Femoral nerve palsy: an unusual complication after femoral vein puncture in a patient with severe coagulopathy.
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Blood Coagulation Disorders↗
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Results for “FEMORAL NERVE”
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[Three-in-one block or femoral nerve block. What should be done and how?].
The "3 in 1" block and the femoral nerve block are widely used for lower limb surgery and postoperative analgesia. Whether these blocks are in fact a same regional block with two different names or represent definitively two different blocks remains controversial. A large number of anatomical as well as functional variations of the lumbar plexus have been described and complicate a rational analysis of the spread of local anaesthetics following these blocks. Anatomical, radiological and especially clinical data seem to confirm that these blocks are to be distinguished from one another. Femoral nerve block requires the use of a nerve stimulator and has a high success rate in the territory of the femoral nerve; a spread towards other lumbar nerves, especially the lateral femoral cutaneous nerve, is sometimes observed. The "3 in 1" block is supported by the idea of diffusion within a space that is located after going through two fascial layers. Even in experienced hands, the success predictive value is not high. However, once the "3 in 1" block is well performed, a complete anaesthesia covering the territories of the femoral nerve, the lateral femoral cutaneous nerve, and the obturator nerve occurs. Specific indications of each technique are different: major knee surgery and postoperative analgesia for the "3-in-1" block and leg surgery for femoral nerve block. The best approach for knee arthroscopy remains open for discussion.
Arthroscopy↗
Motor nerve conduction velocities of the femoral nerve.
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Electromyography↗
Saphenous nerve evoked potentials and the assessment of intraabdominal lesions of the femoral nerve.
A technique for recording somatosensory evoked potentials after stimulation of the patellar branch of the saphenous nerve is described and the results from 11 normal subjects and from two patients with intraabdominal femoral nerve injuries are presented. One patients developed a nerve lesion after an abdominal surgical procedure and the second suffered a gunshot wound causing femoral nerve paralysis. Both patients recovered spontaneously. Evoked potentials from saphenous nerves showed a significant discrepancy between faster motor recovery and delay in reinstating sensory axonal conduction.
Abdomen↗
The effects of femoral nerve blockade in conjunction with epidural analgesia after total knee arthroplasty.
Either epidural analgesia or femoral nerve blockade improves analgesia and rehabilitation after total knee arthroplasty. No study has evaluated the combination of femoral nerve blockade and epidural analgesia. In this prospective, randomized, blinded study we investigated combining femoral nerve blockade with epidural analgesia. Forty-one patients received a single-injection femoral nerve block with 0.375% bupivacaine and 5 microg/mL epinephrine; 39 patients served as controls. All patients received combined spinal-epidural anesthesia and patient-controlled epidural analgesia with 0.06% bupivacaine and 10 microg/mL hydromorphone. Average duration of epidural analgesia was 2 days. All patients received the same standardized physical therapy intervention. Median visual analog scale (VAS) scores with physical therapy were significantly lower for 2 days among patients who received a femoral nerve block versus controls: 3 versus 4 (day 1), 2.5 versus 4 (day 2); P < 0.05. Median VAS pain scores at rest were 0 in both groups on days 1 and 2. Flexion range of motion was improved on postoperative day 2 (70 degrees versus 63 degrees ; P < 0.05). No peripheral neuropathies occurred. We conclude that the addition of femoral nerve blockade to epidural analgesia significantly improved analgesia for the first 2 days after total knee arthroplasty.
Aged↗
The femoral nerve and its relationship to the lateral circumflex femoral artery.
Small branches of the femoral artery in the femoral triangle are not palpable and could increase the risk of intravascular injection during femoral nerve (FN) block. I evaluated the position of the lateral circumflex femoral artery (LCFA), a lateral branch of the femoral artery, in relationship to accepted landmarks for FN blockade, including the inguinal ligament, inguinal crease, and FA. Forty cadaver lower extremities were dissected. In 50% of specimens, the LCFA, as it crossed the FN, was within 1 cm of the inguinal crease, the recommended level for needle insertion for FN blockade. The mean depth of this artery at the inguinal crease was 1.7 cm, whereas the mean depth of the FN was 1.1 cm at this level. In most specimens, the LCFA coursed between the branches of the FN, although it sometimes lay deep to all of the branches. Knowledge of this anatomy may allow for safer FN blockade.
