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At least 145 records · Page 8Linked to original sources
PubMed1991

Post-operative analgesia following femoral-neck surgery--a comparison between 3 in 1 femoral nerve block and lateral cutaneous nerve block.

A prospective controlled randomized trial on patients receiving surgery for fractured neck of femur was carried out, in which post-operative analgesic requirements in three separate groups were compared. Patients in Group 1 acted as controls, whilst those in Groups 2 and 3 received lateral cutaneous nerve blocks and 3 in 1 femoral nerve blocks, respectively. Patients in Group 3 needed significantly less analgesia than the other two groups, and the time to first administration of analgesia was significantly longer. No complications of either of the nerve blocks was noted.

Aged↗
PubMed1982

[Paralysis of the femoral nerve complicating ilio-psoas hemorrhage after iliac bone transplantation (author's transl)].

The author reported an unusual complication of iliac bone transplantation for grafting of a tibial pseudarthrosis. In a patient having anticoagulant therapy, a large iliac haematoma developed in the donor site and extended deep to the iliacus muscle and through the osteomuscular gap into the retroperitoneal space. Moreover it spread downwards and entrapped the femoral nerve as it lies behind the iliac fascia, above the inguinal ligament. Both a paralytic ileus and a femoral nerve injury commanded surgical exploration through an oblique iliac approach; emptying of the clotted haematoma, section of the inguinal ligament and liberation of the femoral nerve enable to avoid definitive sequelae to the quadriceps but the time required is varying: three years after the accident, recovery is not complete in the operated patient probably owing to delayed surgery (three weeks).

Femoral Nerve↗
PubMedDate not supplied

A new rule for femoral nerve blocks.

BACKGROUND AND OBJECTIVES: Acupuncture points are described by use of a proportional system that is based on the width of the thumb at the level of the distal interphalangeal joint, defined as 1 CUN. Our study tested first the correlation between the CUN and weight and height in 500 Americans and second the hypothesis that the CUN system is superior to the conventional landmarks to localize the femoral nerve 1 or 2 cm lateral to the artery in a prospective, double-blinded, randomized study. METHODS: Sixty-two patients were randomized to receive a femoral nerve block by a needle entry point either 1 CUN lateral, 1 cm lateral, or 2 cm lateral to the femoral artery at the level of the inguinal crease. The time from needle entry to injection of local anesthetic was measured by an investigator blind to the technique, who also counted the frequency of needle repositioning, graded the ease of the block and its success, and registered complications. RESULTS: Good correlation occurred between weight and CUN (r = 0.79) and height and CUN (r = 0.83), which indicates that the CUN of a normal person (predefined as 175 cm tall and 70 kg weight) is 18.7 +/- 1 mm. In the CUN group, the femoral block was achieved significantly faster (P < .01) with fewer attempts (P < .003). The success rate was the same and complications did not differ significantly between the groups. CONCLUSION: A needle insertion point 1 CUN lateral to the midpoint of the palpated femoral artery at the level of the inguinal crease makes femoral nerve blocks faster and easier compared with conventional landmark 1 cm to 2 cm lateral to the artery.

Acupuncture Points↗
PubMed1997

Mononeuropathy of a distal branch of the femoral nerve in a body building champion.

A unique case of a body building champion with localised atrophy of the distal portion of the vastus lateralis muscle is reported; neurophysiological evaluation suggests a selective lesion of a distal branch of the vastus lateralis nerve (a motor branch of the femoral nerve). A necroscopic study in four cases was performed to better clarify the site and mechanism of nerve lesion. The data suggest that stretching and compression of the nerve has probably occurred during strenous exercise.

Adult↗
PubMed2002

Femoral nerve palsy caused by a self-retaining polyretractor during major pelvic surgery.

Postoperative femoral neuropathy is not a well-recognized complication in urology. We report 2 cases of femoral nerve palsy due to compression ascribed to the use of the self-retaining retractor. In the first case, the left femoral nerve was injured, and in the second case nerve injury was bilateral and synchronous. The clinical symptoms were a weakness of the quadriceps muscle and sensory anesthesia of the surrounding skin.

Aged↗
PubMed1998

A double-blind comparison of ropivacaine, bupivacaine, and mepivacaine during sciatic and femoral nerve blockade.

