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Ren YM, Tian MQ, Duan YH, Sun YB, Yang T, Hou WY, Xie SH. Was femoral nerve block effective for pain control of medial opening-wedge high tibial osteotomy?: A single blinded randomized controlled study. Medicine (Baltimore) 2021; 100:e23978. [PMID: 33545983 PMCID: PMC7837819 DOI: 10.1097/md.0000000000023978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 11/15/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Medial compartment femoro-tibial osteoarthritis (OA) is a common disease and opening-wedge high tibial osteotomy (OWHTO) is the common surgical procedure carried out for these patients. While most researchers are focusing on the surgical techniques during operation, the aim of this study is to evaluate the pain control effect of femoral nerve block (FNB) for OWHTO patients. METHODS In this prospective, single-center, randomized controlled trial (RCT) study, 41 patients were operated on by OWHTO for OA during 2017 to 2018. Twenty of them (group A) accepted epidural anesthesia with FNB and 21 patients (group B) only had their single epidural anesthesia. All blocks were successful and all the 41 patients recruited were included in the analysis and there was no loss to follow-up or withdrawal. Systematic records of visual analog scores (VAS), quadriceps strength, mean number of times of patient-controlled intravenous analgesia (PCIA), using of additional opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), and complications were done after hospitalization. The Student t test and Chi-Squared test was used and all P values ≤.05 were considered statistically significant. RESULTS VAS scores at rest (3.48 ± 1.0 vs 4.68 ± 1.1) and on movemment (4.51 ± 0.6 vs 4.97 ± 0.8) decreased more in group A than group B with significance at follow-up of 12 hours. The quadriceps strength, consumption of additional opioids or NSAID injections and mean number of times that the patients pushed the PCIA button didnot differ significantly within each group. CONCLUSION This RCT study shows that FNB in patients undergoing OWHTO for unicompartmental osteoarthritis of the knee could result in significant reduction in VAS scores at 12 hours postoperatively.Research registry, Researchregistry4792. Registered April 7, 2019 - Retrospectively registered, http://www.researchregistry.com.
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Karakousis VA, Liouliou D, Loula A, Kagianni N, Dietrich EM, Meditskou S, Sioga A, Papamitsou T. Immunohistochemical Femoral Nerve Study Following Bisphosphonates Administration. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:medicina56030140. [PMID: 32204565 PMCID: PMC7142497 DOI: 10.3390/medicina56030140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 01/07/2023]
Abstract
Background and objectives: Bisphosphonates represent selective inhibitors of excess osteoblastic bone resorption that characterizes all osteopathies, targeting osteoclasts and their precursors. Their long-term administration in postmenopausal women suffering from osteoporosis has resulted in neural adverse effects. The current study focuses on the research of possible alterations in the femoral nerve, caused by bisphosphonates. We hypothesized that bisphosphonates, taken orally (per os), may produce degenerative changes to the femoral nerve, affecting lower-limb posture and walking neuronal commands. Materials and Methods: In order to support our hypothesis, femoral nerve specimens were extracted from ten female 12-month-old Wistar rats given 0.05 milligrams (mg) per kilogram (kg) of body weight (b.w.) per week alendronate per os for 13 weeks and from ten female 12-month-old Wistar rats given normal saline that were used as a control group. Specimens were studied using immunohistochemistry for selected antibodies NeuN (Neuronal Nuclear Protein), a protein located within mature, postmitotic neural nucleus, and cytosol and Sox10 (Sex-determining Region Y (SRY) - High-Motility Group (HMG) - box 10). The latter marker is fundamental for myelination of peripheral nerves. Obtained slides were examined under a light microscope. Results: Samples extracted from rats given alendronate were more Sox10 positive compared to samples of the control group, where the marker's expression was not so intense. Both groups were equally NeuN positive. Our results are in agreement with previous studies conducted under a transmission electron microscope. Conclusions: The suggested pathophysiological mechanism linked to histological alterations described above is possibly related to toxic drug effects on Schwann and neuronal cells. Our hypothesis enhances the existing scientific evidence of degenerative changes present on femoral nerve following bisphosphonates administration, indicating a possible relationship between alendronate use and neuronal function.
