Periarticular cocktail injection is more useful than nerve blocks for pain management after anterior cruciate ligament reconstruction.

Background: Anterior cruciate ligament (ACL) reconstruction is commonly associated with moderate-to-severe postoperative pain. Notably, various pain control strategies, a femoral nerve block (FNB) with a lateral femoral cutaneous nerve block (LFCNB), adductor canal block (ACB) with LFCNB, or periarticular cocktail injection (PI), have been investigated. However, no studies compare the effects of FNB with LFCNB, ACB with LFCNB, and PI for pain control after ACL reconstruction. This study aimed to evaluate the impact of FNB with LFCNB, ACB with LFCNB, and PI for pain relief in the early postoperative period after ACL reconstruction. Methods: This retrospective controlled clinical trial enrolled 299 patients who underwent primary ACL reconstruction at our hospital between April 2016 and October 2022. We categorized these cases into groups based on the use of PI (PI group), FNB with LFCNB (FNB group), and ACB with LFCNB (ACB group) for pain management. We selected 40 cases each, with matched age, sex, and body mass index (BMI) from each group, resulting in 120 cases for analysis. In the FNB and ACB groups, 0.75% ropivacaine 15 ml was injected under ultrasound guidance preoperatively. In the PI group, a mixture of 0.75% ropivacaine 20 ml, normal saline 20 ml, and dexamethasone 6.6 mg was injected half at the start of surgery and the rest just before wound closure. Patient demographics (age, sex, height, body weight, and BMI) and surgical data (the requirement for meniscal repair, operative time, and tourniquet inflation time) were analyzed. After ACL reconstruction, patients' numerical rating scale pain scores (NRS) (0-10) were recorded at 30 min and 4, 8, 12, 24, 48, and 72 h postoperatively. NRS were then compared among the three groups using analysis of variance. In addition, within each group, these data were compared between the NRS ≥7 and NRS ≤6 groups using a t-test. Results: There were no significant differences in patient demographics and surgical data. Pain scores were significantly higher in the PI group than in the FCB and ACB groups 30 min postoperatively, but they were lower at 12, 24, 48, and 72 h postoperatively. In the FNB group, there were no significant differences in the demographic and surgical data by NRS pain score. In the ACB group, the number of men was significantly higher in the NRS ≥7 group than in the NRS ≤6 group (p = 0.015). In the PI group, tourniquet inflation time was significantly longer in the NRS ≥7 group than in the NRS ≤6 group (p = 0.008). Conclusions: Following ACL reconstruction using a hamstring autograft, periarticular cocktail significantly reduced early postoperative pain compared with nerve block combinations.

Right-sided meralgia paresthetica from lateral femoral cutaneous nerve neuroma.

Meralgia Paresthetica (MP) causes outer thigh discomfort, numbness, and tingling. Compression or injury to the Lateral Femoral Cutaneous Nerve (LFCN), which gives sensory innervation to outer aspect of the thigh. It frequently gets impinged beneath the inguinal ligament resulting in in sensory impairment in the distribution of LFCN. Compression of the LFCN is a frequent cause of MP, whereas LFCN neuromas is a rare cause. This case report describes a unique case of Meralgia Paresthetica produced by a LFCN neuroma and enhances our knowledge of Meralgia Paresthetica.

Enhancing functional recovery following postpartum femoral neuropathy: early neurorehabilitation and multidisciplinary obstetric care.

Postpartum femoral neuropathy has a reported incidence of less than 1% and its total recovery time extends up to 6 months to a year. A multidisciplinary approach is vital to rule out permanent disability and to assure a correct diagnosis and earlier rehabilitation. We report a case of a 37-year-old puerperal woman with a history of intrapartum epidural analgesia, who presented post-labor unilateral lower-limb motor weakness and sensory loss, with functional compromise on independent gait. A multidisciplinary team consisting of an anesthesiologist, a physiatrist, a neurologist, and an obstetrician was then established. In the initial physiatry and neurology assessment, the patient reported pain (numerical rating scale 7/10) over the inguinal ligament, lower limb hypoesthesia, and muscle weakness. Femoral neuropathy was suspected. Magnetic resonance imaging ruled out potential complications related to the anesthetic procedure. The patient was then enrolled in a supervised rehabilitation program and, 3 weeks later, electrodiagnostic studies confirmed the initial suspicion. Two months later, the patient had regained lower-limb active range of motion and no pain nor paresthesia was reported. Our case report describes how an early multimodal rehabilitation program within a multidisciplinary framework allows for sooner neuromotor function improvement and activities of daily living independence.

