Bloqueos Nerviosos. Bases Anatómicas del Dolor Somático Abdomino-Pélvico / Nerve Blocks. Anatomy of the Somatic Innervation of the Abdomino-Pelvic Cavity

El dolor abdominal es una de las sintomatologías que afectan con frecuencia la cavidad abdomino-pélvica. Dicha cavidad posee una inervación somática en la que intervienen del séptimo a doceavo nervios intercostales, ramos colaterales y terminales del plexo lumbar y el nervio pudendo; siendo objetivo de este trabajo la descripción anatómica del dolor abdominopélvico a través del plexo lumbar, nervios intercostales y nervio pudendo, sus diferentes patrones y variaciones de conformación, y las implicancias de éstas últimas en las distintas maniobras clínico-quirúrgicas. Se realizó un estudio descriptivo, observacional y morfométrico de la inervación somática de la cavidad abdomino-pélvica, en 50 preparaciones cadavéricas, fijadas en solución de formaldehído, de la Tercera Cátedra de Anatomía, Facultad de Medicina, Universidad de Buenos Aires, entre Agosto/2017-Diciembre/2019. La descripción clásica del plexo lumbar se encontró en 35 casos; la presencia del nervio femoral accesorio en ningún caso; así como también la ausencia del nervio iliohipogástrico en ningún caso; el nervio obturador accesorio se halló en 2 casos; el nervio genitofemoral dividiéndose dentro de la masa muscular del psoas mayor en 6 casos; el nervio cutáneo femoral lateral emergiendo únicamente de la segunda raíz lumbar en 6 casos y por último se encontró la presencia de un ramo del nervio obturador uniéndose al tronco lumbosacro en un caso. Los nervios intercostales y el nervio pudendo presentaron una disposición clásica en todos los casos analizados. Es esencial un adecuado conocimiento y descripción del plexo lumbar, nervios intercostales y nervio pudendo para un adecuado abordaje de la cavidad abdomino-pélvica en los bloqueos nerviosos.

SUMMARY: Abdominal pain is one of the symptoms that affect the abdominal-pelvic cavity. The abdominal-pelvic cavity has a somatic innervation involving the seventh to twelfth intercostal nerves, collateral and terminal branches of the lumbar plexus and the pudendal nerve. The objective of this work is the description of the lumbar plexus, intercostal nerves and pudendal nerve, its different patterns and structure variations, as well as its implications during pain management in patients. A descriptive, observational, and morphometric study of patterns and structure variations of the lumbar plexus, intercostal nerves and pudendal nerve was conducted in 50 formalin-fixed cadaveric dissections of the Third Chair of Anatomy at the School of Medicine in the Universidad de Buenos Aires from August 2017 to December/2019. The standard description of the lumbar plexus was found in 35 cases; accessory femoral nerve was not present in any of the cases; absence of the iliohipogastric nerve was also not found in any case, while the accessory obturating nerve was found in 2 cases; genitofemoral nerve dividing within the muscle mass of psoas in 6 cases; lateral femoral cutaneous nerve emerging only from the second lumbar root in 6 cases and finally, presence of a branch of the obturating nerve was found joining the lumbosacral trunk in one case. The pudendal and intercostal nerve patterns presented a typical pathway in all cases. Adequate knowledge and description of the lumbar plexus, intercostal nerves and pudendal nerve is essential for an adequate approach of the abdominal-pelvic cavity in nerve blocks.

Morphometry of spinal nerve composition and thicknesses of lumbar plexus nerves for use in clinical applications / Morfometría de la composición del nervio espinal y espesores de nervios del plexo lumbar para su uso en aplicaciones clínicas

SUMMARY: The aim of this study was to clarify the diverse spinal compositions of the branches of the lumbar plexus in terms of their prevalence rates and thicknesses. Thirty lumbar plexuses extracted from Korean adults were used in this study. The nerve fascicles were separated and traced with the aid of a surgical microscope. The thickness of each spinal nerve component was calculated based on the mean of the largest and smallest diameters using digital calipers under the surgical microscope. The most common patterns of the spinal composition of the branches of the lumbar plexus were as follows: The iliohypogastric nerve (IHN) and the ilioinguinal nerve (IIN) arose from the ventral ramus of the first lumbar nerve (L1), the genitofemoral nerve (GFN) arose from the anterior division of the ventral ramus of the second lumbar nerve (L2), and the lateral femoral cutaneous nerve (LFCN) arose from the posterior division of the ventral ramus of theL2, the femoral nerve (FN) arose from the posterior division of the ventral ramus of L2-the fourth lumbar nerve (L4), with the thickest spinal component derived from the third lumbar nerve (L3), and the obturator nerve (OBN) arose from the anterior division of the ventral ramus of L2-L4, with the thickest spinal component derived from L3. However, when L5 constituted the FN and OBN, the thickest spinal components of the FN and OBN was L4. This morphometric study has measured the thicknesses of diverse spinal components that constitute the branches of the lumbar plexus after separating the nerve fascicles. The thicknesses of the various spinal components of these branches can be compared in order to understand which make the main and minor contributions to the lower limb.

