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PubMed2005

Best evidence topic report. No evidence found that a femoral nerve block in cases of femoral shaft fractures can delay the diagnosis of compartment syndrome of the thigh.

A short cut review was carried out to establish whether a femoral nerve block may mask the signs and symptoms of thigh compartment syndrome. No relevant papers were found using the reported search. There is no evidence to associate a femoral nerve block with a delayed or missed diagnosis of compartment syndrome.

Compartment Syndromes↗
PubMed1987

[A complication of continuous blockade of the femoral nerve].

The continuous femoral nerve block is an effective method of analgesia after knee surgery. We report a case with acute compression syndrome of the femoral nerve caused by a subfascial hematoma. The symptoms developed 30 h after induction of the block. Immediate decompression brought pain relief and prevented permanent neurologic sequelae.

Adult↗
PubMed1996

[Damage to the inguino-femoral nerves in the treatment of hernias. An anatomical hazard of traditional and laparoscopic techniques].

Laparoscopic techniques currently constitute an alternative proposed for the repair of hernias of the inguinofemoral region. Nerve injuries have led some teams to recommend technical principles based on the anatomical relations of these nerves with the subperitoneal fascia transversalis and inguinal fossae. An anatomical study consisting of dissection of nonembalmed cadavres, allowed, after evisceration, dissection of the lumbar plexus and its terminal branches, particularly those supplying the inguinofemoral region: iliohypogastric and ilio-inguinal nerves, the genitofemoral nerve, the femoral nerve and the lateral cutaneous nerve of the thigh. Via transperitoneal laparoscopy, the posterior surface of the anterior abdominal wall is centered on the deep inguinal ring, containing testicular vessels and the vas deferens. This deep inguinal ring receives the genitofemoral nerve. Medially, the anterior parietal peritoneum describes three folds formed by the outline of the epigastric artery, umbilical artery and urachus on the midline. The outline of Hesselbach's ligament separates the deep inguinal ring from Hesselbach's triangle, the zone of weakness of direct inguinal hernia. The iliac psoas muscle pass laterally underneath the inguinal ligament, while the external iliac vessels, subsequently becoming the femoral vessels, are located medially. Pectineal ligament lies on the posterior surface of the femoral ring between the umbilical artery and the epigastric artery. Installation of an abdominal wall prosthesis, either transperitoneally or retroperitoneally, must be centered on the deep inguinal ring, and its solid sutures are located medially to the pectineal ligament and anterior abdominal wall. On the other hand, the nerves at risk of being damaged are situated laterally: the ilio-inguinal and ilio-hypogastric nerves in the plane between external oblique and internal oblique above the anterior superior iliac spine, lateral cutaneous nerve of the thigh under the inguinal ligament close to the anterior superior iliac spine, genitofemoral nerve with the spermatic cord in the deep inguinal ring and femoral nerve underneath the inguinal ligament with the psoas muscle lateral to the external iliac artery. No stapling must be performed under the plane of the inguinal ligament to avoid damage to the femoral vessels and lateral to the deep inguinal ring to avoid nerve damage.

Femoral Nerve↗
PubMed1990

[An accidental motor blockade of the femoral nerve following a blockade of the lateral femoral cutaneous nerve].

One hundred fifty successful blockades of the lateral cutaneous nerve of the thigh according to the technique of Eriksson with 7-10 ml prilocaine 1% or bupivacaine 0.25% for meralgia paresthetica resulted unexpectedly in 4 cases of complete and 5 cases of partial motor block of the femoral nerve. The fully reversible paralysis or paresis of parts of the lower limb following blockade of the lateral cutaneous nerve of the thigh is explained as a partial 3-in-1 block.

Bupivacaine↗
PubMedDate not supplied

Postoperative analgesia and functional recovery after total-knee replacement: comparison of a continuous posterior lumbar plexus (psoas compartment) block, a continuous femoral nerve block, and the combination of a continuous femoral and sciatic nerve block.

