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.

Comparison of two volumes for sciatic perineural injection using 1% methylene blue in rabbit cadavers / [Comparação de dois volumes para injeção perineural no nervo isquiático utilizando azul de metileno 1% em cadáveres de coelhos]

The purpose of this study was to assess the efficacy of a blind technique for sciatic and femoral nerve block in rabbit cadavers by evaluating the spread of 1% methylene blue at two different volumes. Nine recently euthanized rabbits weighing 2.5(0.3kg were used. The sciatic (SN) and femoral (FN) nerves of each limb were randomly assigned for injection with 1% methylene blue at 0.2mL/kg (G0.2) or 0.3mL/kg (G0.3). Nerves were dissected and measured for depth and extension of staining (cm). Mean comparisons were performed using paired t test. The relation between volume and nerve staining ( 2cm was assessed using chi-square test. The mean depth of SN was 1.9±0.2 and 1.6±0.3cm and staining 1.9±1.4 and 2.0±1.2cm, respectively in G0.2 and G0.3. No relation was found between depth and dye spread and there was no association between nerve staining ( 2.0cm and volume of solution. The FN failed to be stained in all subjects. In conclusion, SN injection can be successfully performed without guidance in rabbits. The lower volume (0.2mL/kg) is recommended to avoid systemic toxicity.(AU)

O objetivo deste estudo foi avaliar a eficácia de uma técnica para bloqueio às cegas dos nervos isquiático e femoral em cadáveres de coelhos, por meio da avaliação da dispersão de azul de metileno 1% em dois volumes distintos. Nove coelhos recém-eutanasiados, com peso 2,5(0,3kg, foram utilizados. Os nervos isquiático (NI) e femoral (NF) de cada membro foram aleatoriamente designados para injeção com azul de metileno 1% a 0,2mL/kg (G0,2) ou 0,3mL/kg (G0,3). Em seguida, foram dissecados e mensurados em relação à sua profundidade e extensão corada (cm). As médias foram comparadas por meio de teste t pareado. A relação entre volume e extensão corada ( 2cm foi avaliada utilizando-se teste de qui-quadrado. A profundidade média do NI foi 1,9±0,2 e 1,6±0,3cm, e a extensão corada 1,9±1,4 e 2,0±1,2cm, respectivamente, no G0,2 e no G0,3. Não houve relação entre a profundidade e a extensão corada ou entre a extensão corada ( 2,0cm e o volume de solução. Não foi observada coloração do NF em nenhum cadáver. Concluiu-se que a injeção do NI pode ser realizada com sucesso sem auxílio de tecnologias em coelhos. O menor volume (0,2mL/kg) é recomendado para evitar toxicidade sistêmica.(AU)

Awake Fiberoptic Assisted Nasotracheal Intubation in Oral Malignancies - A Comparison between Airway Blocks and LA Spray - A Randomized, Interventional Crossover Trial

Awake fiberoptic assisted nasal intubation is the gold standard for securing airway in cases of oral malignancy posted for radical surgeries. Different techniques such as airway blocks, LA gargles, spray, nebulization along with light sedation are in practice. We wanted to evaluate the efficacy of airway blocks over airway spray for intubation conditions, time taken to intubation, patient comfort and complications. METHODSThis randomized, interventional and crossover study was conducted at Chirayu Medical College and Hospital. A total of 60 patients of ASA grade I-II with Mallampati score 3 & 4 undergoing wide local excision and neck dissection were selected after fulfilling of the selection criterion and were divided into two groups, Airway Block (AB, n-30) and Airway Spray group (AS, n-30). AB group received bilateral superior and transtracheal recurrent laryngeal nerve blocks and group AS local anaesthetic spray through the working channel of the fiberoptic scope. Haemodynamics, time taken for intubation, intubating conditions, patients’ comfort, and complications if any were noted. All data was tabulated and analysed using software SPSS 17.0. RESULTSMean total time taken for intubation in seconds was less. Intubating conditions were optimal in 90 % cases. 5-point comfort during and 3-point score immediately after intubation were excellent in AB compared AS group. Haemodynamically both the groups were comparable. CONCLUSIONSCombined block of the superior and recurrent laryngeal nerves provides optimal conditions to facilitate a successful fibreoptic assisted awake nasotracheal intubation in anticipated difficult airway

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.