RESUMEN: El objetivo de este estudio fue evaluar las diversas composiciones espinales de los ramos del plexo lumbar en cuanto a sus tasas de prevalencia y grosor. Se utilizaron treinta plexos lumbares extraídos de individuos adultos coreanos. Se separaron y trazaron los fascículos nerviosos por medio de un microscopio quirúrgico. El grosor de cada componente del nervio espinal se calculó con base en la media de los diámetros mayor y menor utilizando calibradores digitales bajo el microscopio. Los patrones más comunes de la composición espinal de los ramos del plexo lumbar fueron los siguientes: el nervio iliohipogástrico (NIH) y el nervio ilioinguinal (NII) surgieron del ramo ventral del primer nervio lumbar (L1). El nervio genitofemoral (NGF) surgió de la división anterior del ramo ventral del segundo nervio lumbar (L2). El nervio cutáneo femoral lateral (NCFM) surgió de la división posterior del ramo ventral L2. El nervio femoral (NF) surgió de la división posterior del ramo ventral de L2. El cuarto nervio lumbar (L4), con el componente espinal más grueso derivado del tercer nervio lumbar (L3) y el nervio obturador (NOB) surgieron de la división anterior del ramo ventral de L2-L4, con el componente espinal más grueso derivado de L3. Sin embargo, cuando L5 constituía el NF y NOB, los componentes espinales más gruesos del NF y NOB eran de L4. Este estudio morfométrico analizó los espesores de diversos componentes espinales que constituyen las ramas del plexo lumbar después de separar los fascículos nerviosos. Es posible comparar los espesores de los diversos componentes espinales de estos ramos para comprender las contribuciones principales y menores al miembro inferior.

Origin and distribution of the lumbosacral plexus anatomy in van cats / Origen y distribución de la anatomía del plexo lumbosacro en gatos van

SUMMARY: The innervation of the pelvic limbs of the Van cat is investigated in this research. The origins of the nerves, the innervated muscles and nerve diameters were shown in a table. Five cat cadavers were used in the study. The pudendal nerve originated from the S1-S2 spinal nerves. The femoral nerve consisted of the ventral branches of the 5th and 6th lumbar nerves in 4 cats The ischiatic nerve was composed of the 6th and 7th lumbar (L6-L7) and S1 spinal nerves in all cadavers. The ischiatic nerve was the thickest branch of sacral plexus (the average diameter on the right side was 3.31 ± 0.27 mm and the average diameter on the left side was 3.28 ± 0.29 mm). The lumbosacral plexus was formed by the ventral branches of the L4-S3 spinal nerves. N.genitofemoralis consisted of only the ventral branches of L4 in all cadavers. N. femoralis did not give rise to a branch to the m. iliopsoas. N.plantaris lateralis was found to give a branch to the 3th finger. The quadriceps femoris muscles did not take any branches from either the ischiadicus nerve or the pudendal nerve. The obturator nerve did not receive any branches from the L4 spinal nerves. There was no branch to the skin from the caudal gluteal nerve. The thinnest nerve was the pudendal nerve. Due to the scarcity of studies on the lumbosacral plexus of cats, it is thought that this study will complete a gap in the field of veterinary anatomy.

RESUMEN: En esta investigación se estudió la inervación de los miembros pélvicos del gato Van. Los orígenes de los nervios, los músculos inervados y los diámetros de los nervios son mostrados en una tabla. En el estudio se utilizaron cinco cadáveres de gatos. En cuatro gatosel nervio pudendo se originaba a partir de los nervios espinales S1-S2. El nervio femoral consistió en los ramos ventrales de los nervios lumbares quinto y sexto. El nervio isquiático estaba compuesto por los nervios espinales sexto y séptimo lumbar (L6-L7) y S1 en todos los cadáveres. El nervio isquiático era el ramo más grueso del plexo sacro (el diámetro medio del lado derecho medía de 3,31 ± 0,27 mm y el diámetro medio izquierdo 3,28 ± 0,29 mm). El plexo lumbosacro estaba formado por los ramos ventrales de los nervios espinales L4-S3. N. genitofemoralis constaba solo de las ramas ventrales de L4 en todos los cadáveres. N. femoralis no dio lugar a un ramo a la m. iliopsoas. Los músculos del cuádriceps femoral no tomaron ningún ramo ni del nervio isquiático ni del nervio pudendo. El nervio obturador no recibió ramos de los nervios espinales L4. No existían ramos a la piel desde el nervio glúteo caudal. El nervio más delgado fue el nervio pudendo. Debido a la escasez de estudios sobre el plexo lumbosacro de los gatos, este estudio completará un vacío en el campo de la anatomía veterinaria.