Femoral Artery↗
Femoral nerve block for analgesia in fractures of the femoral neck.
The purpose of this study was to investigate the efficacy of femoral nerve blocks in patients with fractures of the neck of the femur. Thirty-six patients with femoral neck fractures attending the accident department over a three month period received femoral blocks from one of the two authors. The effect of the block was assessed both subjectively and objectively. Thirty patients reported a worthwhile reduction in pain following the procedure and this was supported by objective blockade in 29. In all six patients who reported no benefit, the block failed objectively. There were no complications of the procedure.
Adult↗
Reduction of verbal pain scores after anterior cruciate ligament reconstruction with 2-day continuous femoral nerve block: a randomized clinical trial.
BACKGROUND: Single-injection femoral nerve block analgesia and spinal anesthesia have been associated with fewer postoperative nursing interventions and successful same-day discharge after anterior cruciate ligament reconstruction. In the current study, the authors prospectively determined the effect of continuous femoral nerve block on a numeric rating scale (NRS) of pain intensity with movement for 7 postoperative days. METHODS: Patients undergoing this surgery with no history of previous invasive surgery on the same knee were recruited for this study. After standardized spinal anesthesia, intravenous sedation, and perioperative multimodal analgesia, patients received a femoral nerve catheter with (1) saline bolus (30 ml) plus saline infusion (270 ml at 5 ml/h, placebo group); (2) levobupivacaine (0.25%) bolus with saline infusion (group I), or (3) levobupivacaine (0.25%) bolus and infusion (group II). Patients were surveyed preoperatively and on postoperative days 1-4 and 7 to determine NRS scores (scale 0-10). RESULTS: Data from 233 participants were analyzed. On days 1-2, 50% of placebo patients had NRS scores of 5 or above, whereas among group II patients, only 25% had scores of 5 or above (P < 0.001). In regression models for NRS scores during days 1-4, group II was the only factor predicting lower pain scores (odds ratios, 0.3-0.5; P = 0.001-0.03). Overall, patients with preoperative NRS scores greater than 2 were likely to report higher NRS scores during days 1-7 (odds ratios, 3.3-5.2; P < 0.001). CONCLUSIONS: Femoral nerve block catheters reliably keep NRS scores below the moderate-to-severe pain threshold for the first 4 days after anterior cruciate ligament reconstruction.
Adolescent↗
The effects of single or multiple injections on the volume of 0.5% ropivacaine required for femoral nerve blockade.
UNLABELLED: We compared the effects of using a single- or multiple-injection technique on the volume of 0.5% ropivacaine required to block the femoral nerve, in a prospective, randomized, blinded fashion in which 50 premedicated patients received a femoral nerve block with 0.5% ropivacaine by use of a nerve stimulator and either a single- (n = 25) or multiple- (n = 25) injection technique. Muscular twitches were elicited at < or =0.5 mA before anesthetic injection. The designated volume of local anesthetic was equally divided among contraction of the vastus medialis, vastus intermedius, and vastus lateralis for the multiple injections, or it was injected at the contraction of the vastus intermedius with motion of the patella for the single injection. The local anesthetic volumes were varied for consecutive patients by using an up-and-down staircase method; a blinded observer determined the adequacy of nerve blockade (loss of pinprick sensation in the medial, patellar, and lateral portions of the knee, with concomitant block of the quadriceps muscle) 20 min after injection. The mean (95% confidence interval) volume required for blocking the femoral nerve with the multiple-injection technique (14 [12-16] mL) was significantly smaller than that observed with the single injection (23 [20-26] mL) (P = 0.001). According to logistic regression analyses, the 95% effective volumes of ropivacaine required to block the femoral nerve within 20 min after injection were 29 and 21 mL with a single or multiple injection, respectively. We conclude that searching for multiple muscular twitches reduces the volume of 0.5% ropivacaine required to produce blockade of the femoral nerve. IMPLICATIONS: We evaluated the effects of using a single- or multiple-injection technique on the volume of 0.5% ropivacaine required to block the femoral nerve. The 95%effective concentration values for producing the same degree of sensory and motor blockade of the femoral nerve within 20 min after injection were 29 mL after elicitation of a patella twitch and 21 mL when the three main branches of the femoral nerve were identified, potentially leading to an important benefit for patients receiving peripheral nerve blocks.