Ultrasound-guided selective nerve blocks for trigger finger surgeries to maintain flexion/extension of fingers - Case series / Bloqueios seletivos guiados por ultrassom para cirurgias de dedo em gatilho para manutenção da flexão/extensão dos dedos - Série de casos

Abstract Background: A patient's ability to move his/her fingers during hand surgery may be helpful to surgeons because it allows the effectiveness of the intervention evaluation and prediction of hand function in the postoperative period. The purpose of this case series is to demonstrate the efficacy of an ultrasound-guided peripheral nerve block technique to maintain the hand flexor and extensor muscles motor function and discuss the benefits of the technique for trigger finger surgery. Case report: Ten patients scheduled to undergo trigger finger surgery were selected. The goal was to maintain flexion and extension of the fingers during the procedure. Thus, ultrasound-guided ulnar, radial, and medial nerve block was performed in the distal third of the forearm, at 5-7 cm proximal to the wrist. The block was performed with 5 mL of 0.375% bupivacaine on each nerve. All procedures were uneventfully performed maintaining the flexion and extension of the fingers. In two cases, it was observed that the motricity maintenance and the patients' ability to move their fingers when requested allowed the success of the surgical procedure after the third intraoperative evaluation. Conclusion: This case series shows that it is possible to maintain the motor function of the hand flexor and extensor muscles to perform finger trigger surgeries using specific ultrasound-guided distal blocks.

Resumo Justificativa: A capacidade de um paciente mover os dedos durante a cirurgia da mão pode ser útil para o cirurgião porque permite a avaliação da eficácia da intervenção e a predição da função da mão no pós-operatório. O objetivo desta série de casos é demonstrar a eficácia de uma técnica de bloqueio de nervo periférico guiado por ultrassom na manutenção da função motora dos músculos flexores e extensores da mão e discutir os benefícios da técnica para cirurgias de liberação de dedo em gatilho. Relato de caso: Foram selecionados 10 pacientes em programação para cirurgia de liberação de dedo em gatilho. O objetivo era manter a flexão e a extensão dos dedos durante o procedimento. Dessa forma, o bloqueio dos nervos ulnar, radial e mediano, guiados por ultrassom, foi feito no terço distal do antebraço, 5 a 7 cm proximais ao punho. O bloqueio foi feito com 5 mL de bupivacaína a 0,375% em cada nervo. Todos os procedimentos foram feitos sem complicações e com manutenção da flexão e extensão dos dedos. Em dois casos, observou-se que a manutenção da motricidade e a capacidade dos pacientes de mover os dedos quando solicitado permitiu o sucesso do procedimento cirúrgico após a terceira avaliação intraoperatória. Conclusão: Esta série de casos mostra que é possível manter a função motora dos músculos flexores e extensores da mão em cirurgias de liberação de dedo em gatilho por meio de bloqueios distais específicos guiados por ultrassom.

Nerve blocks for optimal postoperative analgesia after total knee arthroplasty

The use of ideal pain management modalities after total knee arthroplasty facilitates enhanced recovery by promoting early ambulation and controlling postoperative pain. To achieve these goals, multimodal analgesia, including motor-sparing peripheral nerve blocks, appears to be promising in older adults undergoing total knee arthroplasty. This review describes optimal nerve blocks, as a part of multimodal analgesia for total knee arthroplasty, and the scientific basis of each technique.

