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Rev. bras. anestesiol ; 70(3): 202-208, May-June 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137174


Abstract Background and objectives: The lumbar plexus block (LPB) is a key technique for lower limb surgery. All approaches to the LPB involve a number of complications. We hypothesized that Chayen's approach, which involves a more caudal and more lateral needle entry point than the major techniques described in the literature, would be associated with a lower rate of epidural spread. Method: We reviewed the electronic medical records and chart of all adult patients who underwent orthopedic surgery for Total Hip Arthroplasty (THA) and hip hemiarthroplasty due to osteoarthritis and femoral neck fracture with LPB and Sciatic Nerve Block (SNB) between January 1, 2002, and December 31, 2017, in our institute. The LPB was performed according to Chayen's technique using a mixture of mepivacaine and levobupivacaine (total volume, 25 mL) and a SNB by the parasacral approach. The sensory and motor block was evaluated bilaterally during intraoperative and postoperative period. Results: A total number of 700 patients with American Society of Anesthesiologists (ASA) physical status I to IV who underwent LPB met the inclusion criteria. The LPB and SNB was successfully performed in all patients. Epidural spread was reported in a single patient (0.14%;p < 0.05), accounting for an 8.30% reduction compared with the other approaches described in the literature. No other complications were recorded. Conclusions: This retrospective study indicates that more caudal and more lateral approach to the LPB, such as the Chayen's approach, is characterized by a lower epidural spread than the other approach to the LPB.

Resumo Justificativa e objetivos: O bloqueio do plexo lombar (BPL) é uma técnica fundamental para a cirurgia de membros inferiores. Todas as abordagens do BPL são associadas a uma série de complicações. Nossa hipótese foi de que a abordagem de Chayen, que envolve um ponto de entrada da agulha mais caudal e mais lateral do que as principais técnicas descritas na literatura, estaria associada a menor incidência de dispersão peridural. Método: Revisamos os prontuários médicos eletrônicos e em papel de todos os pacientes adultos submetidos à artroplastia total do quadril (ATQ) e hemiartroplastia do quadril devido a osteoartrite ou fratura do colo do fêmur empregando-se BPL associado ao bloqueio do nervo ciático (BNC), entre 1 de janeiro de 2002 e 31 de dezembro de 2017 em nossa instituição. Realizamos o BPL usando a técnica de Chayen e uma mistura de mepivacaína e levobupivacaína (volume total de 25 mL) e o BNC pela abordagem parassacral. Testes sensorial e motor bilaterais foram realizados no intra e pós-operatório. Resultados: Os critérios de inclusão foram obedecidos pelo total de 700 pacientes classe ASA I a IV submetidos ao BPL. Os BPL e BNC foram realizados com sucesso em todos os pacientes. A dispersão peridural foi relatada em um único paciente (0,14%; p < 0,05), representando uma redução de 8,30% quando comparada às outras abordagens descritas na literatura. Nenhuma outra complicação foi registrada. Conclusões: Este estudo retrospectivo indica que a abordagem mais caudal e mais lateral do BPL, como a técnica de Chayen, é caracterizada por menor dispersão peridural do que outras abordagens do BPL.

Humans , Male , Female , Adult , Aged , Aged, 80 and over , Sciatic Nerve , Arthroplasty, Replacement, Hip , Hemiarthroplasty , Hip Joint/surgery , Lumbosacral Plexus , Nerve Block/adverse effects , Nerve Block/methods , Incidence , Retrospective Studies , Epidural Space , Middle Aged
Article in Korean | WPRIM | ID: wpr-766751


BACKGROUND: Rhabdomyolysis is a syndrome caused by injury to skeletal muscle and characterized by myalgia and swelling of the affected muscles. Peripheral nerve injury rarely occurs in patients with rhabdomyolysis. METHODS: We reviewed the medical records of 8 consecutive patients with peripheral neuropathies associated with rhabdomyolysis. We assessed the clinical characteristics and electrodiagnostic findings of eight patients. RESULTS: In seven patients, rhabdomyolysis occurred after prolonged immobilization. In one patient, blunt trauma was a cause of rhabdomyolysis. All patients presented with weakness and paresthesia in lower extremities and electrodiagnostic tests showed peripheral nerve injury suggesting sciatic neuropathy or lumbosacral plexopathy. Although rhabdomyolysis itself recovered completely in all patients, neurologic deficits from neuropathy recovered partially and slowly. CONCLUSIONS: Sciatic nerve or lumbosacral plexus was injured in all eight patients. Among the various causes of rhabdomyolysis, prolonged immobilization is associated with development of peripheral neuropathy.