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Schuh A, Handschu R, Eibl T, Janka M, Hönle W. [Meralgia paraesthetica (Bernhardt-Roth syndrome)]. MMW Fortschr Med 2017; 159:66-68. [PMID: 29124578 DOI: 10.1007/s15006-017-0282-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moazzam Z, Yoo PB. Electrical stimulation of the saphenous nerve in anesthetized rats: a novel therapeutic approach to treating overactive bladder. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:3125-3128. [PMID: 28268971 DOI: 10.1109/embc.2016.7591391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Posterior Tibial Nerve Stimulation (PTNS) is a minimally invasive yet effective therapy for treating overactive bladder (OAB) symptoms with electrical stimulations applied at 20 Hz coupled with amplitudes approximating the foot-twitch threshold (T). However, pre-clinical studies indicate that PTNS-evoked bladder reflexes require stimulation amplitudes exceeding 2T. The objective of this work was to evaluate the presence of secondary low-threshold sensory pathways in the hind-limb region that can be a potential target of activation during clinical PTNS set-up. Given the close proximity of the electrode tip and the cutaneous branches in the lower leg, we hypothesized the concomitant activation of saphenous nerve (SAFN) afferents during percutaneous PTNS. To this end, urodynamic model was established in ten anesthetized rats to investigate (1) the isolated role of SAFN trunk in modulating bladder activity and (2) characterize frequency-dependent changes in inhibitory response at low stimulation amplitudes. Our pre-clinical findings suggest that direct stimulation of SAFN can elicit robust and consistent inhibitory effects at 20 Hz. This novel inhibitory reflex may rationalize the therapeutic effects of clinical PTNS therapy and support the feasibility of enhancing the current algorithm of incontinence care.
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Edwards A, Larson E, Beckert M, Sahai N, Albright JP. TT-TG vs. modified lateral patellar edge for determination of tibial tubercle transfer distance in Fulkerson osteotomy procedures. Knee 2016; 23:712-5. [PMID: 27184882 PMCID: PMC6292210 DOI: 10.1016/j.knee.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/14/2016] [Accepted: 04/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial tubercle-trochlear groove (TT-TG) distance is currently used at our institution to determine tibial tubercle medialization required in Fulkerson osteotomies. If the correlation between a modified lateral patellar edge (LPE) and the transfer distance was found to be stronger than its correlation with TT-TG, it would suggest that the best measurement to use is actually modified LPE. METHODS The electronic medical records of 32 patients who underwent Fulkerson osteotomy procedures with femoral nerve stimulation were reviewed and measured. For each patient, modified LPE was measured on quadriceps active hyperextension MRI, and TT-TG was measured on passive extension MRI. Correlation between both TT-TG and LPE and tibial tubercle transfer distance was then determined and analysed. RESULTS The correlation between TT-TG and actual intra-operative tibial tubercle transfer distance in Fulkerson osteotomy procedures with intra-operative femoral nerve stimulation was found to be weak at 0.436 (p<0.05). The correlation between modified LPE and actual intra-operative tibial tubercle transfer distance was found to be strong at 0.697 (p<0.001). CONCLUSIONS The correlation between modified LPE and actual intra-operative tibial tubercle transfer distance was stronger than the correlation between TT-TG and tibial tubercle transfer distance. This suggests that the modified LPE may actually be a better preoperative determinant than the currently-utilized TT-TG of the transfer distance required during Fulkerson osteotomy procedures. LEVEL OF EVIDENCE Level II, diagnostic study.