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.

Classification and fascicular analysis of variant branching pattern of femoral nerve for microsurgical intervention: a series of thirteen cadavers / Clasificación y análisis fascicular de las variantes en el patrón de ramificación del nervio femoral en intervenciones microquirúrgicas: una serie de 13 cadáveres

Femoral neuropathy associated with lower limb is treated by surgical intervention through activation/regeneration/grafting of nerve fibers by a nerve cuff electrode implant or neuro-prosthesis. These procedures require detailed and precise knowledge of neuro-anatomical variants of the femoral nerve and its fascicular anatomy so that the nerve injury can be investigated and treated more efficiently. The aim of the study is to uncover the variations both in the femoral nerve and its branches, to classify them and to bring out corresponding fascicular anatomy using a hypothesis based on the principle of consistency, continuity and traceability of fascicles. The study was carried out in the Department of Anatomy AIIMS Rishikesh using 13 matched lower limbs (26 femoral nerves) from 13 cadavers. The femoral nerve was exposed in the femoral triangle and traced to the posterior abdominal wall. Variations in the shape, size and course of the femoral nerve and its branches were analyzed. The fascicular arrangement was also conceptualized based on the hypothesis. Seven classes, high division, trunk anomaly, semi-scattered, scattered branching pattern, pectocutaneous, lateral cutaneous nerve of thigh and nerve to sartorius anomalies were detected. The corresponding fascicular organizations were modeled. The seven classes along with corresponding fascicular pattern will be very useful for neurosurgeons, radiologists, anesthetists and anatomists in diagnosis and treatment of femoral neuropathy.

La neuropatía femoral asociada con el miembro inferior es tratada por intervención quirúrgica a través de activación, regeneración e injerto de fibras nerviosas mediante un implante de electrodo de manguito de nervios o neuro-prótesis. Estos procedimientos requieren un conocimiento detallado y preciso de las variantes neuro-anatómicas del nervio femoral y su anatomía fascicular de modo que la lesión del nervio pueda ser investigada y tratada de manera más eficiente. El objetivo del estudio fue descubrir las variaciones tanto en el nervio femoral y sus ramas y clasificarlos a partir de la anatomía fascicular utilizando una hipótesis basada en el principio de la continuidad y trazabilidad de los fascículos correspondientes. El estudio se llevó a cabo en el Departamento de Anatomía AIIMS Rishikesh utilizando 13 miembros inferiores pareados (26 nervios femorales) de 13 cadáveres. El nervio femoral se expuso en el triángulo femoral y fue trazado en la pared abdominal posterior. Se analizaron las variaciones en la forma, tamaño y trayecto del nervio femoral y sus ramas. El patrón fascicular fue conceptulizado de acuerdo a la hipótesis planteada. Se detectaron anomalías clasificadas en: siete clases, división alta, anomalías de tronco, semi-dispersos, patrón de ramificación dispersa, pectocutáneo, nervio cutáneo lateral y nervio del músculo sartorio. Las clasificaciones junto con el patrón fascicular correspondientes serán de gran utilidad para los neurocirujanos, radiólogos, anestesistas y anatomistas en el diagnóstico y tratamiento de la neuropatía femoral.

Estudo anatômico do plexo lombossacral de Tamandua tetradactyla / Anatomical study of the lumbosacral plexus of the Tamandua tetradactyla

O tamanduá-mirim (Tamandua tetradactyla) é um xenartro da família Myrmecophagidae, encontrado da Venezuela ao sul do Brasil. Estudos apontam que essa é uma das espécies de animais selvagens mais vitimadas em número de atropelamentos, e, muitas vezes, o atendimento clínico adequado aos indivíduos feridos é dificultado pela carência de informações acerca dos mesmos. Visando contribuir com o conhecimento dessa espécie, este estudo teve como objetivo descrever seu plexo lombossacral. Para tanto, foram utilizados quatro cadáveres de Tamandua tetradactyla adultos e de ambos os sexos. O plexo lombossacral dessa espécie é formado pelos ramos ventrais dos nervos espinhais T18, L1, L2, L3, S1, S2, S3, S4, S5. Os nervos integrantes do plexo lombossacral do T. tetradactyla com suas formações mais frequentes foram os seguintes: genitofemoral (T18), cutâneo femoral lateral (T18-L1), femoral (T18, L1-L3), obturador (T18, L1-L3), glúteo cranial (L3-S1), isquiático (L3-S3), pudendo (S3-S4 ou S4-S5), retal caudal (S4 ou S5) e cutâneo femoral caudal (S4-S5). O plexo lombar e sacral dessa espécie é unido, sendo L3 o ponto de união entre eles. Devido ao pequeno número de vértebras lombares, a composição dos nervos do plexo lombossacral do T. tetradactyla apresenta características peculiares que se diferem das características das demais espécies já estudadas, quais sejam, a ausência dos nervos ílio-hipogástrico e ilioinguinal e participação de nervos torácicos na composição dos nervos do plexo lombar, presença de contribuição sacral na composição do nervo obturador e ausência de contribuição lombar na composição do nervo isquiático e um limite mais caudal na extensão do plexo sacral.

