnetic resonance neurography (MRN) in the diagnosie of sacral plexus injury by comparing MRN findings with surgical results.Methods Ten patients with sacral plexus injury confirmed surgically underwent conventional T1WI,T2WI,TIRM and coronal TIRM MRN before operations from June,2011 to December,2012.The MRI data and surgical data were analyzed retrospectively to observe nerve injury.Results The coronal TIRM MRN images displayed 93 trunks of sacral plexus,of which 37 were confirmed injury by operation.The MRI findings were as follows:6 trunks involved continuous nerves,but with thickening and blurred margin,as well as abnormal high signal intensity;22 trunks were continuous,but with distortion,stiffness and adhesion accompanied by heterogeneous signal intensity and structural disorder;3 trunks showed complete loss of continuity,absence of normal signal,accompanied by retraction;and 3 trunks involved formation of traumatic neurofibroma.The coincidence of injured nerve trunks diagnosed by MRN with surgical findings amounts to 81.08％ (30/37).Conclusion MR with coronal TIRM imaging is effective in the diagnosis and depiction of sacral plexus injury,therefore it can be used as conventional sequence in sacral plexus examination to detect sacral plexus avulsion.

Variaciones del Nervio Isquiático en Relación al Músculo Piriforme / Variations of the Sciatic Nerve in Relation to the Piriformis Muscle

El nervio isquiático nace del plexo sacro y sale de la pelvis a través del foramen isquiático mayor por debajo del musculo piriforme como un tronco común. En ocasiones, este nervio puede emerger dividido en sus dos componentes: el nervio fibular común y nervio tibial, encontrándose, variaciones que podrían dar origen a una condición de compresión nerviosa. En este trabajo se exponen dos variaciones del nervio isquiático en un mismo individuo, donde en la primera el nervio fibular común atraviesa el músculo piriforme y luego desciende junto al nervio tibial y la segunda, donde el nervio fibular común se forma a partir de un ramo superior que perfora el músculo piriforme y el otro inferior que pasa debajo de él, para unirse luego en el margen inferior de éste músculo y formar el nervio fibular común, que desciende junto al nervio tibial. Las variaciones del nervio isquiático en relación al músculo piriforme podrían explicar el síndrome del músculo piriforme.

The sciatic nerve arises from the sacral plexus and exits the pelvis through the greater sciatic foramen below the piriformis muscle as a common trunk. Sometimes this nerve can emerge divided into two components: the common fibular nerve and tibial nerve, finding variations that could give rise to a condition of nerve compression. In this paper we describe two variations of the sciatic nerve in the same individual, where in the first common fibular nerve passes through the piriformis and then descends along the tibial nerve and the second, where the common fibular nerve is formed from a higher branch that pierce to piriform muscle and a lower branch passing under him, then join at the inferior margin of this muscle and form the common fibular nerve, which descends with the tibial nerve. Variations of the sciatic nerve in relation to the piriformis muscle could explain the piriformis syndrome.

Sacral Nerve Stimulation for Treatment of Intractable Pain Associated with Cauda Equina Syndrome

Sacral nerve stimulation (SNS) is an effective treatment for bladder and bowel dysfunction, and also has a role in the treatment of chronic pelvic pain. We report two cases of intractable pain associated with cauda equina syndrome (CES) that were treated successfully by SNS. The first patient suffered from intractable pelvic pain with urinary incontinence and fecal incontinence after surgery for a herniated lumbar disc. The second patient underwent surgery for treatment of a burst fracture and developed intractable pelvic area pain, right leg pain, excessive urinary frequency, urinary incontinence, voiding difficulty and constipation one year after surgery. A SNS trial was performed on both patients. Both patients' pain was significantly improved and urinary symptoms were much relieved. Neuromodulation of the sacral nerves is an effective treatment for idiopathic urinary frequency, urgency, and urge incontinence. Sacral neuromodulation has also been used to control various forms of pelvic pain. Although the mechanism of action of neuromodulation remains unexplained, numerous clinical success reports suggest that it is a therapy with efficacy and durability. From the results of our research, we believe that SNS can be a safe and effective option for the treatment of intractable pelvic pain with incomplete CES.

Origin and distribution of the femoral nerve in fetuses of zebu-crossed bovines

In this study the femoral nerve origin and distribution was assessed through the dissection of 30 fetuses of zebu-crossed bovines, 20 males and 10 females. These animals samples fixation in 10% formaldehyde aqueous medium occurred either by subcutaneous, intra-muscle, and intra-cavity injections in different sites, or by immersion of the mentioned pieces in vessels containing the same medium. The femoral nerve originated from the forth (L4), fifth (L5), and sixth (L6) spinal lumbar ventral branches in 14 animals (46.7%), from L4 and L5 in 13 samples (43.3%), and L5 and L6 in three cases (10%). In the course of its way, on both antimeres the mentioned nerve was branched to the greater psoas (100%), iliac (100%), pectinal (56.7%), femoral quadriceps (100%), muscles, and gave off saphena nerve, which gave branches for the pectinal (43.3%) and sartorius (100%) muscles and continued distally along the saphena artery to spread on the medial face of the knee and leg medial articulation skin. Statistically, there was no significant difference between the muscle branch frequencies given by the femoral nerve to the right and left antimeres. The obtained results related to the femoral nerve origin and distribution in fetuses of zebu-crossed bovines generally presented common characteristics with the ruminant corresponding data found in the literature, and this information is important as the basis for clinical or surgical approaches involving the studied structures.

Anatomic variations of the sacral plexus in Thais.

The aim of this study was to examine the variation of the sacral plexus in Thais in terms of its origin, branches, and variation in each branch. Anatomical dissections were conducted in 150 halves of formalin-embalmed cadavers. All preserved cadavers were Thais, ranging in age from 35 to 85 years old, 86 males and 64 females. The sacral plexus was markedly comprised of the fourth lumbar to fourth sacral ventral rami (L4-S4) in 98.67% of the plexuses (or 148 cases) except for two plexuses (1.33% of the plexuses) those were derived from the ventral rami of the fourth lumbar to fifth sacral ventral rami (L4-S5). The sacral plexus, lying on the posterior wall of the lesser pelvis to the piriformis muscle, has nine named branches. Six of these are distributed to the buttock and lower lomp, including 1) Nerve to the Quadratus Femoris and Gemellus Inferior, 2) Nerve to the Obturator Internus and Gemellus Inferior, 3) Superior Gluteal, 4) Inferior Gluteal, 5) Posterior Femoral Cutaneous and 6) Sciatic. The other branches supply structures belonging to the pelvis, including 7) Nerve to the Piriformis, 8) Pudendal and 9) Pelvic Splanchnic. The variant of origination and formations of all branches occur on both side. However, the anatomic variability of the plexuses was not statistically different with regard to either side or gender. The results from this study provided additional information and new insights into the sacral plexus in terms of its origins, branches, and variations of each branch that might be useful in medicine, anesthesia, surgery and physical therapy.