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Lutz D, Kataria H, Kleene R, Loers G, Chaudhary H, Guseva D, Wu B, Jakovcevski I, Schachner M. Myelin Basic Protein Cleaves Cell Adhesion Molecule L1 and Improves Regeneration After Injury. Mol Neurobiol 2016; 53:3360-3376. [PMID: 26081148 DOI: 10.1007/s12035-015-9277-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/01/2015] [Indexed: 02/05/2023]
Abstract
Myelin basic protein (MBP) is a serine protease that cleaves neural cell adhesion molecule L1 and generates a transmembrane L1 fragment which facilitates L1-dependent functions in vitro, such as neurite outgrowth, neuronal cell migration and survival, myelination by Schwann cells as well as Schwann cell proliferation, migration, and process formation. Ablation and blocking of MBP or disruption of its proteolytic activity by mutation of a proteolytically active serine residue abolish L1-dependent cellular responses. In utero injection of adeno-associated virus encoding proteolytically active MBP into MBP-deficient shiverer mice normalizes differentiation, myelination, and synaptogenesis in the developing postnatal spinal cord, in contrast to proteolytically inactive MBP. Application of active MBP to the injured wild-type spinal cord and femoral nerve augments levels of a transmembrane L1 fragment, promotes remyelination, and improves functional recovery after injury. Application of MBP antibody impairs recovery. Virus-mediated expression of active MBP in the lesion site after spinal cord injury results in improved functional recovery, whereas injection of virus encoding proteolytically inactive MBP fails to do so. The present study provides evidence for a novel L1-mediated function of MBP in the developing spinal cord and in the injured adult mammalian nervous system that leads to enhanced recovery after acute trauma.
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Xiao Y, Hafeez A, Zhang Y, Liu S, Kong Q, Duan Y, Luo Y, Ding Y, Shi H, Ji X. Neuroprotection by peripheral nerve electrical stimulation and remote postconditioning against acute experimental ischaemic stroke. Neurol Res 2015; 37:447-53. [PMID: 25819636 DOI: 10.1179/1743132815y.0000000032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Local electrical stimulation (ES) was reported to protect the brain during ischaemic injury, while the protective effect of limb remote ischaemic postconditioning (RIPostC) was confirmed. The aim of this study was to explore whether remote peripheral nerve ES exerted neuroprotection and whether this procedure shared the same neuroprotective mechanism underlying RIPostC. METHODS Stroke in Sprague-Dawley rats was induced by distal middle cerebral artery occlusion (dMCAO). Rats were divided into five groups: dMCAO, RIPostC, ES, nerve resection (NR) + ES and RIPostC+ES. Twenty-four hours after reperfusion, rats were examined for neurobehavioural function, including forelimb fault placing test, Ludmila Belayev 12 score test, and infarct volume. The expression of Bcl-2 and cleaved-caspase-3 in ischaemic cortex was assessed by Western blot. RESULTS In forelimb fault placing test, as compared to the highest score in the stroke-only group, RIPostC, ES and RIPostC+ES groups showed a significantly (P < 0.01) lower score. The results were similar for the Ludmila Belayev 12 score test. The infarct volume of the treatment groups also exhibited significant (P < 0.01) reduction as compared to the stroke-only group. The volume of infarct tissue in the combination of RIPostC+ES was significantly less than RIPostC and ES alone (P < 0.05). Furthermore, NR blocked the ES's protection (P < 0.05) as compared to the ES group by using above-mentioned methods. Bcl-2 was upregulated, while cleaved-caspase-3 was downregulated in the experimental groups as compared to the control group. No difference was found among the experimental groups. DISCUSSION Peripheral nerve ES appears to have a neuroprotective effect in a rat dMCAO model. This effect may indicate a neural protective mechanism underlying beneficial effect of RIPostC.
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Block J, Silverstein JW, Ball HT, Mermelstein LE, DeWal HS, Madhok R, Basra SK, Goldstein MJ. Motor evoked potentials for femoral nerve protection in transpsoas lateral access surgery of the spine. Neurodiagn J 2015; 55:36-45. [PMID: 26036119 DOI: 10.1080/21646821.2015.1012456] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Detecting potential intraoperative injuries to the femoral nerve should be the main goal of neuromonitoring of lateral lumber interbody fusion (LLIF) procedures. We propose a theory and technique to utilize motor evoked potentials (MEPs) to protect the femoral nerve (a peripheral nerve), which is at risk in LLIF procedures. MEPs have been advocated and widely used for monitoring spinal cord function during surgical correction of spinal deformity and surgery of the cervical and thoracic spine, but have had limited acceptance for use in lumbar procedures. This is due to the theoretical possibility that MEP recordings may not be sensitive in detecting an injury to a single nerve root considering there is overlapping muscle innervation of adjacent root levels. However, in LLIF procedures, the surgeon is more likely to encounter lumbar plexus elements than nerve roots. Within the substance of the psoas muscle, the L2, L3, and L4 nerve roots combine in the lumbar plexus to form the trunk of the femoral nerve. At the point where the nerve roots become the trunk of the femoral nerve, there is no longer any alternative overlapping innervation to the quadriceps muscles. Insult to the fully formed femoral nerve, which completely blocks conduction in motor axons, should theoretically abolish all MEP responses to the quadriceps muscles. On multiple occasions over the past year, our neuro-monitoring groups have observed significantly degraded amplitudes of the femoral motor and/or sensory evoked potentials limited to only the surgical side. Most of these degraded response amplitudes rapidly returned to baseline values with a surgical intervention (i.e., prompt removal of surgical retraction).