Adolescent↗
Paravascular lumbar plexus block: block extension after femoral nerve stimulation and injection of 20 vs. 40 ml mepivacaine 10 mg/ml.
The goal of this prospective randomized study was to assess the extension of the "three-in-one" paravascular lumbar plexus block after femoral nerve stimulation and injection of 20 vs. 40 ml mepivacaine 10 mg/ml. Three-in-one blocks were achieved in 12 of 39 (31%) patients given 20 ml of 1% mepivacine (group 1), and 17 of 41 (41%) patients given 40 ml (Group 2) of the same solution (n.s.). The level of successful blockade at each nerve did not differ between groups. The femoral nerve was blocked in 92% vs. 93% of patients in groups 1 and 2, respectively; the obturator nerve in 62% vs. 78%; and the lateral cutaneous femoral nerve in 41% vs. 44%. We conclude that femoral nerve stimulation is effective in faciliating blockade in the femoral nerve but not the obturator or lateral cutaneous femoral nerve with the tested solution and volumes, and therefore not particularly effective for achieving complete 3-in-1 blockade. Within the clinically relevant range of 20-40 ml, the volume of mepivacaine 10 mg/ml does not appear to influence the extent of blockade.
Adult↗
[Anesthetic management of the elderly patients with femoral neck fracture by sevoflurane and femoral nerve block].
Fracture of the femoral neck (FNF) is a significant cause of morbidity and mortality in the elderly, and the elderly with FNF are often high-risk patients for anesthesia. We studied 15 patients above 80 years of age with severe physical status (ASA III-IV). After femoral nerve block (for the pain of fracture) and lateral femoral cutaneous nerve block (for the cutting pain), surgical procedure was performed under general anesthesia by laryngeal mask airway under spontaneous ventilation. After the operation, morphine 2 mg was administered subcutaneously. In our experience, the majority of 15 patients cardiovascular status of remained stable, except one patient who needed ephedrine for hypotension and another patient who needed diclofenac sodium for post-operative pain relief.
Aged↗
[Unilateral, sensorimotor femoral nerve paralysis following abdominal gynecological operation].
Unilateral or bilateral femoral nerve functional deficiency deficit occurs as a rare iatrogenic complication of gynaecological abdominal or vaginal surgery. Self-retaining abdominal retractors, that exert a constant pressure on the femoral nerve during the operation, are the most frequent cause. This situation occurs especially, if retractors of unsuitable size are used on very slender patients with thin abdominal walls. The favourable prognosis of the femoral nerve sensory and motor deficiencies can be complicated by damage to the knee joint resulting from leg muscle paresis. A personal observation and a literary review on sensomotor paresis after gynaecological abdominal surgery are discussed.
Adult↗
[Femoral nerve palsy due to excessive granuloma in aseptic cup loosening in cementless total hip arthroplasty].
AIM: Femoral nerve palsy after total hip arthroplasty can result from several causes. Delayed neuropathies of the femoral nerve because of excessive granuloma in loosened implants are a rare condition. CASE REPORT: We report the case of delayed neuropathy of the femoral nerve after cementless total hip arthroplasty because of aseptic loosening of the cup. Electrophysiologic evaluation revealed a severe lesion of the femoral nerve with sensomotoric deficits. An abdominopelvic computed tomography (CT) scan revealed an excessive granuloma with a large intrapelvic portion. After revision of the loosened acetabular component and the femoral nerve and removal of the granuloma the neurologic symptoms improved. CONCLUSION: Regular (1-2 years) clinical and radiological follow-ups are requested after total hip arthroplasty to prevent excessive loosening of implants, excessive granuloma and severe sequelae like nerve damage.