BACKGROUND AND OBJECTIVES: Continuous femoral nerve block is a well-accepted technique for regional analgesia after total-knee replacement. However, many patients still experience considerable pain at the popliteal space and at the medial aspect of the knee. The goal of this study is to evaluate whether a psoas compartment catheter provides better postoperative analgesia than a femoral nerve catheter does and whether it is as effective as the combination of a femoral and a sciatic nerve catheter and, thus, improves functional outcome. METHODS: Ninety patients who underwent total-knee replacement under standardized general anesthesia participated in this prospective randomized study. Group FEM received a continuous femoral nerve block, group FEM/SCI received a combination of a femoral and a sciatic continuous nerve block, and group PSOAS received a continuous psoas compartment block. Patient-controlled analgesia with piritramide was available for 48 hours. Maximal bending and extending of the knee and walking distance was assessed during the first 7 days. A standardized telephone survey was conducted after 9 to 12 months to evaluate residual pain and functional outcome. RESULTS: Postoperative opioid consumption during 48 hours was significantly less in the FEM/SCI group (median: 18 mg; 25th/75th percentile: 6/40) compared with the FEM group (49 mg; 25/66) and the PSOAS group (44 mg; 30/62) (P =.002). Postoperative pain scores were not different, and no differences occurred with respect to short-term or long-term functional outcome. CONCLUSION: The FEM/SCI catheter is superior to FEM and PSOAS catheter with respect to reduced analgesic requirements after total-knee replacement, but functional outcome does not differ with those 3 continuous regional analgesia techniques.

Aged↗
PubMed1997

Mechanism of femoral nerve palsy complicating percutaneous ilioinguinal field block.

Femoral nerve palsy has been reported after percutaneous ilioinguinal field infiltration with general anaesthesia for inguinal herniorrhaphy. The mechanism whereby this could occur was studied in cadaver dissections. It was found that the plane between the transversus abdominis muscle and the transversalis fascia was continuous laterally with the tissue plane deep to the iliacus fascia, which is the plane containing the femoral nerve. Injection of methylene blue 1 ml into this plane resulted in pooling of dye around the femoral nerve. Femoral nerve palsy may result from infiltration of a sufficient volume of local anaesthetic into the plane between the transversus abdominis muscle and the transversalis fascia with tracking of the injectate deep to the iliacus fascia to affect the femoral nerve. This finding has important implications for the performance of a percutaneous ilioinguinal field block particularly in day surgery provision.

Anesthetics, Local↗
PubMed1987

Femoral nerve block in the initial management of femoral shaft fractures.

The aim of this study was to demonstrate that the under-used technique of femoral nerve block (F.N.B.) (Berry, 1977) has excellent analgesic action for femoral shaft fractures when performed by junior staff. It had no recorded side effects and was used in all age groups for fractures at all levels along the femoral shaft. Twenty-seven consecutive patients were studied as they presented in an accident room, all received a femoral nerve block (10 ml 1% Lignocaine with 1:200,000 adrenaline) from unsupervised junior accident and emergency staff instructed in the technique. Each case was subsequently followed up, and both the delay before the onset of analgesia and total duration of analgesia, together with its efficacy, were assessed. A further F.N.B. using a different agent (10 ml 0.5% bupivacaine) was performed and the same parameters were assessed. Both agents gave effective analgesia of varying duration at all levels of fracture site.

Analgesia↗
PubMed1994

Femoral nerve damage after abdominal rectopexy.

Iatrogenic femoral nerve damage has already been described after hysterectomy, but never after abdominal rectopexy. We report the occurrence of femoral nerve injury in six of twenty-four patients operated on for complete rectal prolapse (n = 21) or rectorectal intussusception (n = 3). Four patients had unilateral and two bilateral lesions. All six patients had clinical and electromyographic (EMG) assessment. EMG findings were given a score from 0 (complete denervation) to 5 (normal findings). During the immediate postoperative period all patients complained of reduced cutaneous sensation of the anterior surface of the thigh and knee, and quadriceps weakness. EMG showed complete denervation in one patient, marked denervation in three, and slight or moderate denervation in the remaining two. In five patients there was complete clinical resolution at 3 to 12 months postoperatively, while one showed an improvement only. EMG control performed in four patients showed a full recovery in three. Two patients refused this examination. We believe femoral nerve damage was caused by the large-bladed self-retaining retractors used, which directly or indirectly compressed the femoral nerve.

