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Biomedical subjects

S A Lang

Publications and source records attributed to S A Lang.

64 records · Page 4Linked to original sources
PubMedDate not supplied

The femoral 3-in-1 block revisited.

STUDY OBJECTIVE: To estimate the frequency of successful conduction blockade of the femoral, lateral femoral cutaneous, and obturator nerves following a femoral 3-in-1 block. DESIGN: Prospective observational study. SETTING: Operating room at Royal University Hospital, Saskatoon, Saskatchewan. PATIENTS: 32 patients having lower extremity surgery. INTERVENTIONS: Femoral 3-in-1 nerve blocks were performed on all patients. MEASUREMENTS AND MAIN RESULTS: Sensation and motor power in all 3 nerve distributions (femoral, lateral femoral cutaneous, obturator) were assessed before and after each femoral 3-in-1 nerve block. By our criteria, the femoral nerve block was successful in 26 of 32 patients (81%). The lateral femoral cutaneous nerve was successfully blocked in 25 of 26 patients (96%). Incidentally, the saphenous nerve which is classically described as the terminal branch of the femoral nerve, was successfully blocked in 20 of 26 patients (77%). The obturator nerve block was successful in only 1 of 26 patients (4%). CONCLUSIONS: The femoral 3-in-1 nerve block does not block the parent trunk of the obturator nerve.

Adult↗
PubMedDate not supplied

The parasacral sciatic nerve block.

BACKGROUND AND OBJECTIVES: The clinical utility of a new parasacral approach for conduction block of the sciatic nerve was investigated, with critical examination of onset, extent, and success rates when this block was used for surgical procedures below the knee. METHODS: Thirty ASA I-III patients presenting for surgery on the lower limb were enrolled. All received 30 mL of 1.5% lidocaine with 1:200,000 epinephrine following nerve stimulator identification of the sciatic nerve at < or =0.2 mA or less. Trans-sartorial saphenous nerve blocks were performed to provide anesthesia to the medial leg. RESULTS: Overall success for surgical anesthesia with this block was 97%. All components of the sacral plexus could be blocked with this approach, and 93% of patients displayed evidence of obturator nerve motor block. However, no patient displayed evidence of obturator sensory anesthesia that could be mapped. Saphenous nerve blocks were 100% effective in providing surgical anesthesia for the procedures performed. CONCLUSIONS: The parasacral approach to the sciatic nerve exhibits a high success rate, resulting in anesthesia of the entire sacral plexus and generally in motor block of the obturator nerve was an interesting observation.

Adult↗
PubMedDate not supplied

Continuous parasacral sciatic nerve block: two case reports.

OBJECTIVE: This study investigated the use of a continuous parasacral sciatic nerve block for anesthesia and postoperative analgesia for lower extremity surgery. METHODS: A continuous parasacral sciatic nerve block was performed in two patients (triple ankle arthrodesis and below-knee amputation). The sacral plexus was identified using an insulated Tuohy needle and a nerve stimulator. A catheter was placed near the elements of the sacral plexus via the Tuohy needle. RESULTS: In both patients, surgical anesthesia was successfully established through the parasacral catheter with lidocaine 1% (1/200,000 epinephrine), and postoperative analgesia was successfully established with a bolus of bupivacaine 0.375% (1/200,000 epinephrine) and maintained with a continuous infusion of bupivacaine 0.1% (8 mL/h) for 48 hours. CONCLUSION: We conclude that continuous parasacral sciatic nerve block can provide anesthesia and long-term analgesia for operative procedures of the foot and leg.

Amputation, Surgical↗
PubMedDate not supplied

Lateral femoral cutaneous nerve block revisited. A nerve stimulator technique.

BACKGROUND AND OBJECTIVES: Regional block of the lateral femoral cutaneous nerve (LFCN) often has disappointing success rates despite the large volumes of local anesthetic used. This study was undertaken to investigate the utility of using a nerve stimulator (NS) to localize and block the LFCN. METHODS: After obtaining institutional approval and informed consent, the authors proceeded with a two-stage study. In stage 1, 20 ASA 1 volunteers underwent LFCN block by both a fan and a NS technique in a prospective, randomized, crossover study utilizing strict criteria for success and extent of block. To predict clinical utility, 20 patients underwent LFCN block by the NS technique using the same assessment criteria (stage 2). Statistical analysis for the comparisons was completed employing the Fisher's exact or paired t-test as appropriate. P < .05 was considered significant. RESULTS: The NS technique significantly improved the success of LFCN block over the fan technique (100% vs. 40%, P = .00002). The extent of successful blocks was no different with the two techniques. Success in stage 2 was similar to that in stage 1 (85%) predicting clinical utility. CONCLUSIONS: A NS can be used to localize a purely sensory nerve; such as the LFCN, and improve success rates in regional anesthesia.

Adult↗
PubMedDate not supplied

Reevaluation of the sciatic nerve block.

BACKGROUND AND OBJECTIVES: Sciatic nerve blocks are perceived as unreliable, technically demanding, and uncomfortable. With strict criteria to define success rates, we designed a study to examine the efficacy of two techniques of sciatic nerve block. METHODS: All blocks were performed by a novice in sedated patients using an insulated needle and a nerve stimulator. RESULTS: Overall success with both techniques was 87.5%. One transient neurologic deficit attributed to the sciatic nerve block was observed; otherwise, the technique provided satisfactory anesthesia without complications. CONCLUSIONS: Patient acceptance was excellent.

Adult↗
PubMedDate not supplied

Femoral nerve block. Single injection versus continuous infusion for total knee arthroplasty.

BACKGROUND AND OBJECTIVES: This study was conducted to ascertain whether there is any advantage to the continuous-infusion femoral 3-in-1 nerve block over the single-injection femoral nerve block for postoperative analgesia after total knee arthroplasty. METHODS: A double-blind, randomized, controlled study was made of 33 patients undergoing total knee arthroplasty, who were randomized into three groups. Group 1 received a single-injection femoral 3-in-1 nerve block with 20 mL 0.5% bupivacaine with 1:200,000 epinephrine. Group 2 had a catheter placed in the femoral nerve sheath, through which a continuous femoral 3-in-1 nerve block was established. Group 3 patients served as controls. All blocks were performed and assessed prior to induction of standardized general anesthesia. All patients received morphine via patient-controlled analgesia. Pain was recorded on a 100-mm visual analog scale at rest and with motion of the knee. Opioid consumption and side effects were recorded; P = .05 was considered statistically significant. RESULTS: In the recovery room, pain scores with motion were lower in the single-injection and continuous-infusion groups (P < .05). There were no significant differences between any of the groups regarding pain scores or morphine requirements beyond the recovery room. The incidence of nausea was higher in the control group. There were no differences between the groups with respect to overall patient satisfaction. CONCLUSIONS: We were unable to confirm improvements in analgesia provided by continuous-infusion femoral 3-in-1 nerve block for total knee arthroplasty except in the recovery room.

Aged↗