Electrodiagnosis , Humans , Immobilization , Lower Extremity , Lumbosacral Plexus , Medical Records , Muscle, Skeletal , Muscles , Myalgia , Neurologic Manifestations , Paresthesia , Peripheral Nerve Injuries , Peripheral Nervous System Diseases , Rhabdomyolysis , Sciatic Nerve , Sciatic Neuropathy
Anatomy & Cell Biology ; : 100-101, 2019.
Article in English | WPRIM | ID: wpr-738805


In surgical approaches to the perineum in general and anal region specifically, considering the possible variations of the inferior rectal nerve is important for the surgeon. Normally, the inferior rectal nerve originates as a branch of the pudendal nerve. However, during routine dissection, a variant of the inferior rectal nerve was found where it arose directly from the third sacral nerve ventral ramus (S3). Many cases have described the inferior rectal nerve arising independently from the sacral plexus, most commonly from the fourth sacral nerve root (S4); however, few cases have reported the inferior rectal nerve arising from S3. Herein, we describe a variant of the inferior rectal nerve in which the nerve arises independently from the sacral plexus.

Anal Canal , Lumbosacral Plexus , Perineum , Pudendal Nerve
Biosci. j. (Online) ; 34(5): 1334-1338, sept./oct. 2018.
Article in English | LILACS | ID: biblio-967323


The objective of this work was to assess the origin and distribution of femoral nerves in 30 swine fetuses from crosses of Dan Bred and AGPIC-337 lines. Thirty animals­fifteen males and fifteen females­from the collection of the Faculty of Veterinary Medicine's Animal Anatomy Laboratory of the Federal University of Uberlândia, Uberlândia MG, Brazil, were used. The animals were fixed by injecting a 10% aqueous formaldehyde solution into the descending aorta artery and thoracic, abdominal, pelvic and intramuscular cavities. The specimens were then submerged in a solution with the same concentration. These animals have five to seven lumbar vertebrae. The number of lumbar vertebrae was six in 96.67% and seven in 3.33% of the animals. The femoral nerve originated from the L4 and L5 (66.67%), L5 and L6 (26.67%) and L3 and L4 (6.66%) lumbar vertebrae. It sent branches to the psoas major, psoas minor, iliac, pectineus, and quadriceps femoris muscles in all animals, to the sartorius in 43.33% and to the gracilis in 6.66% of animals. No marked differences were found in the characteristics of origin and distribution of the femoral nerve between the swine fetuses from crosses of Dan Bred and AGPIC-337 lines and the animals described in the literature.

Objetivou-se estudar a origem e distribuição dos nervos femorais em 30 fetos suínos oriundos do cruzamento das linhagens Dan Bred e AGPIC337. Foram utilizados 30 animais, quinze machos e quinze fêmeas, pertencente ao acervo do laboratório de Anatomia Animal da Faculdade de Medicina Veterinária da Universidade Federal de Uberlândia. A fixação dos animais se deu por meio de injeção de solução aquosa de formaldeído a 10% na artéria aorta parte descendente, cavidades torácica, abdominal, pélvica e intramusculares, em seguida, os espécimes foram submersos em solução contendo a mesma concentração. Esses animais possuem cinco a sete vértebras lombares. Em 96,67% dos animais o número de vértebras lombares foi seis e em 3,33% sete. O nervo femoral originou-se de L4 e L5 (66,67%), L5 e L6 (26,67%) e L3 e L4 (6,66%). Emitiu ramos para os músculos psoas maior, psoas menor, ilíaco, pectíneo, quadríceps femoral em 100% dos casos, 43,33% para o sartório e 6,66% para o grácil. Nota-se que não foram observadas diferenças marcantes nas características tanto na origem como na distribuição do nervo femoral entre os fetos de suínos oriundos do cruzamento das linhagens Dan Bred e AGPIC337 e os animais da literatura consultada

