The lateral femoral cutaneous nerve block

Ultrasound-Guided Regional Anesthesia for Pediatric Burn Reconstructive Surgery: A Prospective Study

Pediatric patients face multiple reconstructive surgeries to reestablish function and aesthetics postburn injury. Often, the site of the harvested graft for these reconstructions is reported to be the most painful part of the procedure and a common reason for deferring these reconstructive procedures. This study in pediatric burn patients undergoing reconstructive procedures examined the analgesia response to local anesthetic infiltration versus either a single ultrasound-guided regional nerve block of the lateral femoral cutaneous nerve (LFCN) or a fascia iliaca compartment block with catheter placement and continuous infusion. Nineteen patients were randomized to one of three groups (infiltration, single-shot nerve block, or compartment block with catheter) and received intraoperative analgesia intervention. Postoperatively, visual analog scale pain scores were recorded-for pain at the donor site-every 4 hours while awake-for 48 hours. This nonparametric data was analyzed using a two-way ANOVA, Friedman's test, and Kruskal-Wallis test, with significance determined at P < 0.05. The analysis demonstrated that the patients in the regional anesthesia groups were significantly more comfortable over the 48 hour hospital course than the patients in the control group. The patients receiving a single-shot block of the LFCN were more comfortable on postoperative day (POD) 0 while the catheter patients were more comfortable on POD 1 and POD 2. There was not a statistically significant difference in opioid requirements in any group. Regional anesthetic block of the LFCN, with or without catheter placement, provides an improved postoperative experience for the pediatric patient undergoing reconstructive surgery with lateral/anterolateral skin graft versus local anesthesia infiltration of donor site. For optimal comfort throughout the postoperative period, an ultrasound-guided block with continuous catheter may be beneficial.

Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients

OBJECTIVES

The purposes of this study were to describe a technique for treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy) using ultrasound guidance and to report the results of treatment.

METHODS

Twenty consecutive patients (7 male and 13 female; age range, 23-66 years; mean, 39 years) with meralgia paresthetica confirmed by electromyography were treated with perineural injection of 1 mL of methylprednisolone acetate (40 mg/mL) and 8 mL of mepivacaine, 2%, under direct ultrasound guidance. Main outcome measures included the technical success of the procedure, visual analog scale score for the lateral femoral cutaneous nerve (pain, burning sensation, and paresthesia), and visual analog scale global quality of life score.

RESULTS

Technical success (successful nerve block at the distribution of the lateral femoral cutaneous nerve) was achieved in all patients. Five patients felt slight sharp pain during needle insertion. The symptoms in 16 patients (80%) diminished progressively after the first week. The 4 remaining patients (20%) required a further perineural injection. The symptoms disappeared in all patients 2 months after injection (mean visual analog scale score ± SD for lateral femoral cutaneous neuropathy at baseline, 8.1 ± 2.1; at 2 months, 2.1 ± 0.5; t = 6.2; P < .001). The mean visual analog scale quality of life scored decreased from 6.9 ± 3.2 to 2.3 ± 2.5 (t = 5.3; P < .002).

CONCLUSIONS

Treatment of meralgia paresthetica with ultrasound-guided perineural injections resulted in substantial symptom relief in most patients 2 months after injection. Randomized placebo-controlled trials of this treatment should be considered in the future.

Ultrasound-Guided Blockade of the Lateral Femoral Cutaneous Nerve: Technical Description and Review of 10 Cases

Blockade of the lateral femoral cutaneous nerve (LFCN) is performed for therapeutic management of meralgia paresthetica and as a regional anesthetic technique. The conventional technique is associated with high failure rates secondary to variable LFCN anatomy. We describe a technique for blockade of the LFCN using ultrasound guidance. A cross-sectional view of the LFCN was obtained by identifying the anterior superior iliac spine, then moving a 14-to-7MHz linear array ultrasound probe in a medial caudal direction until the nerve was encountered. The needle was advanced to the LFCN under ultrasound guidance via a lateral to medial approach. Injection using dynamic ultrasound demonstrated excellent perineural spread. Ten subjects underwent successful blockade of the LFCN with this technique. Five subjects were obese. Use of ultrasound for precise needle placement allowed low injection volumes to be utilized. Theref were no complications. Ultrasound guidance can facilitate blockade of the LFCN for diagnostic and therapeutic purposes and may be particularly beneficial with patients with challenging surface anatomic landmarks, or when low volume injections are desired.

Grafts in dermatologic surgery: review and update on full- and split-thickness skin grafts, free cartilage grafts, and composite grafts

BACKGROUND

Skin grafting has evolved in the past centuries to encompass numerous well-established reconstruction techniques that are uniquely able to restore structure, function, and cosmesis to a variety of surgical wounds.

OBJECTIVE

To provide a detailed overview of the general principles of skin grafting geared for the dermatologist and the dermatologic surgeon.

METHODS

Comprehensive review of the literature.

RESULTS

A summary of the different applications and techniques of full- and split-thickness skin grafts, free cartilage grafts, and composite grafts is presented. Indications, advantages, disadvantages, techniques, and complications are discussed in depth.

CONCLUSION

Skin grafting is a dynamic and versatile method of cutaneous reconstruction that can be accomplished successfully with a thorough understanding of the principles and techniques of grafting.