The lesser anteater (Tamandua tetradactyla) is a xenarthra of the Myrmecophagidae family found from Venezuela to southern Brazil. Studies have shown that this is one of the most numerous wildlife species victims of car collisions on roads, and often the appropriate clinical care to injured animals is hindered by the lack of information about them. In order to contribute to the knowledge of this species, this study aimed to describe its lumbosacral plexus. For this purpose, four cadavers of adult specimens of both sexes of T. tetradactyla were used. The lumbosacral plexus of the T. tetradactyla is formed by the ventral rami of spinal nerves T18, L1, L2, L3, S1, S2, S3, S4, S5. The lumbosacral plexus nerves with their most common formations in this species were as follows: genitofemoral (T18), lateral femoral cutaneous (T18-L1), femoral (T18, L1-L3), obturator (T18, L1-L3), cranial gluteal (L3-S1), ischiatic (L3-S3), pudendus (S3-S4 or S4-S5), caudal retal (S4 or S5), and caudal femoral cutaneous (S4-S5). The lumbar and sacral plexus of this species is joined, L3 being the link between them. Due to the small number of lumbar vertebrae, the arrangement of the lumbosacral plexus nerves of the T. tetradactyla showed peculiar characteristics that differ it from that of other previously studied species, such as the absence of iliohypogastric and ilioinguinal nerves and contribution of thoracic nerves in the formation of all the nerves of the lumbar plexus, presence of sacral contribution in the formation of the obturator nerve, and the lack of lumbar contribution for sciatic nerve formation and a most caudal extent of the sacral plexus.

Nervio femoral accesorio: una variación del plexo lumbar / Accessory femoral nerve: a variation of lumbar plexus

Variaciones en el origen de los ramos del plexo lumbar son observadas comúnmente durante las disecciones. Entre ellas se pueden mencionar: ausencia del nervio iliohipogástrico, presencia de un nervio obturador accesorio, bifurcación del nervio femoral, entre otras, destacándose la presencia de un nervio accesorio del nervio femoral. Durante una disección de rutina, en un cadáver fijado en formaldehido 10 por ciento, de un individuo adulto, Chileno, de sexo masculino, se observó la presencia unilateral de este nervio femoral accesorio originado del ramo anterior del nervio femoral, el cual estaba formado por dos ramos, describiendo sus características de origen, trayecto y distribución. Las variaciones anatómicas del plexo lumbar deben ser consideradas en el momento de efectuar cirugías en la región, evitando daños al nervio mencionado u otros, durante la disección quirúrgica.

Variations in the origin of the branches of the lumbar plexus are commonly observed during dissections. Among them may be mentioned: absence of iliohypogastric nerve, the presence of an accessory obturator nerve, femoral nerve bifurcation, highlighting the presence of a accessory femoral nerve. During routine dissection in a cadaver fixed in 10 percent formaldehyde, an adult individual, Chilean, male, unilateral accessory femoral nerve was observed, originating from the anterior branch of femoral nerve, which consisted of two branches.The characteristics of origin, course and distribution are described. Anatomical variations of the lumbar plexus must always be considered at the time of surgery in the mentioned sector avoiding nerve damage, during surgical dissection.

Critical analysis of extra peritoneal antero-lateral approach for lumbar plexus / Análise crítica do acesso anterolateral retroperitoneal ao plexo lombar

Lesions of lumbar plexus are uncommon and descriptions of surgical access are derived from vertebral spine approaches. METHOD: The extraperitoneal anterolateral approach to the lumbar plexus was performed in six adult fresh cadavers. The difficulties on dissection were related. RESULTS: An exposure of all distal elements of lumbar plexus was possible, but a cranial extension of the incision was needed to reach the iliohypogastric nerve in all cases. Ligation of vessels derived from common iliac artery was necessary for genitofemoral and obturator nerves exposure in two cases. The most proximal part of the lumbar roots could be identified only after dissection and clipping of most lumbar vessels. CONCLUSION: The extraperitoneal anterolateral approach allows appropriate exposure of terminal nerves of lumbar plexus laterallly to psoas major muscle. Cranial extension of the cutaneous incision may be necessary for exposure of iliohypogastric nerve. Roots exposure increases the risk of vascular damage.