Swine , Peripheral Nervous System , Sus scrofa , Fetus , Anatomy , Lumbosacral Plexus
Rev. bras. anestesiol ; 68(1): 100-103, Jan.-Feb. 2018.
Article in English | LILACS | ID: biblio-897796


Abstract Background and objectives Sympathectomy is one of the therapies used in the treatment of chronic obstructive arterial disease (COAD). Although not considered as first-line strategy, it should be considered in the management of pain difficult to control. This clinical case describes the evolution of a patient with inoperable COAD who responded properly to the lumbar sympathetic block. Case report A female patient, afro-descendant, 69 years old, ASA II, admitted to the algology service due to refractory ischemic pain in the lower limbs. The patient had undergone several surgical procedures and conservative treatments without success. Vascular surgery considered the case as out of therapeutic possibility, unless limb amputation. At that time, sympathectomy was indicated. After admission to the operating room, the patient was monitored, positioned and sedated. The blockade was performed with the aid of radioscopy, bilaterally, at L2-L3-L4 right and L3 left levels. On the right side, at each level cited, 3 mL of absolute alcohol with 0.25% bupivacaine were injected without vasoconstrictor, and on the left side only local anesthetic. The procedure was performed uneventfully. The patient was discharged with complete remission of the pain. Conclusion Neurolitic block of the lumbar sympathetic chain is an effective and safe treatment option for pain control in patients with critical limb ischemia patients in whom the only possible intervention would be limb amputation.

Resumo Justificativa/objetivos A simpatectomia é uma das terapêuticas usadas no tratamento dadoença arterial obstrutiva crônica (DAOP). Embora não seja considerada como estratégia de primeira linha, deve ser lembrada no manejo dos quadros de dor de difícil controle. Este caso clínico descreve a evolução de uma paciente portadora de DAOP inoperável que respondeu adequadamente ao bloqueio simpático lombar. Relato de caso Paciente do sexo feminino, parda, 69 anos, estado físico II, acompanhada no serviço de algologia devido a dor isquêmica refratária em membros inferiores. A paciente já havia sido submetida a diversas abordagens cirúrgicas e tratamentos conservadores, sem sucesso. A cirurgia vascular considerou o caso como fora de possibilidade terapêutica, a não ser amputação do membro. Nesse momento, foi indicada simpatectomia. Após admissão no centro cirúrgico, a paciente foi monitorada, posicionada e sedada. O bloqueio foi feito com auxílio da radioscopia, bilateralmente, nos níveis L2-L3-L4 à direita e L3 à esquerda. Do lado direito, em cada nível citado, foram injetados 3 mL de álcool absoluto com bupivacaína 0,25% sem vasoconstritor e do lado esquerdo somente o anestésico local. O procedimento foi feito sem intercorrências. A paciente recebeu alta com completa remissão da dor. Conclusão O bloqueio neurolítico da cadeia simpática lombar é uma opção de tratamento eficaz e segura para controle da dor em pacientes portadores de isquemia crítica, nos quais a única intervenção possível seria a amputação do membro.

Humans , Female , Aged , Autonomic Nerve Block/methods , Chronic Pain/surgery , Pain Management/methods , Critical Illness , Lower Extremity/blood supply , Chronic Pain/etiology , Ischemia/complications , Lumbosacral Plexus
Article in Chinese | WPRIM | ID: wpr-813184