Iliopsoas haemorrhage complicated by femoral neuropathy in patients with haemophilia: a case series report.

OBJECTIVES: The study aimed to determine the incidence of femoral neuropathy in patients with haemophilia exhibiting iliopsoas haemorrhage. METHODS: Patients with iliopsoas haemorrhage confirmed by ultrasonography or CT scan were studied retrospectively. RESULTS: A total of 44 episodes of iliopsoas haemorrhage occurred in 20 patients with haemophilia (A17, B3). Most episodes in patients without inhibitors (14/16 = 87.5%) were adequately treated followed by prophylaxis. However, 11 of 28 episodes (39.3%) in patients with inhibitors were adequately treated and no prophylaxis was provided. An appropriate rehabilitation programme was arranged during hospitalisation and follow-up. Femoral neuropathy was observed in 28 of 44 episodes, while 16 episodes of persistent femoral neuropathy from previous bleeding were excluded. As a result, 11 of 28 episodes (39.3%) of femoral neuropathy were similarly found amongst patients with and without inhibitors. The mean time of onset and resolution of femoral neuropathy were 3.7 (1.8) and 23.4 (20.5) days after the onset of iliopsoas haemorrhage, respectively. Patients receiving inadequate and delayed replacement had a significantly higher rate of femoral neuropathy than those who received adequate and prompt replacement. CONCLUSION: Femoral neuropathy following iliopsoas haemorrhage was common in haemophilia patients with and without inhibitors.

A Case Report of Neuropathic Pain and Unilateral Lower Extremity Weakness Following a Cardiac Arrest.

Femoral nerve palsy is a rare, but significant complication following percutaneous coronary intervention (PCI) for conditions such as myocardial infarction. We present a case of a 61-year-old male patient who presented for cardiac rehabilitation following an emergent PCI procedure for cardiac arrest secondary to ST-elevation myocardial infarction. He later developed right lower extremity weakness and severe neuropathic pain on arrival to the acute rehabilitation unit. After physical examination and electrodiagnostic studies, he was determined to have a right femoral nerve neuropathy. This case report highlights the clinical course, physical examination/electrodiagnostic findings, and subsequent pain management of femoral nerve palsies.

Chronic abdominal aortic rupture mimicking femoral neuropathy.

Chronic-contained rupture of an aortic aneurysm is a rare subset of ruptured aneurysms. The presentation is unusual, and the diagnosis is frequently delayed. Here, we describe a case of contained rupture of abdominal aortic aneurysm that presented with signs and symptoms of femoral neuropathy. Clinical and radiological findings were initially misinterpreted. The correct diagnosis was formulated belatedly, causing a progressively increased risk of fatal events. Surgical aortic repair was performed and the postoperative course was uneventful. In conclusion, in the presence of a retroperitoneal mass, a diagnosis of chronic-contained rupture of an abdominal aortic aneurysm should be considered.

Iatrogenic Deep Femoral Artery Pseudoaneurysm Causing Quadriceps Paralysis: An Indication for Open Surgery in an Endovascular Era.

Contemporary management of iatrogenic pseudoaneurysms is mostly performed using non-surgical techniques. Herein, we present a rare case of deep femoral artery (DFA) pseudoaneurysm with compression neuropathy, which required open repair. A 67-year-old female patient presented with increasing pain in the right groin, sensory neuropathy of the anteromedial thigh and upper leg, and quadriceps paralysis 4 days after coronary angiography via femoral puncture. Computed tomography angiography revealed a pseudoaneurysm of the DFA. The disabling compressive neuropathy warranted urgent open decompression rather than thrombin injection or endovascular therapy. Timely open evacuation of the hematoma, release of compression on the femoral nerve, and postoperative physiotherapy resulted in complete recovery of quadriceps power. The patient was pain free within 12 weeks and able to ambulate independently. This case report highlights the role of prompt open surgery for pseudoaneurysms with compression neuropathy.

Severe Postpartum Femoral Neuropathy: A Case Series.

