Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “FEMORAL NERVE”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources
PubMed2002

Transient femoral nerve palsy following ilio-inguinal nerve blockade for day case inguinal hernia repair.

BACKGROUND: Transient femoral nerve palsy (TFNP) has been reported in patients undergoing inguinal hernia repair involving the use of ilio-inguinal nerve block. Ilio-inguinal nerve blocks can be administered under vision by the surgeon or by the anaesthetist using a standard blind technique. There has been no study that has specifically examined the incidence of this complication and whether its development is related to the type of method used to administer the block. PATIENTS AND METHODS: Data on patients undergoing surgery in the Royal Infirmary Edinburgh Day Case Unit are collected prospectively. All patients who undergo inguinal hernia repair are given ilio-inguinal field blocks, either pre-operatively by anaesthetists (blind technique) or peri-operatively under direct vision by surgeons. Several cases of TFNP were initially identified during the process of surgical audit and this led to a retrospective analysis over a period of one year. RESULTS: During a 12-month period, 194 patients underwent 200 open inguinal hernia repairs (188 unilateral and 6 bilateral), under general anaesthesia. Ten patients (5%) developed TFNP resulting in overnight admission. Surgeons administered 101 blocks under direct vision of which 4 (4%) resulted in TFNP, whereas 6 out of 99 (6%) blind blocks resulted in TFNP (p=0.49, df=1, Chi2 test). DISCUSSION AND CONCLUSION: TFNP is a recognised complication following ilioinguinal nerve blockade for inguinal hernia surgery. Our series shows that ilio-inguinal block given under direct vision does not appear to reduce the chance of this complication occurring. This may result from the fact that this complication could be due to local infiltration into the operative field rather than direct infiltration around the femoral nerve. As inguinal hernia repair undertaken as a day case procedure increases, the awareness of this complication is important to avoid morbidity

Adult↗
PubMed1992

Posttraumatic hematoma of iliacus muscle with paralysis of the femoral nerve.

One case of traumatic rupture of the iliacus muscle associated with a femoral nerve paralysis is described. The clinical picture was characterized by posttraumatic gradual worsening of pain in the groin, a tender mass in the iliac fossa, flexion deformity of the hip, and femoral nerve paralysis. The review of literature revealed a description of only nine similar cases. Early evacuation of the hematoma is suggested.

Adult↗
PubMed1996

Variant slips of psoas and iliacus muscles, with splitting of the femoral nerve.

In bilateral dissections of 68 cadavers, four examples were found unilaterally of variant slips of iliacus and psoas major muscles. In three of them the femoral nerve was pierced by the variant slip. One of these variants was a previously undocumented accessory slip of iliacus, originating from the iliolumbar ligament, passing inferiorly anterior to iliacus, and traversing the femoral nerve; its tendon split to be attached proximally to the lesser trochanter of the femur and distally to an unknown insertion. Such anomalies might cause tension on the femoral nerve resulting in referred pain to the hip and knee joints and to the lumbar dermatomes L2,3 and 4.

Femoral Nerve↗
PubMed1982

Femoral nerve lesion subsequent to renal transplantation.

Severe femoral neuropathy subsequent to renal transplantation is described in a patient who died in the 5th postoperative week. Postmortem examination revealed a compression of the femoral nerve by an older hematoma of the iliac muscle, ipsilateral to the transplantation, and severe Wallerian degeneration of the nerve beginning at the site of the hematoma. It is postulated that the hematoma resulted from surgical trauma on the iliac muscle and was facilitated by previous anticoagulation and hypertensive vasculopathy. We suggest that every patient with similar symptoms occurring after renal transplantation should be investigated for a retroperitoneal hematoma. If such a hematoma is diagnosed, immediate decompression neurolysis should be performed in order to prevent prolonged recovery time or permanent disability.

Femoral Nerve↗
PubMed1996

Femoral nerve palsy after arthroscopic surgery with an infusion pump irrigation system. A report of three cases.