To observe the impacts of continuous lumbar plexus block (CLPB) on postoperative cognitive dysfunction (POCD) in elderly patients undergoing hip arthroplasty.
 Methods: Sixty elderly patients scheduled for hip arthroplasty with general anesthesia, were randomly allocated into a CLPB group and a PCIA group (n=30 each). In the CLPB group, lumbar plexus block was performed before trachea intubation, and CLPB was used for postoperative analgesia. In the PCIA group, intravenous analgesia was controlled in patients after operation. Visual Analogue Scale (VAS) at 12, 24, and 48 h after operation was recorded. Mini-Mental State Examination (MMSE) scale was used to evaluate the cognitive dysfunction at the 1st day before operation (D0) and at the 1st (D1), 3rd (D3), and 7th (D7) days after operation and the occurrence of POCD was recorded. S-100β concentrations were detected by ELISA at D1, D3, and D7. Postoperative adverse events were recorded.
 Results: VAS scores at 12, 24, and 48 h after operation in the CLPB group were significantly lower than those in the PCIA group (P<0.05). Compared with the PCIA group, the MMSE scores were significantly higher (P<0.05), and the incidence of POCD at D1 and D3 was obviously reduced in the CLPB group (P<0.05). S-100β concentration at D1 and D3 in the CLPB group was significantly lower than that in the PCIA group (P<0.05).
 Conclusion: Application of CLPB in elderly patients undergoing hip arthroplasty could obviously relieve their postoperative pain, inhibit the production of S-100β, and reduce the incidence of early postoperative cognitive dysfunction.

Aged , Analgesics , Arthroplasty, Replacement, Hip , Cognitive Dysfunction , Humans , Incidence , Lumbosacral Plexus , Nerve Block , Methods , Pain Measurement , Pain, Postoperative , Postoperative Complications
Rev. bras. anestesiol ; 67(1): 107-109, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-843361


Abstract Background and objectives: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. Case report: Male patient, 61 years old, 83 kg, with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25 mL) and depot (vial) methylprednisolone (20 mg) on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. Conclusions: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.

Resumo Justificativa e objetivos: O bloqueio da fáscia do músculo quadrado lombar foi descrito por R. Blanco nas suas duas abordagens (I e II). A deposição de anestésico local nessa localização pode conferir bloqueio dos dermátomos T6-L1. Os autores fizeram esse bloqueio de fáscia, guiado por ultrassom, para tratamento de uma dor crônica neuropática da parede abdominal. Relato de caso: Paciente do gênero masculino, 61 anos, 83 kg, com antecedentes de trombocitopenia por hepatopatia alcoólica, entre outros, apresentava dor crônica da parede abdominal após hernioplastias abdominais múltiplas havia um ano e meio, com má resposta ao tratamento com neuromoduladores e opioides. No exame clínico, apresentava uma dor neuropática, com predomínio de alodinia ao toque, que abrangia toda a parede abdominal anterior, desde os dermátomos T7 a T12. Optou-se pela realização de um bloqueio do quadrado lombar tipo II bilateral, guiado por ultrassom, com administração de 25 mL de ropivacaína 0,2% e 20 mg de metilprednisolona depot (ampola) em cada um dos lados. O procedimento conferiu alívio imediato da sintomatologia e, após seis meses, o paciente mantinha redução significativa da alodinia, sem compromisso da qualidade de vida. Conclusões: Os autores consideram que a realização do bloqueio do quadrado lombar tipo II foi uma opção analgésica relevante no tratamento de um paciente com dor crônica pós-hernioplastia abdominal e salientaram os efeitos da dispersão do anestésico local até o espaço paravertebral torácico. A técnica mostrou ser segura e bem tolerada. É desejável a publicação de mais casos clínicos que reproduzam a eficácia desse bloqueio no contexto de dor crônica.

Humans , Male , Hernia, Abdominal/surgery , Chronic Pain/prevention & control , Herniorrhaphy/methods , Nerve Block/methods , Ultrasonography, Interventional , Muscle, Skeletal/innervation , Lumbosacral Plexus , Middle Aged , Neuralgia/prevention & control
National Journal of Andrology ; (12): 276-279, 2017.
Article in Chinese | WPRIM | ID: wpr-812772


The genitofemoral nerve (GFN) has its unique anatomic characteristics of location, run and function in the male urinary system and its relationship with the ureter, deferens and inguinal region is apt to be ignored in clinical anatomic application. Clinical studies show that GFN is closely correlated with postoperative ureteral complications and pain in the inguinal region after spermatic cord or hernia repair. GFN transplantation can be used in the management of erectile dysfunction caused by cavernous nerve injury. Therefore, GFN played an important role in the clinical application of uroandrology. This review summarizes the advances in the studies of GFN in relation to different diseases in uroandrology.