BACKGROUND: Femoral neuropathy is a rare complication of vaginal delivery that is often under-reported. It is marked by weakness and sensory loss in the lower limbs. This report presents 3 cases to outline possible prevention strategies, as well as to describe the process of diagnosis, management, and recovery for this injury. CASES: Diagnosis is made clinically, and prognosis is determined by clinical follow-up along with nerve conduction studies and electromyography. Management involves interdisciplinary efforts with physiotherapy. Prevention includes frequent repositioning and avoidance of hip hyperflexion during labour. The expected recovery period ranges from 2 to 24 months. CONCLUSION: Femoral neuropathy after vaginal delivery is under-reported. Though prognosis is often excellent, special attention to positioning during labour, prompt clinical diagnosis, and interdisciplinary management are essential for this rare injury.

Idiopathic Lumbosacral Neuropathy Syndrome: Case Report.

Idiopathic lumbosacral plexitis or lumbosacral radiculoplexus neuropathy is a disease characterized by nerve damage in lumbar and/or sacral plexus without trauma, mass effect or diabetic complications. A 47-year-old male patient with right groin pain and loss of right leg muscle strength is presented in this case report. Neuropathy was detected in the L4 nerve root by electromyography and magnetic resonance neurrographic imaging. The underlying cause was investigated; however, it is linked to the idiopathic outcome. Idiopathic lumbosacral neuropathy is a lumbosacral plexus disease in which no underlying pathology plays a role in causing severe pain and muscle weakness. Patients should be avoided urgently operation because of the sudden onset symptoms.

Femoral neuropathy following venoarterial-extracorporeal membrane oxygenation therapy: a case report.

BACKGROUND: Although life-threatening complications of extracorporeal membrane oxygenation (ECMO) are well described, non-life threatening complications are less known. Herein, we report a case of femoral neuropathy (FN) due to nerve compression caused by cannula compression and deep vein thrombosis (DVT) after successful ECMO therapy, which seriously undermined one's quality of life. CASE PRESENTATION: A 70-year old male presented to the emergency department for chest pain. The patient had cardiac arrest before percutaneous coronary intervention (PCI) and was inserted with ECMO. Although he was successfully weaned from ECMO 4 days after PCI, he consistently complained swelling, abnormal sensation, and weakness in his right lower extremity, where the cannulas were inserted. Imaging studies showed deep vein thrombosis (DVT) in his right leg, which was further treated with anticoagulants. Symptoms, however, remained after the regression of DVT. Nerve conduction study revealed femoral neuropathy, which may have been caused by ECMO cannula compression and tissue swelling. CONCLUSION: The current case proposes that non-life threatening complications of ECMO therapy can seriously affect quality of life. Venous drainage distant from the arterial cannula may prevent such complications.

Femoral Neuropathy: A Rare Presentation of Retroperitoneal Hematoma with Review of Literature.

Hematomas in close compartments and in pelvic gutters are always challenging to treat and diagnose. A young female on apixaban for recently diagnosed pulmonary thromboembolism (PE) presented to us for the complaints of right sided lower limb weakness. Neurological examination was positive for the right femoral nerve distribution deficit. Computed tomography (CECT) showed large right sided iliopsoas hematoma. Anticoagulation was stopped and was given blood transfusions with which she improved without need of any surgical evacuation. We hereby aim to enrich the understanding of our readers regarding this topic with a review of our experience and other recent publications in medical literature. It is important for the internists to be aware of varied and atypical presentations of retroperitoneal hematoma (RPH) especially following surgical/orthopaedic procedures or in association with anticoagulants and antiplatelets.

Subperiosteal hematoma of the iliac wing presenting with leg weakness in a young adult footballer.

We present the case of a 17 year old football player with a 2 week history of left leg weakness and difficulty weight-bearing. Magnetic resonance imaging revealed a well-circumscribed lesion deep to the left iliacus muscle. The patient proceeded to computed tomography-guided biopsy. The likely diagnosis was that of a subperiosteal haematoma of the iliac wing, which was exerting mass effect upon the left femoral nerve resulting in leg pain and weakness. Imaging was repeated at an interval of 1 month, at which time the lesion had almost entirely resolved. Subperiosteal haematoma of the iliac bone is a rare entity but should be considered as a potential diagnosis in young adults, particularly where there is a history of trauma or recent sports injury.

[Femoral neuropathy: Haematoma in iliac muscle and a lumbar vertebral fracture]. / Neuropatía femoral: hematoma en músculo ilíaco y fractura vertebral lumbar.