One patient developed complete, and two patients, partial, femoral nerve palsy after arthroscopic surgery in which an infusion pump was used to operate an irrigation system. In one case, hip flexor and quadricep function was completely lost after the patient underwent arthroscopic partial medial meniscectomy without the use of a tourniquet. A CT scan of the pelvis demonstrated considerable fluid accumulation in the thigh and inguinal regions. The remaining two patients developed quadriceps weakness, but not complete femoral nerve palsy, after arthroscopic-assisted anterior cruciate ligament reconstructions. Although tourniquets were used in these latter two procedures, the pressures were low (300 to 325 mm Hg) and the tourniquet times not excessive, suggesting that femoral nerve palsy in these two patients resulted from fluid extravasation. In all three cases, muscle function returned within 6 to 7 months, but sensory nerve deficits were still present at that time.

Adult↗
PubMed2002

Morphometric analysis of the human femoral nerve and its ageing process.

We analysed the sizes of nerve fibres in the human femoral nerve which innervates the quadriceps femoris muscles. The material was taken from 14 cadavers aged from 61 to 97 years. A linear regression analysis disclosed a significant age-related decrease of the mean transverse area of axons. Such decrease with age may be an indication of motoneuron atrophy. Our results could help in the understanding of the correlation between morphology and function during the ageing process.

Aged↗
PubMed2001

Extended femoral nerve sheath block after total hip arthroplasty: continuous versus patient-controlled techniques.

We assessed the efficacy of patient-controlled analgesia (PCA) techniques for extended femoral nerve sheath block after total hip arthroplasty. Forty-five patients were divided into three groups of 15. Over 48 h, all patients received 0.125% bupivacaine with clonidine 1 microg/mL and sufentanil 0.1 microg/mL via a femoral nerve sheath catheter as a continuous infusion at 10 mL/h in Group 1, as PCA boluses only of 10 mL/h in Group 2, or as PCA boluses of 5 mL per 30 min in Group 3. Pain scores, sensory block, supplemental analgesia, bupivacaine consumption, side effects, and satisfaction scores were recorded. Pain scores at rest and supplemental analgesia were comparable in the three groups. At 48 h, pain relief on movement was significantly better in Group 3 than in Group 1 (P = 0.01). Bupivacaine consumption was significantly less in Groups 2 and 3 than in Group 1 (P < 0.001). Side effects were comparable in the three groups. Satisfaction scores were significantly higher in Group 3 than in the other groups (P < 0.01). We conclude that, to maintain extended femoral nerve sheath block after total hip arthroplasty, PCA techniques reduce the local anesthetic consumption without compromise in patient satisfaction or visual analog scale scores. Of the two PCA techniques tested, PCA boluses (5 mL per 30 min) of 0.125% bupivacaine with clonidine 1 microg/mL and sufentanil 0.1 microg/mL are associated with the smallest local anesthetic consumption and the most patient satisfaction.

Adult↗
PubMedDate not supplied

Is there any need for expanding the perineural space before catheter placement in continuous femoral nerve blocks?

BACKGROUND AND OBJECTIVE: There is debate regarding the benefit of perineural space expansion before catheter placement in continuous femoral nerve block. This question is addressed in this prospective, comparative, and randomized study. METHODS: Sixty patients scheduled for total knee replacement were randomly assigned to receive continuous femoral nerve block with or without perineural space expansion using 10 mL dextrose 5% in water (D5W) flush before stimulation-guided catheter placement. Femoral block was initiated with a 5-mL bolus followed by an infusion of 5 mL/h ropivacaine 0.2% during the 2-hour surgery. The number of attempts before successful placement of the stimulating catheter and the resistance during its insertion were assessed. Patients also received obturator nerve blocks by using ropivacaine 0.75% (10 mL) and sciatic nerve blocks (20 mL). The number of boluses of ropivacaine 0.2% needed to achieve zero VAS scoring was recorded in the postanesthesia care unit during the 2-hour stay. Images of the contrast spread were also studied. RESULTS: There were 30 patients in each group. The number of successful catheter placements at the first attempt was higher with expansion than without (22 vs. 8, P = .007). The resistance felt during insertion was lower with than without expansion (P = .01). More boluses of ropivacaine were required postoperatively without expansion (P = .03). No difference between groups was found regarding the images of the contrast spread. CONCLUSION: Expansion of the perineural space with D5W is useful for catheter placement in continuous femoral nerve block.