As lesões do plexo lombar são incomuns e as descrições dos acessos cirúrgicos são derivadas de vias de acesso à coluna vertebral. MÉTODO: A via extraperitoneal anterolateral foi realizada em seis cadáveres para o acesso ao plexo lombar. Eventuais dificuldades na dissecção foram relatadas. RESULTADOS: Tal acesso permitiu a exposição dos elementos distais do plexo lombar, mas uma extensão cranial da incisão foi necessária para a exposição do nervo iliohipogástrico. Para a exposição dos nervos genitofemoral e obturador houve a necessidade da ligadura de vasos originados da artéria ilíaca comum em 2 casos. As raízes foram identificadas somente após dissecção e ligadura dos vasos lombares. CONCLUSÃO: O acesso anterolateral extraperitoneal permite uma exposição adequada dos nervos terminais do plexo lombar lateralmente ao músculo psoas maior. Uma extensão cranial da incisão pode ser necessária para exposição do nervo iliohipogástrico. A exposição das raízes implica em maior risco de lesão vascular.

Aspectos anatómicos y topográficos del nervio pudendo en la región glútea / Anatomical and topographical aspects of the pudendal nerve in gluteal region

El nervio pudendo distribuye ramos motores y sensitivos para la región perineal y órganos genitales externos. Tiene importancia funcional en la micción, defecación, erección y parto. Desde el punto de vista clínico, se realiza bloqueo anestésico del mismo en la práctica obstétrica, se electroestimula en casos de incontinencia fecal o urinaria, entre otros procedimientos. Investigaciones anatómicas han señalado que puede presentar variaciones en su conformación y topografía. Con el propósito de complementar el conocimiento sobre este nervio en su trayecto por la región glútea, se estudió su conformación, biometría y relaciones con los vasos pudendos internos y ligamentos adyacentes. Se disecaron 30 regiones glúteas de 15 cadáveres formolizados de individuos brasileños, adultos, de ambos sexos, observando la conformación del nervio, número de ramos, disposición respecto a los vasos pudendos internos y ligamentos sacrotuberoso y sacroespinoso, registrando también su ancho en el trayecto entre los forámenes isquiático mayor y menor. El nervio pudendo se presentó como tronco único en 53,3 por ciento de los casos y dividido en ramos en 46,7 por ciento (dos ramos en 36,7 por ciento, tres en 6,7 por ciento y cuatro en 3,3 por ciento). Cuando estaba dividido, en 36,7 por ciento los ramos permanecieron separados y en 10 por ciento se unieron antes de ingresar en el foramen isquiático menor. El nervio (único o dividido) fue medial a los vasos pudendo internos en 70 por ciento y lateral a ellos en 3,3 por ciento. En el 26,7 por ciento restante, estaba dividido en dos o tres ramos, que se situaban medial y lateralmente a los vasos o los cruzaban posteriormente. Su posición fue anterior al ligamento sacrotuberoso en 93,3 por ciento. El nervio pudendo presenta interesantes variaciones en su conformación y topografía, que deben ser consideradas durante los procedimientos clínicos y quirúrgicos que lo involucren.

The pudendal nerve distributes motor and sensory branches to the perineum and genital external organs. It has functional importance in the micturition, defecation, erection and labor. From the clinical point of view, anaesthetic blockade of the same one is realized in the obstetric practice, electroestimulation in cases of fecal or urinary incontinence, among other procedures. Anatomical investigations have indicated that it can present variations in its conformation and topography. The objective of this study was complete knowledge about this nerve in its course through the gluteal region, its conformation, biometry and its relationship with the internal pudendal vessels and adjacent ligaments were studied. We dissected 30 gluteal regions of 15 corpses fixed in formaldehyde 10 percent of Brazilian individuals, adult, of both sexes, observing the conformation of the nerve, number of branches, disposition with regard to the internal pudendal vessels and sacrotuberous and sacrospinous ligaments, also recording its external diameter in the distance between greater sciatic foramen and lesser sciatic foramen. The pudendal nerve appeared as a single trunk in 53.3 percent of the cases and divided in branches in 46.7 percent (two branches in 36.7 percent, three in 6.7 percent and four in 3.3 percent). When it was divided, in 36,7 percent the branches remained separated and in 10 percent they joined before the lesser sciatic foramen. The nerve (single or divided) was medial to the internal pudendal vessels in 70 percent and lateral to them in 3.3 percent. In 26.7 percent, it was divided in two or three branches, which were located medially and laterally to these vessels or crossing posterior to them. Its position was anterior to the sacrotuberous ligament in 93.3 percent. The pudendal nerve presents interesting variations in its conformation and topography which must be considered during the clinical and surgical procedures.