Abdomen↗
PubMed1999

Anatomical landmarks for femoral nerve block: a comparison of four needle insertion sites.

UNLABELLED: The site for needle insertion in femoral nerve block varies significantly among various descriptions of the technique. To determine the site with the highest likelihood of needle-femoral nerve contact, femoral nerve block was simulated in a human cadaver model (17 femoral triangles from 9 adult cadavers). Four 20-gauge 50-mm-long styletted catheters were inserted at four frequently suggested insertion sites for femoral nerve block. At the levels of inguinal ligament and the inguinal crease, the catheters were inserted adjacent to the lateral border of the femoral artery and 2 cm lateral to the femoral artery. During anatomical dissection, we studied the number of catheter-nerve contacts for each of the four insertion sites, and relationships between the femoral nerve and other anatomical structures of relevance to femoral nerve block. Insertion of the needle at the level of the inguinal crease, next to the lateral border of the femoral artery resulted in the highest frequency of needle-femoral nerve contacts (71%). Of note, the femoral nerve was significantly wider (14.0 vs 9.8 mm) and closer to the fascia lata (6.8 vs 26.4 mm) at the inguinal crease than at the inguinal ligament level. We conclude that needle insertion at the inguinal crease level immediately adjacent to the femoral artery produced the highest rate of needle-femoral nerve contacts. The main factors influencing this result include the greater width of the femoral nerve and the more predictable femoral artery-femoral nerve relationship at the inguinal crease level, compared with the inguinal ligament level. IMPLICATIONS: Insertion of a needle at the inguinal crease level and immediately adjacent to the lateral border of the femoral artery results in a high rate of needle-femoral nerve contact.

Adult↗
PubMed1993

The efficacy of femoral nerve intraoperative somatosensory evoked potentials during surgical treatment of thoracolumbar fractures.

Somatosensory evoked potential (SEP) monitoring of thoracolumbar procedures typically includes posterior tibial and peroneal nerve recordings. The addition of femoral nerve SEP monitoring, however, should better predict the evolution of postoperative neurologic deficits affecting the midlumbar roots. To assess the value of intraoperative femoral SEPs, 26 cases of traumatic injury to the thoracolumbar spine between T12 and L4 were prospectively assessed. Twenty-four had clear femoral nerve responses bilaterally recorded from an epidural electrode. Five had significant intraoperative SEP changes: one had isolated femoral nerve changes, two had only peroneal or tibial nerve changes, and two had concomitant changes in both femoral and peroneal or tibial nerves. Loss of the femoral nerve response in one patient was correlated with marked postoperative knee extensor weakness, in spite of immediate action taken by the surgeon. The authors conclude that femoral nerve SEPs provide an effective tool to monitor the midlumbar roots intraoperatively.

Adult↗
PubMed2007

Femoral nerve entrapment: a new insight.

Compression of the femoral nerve in the iliac fossa has been reported as a consequence of several pathologies, but never as a result of muscular compression. Aberrant slips of iliacus, however, have occasionally been reported to cover or split the femoral nerve. This study aimed to assess such variations as potential factors in femoral nerve compression. A large and homogeneous sample of 121 embalmed cadavers (242 specimens) was studied. Statistical comparisons were made using the chi-squared test. Muscular slips from iliacus and psoas, piercing or covering the femoral nerve, were found in 19 specimens (7.9%). No significant differences by sex or side were found. The more frequent variation was piercing of the femoral nerve by a muscular slip (17 specimens, 7.0%). The nerve then entered the thigh as one or more branches. The less frequent variation found was a muscular slip or sheet covering the femoral nerve as it lay on iliacus (2 specimens, 0.8%). Each disposition may be a potential risk for nerve entrapment.

Abdominal Muscles↗
PubMed1998

Femoral nerve transfer for treatment of brachial plexus root avulsion.