Adult↗
PubMed2002

Prevention of femoral nerve injuries in gynecologic surgery.

Abdominopelvic operation is the most frequent cause of iatrogenic femoral nerve injury, particularly when self-retaining retractors are used. Transverse abdominal incisions and thin body habitus are significant risk factors. Patients typically have mild sensory and/or motor disturbances with diminished knee jerk reflexes. Most cases are self-limited, and symptoms resolve within several weeks. Most femoral nerve injuries that are associated with pelvic surgery can be prevented with a thorough understanding of the pelvic anatomy and proper placement of self-retaining retractors.

Femoral Nerve↗
PubMed2004

[Pregnancy-associated femoral nerve affection].

BACKGROUND: Common neuropathies during pregnancy are carpal tunnel syndrome or peripheral facial paralysis. However, there is little information about femoral nerve affection during pregnancy. CASE REPORT: We report on a female at 30 weeks of gestation, complaining of pain in hips and thighs and gait difficulty. Pregnancy was normally developed. Neurological examination showed a bilateral weakness in both quadriceps and iliopsoas muscles combined with soreness in hips and thighs, without deficits of sensibility. Laboratory findings and results of a lumbar punction were normal. Pelvic ultrasound and an MRI scan of the spine and pelvis showed no mass or disc prolaps. Neuromyographic evaluation bilaterally revealed acute signs of denervation of the muscles innervated by femoral nerve. Caesarean section was performed at 32 gestational weeks, as pain was unbearable and refractory to treatment with even opiates. Post partum, pain relieved immediately, and after weeks of physiotherapy, complete remission was achieved. CONCLUSION: This unusual manifestation of a neuropathy in pregnancy could be due to pressure on the femoral nerve. The patients' anxiety can be eliminated, as the described cases in literature show an excellent prognosis. However, the severity of symptoms can lead us to necessity of premature delivery.

Female↗
PubMed1982

[On the prevention of paresis of the femoral nerve following abdominal gynaecological operations (author's transl)].

Self retaining retractors may cause paresis of the femoral nerve following abdominal gynaecological operation. In principle all types of retractors may be the cause. Self retaining retractors with small and long lateral blades are especially dangerous. The paresis is caused by direct and indirect pressure of the lateral blades of the retractor on the nerve. The discrepancy between large and deep retractor blades and thin abdominal walls predisposes to paresis of the femoral nerve. Thin underweight patients are especially in danger. In addition, a transverse incision, too much tension and a long duration of the operation are predisposing factors. The prevention is possible by knowledge of the case and a careful selection of the lateral blades of the retractor in accordance with the individual anatomy encountered. Sometimes manual retractors have to be used instead of a self retaining retractor.

Adult↗
PubMedDate not supplied

Prospective comparison of continuous femoral nerve block with nonstimulating catheter placement versus stimulating catheter-guided perineural placement in volunteers.