UNLABELLED: No study has evaluated the efficacy of ropivacaine in peripheral nerve block of the lower extremity. The purpose of this prospective, randomized, double-blind study was to compare ropivacaine, bupivacaine, and mepivacaine during combined sciatic-femoral nerve block. Forty-five ASA physical status I or II patients scheduled for elective hallux valgus repair with thigh tourniquet were randomized to receive combined sciatic-femoral block with 0.75% ropivacaine (ROPI, n = 15), 0.5% bupivacaine (BUPI, n = 15), and 2% mepivacaine (MEPI, n = 15). Time required for onset of sensory and motor block on the operated limb (readiness for surgery) and resolution of motor block, as well as onset of postsurgical pain and time of first analgesic requirement, were recorded. The three groups were similar with regard to demographic variables, duration of surgery, and measured visual analog pain scores. Onset of sensory and motor blockade was similar in Groups ROPI and MEPI and significantly shorter than in Group BUPI (P = 0.002 and P = 0.001, respectively). Resolution of motor block occurred later in Groups ROPI and BUPI than in Group MEPI (P = 0.005 and P = 0.0001, respectively). Duration of postoperative analgesia was significantly longer in Groups ROPI (670+/-227 min) and BUPI (880+/-312 min) compared with Group MEPI (251+/-47 min) (P = 0.0001), with a significant decrease in postoperative pain medication requirements (P < 0.05). We conclude that for sciatic-femoral nerve block, 0.75% ropivacaine has an onset similar to that of 2% mepivacaine and a duration of postoperative analgesia between that of 0.5% bupivacaine and 2% mepivacaine. IMPLICATIONS: Quick onset of block with prolonged postoperative analgesia is an important goal in peripheral nerve blockade. We evaluated the clinical properties of 0.5% bupivacaine, 2% mepivacaine, and 0.75% ropivacaine for sciatic-femoral nerve block and demonstrated that ropivacaine has an onset similar to that of mepivacaine but allows for postoperative analgesia between that of bupivacaine and mepivacaine.

Adult↗
PubMed2004

A single injection ultrasound-assisted femoral nerve block provides side effect-sparing analgesia when compared with intrathecal morphine in patients undergoing total knee arthroplasty.

Postoperative pain after total knee arthroplasty (TKA) is severe, and achieving adequate analgesia remains a clinical challenge. We tested the hypothesis that, in patients having unilateral TKA under intrathecal (IT) anesthesia, the addition of a femoral nerve block would provide superior analgesia when compared with IT morphine and demonstrate fewer adverse side effects. In a single-blinded and controlled trial, 41 ASA I-III patients undergoing unilateral TKA were randomized into 2 groups. Both groups received 15 mg of IT hyperbaric bupivacaine for the surgical anesthetic. Group ITM received 250 microg of IT morphine and group FNB received an ultrasound-assisted femoral nerve block with 40 mL of 0.5% ropivacaine, 5 microg/mL of epinephrine, and 75 microg of clonidine. At 1, 2, 4, 6, 12, and 24 h postoperatively, we measured visual analog scales for pain, cumulative IV morphine consumption, hemodynamics, and side effects. There were no statistically significant differences in morphine consumption, pain at rest, or pain with movement. However, group FNB had fewer perioperative side effects including nausea, vomiting, and pruritus (P < 0.05 for each event). This corresponded to a decrease in patient satisfaction in group ITM, in which 20% of the patients rated their experience as "unsatisfactory" (P < 0.05). We conclude that, in comparison with IT morphine, a single injection femoral nerve block provides equivalent analgesia but with a significant reduction in side effects for patients having TKA under bupivacaine intrathecal anesthesia.

Aged↗
PubMed1991

[War injuries of the femoral nerve. Apropos of a series of 27 cases].

The authors report a series of 27 war injuries to the femoral nerve which represent approximately 1% of all of the war injuries to peripheral nerves operated in our department since the Islamic revolution in Iran in 1978 and during the 8 years of the war between Iran and Iraq. All of the victims presented with associated lesions: abdominal (24 laparotomies, including 10 colostomies) and/or vascular (3 iliac artery by-pass grafts). We divided the cases into 3 groups. In Group 1 (18 cases), the femoral nerve had a mean defect of 8 centimetres which was grafted. In Group 2 (4 cases), the nerve was simply compressed by fibrosis and/or metallic bodies and was released. In Group 3 (5 cases), the nerve trunk had a partial loss of substance which was grafted. The motor results were very satisfactory (M3 to M5) in the 3 groups with muscular recovery in about 2 years.