Bloqueo de la rama lingual del nervio glosofaríngeo en pacientes pediátricos sometidos a adenotonsilectomía: estudio prospectivo y de corte transversal / Lingual branch of glossopharyngeal nerve block in pediatric patients undergoing adenotonsillectomy: prospective and cross-sectional clinical trial

OBJECTIVE: To determine the efficacy of lingual branch of glossopharyngeal nerve block in postoperative management of pain in pediatric patients undergoing adenotonsillectomy. METHODS: Prospective and cross-sectional clinical trial. The sample was 105 patients between 3 and 8 years old scheduled for adenotonsillectomy, who performed lingual branch of glossopharyngeal nerve block by anterior intraoral approach with bupivacaine 0.5% + adrenaline 1:200,000. Postoperative pain using CHEOPS scale, complications, need for postoperative analgesics, recovery time using modified Aldrete scale and time for oral tolerance was assessed. RESULTS: We studied 101 patients classified into three groups according to the level of postoperative pain divided into mild (88.1%), moderate (7.9%) and severe (4%), with means and DS for discharged time of 50.13 ± 13.912 min, 63.75 ± 10.607 min and 86.25 ± 7.5 min; first oral intake 3.08 ± 0.829 h, 4 ± 0 h and 4 ± 0 h; and, first post-discharge pain reference of 18.3 ± 7.414 h, 5.75 ± 0.866 h and 4.5 ± 1 h respectively. Analgesic reinforcement was needed in 11.9% of the cases. There were not complications. CONCLUSIONS: Lingual branch of glossopharyngeal nerve block is a useful and effective tool in the management of pain and anesthetic recovery of pediatric patients undergoing adenotonsillectomy.

OBJETIVO: Determinar la eficacia del bloqueo de la rama lingual del nervio glosofaríngeo en el manejo postoperatorio del dolor en pacientes pediátricos para adenotonsilectomía. MÉTODOS: Estudio con diseño prospectivo y de corte transversal. La muestra consistió en 105 pacientes con edades comprendidas entre los 3 y 8 años de edad programados para adenotonsilectomía, a los que se realizó bloqueo de la rama lingual del nervio glosofaríngeo abordaje intraoral anterior con bupivacaína 0,5% + adrenalina 1:200.000. Se estudió el dolor postoperatorio mediante escala CHEOPS, complicaciones, necesidad de analgésicos postoperatorio, tiempo de recuperación mediante escala de Aldrete modificado y tiempo para tolerancia oral. RESULTADOS: Se estudiaron 101 pacientes en tres grupos según el grado de dolor postoperatorio divididos en leve (88,1%), moderado (7,9%) y severo (4%), con medias y DS para tiempo de alta de 50,13 ± 13,912 min, 63,75 ± 10,607 min y 86,25 ± 7,5 min; primera ingesta oral 3,08 ± 0,829 h, 4 ± 0 h y 4 ± 0 h; y, primera referencia de dolor posterior al alta de 18,3 ± 7,414 h, 5,75 ± 0,886 h y 4,5 ± 1 h respectivamente. Se ameritó refuerzo analgésico en el 11,9% de los casos. No se evidenciaron complicaciones. CONCLUSIONES: El bloqueo de la rama lingual del nervio glosofaríngeo es una herramienta útil y eficaz en el manejo del dolor y recuperación anestésica de pacientes pediátricos sometidos a adenotonsilectomía.

Effects of perineural administration of Dexmedetomidine in combination with Bupivacaine in a femoral-sciatic nerve block

Background: In few studies, Dexmedetomidine was used an adjuvant to local anesthetics in peripheral nerve blocks Aim: This study was aimed to examine the effect of adding Dexmedetomidine to Bupivacaine 05% during the femoral sciatic nerve blocks and to evaluate its effect in prolonging post-operative analgesia Materials and methods: This was a prospective, double blinded, randomized study which consisted of 80 patients, Patients were randomly allocated into two groups (40patients each): In group BD, (Bupivacaine-Dexmedetomidine hydrochloride), one mL, containing 100 μg, was added to 39 mL of Bupivacaine 05% In group B; 1 mL of normal saline was added to the same volume of Bupivacaine 05% Results: There were no statistically differences between the two groups in demographic data and surgical characteristics The onset time of sensory block, motor block and surgical anesthesia time were significantly shorter in group BD when compared to group B The durations of sensory block, motor block and analgesia were longer in BD group when compared to group B Systolic arterial pressure (SAP) and heart rate were significantly lower in group BD when compared to group B from 10 to 90minutes after initiation of block (P<005), diastolic arterial pressure was similarly lower in group BD at 45, 60, and 90 minutes following initiation of block Conclusion: This study showed that a prolonged duration of analgesia was associated with addition of Dexmedetomidine 100μg to bupivacaine 05% during US-guided combined femoral and sciatic block for below knee surgery and is also associated with significant bradycardia requiring treatment