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Satin AM, DePalma AA, Cuellar J, Gruson KI. Lateral femoral cutaneous nerve palsy following shoulder surgery in the beach chair position: a report of 4 cases. AMERICAN JOURNAL OF ORTHOPEDICS (BELLE MEAD, N.J.) 2014; 43:E206-E209. [PMID: 25251534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Neuropathy of the lateral femoral cutaneous nerve can present as pain, decreased sensation, and/or burning or tingling on the anterolateral thigh. We present 4 cases of lateral femoral cutaneous nerve palsy following shoulder surgery in the beach chair position, all of which occurred in obese patients. This complication, to our knowledge, has never been reported in conjunction with the beach chair position. We believe that the neurapraxia was due to external compression by the patients' abdominal pannus. Full resolution of symptoms can be expected within 6 months following conservative management. A preoperative discussion regarding this complication should occur with obese patients undergoing shoulder surgery in the beach chair position.
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Alant JDDV, Senjaya F, Ivanovic A, Forden J, Shakhbazau A, Midha R. The impact of motor axon misdirection and attrition on behavioral deficit following experimental nerve injuries. PLoS One 2013; 8:e82546. [PMID: 24282624 PMCID: PMC3839879 DOI: 10.1371/journal.pone.0082546] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/02/2013] [Indexed: 11/30/2022] Open
Abstract
Peripheral nerve transection and neuroma-in-continuity injuries are associated with permanent functional deficits, often despite successful end-organ reinnervation. Axonal misdirection with non-specific reinnervation, frustrated regeneration and axonal attrition are believed to be among the anatomical substrates that underlie the poor functional recovery associated with these devastating injuries. Yet, functional deficits associated with axonal misdirection in experimental neuroma-in-continuity injuries have not yet been studied. We hypothesized that experimental neuroma-in-continuity injuries would result in motor axon misdirection and attrition with proportional persistent functional deficits. The femoral nerve misdirection model was exploited to assess major motor pathway misdirection and axonal attrition over a spectrum of experimental nerve injuries, with neuroma-in-continuity injuries simulated by the combination of compression and traction forces in 42 male rats. Sciatic nerve injuries were employed in an additional 42 rats, to evaluate the contribution of axonal misdirection to locomotor deficits by a ladder rung task up to 12 weeks. Retrograde motor neuron labeling techniques were utilized to determine the degree of axonal misdirection and attrition. Characteristic histological neuroma-in-continuity features were demonstrated in the neuroma-in-continuity groups and poor functional recovery was seen despite successful nerve regeneration and muscle reinnervation. Good positive and negative correlations were observed respectively between axonal misdirection (p<.0001, r(2)=.67), motor neuron counts (attrition) (p<.0001, r(2)=.69) and final functional deficits. We demonstrate prominent motor axon misdirection and attrition in neuroma-in-continuity and transection injuries of mixed motor nerves that contribute to the long-term functional deficits. Although widely accepted in theory, to our knowledge, this is the first experimental evidence to convincingly demonstrate these correlations with data inclusive of the neuroma-in-continuity spectrum. This work emphasizes the need to focus on strategies that promote both robust and accurate nerve regeneration to optimize functional recovery. It also demonstrates that clinically relevant neuroma-in-continuity injuries can now also be subjected to experimental investigation.
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Kabakov BO. [Impact of saturation of the mixed capillary blood on the subjective estimation of the postoperative pain intensity]. KLINICHNA KHIRURHIIA 2013:45-47. [PMID: 24501968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The impact of prolonged perineural blocade of n. femoralis on a subjective estimation of the postoperative pain intensity and its connection with the mixed capillary blood saturation was investigated.
