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PubMed1982

[Functional morphology of neural elements in interorganic adhesions and in coalesced organs].

The results of investigations concerning the problem on reinnervation of organs and vessels are summarized. Under the conditions of organo- and neuropexy, regenerating neural fibers pass through two stages of development. The first stage--formation and growth of neural fibers, the second--a more prolonged period of successive quantitative and qualitative morpho-functional transformations of these elements into mature structures. Judging from the histochemical characteristics, the latter become functionally competent by the 5th month after implantation of neural trunks into the arterial walls (the common, carotid and femoral arteries). The organopexies affect the neural cells structure in the denervated urinary organs. The reparative processes occurring, to some extent, protect them from destruction and stimulate their partial restoration. When the vegetative ganglia (the cranial cervical, caudal mesenteric ganglia) are transposed on the organs, some neurocytes are preserved. Their composition and histochemical structure correspond to an intact ganglion. A suggestion is made that the partly preserved ganglion could be used to form a new center of local regulation. An observation has been made according to which under the inductive effect of the donor-organ in the organ-recipient numerous newly formed neural fibers appear. They are capable to participate in reinnervation of the injured organ and, hence, in restoration of its function.

Acetylcholinesterase↗
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↗
PubMedDate not supplied

Inguinal paravascular (lumbar plexus) neurolytic block--description of a catheter technique: case report.

BACKGROUND AND OBJECTIVES: We provided care for a 47-year-old female with a history of lung carcinoma and bony metastases who sustained a pathologic fracture of the right acetabulum causing severe and uncontrolled pain in the right groin. Her pain was rated as 8-10 on a 10-point visual analog scale (VAS). Her terminal disease and poor surgical risk precluded therapeutic operative intervention. Consequently, a neurolytic block of the lumbar plexus was performed as a palliative measure. METHODS: A modified inguinal paravascular (lumbar plexus) block technique was used. A 17-gauge Tuohy needle was inserted in the groin area just lateral to femoral artery and 1 cm below the inguinal ligament. A guide wire was threaded through the needle and subsequently an angiogram catheter was introduced over the wire into the psoas muscle. Radiographic confirmation of the position was obtained, and the catheter was secured in place. A prognostic block using an infusion of 0.25% bupivacaine at 5 mL/h was initiated for the first 2 days. On the third day a neurolytic block with 6% phenol was performed. RESULTS: Marked pain relief was experienced by the patient (VAS: 0-1). Sensory block in the femoral, lateral femoral cutaneous, and obturator nerve distributions was elicited. Motor weakness in the femoral nerve was demonstrated. Narcotic use was markedly reduced, and the patient was discharged to home in a pain-free state. CONCLUSIONS: This case report supports the feasibility of placing a catheter via a modified anterior inguinal paravascular block technique and its subsequent use for both local anesthetic infusion and neurolytic block of the lumbar plexus.

Acetabulum↗