Comparison of clonidine adjuvants to ropivacaine in subclavian perivascular approach of supra clavicular brachial plexus block

Introduction: Brachial plexus block is sole anesthesia for upper limb surgeries. Several techniques have been used to prolong the duration of regional anesthesia. The aim of the study: To compare the effectiveness of Clonidine as adjuvants to Ropivacaine in supraclavicular Brachial plexus block for prolonging the duration of motor blockade and prolonging the duration of analgesia. Materials and methods: 60 Patients of ASA grade I and II undergoing upper limb surgeries were randomly assigned into two groups R and RC. Surgery was done under the subclavian perivascular approach of supraclavicular brachial plexus block. The patients in group R received 25 ml at 0.75% Ropivacaine with 1 ml Normal saline. In a group RC received 25 ml at 0.75% Ropivacaine and 1 ml of (150 micrograms) clonidine. Parameters observed were a time of onset at the sensory block and motor block, duration of motor blockade, and sensory blockade, duration of postoperative analgesia, sedation score and side effects. Results: Addition of clonidine to Ropivacaine shows early onset of motor blockade compared to Ropivacaine alone. Addition of clonidine to local anesthetic solution significantly prolongs the duration of postoperative analgesia by 276 minutes compared to Ropivacaine alone. Addition of clonidine to Ropivacaine increased the duration of motor blockade by 132 minutes compared to Ropivacaine alone. S. Arul Rajan, N. Sathyan, T. Murugan. Comparison of clonidine adjuvants to ropivacaine in subclavian perivascular approach of supra clavicular brachial plexus block. IAIM, 2018; 5(5): 33-37. Page 34 Conclusion: The addition of clonidine to the local anesthetic in supraclavicular brachial plexus produces the early onset of sensory and motor blockade and prolongs the duration of both sensory and motor blockade and postoperative analgesia, when compared to Ropivacaine alone.

Accidental intracerebral injection and seizure during scalp nerve blocks for awake craniotomy in a previously craniotomized patient: a case report / 대한마취과학회지

A 34-year-old man who previously underwent a craniotomy due to oligodendroglioma was admitted with a diagnosis of recurrent brain tumor. An awake craniotomy was planned. Approximately 15 minutes after completing the scalp nerve block, his upper torso suddenly moved and trembled for 10 seconds, suggesting a generalized clonic seizure. He recovered gradually and fully in 55 minutes without any neurological sequelae. The emergency computed tomography scan revealed a localized fluid collection and small intracerebral hemorrhage nearby in the temporoparietal cortex beneath the skull defect. He underwent surgery under general anesthesia at 8 hours after the seizure and was discharged from the hospital after 10 days. This report documents the first case of generalized seizure that was caused by the accidental intracerebral injection of local anesthetics. Although the patient recovered completely, the clinical implications regarding the scalp infiltration technique in a patient with skull defects are discussed.