Femoral nerve transfer to the muscular branches of the thenar and hypothenar muscles was performed to determine its protective effect on the hand intrinsic muscles. Seven cases of brachial plexus root avulsion treated from May of 1989 to October of 1991 were involved. The femoral nerve transfer to the muscular branches of the thenar and hypothenar muscles was done at the same stage of multiple neurotization. The muscular branches derived from the femoral nerve were isolated and coapted with the thenar muscle branch of the median nerve and the deep branch of the ulnar nerve. A groin flap was harvested simultaneously to form a skin-tube pedicle that covered the nerve bridge. At the second stage, when regeneration of the median and ulnar nerves was found to reach as far as the level of the wrist, the femoral nerve was divided and the muscular branches of the thenar and hypothenar muscles were anastomosed with the regenerated median and ulnar nerves. All the cases were followed up for more than 6 years. Six months after femoral nerve transfer, muscle power of the interosseous muscles and adductor pollicis recovered to MRC3, whereas that of the abductor pollicis brevis recovered to MRC1 to 2. Five cases underwent second-stage transfer. Four to five years of follow-up revealed that the muscle power of the interosseous muscles and adductor pollicis was MRC2 in one case, MRC1 in three cases, and MRC0 in one case. As for the donor area, muscle power of the quadriceps femoris reduced to M3 to 4 within 1 month after femoral nerve transfer and recovered to normal at 3 months. In conclusion, femoral nerve transfer to the muscular branches of the thenar and hypothenar muscles has some protective effect on the hand intrinsic muscles. The outcome of the second stage, however, is not satisfactory.

Adolescent↗
PubMed1979

Iatrogenic femoral nerve injuries.

Eighteen cases of iatrogenic femoral nerve injury are described. In two patients the damage was incurred as a result of an intra-abdominal operation. In three others the nerve was injured at the level of the inguinal ligament. In the majority femoral nerve palsy followed surgery to the hip joint and was attributable to a lesion-in-continuity. Only one of the patients in the series made a full recovery, but because only severe cases were included these disappointing results by no means represent the expected outcome. To avoid this serious and distressing complication of surgery, the surgeon must be familiar with the anatomic features of the region and must take care to avoid compression of the femoral nerve by retractors and its overstretching during operations on the the hip joint.

Adolescent↗
PubMed1983

[Anatomical and clinical study on the femoral nerve lesion].

Neuralgic and paralytic symptoms due to lesions of the femoral nerve or its related nerve roots are not infrequently encountered and therefore, clinically important. In order to clarify their pathomechanism the author has done anatomical, kinesiologic, and clinical studies. The topographic course of the femoral nerve was carefully observed in 40 cadavers (80 nerves) and transverse sections of 4 cadavers cut horizontally at various levels. The interrelation between the nerve and its surrounding organs was thus analysed. The 81 cases (87 nerves) of femoral nerve lesion, including lumbar radiculopathy, femoral neuropathy, and saphenous nerve lesion, were clinically followed up and the mechanism of their production was analysed. Besides, kinesiologic studies using electromyograms of the trunk and lower extremity muscles were performed in 8 cases (9 lesions) and 20 normal male controls. The main results obtained are as follows: 1. From the embryologic and morphologic points of view, the femoral nerve runs a peculiar course and has characteristic shapes in its transverse sections at various levels. 2. As the nerve lies closely adjacent to several pelvic organs, it can easily be influenced by their pathological conditions. 3. When the adjacent organs are treated surgically, it may be rare that the nerve is injured, constituting a complication. 4. The pathomechanism of the femoral neuropathy occurring at the inguinal ligament is quite similar to that of entrapment neuropathy of the peripheral nerve that occurs at a fibro-osseous tunnel. 5. Even if the quadriceps femoris muscle is totally paralysed, extention of the knee joint is possible to some extent because of a compensatory action of the tensor fasciae latae muscle.

Adult↗
PubMed1995

Femoral nerve "sheath" for inguinal paravascular lumbar plexus block is not found in human cadavers.