75-year-old patient with a history of acenocumarol anticoagulated atrial fibrillation, which shows pain, functional impotence and right lower limb paresthesias after fall. Studies evidenc evertebral fracture L5 and haematoma on right iliac muscle, proceeding to surgical drainage, suspension of acenocumarol, and onset of apixaban. After treatment persisted femoral neuropathy, which not allowed complete functional recovery. DISCUSSION: Femoral neuropathy as possible cause of compressive hematoma over iliopsoas muscle or secundary to lumbar canal stenosis and contact with L4 root. In both of the misit posible to observe weakness of proximal lower limb musculature. Haematoma was suspected due to lower back pain, flank mass and hypovolemia. Handlingis based on the severity of the symptomatology, from conservative to surgical drainage to reduce sequelae and bleeding complications. Apixaban has shown a higher safety profile. Stabilization of lumbar fracture allowed partial functional recovery.

Femoral mononeuropathy in Lyme disease: a case report.

BACKGROUND: Peripheral neuropathy is a common complication of Lyme disease. Cranial mononeuropathy, particularly that affecting the facial nerve, can be a presenting symptom, and at times, it can be associated with polyradiculopathies or plexopathies. However, isolated femoral neuropathy has not yet been reported in Lyme disease; therefore, we felt the need to present this case. CASE PRESENTATION: Laboratory investigations were performed on a 67-year-old man living in a region at high risk for Lyme disease after he developed erythema migrans on his chest, accompanied by the swelling of his left knee joint. A Western blot immunoglobulin assay was performed, including a screening for connective tissue disorders. Positive serological test results led to the administration of oral doxycycline therapy at a dosage of 100 mg twice daily. Shortly afterwards, he developed gait difficulties and frequent falls. The clinical examination and electrodiagnostic studies were consistent with femoral neuropathy. To look for etiologies other than Lyme disease, radiographic studies of his lumbar spine, pelvic cavity, retroperitoneal compartment, and hips were conducted. In addition, he was screened for diabetes. However, no other etiologies were found to explain the femoral neuropathy. Eventually, he recovered, and he was able to return to work. CONCLUSION: We firmly believe that the femoral neuropathy and Lyme disease seen in this patient were causally related.

Entrapment Neuropathies of the Lower Extremity.

Entrapment neuropathies in the lower limbs are a common neurologic problem and may present in any medical setting. Accurate identification and management of these nerve palsies can prevent pain, sensory loss, incoordination, and muscle weakness that may significantly affect a patient's functional mobility. In this article, the authors focus on the cause, signs and symptoms, diagnosis, and treatment of select entrapment neuropathies of the lower extremity, including palsies of the common peroneal, lateral femoral cutaneous, femoral, and posterior tibial nerves.

Femoral Neuropathy Following Transfemoral Neuroendovascular Procedures. An Analysis of a Prospective Registry.

BACKGROUND AND PURPOSE: Although femoral neuropathy is recognized as an adverse consequence following transfemoral neuroendovascular procedures, no reliable estimates are available. We analyzed data from a prospective registry to ascertain the frequency and characteristics of femoral neuropathy following transfemoral neuroendovascular procedures. METHODS: Consecutive patients who underwent neuroendovascular procedures through the transfemoral route were included. Detailed assessment was performed if any patient reported occurrence of sensory or motor symptoms in the femoral or lower extremity region including neurological examination (sensory/motor deficits) and femoral region ultrasound. RESULTS: Femoral neuropathy was diagnosed following 4 of 270 neurovascular procedures with an occurrence rate of 1.5% (95% confidence intervals = .4-3.7%). The symptoms were exclusively sensory without any motor involvement. The femoral neuropathy appeared to involve anterior femoral cutaneous nerves in all and medial cutaneous branches in 2 patients, and more than one nerve distribution in 1 patient in whom lateral cutaneous nerve appeared to be involved. All patients reported resolution of symptoms within a period ranging from 1 week to 2 months. No local hematoma or arterial pseudoaneurysm was identified at femoral region ultrasound. CONCLUSIONS: Femoral neuropathy is a rare occurrence following transfemoral neuroendovascular procedures and it usually occurs with pure sensory manifestations with complete resolution.