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Lavasani M, Gehrmann S, Gharaibeh B, Clark KA, Kaufmann RA, Péault B, Goitz RJ, Huard J. Venous graft-derived cells participate in peripheral nerve regeneration. PLoS One 2011; 6:e24801. [PMID: 21966370 PMCID: PMC3179479 DOI: 10.1371/journal.pone.0024801] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 08/19/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Based on growing evidence that some adult multipotent cells necessary for tissue regeneration reside in the walls of blood vessels and the clinical success of vein wrapping for functional repair of nerve damage, we hypothesized that the repair of nerves via vein wrapping is mediated by cells migrating from the implanted venous grafts into the nerve bundle. METHODOLOGY/PRINCIPAL FINDINGS To test the hypothesis, severed femoral nerves of rats were grafted with venous grafts from animals of the opposite sex. Nerve regeneration was impaired when decellularized or irradiated venous grafts were used in comparison to untreated grafts, supporting the involvement of venous graft-derived cells in peripheral nerve repair. Donor cells bearing Y chromosomes integrated into the area of the host injured nerve and participated in remyelination and nerve regeneration. The regenerated nerve exhibited proper axonal myelination, and expressed neuronal and glial cell markers. CONCLUSIONS/SIGNIFICANCE These novel findings identify the mechanism by which vein wrapping promotes nerve regeneration.
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De Burca N. Anterior thigh pain - A case report. MANUAL THERAPY 2011; 16:291-295. [PMID: 21185767 DOI: 10.1016/j.math.2010.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 11/20/2010] [Accepted: 11/24/2010] [Indexed: 05/30/2023]
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Tsubota H, Nakamura T. Chronic contained rupture of an abdominal aortic aneurysm manifesting as lower extremity neuropathy. J Vasc Surg 2011; 55:548. [PMID: 21458206 DOI: 10.1016/j.jvs.2010.12.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 12/17/2010] [Accepted: 12/17/2010] [Indexed: 11/16/2022]
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Goulding K, Beaulé PE, Kim PR, Fazekas A. Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty. Clin Orthop Relat Res 2010; 468:2397-404. [PMID: 20532717 PMCID: PMC2919880 DOI: 10.1007/s11999-010-1406-5] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although injury to the lateral femoral cutaneous nerve (LFCN) is a known complication of anterior approaches to the hip and pelvis, no study has quantified its' incidence in anterior arthroplasty procedures. QUESTIONS/PURPOSES We therefore defined the incidence, functional impact, and natural history of LFCN neuropraxia after an anterior approach for both hip resurfacing (HR) and primary total hip arthroplasty (THA). METHODS We followed 132 patients who underwent an anterior hip approach (55 THA; 77 HR). We administered self-reported questionnaires for sensory deficits of LFCN, neuropathic pain score (DN4), visual analog scale, as well as SF-12, UCLA, and WOMAC scores at one year postoperatively. A subset of 60 patients (30 THA; 30 HR) was evaluated at two time intervals. RESULTS One hundred seven patients (81%) reported LFCN neuropraxia with a mean severity score of 2.32/10 and a mean DN4 score of 2.42/10. Hip resurfacing had a higher incidence of neuropraxia as compared with THA: 91% versus 67%, respectively. No functional limitations were reported on SF-12, WOMAC, or UCLA scores. Of the subset of 60 patients followed over an average of 12 months, 53 (88%) reported neuropraxia at the first followup interval with only three (6%) having complete resolution at second followup. Improvement in DN4 scores was observed over time: 3.6 versus 2.5, respectively. CONCLUSIONS Although LFCN neuropraxia was a frequent complication after anterior approach THA, it did not lead to functional limitations in our patients. A decrease in symptoms occurred over time but only a small number of patients reported complete resolution. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Villegas Duque A, Ortiz de la Tabla González R, Martínez Navas A, Echevarría Moreno M. [Continuous femoral block for postoperative analgesia in a patient with poliomyelitis]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:123-124. [PMID: 20337008 DOI: 10.1016/s0034-9356(10)70179-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res 2010; 468:135-40. [PMID: 19680735 PMCID: PMC2795813 DOI: 10.1007/s11999-009-1025-1] [Citation(s) in RCA: 217] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 07/23/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Preemptive and multimodal pain control protocols have been introduced to enhance rehabilitation after total knee arthroplasty (TKA). We determined the complication rate associated with preoperative femoral nerve block (FNB) for TKA. Among 1018 TKA operations, we performed 709 FNBs using a single-injection technique into the femoral nerve sheath and confirming position with nerve stimulation before induction. After TKA, weightbearing as tolerated was initiated using a walker or crutches on postoperative Day 1. Twelve patients (1.6%) treated with FNB sustained falls, three (0.4%) of whom underwent reoperations. Five patients had postoperative femoral neuritis, which may have been secondary to the block. One patient had new onset of atrial fibrillation after FNB, and the TKA was postponed. Femoral nerve block before TKA is not a harmless intervention. We recommend postoperative protocols be modified for patients who have FNB to account for decreased quadriceps function in the early postoperative period, which can lead to falls. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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MESH Headings
- Accidental Falls/statistics & numerical data
- Adult
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/rehabilitation
- Female
- Femoral Nerve/drug effects
- Femoral Nerve/pathology
- Femoral Nerve/physiopathology
- Humans
- Joint Diseases/drug therapy
- Joint Diseases/surgery
- Length of Stay
- Male
- Middle Aged
- Nerve Block/adverse effects
- Nerve Block/methods
- Neuritis/chemically induced
- Neuritis/diagnosis
- Neuritis/physiopathology
- Pain Measurement
- Pain, Postoperative/etiology
- Pain, Postoperative/physiopathology
- Pain, Postoperative/prevention & control
- Postoperative Complications/etiology
- Quadriceps Muscle/drug effects
- Quadriceps Muscle/physiopathology
- Range of Motion, Articular
- Recovery of Function
- Reoperation
- Retrospective Studies
- Treatment Outcome
- Weight-Bearing
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Stephenson LL, Webb NA, Smithers CJ, Sager SL, Seefelder C. Lateral femoral cutaneous neuropathy following lateral positioning on a bean bag. J Clin Anesth 2009; 21:383-4. [PMID: 19700294 DOI: 10.1016/j.jclinane.2008.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 11/29/2008] [Accepted: 12/16/2008] [Indexed: 11/16/2022]
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Puzdrova VA, Kargina-Terent'eva RA, Tarasova OS. [Effect of chronic hypotension on the adrenergic nerve plexus of the rat a. saphena and on its regeneration after femoral nerve injury]. MORFOLOGIIA (SAINT PETERSBURG, RUSSIA) 2008; 133:15-19. [PMID: 18942350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The influence of chronic hypotension on density and fluorescence intensity (after glyoxylic acid treatment) of periarterial plexus of nerve fibers in saphenous artery wall and on reinnervation of this vessel was studied in Wistar rats. Regional hypotension in the rat hindquarters vascular system was created by partial occlusion of abdominal aorta distally to the renal arteries. Four weeks later, the segment of femoral nerve was resected in one of the limbs to denervate the saphenous artery. In the limb with intact nerve, chronic (6-7 weeks-long) hypotension resulted in 20% decrease of fluorescence intensity of nerve fibers, as compared to that one in normotensive (control) rats, however the density of the nerve plexus did not change. Partial reinnervation of the vessel occurred in 2-3 weeks after femoral nerve injury. After 2 weeks parameters of reinnervation were similar in hypotensive and normotensive rats, but after 3 weeks hypotensive rats demonstrated more complete restoration of the innervation.
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Mathis F, Desfoux N, Sprumont P, Hecker E, Rossier P, Spicher C. [Peripheral neuropathic pain relieved by somatosensory rehabilitation]. REVUE MEDICALE SUISSE 2007; 3:2745-2748. [PMID: 18214230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The femoral neuralgia is a rather frequent and invalidating clinical disorder. It takes on many clinical forms because of the anatomical variations of the cutaneous branches of saphenous and femoral nerves. The neuroplasticity of the somato-sensory system has now been determined which allows for a better understanding of the techniques of somatosensory rehabilitation. The authors precisely explain the various stages necessary in the care of patients suffering from femoral neuralgia. The various strategies of somatosensory rehabilitation are mentioned. The authors also present a brief review of the pharmacological treatments of peripheral neuropathic pain. Lastly, the result of the somatosensory rehabilitation of femoral neuralgia (NNT = 1.8) is documented on the basis of a prospective study done on 59 patients.