Arthroplasty, Replacement, Hip↗
Surgical outcome for intra- and extrapelvic femoral nerve lesions.
Seventy-eight traumatic neuropathies were seen in 94 patients with femoral nerve lesions; 54 of these were operated on because of persistent complete functional loss and/or pain. The most common mechanism of injury to the femoral nerve was iatrogenic due to inguinal herniorrhaphy, total hip replacement, intraabdominal vascular or gynecological operation, and, less commonly, appendectomy, lumbar sympathectomy, and laparoscopic procedures. Femoral nerve injuries also resulted from penetrating gunshot and stab wounds, laceration by glass, and stretch/contusive injuries associated with pelvic fractures. There were no signs of clinical or electrical recovery in 45 of 78 patients with traumatic nerve injuries. These and other partial injuries associated with pain were explored and evaluated by intraoperative nerve stimulation and recording of nerve action potentials (NAPs). Despite complete loss of nerve function preoperatively, 13 patients had recordable NAPs and underwent neurolysis; each recovered function to at least a Grade 3 level. Twenty-seven patients had sural graft repairs performed with graft lengths varying from 2.5 to 14 cm. Most patients had some nerve regeneration and regained function to Grade 3 to 4 levels by 2 years postoperatively. Four of five patients with suture repairs recovered to Grade 3 or better within 2 years postoperatively. Despite a proximal pelvic level for most of these injuries and, as a result, lengthy graft repairs, recovery of some useful function was the rule rather than the exception. Tumors involved the femoral nerve in 16 patients and included eight neurofibromas, four schwannomas, one neurogenic sarcoma, two ganglion cysts, and one leiomyosarcoma. All tumors were treated surgically and most were removed successfully.
Action Potentials↗
Femoral nerve blockade in children using bupivacaine.
The authors evaluated the efficacy and incidence of side effects from blockade of the femoral nerve with 0.5% bupivacaine in 14 children with fracture of the middle third of the femoral shaft. In nine of these children, a pharmacokinetic analysis was also performed. The onset of analgesia occurred in 8.0 +/- 3.5 minutes after blockade of the femoral nerve. One block failed, resulting in iv narcotics being administered to alleviate the pain. In the remaining 13 children, pain decreased to nonexistent in 11 of the children and only mild pain with movement in the remaining two children. The level of analgesia did not change when the children underwent radiographic examination (60 +/- 18 min after the femoral nerve block) and application of traction (124 +/- 19 min after femoral nerve block). The maximum bupivacaine plasma concentration was 0.89 +/- 0.37 microgram/ml, obtained 24.4 +/- 12.6 min after the end of the injection. The femoral nerve blockade with bupivacaine provides prompt, effective, and prolonged analgesia in children suffering from fractures of the femoral shaft, allowing transport, radiographic examination, and application of traction in optimal conditions. Although the sample size was small, the side effects appeared to be rare.
Bupivacaine↗
Changes in nerve root motion and intraradicular blood flow during intraoperative femoral nerve stretch test. Report of four cases.
OBJECT: It is not known whether changes in intraradicular blood flow (IRBF) occur during the femoral nerve stretch test (FNST) in patients with lumbar disc herniation. An FNST was conducted in patients with lumbar disc herniation to observe the changes in IRBF, and results were then compared with clinical features. METHODS: The study was composed of four patients with L3-4 disc herniation who underwent microdiscectomy. Patients were placed prone immediately before surgery, so that their knee flexed on the operating table with the hip joint kept in hyperextension, and the FNST was performed to confirm at which region pain developed in the anterolateral thigh. During the operation, the hernia-affected nerve roots were visualized under a microscope. The needle sensor of a laser Doppler flowmeter was then inserted into each nerve root immediately above the hernia, and the change in IRBF was measured during the intraoperative FNST. After removal of the herniated disc, a similar procedure was repeated and IRBF was measured again. The intraoperative FNST showed that the hernia compressed the nerve roots and there was marked disturbance of gliding, which was reduced to only a few millimeters. During the test, IRBF decreased by 92.8 to 100% (mean 96.9 +/- 3.7% [+/- standard error of the mean]) relative to the blood flow before the test. This study demonstrated that the blood flow in the nerve root is reduced when the nerve root is compressed in vivo. CONCLUSIONS: The intraoperative FNST showed that the hernia compressd the nerve roots and there was marked disturbance of gliding, which was reduced to only a few millimeters. During the test, IRBF decreased by 92.8 to 100% (96.9 +/- 3.7% [mean +/- standard error of the mean]).