STUDY OBJECTIVE: To determine if a femoral nerve sheath capable of conveying local anesthetic to the lumbar plexus and the obturator nerve exists in human cadavers. DESIGN: Injection of methylene blue dye into the femoral nerves of human cadavers followed by dissection and observation of dye distribution. SETTING: University medical center pathology department autopsy room. PATIENTS: Six fresh adult cadavers about to undergo postmortem examination. INTERVENTIONS: Both femoral nerves of six fresh cadavers were injected with either 20 ml or 40 ml of dye. The abdomen was opened and distribution of the dye was observed. MEASUREMENTS AND MAIN RESULTS: In all of the cadavers studied there was no evidence of a femoral nerve sheath capable of conveying methylene blue dye to the lumbar plexus. Both 20 ml and 40 ml of dye injected into the femoral nerve failed to reach the lumbar plexus or the obturator nerve. When 40 ml of dye was injected it always stained the femoral nerves, it usually stained the lateral femoral cutaneous nerves, but it never stained the obturator nerves. CONCLUSIONS: A femoral nerve sheath capable of conveying a solution to the cadaver lumbar plexus does not exist in human cadavers. Dye injected into the cadaver femoral nerve does not reach either the lumbar plexus or the obturator nerve. When 40 ml of methylene blue dye is injected into the cadaver femoral nerve, some dye usually diffuses under the iliacus muscle fascia to the lateral femoral cutaneous nerve. This study indicates that in patients the "3-in-1 block" always blocks the femoral nerve, it usually blocks the lateral femoral cutaneous nerve, but it probably does not block the lumbar plexus or the obturator nerve.

Adult↗
PubMed1991

Retroperitoneal part of the femoral nerve. Normal ultrasound features.

The retroperitoneal part of the normal femoral nerve has been studied in 34 healthy subjects with ultrasound (US) to evaluate its course, thickness and anteroposterior diameter. A correlative cadaver study was also undertaken; a cadaver was scanned during dissection, and 12 cadavers were studied macroscopically to evaluate the length of the retroperitoneal part of the nerve. Because the femoral nerve could be well seen in its course in the retroperitoneum with US, it is suggested in this study which--to the authors' knowledge--is the first report on imaging of the femoral nerve, that sonography may serve as an initial imaging tool to detect lesions of the nerve itself as well as lesions adjacent to it.

Adolescent↗
PubMed2003

The ultrasonographic appearance of the femoral nerve and cases of iatrogenic impairment.

OBJECTIVE: To assess the feasibility of ultrasonography of femoral nerves in a cadaveric specimen, healthy volunteers, and patients. METHODS: In 1 unembalmed cadaveric specimen (female, 90 years) and 20 healthy volunteers (9 male and 11 female, 18-50 years; n = 40 scans), the topographic features, cross-sectional shapes (oval or triangular), and cross-sectional areas of the femoral nerves were evaluated by ultrasonography (5- to 12-MHz broadband linear array). In a subsequent study, 7 consecutive patients with postoperative findings assigned to the femoral nerve were evaluated and assessed by a neurologist. RESULTS: The mean +/- SD anteroposterior and mediolateral diameters of the femoral nerves in the volunteers were 3.1 +/- 0.8 and 9.8 +/- 2.1 mm, respectively, at an average cross-sectional area of 21.7 +/- 5.2 mm2. The cross-sectional shape was oval in 67.5% superior to the inguinal ligament and in 95% inferior to the ligament. The infrainguinal femoral nerve showed variable distances to the femoral artery. In the subsequent patient study, 5 patients had swelling of the femoral nerve in the affected side. In 1 patient, the nerve had a blurred echo structure due to a hematoma. In 1 patient, major damage of the femoral nerve was ruled out clearly. CONCLUSIONS: Ultrasonography allows the depiction and assessment of the femoral nerve from about 10 cm superior to 5 cm inferior to the inguinal ligament. In this region, ultrasonography is helpful in detection of impairments and, therefore, in decisions about planning and even acceleration of further treatment.

Adult↗