Topografia do cone medular em gatos sem raça definida / Topography of the medullar cone in the domestic non-defined breed cat

Estudou-se a topografia post mortem do cone medular em 30 gatos adultos sem raça definida. Procedeu-se à remoção da pele e da musculatura dorsal da coluna vertebral e expuseram-se a medula espinhal e seus envoltórios, após a secção dos arcos vertebrais. O cone medular foi evidenciado e mensurado. Avaliou-se a sua relação com as vértebras lombares (L), sacrais (S) e caudais (Cd). O cone medular variou de 3,40 a 8,00cm (média=5,08cm). A esqueletopia foi variável, pois em 24 (80 por cento) animais o cone medular iniciou-se na vértebra L6; em quatro (13,3 por cento), na L7; e em dois (6,7 por cento), na L5. Em 12 (40 por cento) animais terminou na vértebra S2; em 10 (33,3 por cento), na S3; em cinco (16,7 por cento), na Cd1; em dois (6,7 por cento), na S1; e em um (3,3 por cento) na Cd2.

It was studied the post mortem topography of the medullar cone in 30 adult non-defined breed cats. The dorsal skin and muscles from the vertebral column were removed and the spinal cord and its wrappers were visualized, after the section of the vertebral arcs. The medullar cone was then exposed and measured. Its relationship with lumbar (L), sacral (S), and caudal (Cd) vertebrae was determined. The length of the medullar cone presented a variation from 3.40 to 8.00cm (average 5.08cm). Its skeletopy was variable; since in 24 animals (80 percent), the medullar cone began at the L6 vertebra; in four (13.3 percent), at the L7; and in two (6.7 percent) at the L5 vertebra. It ended in 12 (40 percent) animals at the S2 vertebra; in 10 (33,33 percent), at the S3; in five (16.7 percent) at the caudal (Cd) vertebra; in two (6.7 percent), at the S1; and in one (3.3 percent), at the Cd2.

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.

Anomalias dos nervos lombossacrais em natimortos a termo. Estudo anatômico / Anomalies of the lumbosacral nerve roots in stillborns. An anatomical study

Contexto: Existe controvérsia entre autores quanto à incidência de variações anatômicas dos nervos espinhais lombossacros. A incidência dessas anomalias nervosas varia de 0% a 30% como verificado em estudos anatômicos em cadáveres adultos de diferentes nacionalidades, de 2,0% a 4,0% em estudos de imagem diagnóstica e de 0,34% a 10% em séries cirúrgicas. Objetivo: Determinar a incidência de anomalias anatômicas nos nervos espinhais lombossacros em 40 natimortos a termo de nacionalidade brasileira. Métodos: O segmento lombossacro da coluna vertebral de 40 natimortos, provenientes do laboratório de patologia clínica do Hospital Universitário da Universidade Federal de Sergipe (UFS), foi estudado no Laboratório de Neuroanatomia do Departamento de Morfologia da UFS. Foram excluídos aqueles casos que possuíam síndromes ou qualquer defeito orgânico associado. Os espécimes anatômicos foram fixados com solução de formaldeído a 10%, infundida por meio da veia umbilical. As peças foram preparadas com a ressecção em bloco das partes moles dorsais, processos espinhosos e lâminas da décima vértebra torácica até o sacro. Resultado: Neste estudo, foram encontradas seis variações anatômicas dos nervos espinhais lombossacros, em seis diferentes espécimes, de quatro tipos, totalizando 15% das peças. As variações anatômicas dos nervos espinhais lombossacros foram classificadas em oito tipos, sendo a anastomose intradural a mais presente. O quinto nervo lombar foi o mais frequentemente comprometido Não foi observada diferença significativa quanto ao sexo e lado envolvido. Conclusão: O presente estudo enfatiza a importância do conhecimento dessas anomalias anatômicas durante os procedimentos cirúrgicos na região lombossacral, pois não se trata de evento muito raro.