Erectile Dysfunction , General Surgery , Hernia, Inguinal , General Surgery , Humans , Inguinal Canal , Lumbosacral Plexus , Wounds and Injuries , Male , Pain, Postoperative , Peripheral Nerves , Transplantation , Postoperative Complications , General Surgery , Ureter , General Surgery , Urogenital System , Vas Deferens
The Korean Journal of Pain ; : 287-295, 2017.
Article in English | WPRIM | ID: wpr-207161


BACKGROUND: Recently, the use of ultrasound (US) techniques in regional anesthesia and pain medicine has increased significantly. However, the current extent of training in the use of US-guided pain management procedures in Korea remains unknown. The purpose of the present study was to assess the current state of US training provided during Korean Pain Society (KPS) pain fellowship programs through the comparative analysis between training hospitals. METHODS: We conducted an anonymous survey of 51 pain physicians who had completed KPS fellowships in 2017. Items pertained to current US practices and education, as well as the types of techniques and amount of experience with US-guided pain management procedures. Responses were compared based on the tier of the training hospital. RESULTS: Among the 51 respondents, 14 received training at first- and second-tier hospitals (Group A), while 37 received training at third-tier hospitals (Group B). The mean total duration of pain training during the 1-year fellowship was 7.4 months in Group A and 8.4 months in Group B. Our analysis revealed that 36% and 40% of respondents in Groups A and B received dedicated US training, respectively. Most respondents underwent US training in patient-care settings under the supervision of attending physicians. Cervical root, stellate ganglion, piriformis, and lumbar plexus blocks were more commonly performed by Group B than by Group A (P < 0.05). CONCLUSIONS: Instruction regarding US-guided pain management interventions varied among fellowship training hospitals, highlighting the need for the development of educational standards that mandate a minimum number of US-guided nerve blocks or injections during fellowships in interventional pain management.

Anesthesia, Conduction , Anonyms and Pseudonyms , Education , Fellowships and Scholarships , Korea , Lumbosacral Plexus , Nerve Block , Neuronavigation , Organization and Administration , Pain Management , Spinal Nerve Roots , Spine , Stellate Ganglion , Surveys and Questionnaires , Ultrasonography
Article in English | WPRIM | ID: wpr-162082


STUDY DESIGN: A case report. OBJECTIVES: To report and discuss an extremely uncommon cause of lumbar plexopathy seat belt injury. SUMMARY OF LITERATURE REVIEW: For patients who undergo traffic accidents, most cases of seat belt injury cause trauma to the lower torso. Seat belt injury is associated with variable clinical problems such as vascular injury, intestinal injury (perforation), vertebral injury (flexion-distraction injury), chest wall injury, diaphragmatic rupture/hernia, bladder rupture, lumbosacral plexopathy, and other related conditions. MATERIALS AND METHODS: A 38-year-old male truck driver (traffic accident victim) who suffered monoplegia of his right leg due to lumbar plexus injury without spinal column involvement. Injury to a lumbar plexus and the internal vasculatures originated from direct compression to internal abdominal organs (the iliopsoas muscle and internal vasculatures anterior to the lumbar vertebrae) caused by the seat belt. We have illustrated an extremely uncommon cause of a neurologic deficit from a traffic accident through this case. RESULTS: Under the impression of traumatic lumbar plexopathy, we managed it conservatively, and the patient showed signs of recovery from neurologic deficit. CONCLUSIONS: We need to review the lumbar plexus pathway, in patients with atypical motor weakness and sensory loss of the lower extremities which are not unaccompanied by demonstrable spinal lesions. Therefore, close history taking, physical examination and comprehension of injury mechanism are important in the diagnosis.

Accidents, Traffic , Adult , Comprehension , Diagnosis , Hemiplegia , Humans , Leg , Lower Extremity , Lumbosacral Plexus , Male , Motor Vehicles , Neurologic Manifestations , Physical Examination , Rupture , Seat Belts , Spine , Thoracic Wall , Torso , Urinary Bladder , Vascular System Injuries
Int. j. morphol ; 34(2): 561-569, June 2016. ilus
Article in English | LILACS | ID: lil-787037


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.