BACKGROUND AND OBJECTIVES: Stimulating catheter-guided perineural placement may potentially increase the success rate and quality of continuous femoral nerve block as compared with a nonstimulating catheter technique. These hypotheses have not been rigorously tested. METHODS: Twenty volunteers underwent placement of bilateral femoral nerve catheters in this prospective, randomized, double-blind study. For each side, a stimulating needle was advanced until quadriceps contractions were obtained at < or =0.5 mA. On one side, a stimulating catheter was advanced 4 to 5 cm beyond the needle tip while eliciting quadriceps contractions via the catheter. If quadriceps contractions decreased or disappeared, the catheter position was adjusted until quadriceps contractions could be elicited at < or =0.5 mA. On the contralateral side, an identical catheter was advanced 4 to 5 cm beyond the needle tip without attempts to elicit quadriceps contractions via the catheter. After bolus injection of 10 mL lidocaine 1%, ropivacaine 0.2% at 10 mL/h was continuously infused through both catheters for 4 hours. Success of femoral block was defined as loss of sensation to cold and pinprick stimuli. Quality of successful block was determined by tolerance to transcutaneous electrical stimulation and force dynamometry of quadriceps strength. RESULTS: Block success was 100% via the stimulating catheters versus 85% via the nonstimulating catheters (P =.07). Overall tolerance to transcutaneous electrical stimulation (P =.009) and overall depth of motor block (P =.03) was significantly higher in the stimulating catheter-guided femoral nerve blocks. CONCLUSIONS: In this volunteer study, there was no statistically significant difference in block success between the two techniques. However, stimulating catheter-guided placement provided an increased overall quality of continuous femoral perineural blockade. Further studies are needed to verify these observations in the clinical setting.

Adolescent↗
PubMed1997

Femoral nerve palsy associated with an associated posterior wall transverse acetabular fracture.

A case is presented of a patient who sustained bilateral acetabular fractures in a motor vehicle crash. On the right, he sustained a variant associated posterior wall transverse fracture, with a femoral nerve lesion noted preoperatively. Open reduction and internal fixation of both fractures was performed in a staged fashion with an ilio-inguinal approach on the right. At surgery, the femoral nerve was 90% divided and damaged over approximately 5 cm of length, with marked damage also of the ilio-psoas muscle and tendon and the inguinal canal. No attempt was made to repair the nerve, and at 11-month follow-up he has had no recovery and electrodiagnostic tests indicate no femoral nerve function.

Accidents, Traffic↗
PubMed2005

Intraoperative myocardial ischemia in peripheral vascular surgery: general anesthesia vs combined sciatic and femoral nerve blocks.

STUDY OBJECTIVE: The aim of this study was to compare the frequency of intraoperative myocardial ischemia in lower extremity vascular surgery with general anesthesia vs regional anesthesia via combined sciatic and femoral nerve blocks. DESIGN: This is a prospective, randomized study. SETTING: This study was set at an academic medical center. PATIENTS: The study included 50 patients scheduled for elective lower extremity vascular surgery. INTERVENTIONS: Patients in group 1 received balanced general anesthesia, whereas patients in group 2 received combined sciatic and femoral nerve blocks with 40 mL of 0.375% bupivacaine. Monitoring included a radial artery catheter and multilead, dual-channel electrocardiogram with computerized ST-segment analysis. Blood pressure and heart rate variations were maintained within 10% of preoperative values by adjusting anesthetic depth, fluid replacement, and vasoactive drug dosages. MEASUREMENTS AND MAIN RESULTS: An ST-segment depression of at least 1 mm or elevation of at least 2 mm lasting for more than 1 minute was considered a significant episode of myocardial ischemia. Intraoperative hemodynamic data and the frequency of significant ST-segment change episodes were recorded. The number of patients with ischemic episodes and the total number of these episodes were lower in group 2 than in group 1 (1 patient vs 7 patients, P = 0.02; and 2 vs 14 episodes, P = 0.04). No significant difference was found between groups 1 and 2 regarding systolic or diastolic arterial pressures, or heart rate. CONCLUSION: Compared with general anesthesia, combined sciatic and femoral nerve blocks reduce the frequency of intraoperative myocardial ischemia in patients undergoing lower extremity vascular surgery.

Aged↗
PubMed1998

Sciatic and femoral nerve sensory neurones occupy different regions of the L4 dorsal root ganglion in the adult rat.