Context: There is such controversy among authors about the real incidence of lumbosacral nerve roots anomalies. The incidence ranges from 0% to 30% in anatomic studies in different populations, from 2% to 4% in diagnostic image studies and 0.34% to 10% in surgical series. Objective: To determine the incidence of anatomical abnormalities of the lumbossacral spinal nerves in 40 Brazilian stillborns. Methods: The segment of the lumbosacral spine of 40 stillborns, from the clinical pathology laboratory at the University Hospital of Federal University of Sergipe (UFS) was studied in the Laboratory of Neuroanatomy, Department of Morphology of the UFS. We excluded those cases that had any defects or syndromes associated. The anatomical specimens were fixed with formaldehyde solution 10%, infused through the umbilical vein. The specimens were prepared with en bloc resection of the soft dorsal spinous processes and laminae from the tenth thoracic vertebra to the sacrum. Results: In this study, were found four types of anatomical variations of lumbosacral spinal nerves in six different specimens, accounting for 15% of the specimens. The fifth lumbar nerve was the most frequently involved (66%).The anatomical variations of lumbosacral spinal nerves were classified into eight types, and the intradural anastomosis was the most frequent. There was no significant difference regarding gender and side involved. Conclusion: Our study emphasizes the importance of knowledge of these anatomical anomalies during surgical procedures in the lumbosacral region because they are not too rare.

Estudo anatômico da porção intrapélvica do nervo isquiático em fetos de bovinos azebuados / Anatomical study of the intrapelvic portion of ischiatic nerve in fetuses in crossbred zebu cattle

O nervo isquiático é o maior de todos os nervos do organismo. Ele emerge da cavidade pélvica pelo foram e isquiático maior como um cordão amplo, plano e acinzentado. Dirige-se caudal e ventralmente sobre a parte distal e lateral do ligamento largo da pelve. Há muitas evidências clínicas e experimentais de que a maior parte das injúrias que acometem o nervo isquiático, em bovinos, envolve a contribuição do 6º nervo lombar para o referido nervo. Neste estudo foram analisados por meio de dissecção, a origem e sintopia do nervo isquiático, em 33 fetos de bovinos azebuados. O nervo isquiático mostra sua origem a partir dos ramos ventrais do 5º e 6º nervos lombares e do 1º, 2º e 3° nervos sacrais. A origem mais freqüente parao nervo isquiático é representada pelo ramo ventral do 6º nervo lombar e 1º e 2º nervos sacrais (100%). Em 39,4% desses casos, o nervo recebe contribuição do 5º nervo lombar e, em 12,1% dos casos, também do 3º nervo sacral. A participação mais conspícua na formação do nervo isquiático é a do 6º nervo lombar e 1º nervo sacral (39,4%), seguida somente do 1º nervo sacral em 33,33% e da associação do 1º e 2º nervos sacrais em 18,18%. O nervo isquiático revela íntima aposição na face ventral do sacro e em relação às raízes ventrais do 5º e 6º nervos lombares. De modo geral, os resultados obtidos em relação à origem do nervo e sua sintopia, não mostram discordância com os correspondentes dados obtidos na literatura referente a bovinos de origem européia.

The sciatic nerve is the largest of all nerves of the body. It emerges from the pelvic cavity through the major sciatic for a men as a wide, flat and brownish cord. It extends caudally and ventrally over the distaland lateral part of the pelvic broad ligament. There are several experimental and clinical evidences supporting that the majority of injuries affecting the sciatic nerve in bovines are associated with its 6th lumbar nerve. This study analyzed the sciatic nerve origin and topography by means of dissection in 33 crossbred zebu fetuses. The sciatic nerve originates from the ventral branches of the 5th and 6th lumbar nerves and 1st, 2nd and 3rd sacral nerves. The most frequent origin of the sciatic nerve is represented by the ventral branch of the 6th lumbar nerve and 1st and 2nd sacral nerves (100%). The most conspicuous participation in the sciatic nerve formation is from the 6th lumbar nerve and 1st sacral nerve (39.4%), followed only by the 1st sacral nerve in 33% and from the association of the 1st and 2nd sacral nerves in 18.18%. The sciatic nerve shows close apposition in the sacral ventral face and as to the 5th and 6th lumbar nerve ventral roots. In general, the obtained results concerning the nerve origin and its topography do not demonstrate any discrepancy when compared todata from the literature regarding European cattle.

Origem do plexo lombossacral de mocó (Kerondo rupestris) / Origin of lumbar sacral plexus of rock cavy (Kerondo rupestris)