Humans , Male , Female , Aged , Aged, 80 and over , Femoral Nerve/abnormalities , Lower Extremity/innervation , Anatomic Variation , Cadaver , Femoral Nerve/anatomy & histology , Lumbosacral Plexus/anatomy & histology
Biosci. j. (Online) ; 32(3): 713-720, may/june 2016. ilus, tab
Article in English | LILACS | ID: biblio-965513


The Mongolian gerbil, belonging to the Muridae family, is characterized as an economic asset in the pet market due to its easy management. Current research analyzes and describes the origin of the nerves that make up the lumbosacral plexus in the species, foregrounding comparative anatomy, especially among wild rodents. The experiment, approved by the Committee of Institutional Bioethics, involved 15 animals which had been used in other studies and were donated to the Laboratory of Applied Animal Morphophysiology of the Federal Rural University of the Semi-Arid, Mossoró, Rio Grande do Norte, Brazil. The animals were fixed in a water solution of formaldehyde 10%. After 72 hours, they were dissected, the abdominal cavity was opened and eviscerated, and the psoas minor, psoas major and the quadratus lumborum muscles were removed to inspect the nerves that form the lumbosacral plexus. Results were given in percentages and grouped in tables. The lumbosacral plexus of the Mongolian gerbil frequently derived from the ventral roots of the last thorax nerves, from the seven lumbar nerves and from the four sacral nerves (Type II ­ T12-S4). The nerves of the gerbil´s lumbosacral plexus are the iliohypogastricus, ilioinguinalis, cutaneus femoris lateralis, genitofemoralis, femoralis, obturatorius, ischiadicus, gluteus cranialis, pudendus, gluteus caudalis and rectales caudales nerves. Information on the origin of the nerves of the gerbil´s lumbosacral plexus and their description is relevant for clinical and surgical studies, and for the application of techniques or anesthetic drugs.

O esquilo da Mongólia é um roedor pertencente à família Muridae, caracterizado por seu interesse econômico no mercado pet e por ser de fácil manejo. Esta pesquisa analisa e descreve a origem dos nervos que formam o plexo lombossacral da espécie. No experimento foram utilizados 15 animais, provenientes de outros estudos aprovados pelo Comitê de Bioética Institucional, que foram doados ao Laboratório de Morfofisiologia Animal Aplicada da Universidade Federal Rural do Semi-Árido, Mossoró, Rio Grande do Norte. Os animais foram fixados em solução aquosa de formaldeído a 10%. Após 72 horas, os animais foram dissecados, realizando-se a abertura da cavidade abdominal, depois, eviscerados e em seguida, os músculos psoas maior, psoas menor e quadrado lombar foram removidos para visualização dos nervos que formam o plexo lombossacral. Os resultados foram expressos em percentagens e agrupados em tabelas. O plexo lombossacral do gerbil originou-se mais frequentemente das raízes ventrais do último nervo torácico, dos sete nervos lombares e dos quatro nervos sacrais (Tipo II ­ T12-S4). Os nervos que formaram o plexo lombossacral do gerbil foram: ílio-hipogástrico, ílioinguinal, cutâneo femoral lateral, genitofemoral, femoral, obturatório, isquiático, glúteo cranial, pudendo, glúteo caudal, e nervo retal caudal. O conhecimento sobre a origem e os nervos do plexo lombossacral no gerbil mostra-se útil para estudos clínico-cirúrgicos e aplicação de técnicas ou fármacos anestésicos.

Gerbillinae , Lumbosacral Plexus , Muridae , Nervous System
Int. braz. j. urol ; 41(4): 739-743, July-Aug. 2015. tab
Article in English | LILACS | ID: lil-763071