Controlled delivery of glial cell line-derived neurotrophic factor enhances motor nerve regeneration / 中国医师杂志

Objective@#To determine the effect of a motor-specific neurotrophic factor, glial-derived neurotrophic factor (GDNF) on motor nerve regeneration.@*Methods@#We used a nerve conduit filled with a fibrin-based delivery system that provided controlled release of GDNF during nerve regeneration. The motor branch of the rat femoral nerve was used to assess motor nerve regeneration across a 5-mm gap. Four experimental groups (n=5) were evaluated. These included GDNF with the fibrin-based delivery system (GDNF-DS group), fibrin alone(fibrin group), empty conduit (negative control group), and nerve isograft (positive control group). Nerves were harvested at 5 weeks for analysis by histomorphometry and electron microscopy.@*Results@#At 5 mm distal to the conduit or isografts, the GDNF-DS group was not significantly different from the nerve isograft group in the following histomorphometric measures: total nerve fibers, percentage of neural tissue, and nerve density. The number of nerve fibers (respectively: 1 744±274 , 1 481±288) and the percentage of nerve tissue [(14.2±3.9)%, (11.0±2.2)%] in theisograft group and the GDNF-DS group were significantly higher than that in the fibrin group and the empty conduit group [(respectively: 538±93, 535±96) and the percentage of nerve tissue respectively: (4.3±1.6)%, (3.7±0.9)%]. There were no differences in fiber width among all groups. By electron microscopy, the GDNF-DS and isograft groups also demonstrated more organized nerve architecture than the fibrin alone and empty conduit groups.@*Conclusions@#The delivery of GDNF from the fibrin-based delivery system promotes motor nerve regeneration at a level similar to an isograft in the femoral motor nerve model. This study gives insight into the potential beneficial role of GDNF in the treatment of motor nerve injuries.

Controlled delivery of glial cell line-derived neurotrophic factor enhances motor nerve regeneration / 中国医师杂志

Objective To determine the effect of a motor-specific neurotrophic factor,glial-derived neurotrophic factor (GDNF) on motor nerve regeneration.Methods We used a nerve conduit filled with a fibrin-based delivery system that provided controlled release of GDNF during nerve regeneration.The motor branch of the rat femoral nerve was used to assess motor nerve regeneration across a 5-mm gap.Four experimental groups (n =5) were evaluated.These included GDNF with the fibrin-based delivery system (GDNFDS group),fibrin alone(fibrin group),empty conduit (negative control group),and nerve isograft (positive control group).Nerves were harvested at 5 weeks for analysis by histomorphometry and electron microscopy.Results At 5 mm distal to the conduit or isografts,the GDNF-DS group was not significantly different from the nerve isograft group in the following histomorphometric measures:total nerve fibers,percentage of neural tissue,and nerve density.The number of nerve fibers (respectively:1 744 ± 274,1 481 ± 288)and the percentage of nerve tissue [(14.2 ± 3.9) ％,(11.0 ± 2.2) ％] in theisograft group and the GDNFDS group were significantly higher than that in the fibrin group and the empty conduit group [(respectively:538 ± 93,535 ± 96) and the percentage of nerve tissue respectively:(4.3 ± 1.6) ％,(3.7 ± 0.9) ％].There were no differences in fiber width among all groups.By electron microscopy,the GDNF-DS and isograft groups also demonstrated more organized nerve architecture than the fibrin alone and empty conduit groups.Conclusions The delivery of GDNF from the fibrin-based delivery system promotes motor nerve regeneration at a level similar to an isograft in the femoral motor nerve model.This study gives insight into the potential beneficial role of GDNF in the treatment of motor nerve injuries.

Meralgia paresthetica following hemorrhoidectomy in the jack-knife position: A case report

Meralgia paresthetica (MP) is a neuropathic pain caused by the entrapment of the lateral femoral cutaneous nerve (LFCN). There have been reports of MP following various surgeries; however, it has not yet been reported after hemorrhoid surgery. We report a case of bilateral MP after hemorrhoid surgery in a jack-knife position. The patient presented with pain, tightness, and a tingling sensation in the anterolateral aspect of both thighs. Ultrasonography-guided LFCN block was used for diagnosis and treatment, along with conservative management for 20 days with oral medication. One month later, the patient's symptoms had resolved completely. MP due to the jack-knife position may occur postoperatively in patients with predisposing risk factors such as obesity and diabetes mellitus, despite adequate padding and a shorter operating time.