The analgesia effect of ultrasound-guided suprascapular blocks for shoulder arthroscopy / 临床麻醉学杂志

Objective To investigate the analgesia effects of ultrasound-guided suprascapular nerve blocks for shoulder arthroscopy without impacting respiratory function.Methods Forty seven patients scheduled for shoulder arthroscopy,17 males and 30 females,aged 26-78 years,weighing 50-75 kg,ASA physical status Ⅰ or Ⅱ,were randomized into suprascapular nerve blocks group (group S,n=24) and interscalene plexus blocks group (group Ⅰ,n =23).0.375％ ropivacaine 20 ml and 1 ％ lidocaine plus 1 ml of dexamethasone 5 mg.The vital capacity before and 6 h after surgery,extubation time,total PACU duration,VAS scores at awake time and 6 h,12 h,24 h after surgery,total opiods consumption,and other complications were recorded.Results The patients in group S exbuted significantly earlier than in group Ⅰ [(13.0±3.9) min vs (21.2±4.0) min,P＜0.05].The mean vital capacity 6 h after surgery significantly decreased in group Ⅰ [(2 909±502) ml vs (3 533±726) ml,P＜0.05].There were no significant differences of VAS scores or opiods consumption between the two groups.Conclusion Selective suprascapular nerve blocks can provide effective analgesia for shoulder arthroscopy without impacting the vital capacity.

Advantages of anterior inferior alveolar nerve block with felypressin-propitocaine over conventional epinephrine-lidocaine: an efficacy and safety study

BACKGROUND: Conventional anesthetic nerve block injections into the mandibular foramen risk causing nerve damage. This study aimed to compare the efficacy and safety of the anterior technique (AT) of inferior alveolar nerve block using felypressin-propitocaine with a conventional nerve block technique (CT) using epinephrine and lidocaine for anesthesia via the mandibular foramen. METHODS: Forty healthy university students with no recent dental work were recruited as subjects and assigned to two groups: right side CT or right side AT. Anesthesia was evaluated in terms of success rate, duration of action, and injection pain. These parameters were assessed at the first incisor, premolar, and molar, 60 min after injection. Chi-square and unpaired t-tests were used for statistical comparisons, with a P value of < 0.05 designating significance. RESULTS: The two nerve block techniques generated comparable success rates for the right mandible, with rates of 65% (CT) and 60% (AT) at both the first molar and premolar, and rates of 60% (CT) and 50% (AT) at the lateral incisor. The duration of anesthesia using the CT was 233 ± 37 min, which was approximately 40 min shorter than using the AT. This difference was statistically significant (P < 0.05). Injection pain using the AT was rated as milder compared with the CT. This difference was also statistically significant (P < 0.05). CONCLUSIONS: The AT is no less successful than the CT for inducing anesthesia, and has the added benefits of a significantly longer duration of action and significantly less pain.

Survey of Sonoanatomic Distances For Lumbar Medial Branch Nerve Blocks in Healthy Volunteers

BACKGROUND: The precise knowledge of anatomy and the region of transverse process (TP) and superior articular processes (AP) and their distance from the skin are important in blocking and treating lumbar facet syndrome. Evaluation of these anatomic distances from 3rd and 5th lumbar vertebrae in both sides and in different body mass index (BMI) in healthy volunteers might improve knowledge of ultrasound (US) lumbar medial branch nerve blocks (LMBB). METHODS: Bilateral US in the 3rd and 5th lumbar vertebrae of 64 volunteers carried out and the distance between skin to TP and skin to AP was measured. These distances were compared on both sides and in different BMI groups. The analysis was done using SPSS 11. Analysis of variance was used to compare the means at three vertebral levels (L3-L5) and different BMI groups. P values less than 0.05 were considered statistically significant. The paired t-test was used to compare the mean distance between skin to TP and skin to AP on both sides. RESULTS: The distance between skin to TP and skin to AP of 3rd vertebrae to 5th vertebrae was increased in both right and left sides (P < 0.001) from up to down. The mean distance from skin to TP were greater on the left side compared to the right in all three vertebral levels from L3 to L5 (P values 0.014, 0.024, and 0.006 respectively). The mean distance from skin to TP and the skin to AP was statistically significant in different BMI groups (P < 0.001). CONCLUSIONS: We found many anatomic distances which may increase awareness of US guided LMBB.