Adult↗
The effects of the single or multiple injection technique on the onset time of femoral nerve blocks with 0.75% ropivacaine.
UNLABELLED: We evaluated the effect of the injection technique on the onset time and efficacy of femoral nerve block performed with 0.75% ropivacaine. A total of 30 patients undergoing arthroscopic knee surgery were randomly allocated to receive femoral nerve blockade with 0.75% ropivacaine by using either a single injection (Single group, n = 15) or multiple injection (Multiple group, n = 15). Nerve blocks were placed by using a short-beveled, Teflon-coated, stimulating needle. The stimulation frequency was set at 2 Hz, and the intensity of stimulating current, initially set at 1 mA, was gradually decreased to <0.5 mA after each muscular twitch was observed. In the Single group, 12 mL of 0.75% ropivacaine was slowly injected, as soon as the first muscular twitch was observed. In the Multiple group, the stimulating needle was inserted and redirected, eliciting each of the following muscular twitches: contraction of vastus medialis, vastus intermedius, and vastus lateralis. At each muscular twitch, 4 mL of the study solution was injected. Placing the block required 4.2 +/- 1.7 min (median, 5 min; range, 2-8 min) in the Multiple group and 3.4 +/- 2.2 min (median, 3 min; range, 1-5 min) in the Single group (P = 0.02). Onset of nerve block (complete loss of pinprick sensation in the femoral nerve distribution with concomitant inability to elevate the leg from the operating table with the hip flexed) required 10 +/- 3.7 min in the Multiple group (median, 10 min; range, 5-20 min) and 30 +/- 11 min in the Single group (median, 30 min; range, 10-50 min) (P < 0.0005). Propofol sedation was never required to complete surgery; although 0.1 mg fentanyl at trocar insertion was required in two patients of the Multiple group (13%) and nine patients of the Single group (60%) (P = 0.02). We conclude that searching for multiple muscular twitches shortened the onset time and improved the quality of femoral nerve block performed with small volumes of 0.75% ropivacaine. IMPLICATIONS: This prospective, randomized, blinded study was conducted to evaluate the effect of searching for multiple muscular twitches when performing femoral nerve block with small volumes of 0. 75% ropivacaine. Our results demonstrated that multiple injections markedly shortened the onset time and improved the quality of nerve blockade. This technique-related effect must be carefully considered when different clinical studies evaluating the use of new local anesthetic solutions for peripheral nerve blocks are compared.
Adolescent↗
Preferential motor reinnervation in the mouse: comparison of femoral nerve repair using a fibrin sealant or suture.
Previous studies in rat femoral nerve demonstrated that regenerating motor axons preferentially reinnervate a nerve branch to muscle as opposed to skin, a process that has been termed preferential motor reinnervation (PMR). This process has not been previously reported in the mouse, where the use of transgenic animals could be a powerful tool to study the basic mechanisms that determine accuracy of regenerating motor axons. In the mouse, we applied the same nerve repair (suture) and retrograde labeling strategies that successfully demonstrated PMR in the rat femoral nerve but surprisingly were unable to demonstrate PMR. However, if the mouse femoral nerve was repaired with a fibrin sealant, PMR was readily apparent, suggesting that PMR in the mouse is dependent on the method of nerve repair.
Animals↗