Adolescent↗
PubMed1996

Tracheal, circulatory, and respiratory responses to femoral nerve stimulation.

Tracheal, circulatory, and respiratory responses to electrical stimulation of the afferent nerve from the hindlimb were analyzed in decerebrate, paralyzed, and mechanically ventilated dogs. Tension of the tracheal smooth muscle (TSM), arterial blood pressure, and phrenic nerve activity (PNA) were measured during stimulation of the proximal end of the transected femoral nerve (FNS) with train pulses (duration; 0.5 ms, frequency; 40 Hz). With low intensity (e.g., 0.62 V) FNS, TSM exhibited relaxation, arterial pressure decreased, and neural respiratory output (NRO) was reduced (3 of 8 dogs) or unchanged (5 of 8 dogs). With increases in stimulus intensity, TSM always exhibited relaxation while arterial pressure and NRO exhibited excitatory responses almost at the same thresholds (approximately 5 V). The TSM relaxation and the excitatory NRO and arterial responses augmented with increases in stimulus intensity up to 16 times of threshold of the excitatory NRO response. TSM response was blocked by intravenous atropine but pressor response and phrenic response were not. The arterial response disappeared after administration of a ganglionic blocker. These findings suggest that TSM, arterial pressure, and PNA may be controlled by one neuronal mechanism during high intensity FNS, but that arterial pressure and PNA may be modified by another mechanism in an inhibitory direction when the stimulus intensity is low. This study suggested the existence of a neural mechanism which controls the airway and cardiorespiratory systems properly to execute exercise. Physiological significance of the responses to low intensity femoral nerve stimulation was uncertain.

Animals↗
PubMed1983

Femoral nerve block--the anatomical basis for a single injection technique.

A technique for blocking the femoral nerve using a single needle placement is described. It depends on an appreciation of the anatomy and the need to feel loss of resistance twice as two fascial layers are penetrated during insertion of the needle just lateral to the femoral artery. A single injection of bupivacaine 0.35-0.5 per cent of at least 0.3 ml/kg will produce a satisfactory block.

Bupivacaine↗
PubMed2005

Manipulations of the mouse femoral nerve influence the accuracy of pathway reinnervation by motor neurons.

Previous studies using the femoral nerve model in both mice and rats have shown that regenerating motor axons prefer to reinnervate the terminal nerve branch to muscle versus a terminal nerve branch to skin, a process that has been termed preferential motor reinnervation (PMR). If end organ contact with muscle and skin is prevented, this preferential motor reinnervation still occurs in the rat. To better understand the process of preferential motor reinnervation in the mouse, we examined motor neuron reinnervation of muscle and cutaneous pathways without any end organ contact as well as with only cutaneous end organ contact. Surprisingly, there was no preferential motor reinnervation: Motor neurons preferred the cutaneous pathway over the muscle pathway when all end organ contact was prevented and showed an even greater preference for the cutaneous pathway when it was attached to skin.

Afferent Pathways↗
PubMed1998

AANA Journal Course: update for nurse anesthetists--femoral nerve block and 3-in-1 block in anesthesia.

Femoral nerve blocks and 3-in-1 blocks are simple and useful alternatives to other regional or general anesthetic techniques for selected surgeries. These blocks also may provide postoperative analgesia that may be a useful alternative to epidural or parenteral analgesia. Understanding the techniques of blockade, its appropriate applications, and the relevant anatomy may provide the anesthetist with a valuable alternative.

Contraindications↗
PubMed2006

Femoral nerve palsy after mandibular reconstruction with microvascular iliac flap: a complication under anticoagulation therapy.

Pharmacological prophylaxis and intervention are used extensively in head and neck reconstructions with microvascular flaps. There is no universally accepted protocol, but the microvascular surgery literature recommends intraoperative anticoagulation with heparin. Here is reported a case of iliacus haematoma with subsequent femoral nerve palsy after the harvest of a microvascular iliac flap for mandibular reconstruction in a patient who had been treated with heparin. The association between femoral nerve palsy and anticoagulant therapy has been well described. It remains unclear as to why the iliacus muscle is particularly vulnerable to intramuscular haemorrhage. Femoral nerve neuropathy is also an uncommon but recognized complication after abdominopelvic surgery. Iliacus haematoma secondary to microvascular surgery has not been previously reported. This case illustrates the need to be aware of this type of complication and its clinical manifestations for patients under anticoagulant therapy in the perioperative period during microvascular reconstructions.

Adult↗