The topographical distribution of sciatic and femoral nerve sensory neuronal somata in the L4 dorsal root ganglion of the adult rat was mapped after retrograde tracing with one or two of the dyes Fast Blue, Fluoro-Gold, or Diamidino Yellow. The tracers were applied to the proximal transected end of either nerve alone, or from both nerves in the same animal using separate tracers. Three-dimensional reconstructions of the distribution of labelled neurones were made from serial sections of the L4 dorsal root ganglion which is the only ganglion that these two nerves share. The results showed that with little overlap, femoral nerve neurones distribute dorsally and rostrally whereas sciatic nerve neurones distribute medially and ventrally. This finding indicates the existence of a somatotopical organisation for the representation of different peripheral nerves in dorsal root ganglia of adult animals.

Animals↗
PubMed1993

Changes in the myelinated axons of femoral nerve in amyotrophic lateral sclerosis.

Myelinated fibres in femoral nerves removed from amyotrophic lateral sclerosis (ALS) cases at post mortem were compared with age matched controls. A technique for processing whole transverse sections of the nerves for osmication and subsequent morphometric analysis is described. Although areas depleted in myelinated fibres were seen in the nerves from the ALS group, no statistically significant difference was shown due to wide variations in the controls. However, the ALS nerves showed a degree of disruption in the myelin which was not apparent in the controls. The most obvious effect was widespread "wrinkling" of the myelin in both large and small fibres from the ALS nerves. This phenomenon is the initial stage of a process which eventually results in uneven myelin thickness and nodal swellings and finally myelin ovoids and balls. We illustrate the steps in the progression of this degeneration with teased nerve studies and electron microscopy and propose that there are qualitative changes in the myelin of peripheral nerve in ALS. It seems likely that these are secondary effects resulting from axonal degeneration caused by deterioration and loss of anterior horn cells in the spinal cord.

Amyotrophic Lateral Sclerosis↗
PubMed1999

Analgesia with femoral nerve block for anterior cruciate ligament reconstruction.

Anterior cruciate ligament reconstruction is performed routinely as an outpatient surgical procedure despite few studies of patient acceptance or postoperative patient analgesia. This study reports the first series of postoperative femoral nerve blocks as analgesia for outpatient anterior cruciate ligament reconstruction. The authors retrospectively reviewed 161 patients undergoing two incision arthroscopically assisted autograft middle 1/3 patellar tendon anterior cruciate ligament reconstruction on an out-patient basis at the authors' institution during a period of 30 months. Hospital and anesthesia records were reviewed, and 83% of patients were contacted retrospectively to survey their perceptions of the procedure and its outcome. Ninety-eight percent of the patients were discharged from the ambulatory surgery center, with 51% discharged the same day as the surgery and 47% discharged by 7:00 AM the next day. As the study progressed, the number of patients staying overnight was reduced by 50%. Ninety-eight percent of patients surveyed found femoral nerve block to be beneficial, and the same percentage thought the discharge time was appropriate. However, 69% of patients staying overnight cited reasons other than pain as factors in their stay. No significant complications were reported. Based on these results, the administration of a femoral nerve block is recommended for patients undergoing outpatient anterior cruciate ligament reconstruction because it is a highly effective form of analgesia with an excellent degree of patient satisfaction.

Adolescent↗
PubMed1978

Ultrastructural sequence of myelin degradation. II. Wallerian degeneration in the rat femoral nerve.

Myelin degradation in Wallerian degeneration of rat femoral nerves has been studied with the electron microscope. In the initial stages, a decrease of myelin periodicity from 115 A to 88 A was noted, followed by the transformation of the myelin structure into uniformly layered lipid inclusions. 10--14 days after nerve section, most of the inclusions found represented unstructured lipid droplets or crystals. In the later stages of degeneration, numerous pleomorphic lamellar inclusions were found, some of them resembling the structure of pi and micron-granules. Lysosomal enzyme activity was found especially in pleomorphic inclusions during the late stages of myelin degradation. Normal myelin sheaths, as well as unstructured lipid droplets and crystals, were devoid of enzyme activity. The results are compared with alterations found in Wallerian degeneration of the central nervous system.

Animals↗