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Tataroglu C, Bicerol B, Kiylioglu N, Ozkul A, Akyol A. Proximal femoral conductions in patients with lumbosacral radiculoplexus neuropathy. Clin Neurol Neurosurg 2007; 109:654-60. [PMID: 17573186 DOI: 10.1016/j.clineuro.2007.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 05/07/2007] [Accepted: 05/11/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Lumbosacral radiculoplexus neuropathy (DLRPN) is a rare form of neuropathy observed in diabetic and rarely non-diabetic patients. Pathophysiology and lesion location are not clearly understood. Our aim was to analyze proximal and distal femoral conductions in patients with DLRPN. METHODS Six patients with DLRPN, 14 patients with diabetic polyneuropathy and 25 healthy subjects were included in the study. We performed L3 monopolar root stimulation and femoral nerve trunk stimulation at the inguinal region and calculated lumbar plexus conduction time by subtracting the latency of compound muscle action potential (CMAP) of the vastus medialis evoked by femoral nerve stimulation from the latency of CMAP of vastus medialis evoked by L3 root stimulation. Additionally peak to peak amplitudes and areas of CMAPs were analyzed. RESULTS Electrophysiological examination showed that there was an axonal involvement in all patients with DLRPN. Prolonged lumbar plexus conduction time (in five extremities), and prolonged distal latency of the femoral nerve (in five extremities) probably due to secondary demyelination were also observed. Similar abnormalities were not observed in the diabetic polyneuropathy group. CONCLUSIONS DLRPN may affect different localizations on the peripheral nerves. L3 root stimulation may have an important role in the electrodiagnosis of DLRPN.
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Cameron NE, Cotter MA. The neurocytokine, interleukin-6, corrects nerve dysfunction in experimental diabetes. Exp Neurol 2007; 207:23-9. [PMID: 17560573 DOI: 10.1016/j.expneurol.2007.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 05/11/2007] [Accepted: 05/11/2007] [Indexed: 10/23/2022]
Abstract
Interleukin-6 (IL-6) is a member of the neuropoietic cytokine family and has a multifunctional biological role in regulating the immune response, acute phase reactions, and hematopoiesis. IL-6 is also important in neural development and has neurotrophic actions. The aim was to ascertain whether IL-6 treatment could rectify some of the adverse early changes in neurovascular function in streptozotocin-induced diabetic rats. After 4 weeks of untreated diabetes, rats were treated with IL-6 (1-10 microg/kg thrice weekly) for 4 weeks. Diabetes caused 22% and 22.5% reductions in sciatic nerve motor and saphenous nerve sensory conduction velocity, respectively, which were dose dependently corrected by treatment. Diabetic rats also showed thermal hyperalgesia and tactile allodynia, which were completely corrected by IL-6; however, IL-6 was ineffective against mechanical hyperalgesia. Sciatic nerve endoneurial perfusion was 42.2% reduced by diabetes and blood flow was returned to the nondiabetic range by 10 microg/kg IL-6 treatment. The ED(50) values for these actions ranged from 1.2 microg/kg for sensory conduction velocity to 3.2 microg/kg for sciatic nerve perfusion. Thus, IL-6 treatment improved several measures of nerve dysfunction in experimental diabetes, and these effects correlated with a recovery of nerve blood flow. The magnitude of these beneficial effects and the potential joint neurotrophic and vascular action suggests that IL-6 could be a candidate for further evaluation in clinical trials of diabetic neuropathy.