Comparison of ultrasound-guided supraclavicular block according to the various volumes of local anesthetic / 대한마취과학회지

BACKGROUND: The ultrasound guidance in regional nerve blocks has recently been introduced and gaining popularity. Ultrasound-guided supraclavicular block has many advantages including the higher success rate, faster onset time, and fewer complications. The aim of this study was to examine the clinical data according to the varied volume of local anesthetics in the ultrasound-guided supraclavicular block. METHODS: One hundred twenty patients were randomized into four groups, according to the local anesthetic volume used: Group 35 (n = 30), Group 30 (n = 30), Group 25 (n = 30), and Group 20 (n = 30). Supraclavicular blocks were performed with 1% mepivacaine 35 ml, 30 ml, 25 ml, and 20 ml, respectively. The success rate, onset time, and complications were checked and evaluated. RESULTS: The success rate (66.7%) was lower in Group 20 than that of Group 35 (96.7%) (P < 0.05). The average onset times of Group 35, Group 30, Group 25, and Group 20 were 14.3 +/- 6.9 min, 13.6 +/- 4.5 min, 16.7 +/- 4.6 min, and 16.5 +/- 3.7 min, respectively. There were no significant differences. Horner's syndrome was higher in Group 35 (P < 0.05). CONCLUSIONS: In conclusion, we achieved 90% success rate with 30 ml of 1% mepivacaine. Therefore, we suggest 30 ml of local anesthetic volume for ultrasound-guided supraclavicular block.

Tratamento da dor neuropática crônica pós-trauma com o uso do bloqueio periférico: relato de caso / Treatment of post-traumatic chronic neuropathic pain with peripheral block: case report

JUSTIFICATIVA E OBJETIVOS: As dores neuropáticas podem apresentar sinais inequívocos, mas, podem ser de difícil diagnóstico e o tratamento é difícil. O objetivo deste estudo foi relatar o caso de um paciente com dor crônica pós-traumática, com baixa adesão ao tratamento farmacológico e que foi tratado com bloqueios periféricos e adjuvantes. RELATO DO CASO: Paciente do gênero masculino, 42 anos, sofreu acidente automobilístico com trauma no quadril e na região lombar direita. Foi submetido à laparotomia exploradora com nefrectomia direita, osteossíntese de fêmur direito e de semilunar direito. Evoluiu com dor na região lombar direita que não melhorava com as medicações prescritas e com baixa adesão ao esquema terapêutico proposto, devido a sua difícil situação socioeconômica. Optou-se pelos bloqueios de nervos periféricos, em cinco sessões, realizados em regime ambulatorial. CONCLUSÃO: O tratamento com os bloqueios de nervos periféricos na região lombar foi eficaz e reduziu as sintomatologias da dor neuropática em até 60%, permanecendo com intensidade entre 3 e 4 pela escala analógica visual e ausência de dor ao toque da cicatriz.

BACKGROUND AND OBJECTIVES: Neuropathic pain may have earmarks, but may be difficult to diagnose and treat. This study aimed at reporting a case of post-traumatic chronic pain, with poor adherence to pharmacological treatment, which was treated with peripheral blocks and adjuvants. CASE REPORT: Male patient, 42 years old, who suffered a car accident with hip and right lumbar region trauma. Patient was submitted to laparotomy with right nephrectomy, right femur and right lunate osteosynthesis. Patient evolved with right lumbar region pain not improving with prescribed drugs and with poor adherence to proposed therapeutic approach due to his difficult socio-economic status. We decided for peripheral nerve blocks in five sessions, in outpatient regimen. CONCLUSION: Treatment with peripheral nerve blocks in the lumbar region was effective and has decreased neuropathic pain symptoms in up to 60%, remaining with intensity between 3 and 4 by the visual analog scale and with no pain when the scar was touched.