O mocó (Keredon rupestris), é um roedor da fauna silvestre brasileira, pertencente à família dos cavídeos, e da subfamília caviinae. No Brasil, o mocó já vem sendo criado em cativeiro com o objetivo de fornecer alimento, manter a espécie e proporcionar o desenvolvimento de pesquisas voltadas ao conhecimento mais aprofundado desta espécie. Nossa pesquisa visa conhecer a origem e os nervos resultantes do plexo lombossacral deste animal, fornecendo subsídios indispensáveis para o estudo da anatomia comparativa, especialmente dos mamíferos Silvestres. Foram utilizados 10 animais adultos de diferentes idades provenientes do Centro de Multiplicação de Animais Silvestres da ESAM (CEMAS-ESAM). Foram fixados em solução aquosa de formal a 10% durante 48 horas, realizou-se dissecação de cada antímero a fim de expor os nervos através da retirada dos músculos psoas maior e psoas menor, cujos resultados foram registrados através de desenhos esquemáticos e imagens fotografadas. Observaram-se variações no número de vértebras lombares e sacrais destes animais, alterando a relação entre os nervos que dão origem ao plexo lombossacral que apresentou três tipos diferentes de constituição. As raízes ventrais originando-se a partir dos três últimos nervos lombares e dos três primeiros nervos sacrais correspondeu a 80% dos exemplares estudados, onde o tipo II (Lsubscrito5,Lsubscrito6Lsubscrito7,Ssubscrito1,Ssubscrito2 e Ssubscrito3). foi o mais comumente encontrado (50%) das amostras. Os nervos considerados originários do plexo foram o Femoral, obturatório, isquiático, glúteo cranial, glúteo caudal e pudendo.

Rock cavy (Kerondon rupestris) is a rodent of the Brazilian wild fauna, belonging to the cavied family, and to the caviinae under family. In Brazil, this animal is already been raised in captivity with the aim of food supply, to preserve the species and to offer subsidy to the research development concerning to the deeper knowledge of these species. To know the origin and the nerves of the rock cavy (Keredon rupestris) lumbar sacral plexus, supplying indispensable subsidies for the study of the comparative anatomy, especially of the wild mammals, we intended to accomplish this research. Ten adult animals of different ages from the Wild Animals Multiplication Center (CEMAS) of the Superior School of Agriculture of Mossoró (ESAM) were used. The segments were fastened in 10% aqueous solution of formal for 48 hours, followed by dissection in order to expose the nerves by the retreat of the muscles, psoas major and psoas minor, and the results were registered by schematic drawings and photographed images. Differences were observed in the number of lumbar and sacral vertebrae of these animals. The lumbar sacral Plexus presented their ventral roots starting from the last three lumbar nerves and from the first three sacral nerves, corresponding to 80% of the studied animals. The type II (Lsubscript5,Lsubscript6,Lsubscript7,Ssubscript1,Ssubscript2 e Ssubscript3) was the most commonly found (50%) of the between samples. Considered nerves, originated in the plexus, were: femoral, obturatory, ischiatic, cranial gluteus, caudal gluteus and pudendus.

Bloqueos regionales continuos en anestesiología pediátrica / Continuous regional blocks in pediatric anesthesia

La demanda por aumentar la eficiencia y disminuir la estadía hospitalaria ha llevado a los anestesiólogos a buscar técnicas que mejoren el bienestar del paciente tratando el dolor intra y post-operatorio, como también que permitan un alta precoz. Se describen en este artículo dos trabajos realizados en pacientes pediátricos de la Clínica Alemana basados en bloqueo continuo de nervios periféricos. El primero se relaciona con el bloqueo continuo de los nervios ilioinguinal e iliohipogástrico bajo anestesia general en los casos de pacientes fisurados que presentan una fístula vestíbulo-oral cuya cirugía consiste en colocar injerto de cresta ilíaca en la fístula. El segundo es un bloqueo de fascia ilíaca en pacientes con ruptura de ligamento cruzado anterior de rodilla en los que se realiza una plastía de ligamento cruzado anterior de rodilla con injerto semitendinoso o hueso-tendón-hueso. Este tipo de bloqueos continuos periféricos son fáciles de realizar y seguros para manejar el dolor intra y post-operatorio; no se han reportado complicaciones ni efectos colaterales ya que las dosis utilizadas están muy por debajo de los máximos niveles de anestésicos locales permitidos. Se sugiere considerar los bloqueos regionales periféricos como primera opción en el tratamiento del dolor post-operatorio.

The demand for increased efficiency and decreased hospital stay force the anesthesiologist to find new techniques for acute postoperative pain management which are increasingly recognized for their positive effect on the length of hospital stay, functional recovery and patient and parent satisfaction. In this article we described two studies related with continuous peripheral blocks at Clínica Alemana of Santiago Chile performed in pediatric patients. The first is an ilioinguinal and iliohypogastric continuous block that we performed in children under general anesthesia who has oral vestibular fistulae and it is repair with iliaca bone graft. The second one is a fascia iliac compartment continuous block in patients with ruptured of anterior cruciated ligament of the knee repaired with semitendinous ligament or bone tendinose bone. These techniques have been shown to be effective and safe in controlling postoperative pain, both at rest and during physical therapy. There are no reports about complications or side effects. The local anesthetic doses are under the maximum level permitted. We suggest to consider as an option the peripheral nerve blocks in the post operative pain management and treatment.