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Truffert A, Alisauskiene M, Vaiciene N, Magistris MR. A clinical study of corticospinal and peripheral conductions to proximal lower limb muscles. Clin Neurophysiol 2007; 118:1824-34. [PMID: 17587640 DOI: 10.1016/j.clinph.2007.05.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Revised: 04/26/2007] [Accepted: 05/11/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the clinical utility of the newly developed "quadriceps combined technique" (QCT), which provides a global evaluation of the central and peripheral conduction to the proximal muscles of lower limbs, in a variety of central and peripheral neurological disorders. METHODS Using surface recordings from the vastus medialis of the quadriceps muscle, we analyzed amplitudes and latencies of M response, patellar T reflex and motor evoked potentials (MEPs) after transcranial magnetic stimulation. We studied 180 patients with disorders impairing proximal strength of one or both lower limbs and compared them with 100 controls reported previously. RESULTS The best parameters to detect central motor disorders were the central motor conduction time, MEP/M amplitude, T/MEP amplitude and latency ratios, whereas peripheral motor conduction time (PMCT) was best to assess peripheral disorders. The best parameter to identify proximal peripheral disorder was PMCTprox, whereas for distal peripheral disorders M amplitude and T/MEP amplitude ratio were most discriminative. CONCLUSIONS We report a simple, rapidly performed and well-tolerated method that improves proximal lower limbs evaluation, helps distinguishing pathologic from physiological brisk reflexes and provides clues for etiologic diagnosis. SIGNIFICANCE The QCT is a sensitive and specific tool to investigate central and peripheral neurological disorders.
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Ley L, Ikhouane M, Staiti G, Benhamou D. Complication neurologique après posture obstétricale «en tailleur» lors d'un travail sous analgésie péridurale. ACTA ACUST UNITED AC 2007; 26:666-9. [PMID: 17574376 DOI: 10.1016/j.annfar.2007.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 04/03/2007] [Indexed: 11/17/2022]
Abstract
Obstetrical positioning is used more and more often because of the supposed or proven benefits although side effects are not well known. We therefore report the case of a patient who presented with a postpartum neurological deficit after a seven hour hip-flexed posture during labour under epidural analgesia. The parturient did not complain of pain or discomfort during labour. The neurological injury was suspected because of delayed recovery of epidural analgesia-induced motor block. Neurological examination disclosed sensory and motor abnormalities in the left femoral and sciatic nerve distribution areas. The early performed lumbar CT-scan did not show any complication and electromyographic evaluation performed on the ninth postpartum day was normal. Three months after delivery, some degree of neuropathic pain in the sciatic nerve distribution remained. The risk of neurological injury directly related to obstetrical positioning is discussed. Prolonged positioning using a posture which can induce nerve stretching should be avoided. This is especially true when the patient is receiving epidural analgesia which can mask pain or discomfort.
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Fanning J, Carol T, Miller D, Flora R. Postoperative femoral motor neuropathy: diagnosis and treatment without neurologic consultation or testing. THE JOURNAL OF REPRODUCTIVE MEDICINE 2007; 52:285-8. [PMID: 17506367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To review the diagnosis and treatment of postoperative femoral motor neuropathy without neurologic consultation or testing. STUDY DESIGN A retrospective review of 6 consecutive patients with postoperative femoral motor neuropathy following gynecologic surgery. Diagnosis was made on clinical evaluation: history of falling during postoperative ambulation, quadriceps weakness, straight leg raise weakness, diminished knee jerk response, and no evidence of psoas hematoma or abscess. Neurologic consultation, electromyography, nerve conduction study and radiologic imaging, such as computed tomography, were not obtained. Instead, a physical therapy consultation was obtained for a knee orthotic and rehabilitation. RESULTS Four postoperative femoral motor neuropathies developed following 3,014 cases of major gynecologic surgery (0.1%). Two additional cases were seen in consultation. The median age was 57 years. All patients fell while attempting ambulation on postoperative day 1. Recovery occurred at a median of 3 months (1-4). At a median follow-up of 4 years, no patient had developed additional neurologic sequelae. A history of prior postoperative femoral motor neuropathy was noted in 2 of 6 patients (33%). CONCLUSION This was the first study of diagnosis and treatment of postoperative femoral motor neuropathy following gynecologic surgery without neurologic consultation or testing. Because of the significant expense of neurologic consultation and testing, patients with postoperative femoral motor neuropathy can have the condition diagnosed by the gynecologist and be referred directly to physical therapy without adversely affecting outcome. This also was the first study to elicit a prior history offemoral neuropathy in 33% of patients. Thus, a prior history may be a risk factor for recurrence.
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