ABSTRACTObjective:To evaluate the urodynamic changes immediately after the first session (acute effect) and after the last session of parasacral TENS in children with idiopathic OAB.Materials and methods:We performed urodynamic evaluation immediately before and after the first session of parasacral TENS and immediately after the last session (7 weeks later). Only children with idiopathic isolated OAB were included. Patients with dysfunctional voiding were not included.Results:18 children (4 boys and 14 girls, mean age of 8.7) were included in the first analysis (urodynamic study before and immediately after the first session) and 12 agreed to undergo the third urodynamic study. Urodynamic before and immediately after the first session: There was no change in the urodynamic parameters, namely low MCC, low bladder compliance, presence of IDC, the average number of IDC, or in the maximum detrusor pressure after the first exam. Urodynamic after the last session: The bladder capacity improved in most patients with low capacity (58% vs. 8%). Detrusor overactivity was observed in 11 (92%) before treatment and 8 (76%) after. There was not a significant reduction in the average number of inhibited contractions after TENS (p=0.560) or in the detrusor pressure during the inhibited contraction (p=0.205).Conclusion:There was no change in the urodynamic parameters immediately after the first session of stimulation. After the last session, the only urodynamic finding that showed improvement was bladder capacity.

Child , Female , Humans , Male , Lumbosacral Plexus , Transcutaneous Electric Nerve Stimulation , Urinary Bladder, Overactive/therapy , Urodynamics/physiology , Compliance/physiology , Muscle Contraction/physiology , Treatment Outcome , Urinary Bladder/physiopathology
Biosci. j. (Online) ; 31(2): 527-531, mar./abr. 2015.
Article in Portuguese | LILACS | ID: biblio-964103


A criação de javalis vem crescendo no Brasil devido à procura de um produto de qualidade e com propriedades nutricionais. Analisou-se a origem e distribuição dos nervos obturatórios em 19 fetos de javalis (Sus scrofa scrofa) visando fornecer dados morfológicos para anatomia comparativa e áreas afins. A fixação destes animais em solução aquosa de formaldeído a 10% ocorreu mediante diferentes pontos de injeções subcutâneas, intramusculares e intracavitárias, bem como por imersão dos referidos exemplares em recipientes com a mesma solução por um período mínimo de 48 horas. Foi observado que o referido nervo originou-se dos ramos ventrais de L4 a L6. Distribui-se para os músculos obturatório externo, grácil, adutor e pectíneo. Pode-se afirmar que tanto a origem como a distribuição do nervo obturatório em javalis se assemelha aos padrões evidenciados em suínos domésticos.

The creation of wild boars is increasing in Brazil due to demand for a quality product and excellent nutritional properties. This study analyzed the origin and distribution of the obturatorius nerve in 19 fetuses of wild boar (Sus scrofa scrofa) in order to provide morphological data for comparative anatomy and areas related. The introduction of these animals in aqueous formaldehyde 10% was by different points of subcutaneous, intramuscular and intracavitary injections, as well as by immersion of those specimens, in containers of the same solution for a minimum of 48 hours. It was noted that the nerve was originated from the ventral branches of L4, L5 and L6. Concerning to distribution, the nerve dispatched ventral branches to the external obturator, gracilis, adductor and pectineus muscles. It can be stated that both the origin and distribution of the obturatorius nerve in wild boars is similar to the patterns evidenced in domestic swine.

Animals , Swine , Sus scrofa , Fetus , Lumbosacral Plexus , Neuroanatomy , Obturator Nerve
Korean Journal of Spine ; : 103-106, 2015.
Article in English | WPRIM | ID: wpr-182512


Radiculopathy triggered by degenerative spinal disease is the most common cause of spinal surgery, and the number of affected elderly patients is increasing. Radiating pain that is extraspinal in origin may distract from the surgical decision on how to treat a neurological presentation in the lower extremities. A 54-year-old man with sciatica visited our outpatient clinic. He had undergone laminectomy and discectomy to treat spinal stenosis at another hospital, but his pain remained. Finally, he was diagnosed with a plexopathy caused by late recurrence of colorectal cancer, which compressed the lumbar plexus in the presacral area. This case report illustrates the potential for misdiagnosis of extraspinal plexopathy and the value of obtaining an accurate history. Although the symptoms are similar, spinal surgeons should consider both spinal and extraspinal origins of sciatica.

Aged , Ambulatory Care Facilities , Colonic Neoplasms , Colorectal Neoplasms , Diagnostic Errors , Diskectomy , Humans , Laminectomy , Lower Extremity , Lumbosacral Plexus , Middle Aged , Radiculopathy , Recurrence , Sciatica , Spinal Diseases , Spinal Stenosis