The Efficacy and Persistence of Selective Nerve Root Block under Fluoroscopic Guidance for Cervical Radiculopathy

STUDY DESIGN: Retrospective study. OBJECTIVES: To investigate the outcomes of fluoroscopically guided selective nerve root block as a nonsurgical treatment for cervical radiculopathy. OVERVIEW OF LITERATURE: Only a few studies have addressed the efficacy and persistence of cervical nerve root block. METHODS: This retrospective study was conducted on 28 consecutive patients with radicular pain due to cervical disc disease or cervical spondylosis. Myelopathy was excluded. Cervical nerve root blocks were administered every 2 weeks, up to 3 times. Outcomes were measured by comparing visual analogue scale (VAS) scores, patient satisfaction, and medication usage before the procedure and at 1 week and 3, 6, and 12 months after the procedure. In addition, complications associated with the procedure and need for other treatments were evaluated. RESULTS: The average preoperative VAS score was 7.8 (range, 5 to 10), and this changed to 2.9 (range, 1 to 7) at 3 months and 4.6 (range, 2 to 7) at 12 months. Patient satisfaction was 71% at 3 months and 50% at 12 months. Five patients used medication at 3 months, whereas 13 used medication at 12 months. Average symptom free duration after the procedure was 7.8 months (range, 1 to 12 months). Two patients were treated surgically. Only two minor complications were noted; transient ptosis with Horner's syndrome and transient causalgia. CONCLUSIONS: Although selective nerve root block for cervical radiculopathy is limited as a definitive treatment, it appears to be useful in terms of providing relief from radicular pain in about 50% of patients at 12 months.

Ultrasound Guided Nerve Root Injection in Patients with Cervical Spondylytic Radicular Pain

Selective cervical nerve root injection using a mixture of corticosteroid and lignocaine is a treatment option for managing cervical radiculopathic pain. The procedure is usually performed under image guided fluoroscopy or Computerized Tomograhy. Ultrasound guided cervical nerve root block does not expose the patients and personnel to radiation. During injection, the fluid is mostly visualized in a real time fashion. This retrospective study reviewed the effectiveness of ultrasound in guiding cervical peri radicular injection for pain relief in patients with recalcitrant cervical radiculopathy. There were no complications reported in this series.

Combined femoral and popliteal sciatic nerve blocks versus epidural anesthesia in great saphenous veins stripping surgery with multiple stab avulsion / 대한마취과학회지

BACKGROUND: This study was designed to test the hypothesis that a combined femoral and politeal sciatic nerve blocks (FPSNB) would have excellent clinical properties and better patient satisfaction than epidural anesthesia for the great saphenous veins stripping (GSVS) surgery with multiple stab avulsion (MSA). METHODS: Sixty patients were allocated into two groups. The epidural group received epidural anesthesia with 15 ml of 0.75% ropivacaine (n = 30), and the FPSNB group received a combined FPSNB with 25 ml of 1.5% mepivacaine with a nerve stimulator (n = 30). We assessed the anesthetic and postoperative records. A questionnaire-based study including patient satisfaction for anesthetic techniques (100 point scale) was conducted 3 days postoperatively by a blinded observer. RESULTS: The time from initial injection to the start of surgery and the duration of sensory blockade were not different between groups (P > 0.05). The percentage of patients with anesthesia-related complications in epidural anesthesia was 33.3%, 46.6%, 23.3% and 20% for shivering, hypotension, bradycardia and postoperative voiding difficulty, respectively. FPSNB did not produce these complications. Additional analgesia with 50-100 microgram of fentanyl was more frequently used in FPSNB (60% vs 6.7%, FPSNB vs Epidural group, P < 0.01), but patient satisfaction of FPSNB was higher than epidural anesthesia (88.1 +/- 13.2 vs 76.5 +/- 15.8, FPSNB vs Epidural group, P < 0.01). CONCLUSIONS: A combined FPSNB with a small amount of narcotics is an adequate anesthetic technique for unilateral GSVS surgery with MSA.

A clinical study of anesthetic efficacy of alkalinizing lidocaine in inferior alveolar nerve blocks

0.05). but there was boundary significance (0.050.05). These results suggest that addition of sodium bicarbonate to 2% lidocaine (1:100,000 epinephrine) for inferior alveolar nerve block is more effective for reduction of injection pain and onset time.