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At least 541 records · Page 30Linked to original sources
PubMed1990

Blood loss reduced during hip arthroplasty by lumbar plexus block.

We measured the blood loss during and after hip replacement in two groups of women, each consisting of 10 patients. In one group the lumbar plexus was infiltrated with bupivacaine, in the other it was not. The group in whom the plexus was blocked had significantly less blood loss.

Blood Loss, Surgical↗
PubMed2001

Plexus avulsion and spinal cord injury increase the serum concentration of S-100 protein: an experimental study in rats.

The possibility of using the presence of the glial-cell-derived protein S-100 in serum as a marker for neuronal damage caused by spinal cord injury and plexus avulsion injury was investigated in 144 adult rats. After a spinal cord injury had been induced at the thoracic level or a plexus avulsion injury at the lumbar level, blood samples were taken and analysed for S-100 protein by a monoclonal two-site immunoluminometric assay. The two types of neurotrauma changed the kinetics of serum S-100 in different ways. After spinal cord injury it rapidly increased and within 72 hours had reached a concentration about 5 times that of the control animals. Three peak concentrations occurred at 3, 12, and 72 hours, respectively, and differed significantly from those of the control group (p < 0.05). After six days the values had returned to normal. After lumbar plexus injury alone there was no significant increase in the concentration of S-100. These results suggest that the concentration of S-100 protein in serum may be used as an early diagnostic tool for detecting neuronal damage caused by spinal cord injury or plexus avulsion associated with damage to the root entry zone.

Animals↗
PubMed1990

[Inguinal paravascular block (3-in-1 block)].

The three main nerves from the lumbar plexus may be blocked by injection of local anesthetic into the facial envelope of the femoral nerve ("three-in-one block"). The femoral nerve may be localized by obtaining paresthesia, by employing a nerve stimulator or by the loss of resistance technique. We prefer the use of a nerve stimulator. The "three-in-one block" may be employed for immediately pain relief of pain and for treatment of postoperative pain from fractures in the hip, femur and knee. Introduction of a catheter into the femoral nerve sheath is recommended to provide continuous block of the lumbar plexus for relief of postoperative pain.

Anesthesia, Local↗
PubMed2004

Anatomy and anaesthesia of the lumbar somatic plexus.

Cadaveric dissection demonstrated the lumbar plexus to lie within the substance of psoas major, with the major branches of the lumbar plexus emerging into the psoas compartment adjacent to the L5 vertebra. Within psoas major, the lateral femoral cutaneous and femoral nerves were separated from the obturator nerve by a muscular fold in 36 of 60 plexuses. Anatomical variations were common, with the accessory obturator nerve being identified in 12 per cent of plexuses. All previously described lumbar plexus block approaches positioned the needle within close proximity to the lumbar plexus. Modifications to these approaches may increase efficacy and reduce complication rates.

Aged↗
PubMed1978

Continuous lumbar plexus block--analgesia for femoral neck fractures.

In a series of 21 patients with fractures of the neck of the femur, continuous lumbar plexus block provided effective pain relief in 17 cases. The technique for continuous lumbar plexus block is described. The technique has advantages over conventional methods of analgesia.

Aged↗
PubMedDate not supplied

Combined lumbar-plexus and sciatic-nerve blocks: an analysis of plasma ropivacaine concentrations.

BACKGROUND AND OBJECTIVES: Lumbar-plexus and sciatic-nerve blocks are commonly combined for lower-extremity anesthesia using large doses of ropivacaine. Limited information is available about the pharmacokinetics of this practice. We analyzed plasma ropivacaine concentrations after single-injection lumbar-plexus blocks with and without sciatic-nerve blocks. METHODS: Twenty patients having lower-extremity surgery using a lumbar-plexus block with 0.5% ropivacaine with 1:400,000 epinephrine (35 mL, n = 10) or the same lumbar-plexus block with the addition of a sciatic-nerve block (25 mL, n = 10, 60 mL total) using the same solution were enrolled. Venous blood samples were collected at 5, 15, 30, 45, 60, 120, and 240 minutes after block placement and analyzed for total ropivacaine concentration by use of gas chromatography. Individual timepoints, maximum concentrations (C(max)), and time to C(max) (T(max)) were compared. Values are mean +/- SD. RESULTS: Both groups demonstrated a rapid increase in plasma concentration over the first 30 to 45 minutes. Concentrations were greater for those who received both blocks (P = .0005) at all timepoints. The lumbar-plexus block C(max) was less (986 +/- 221 ng/mL) than for the combined blocks (1,560 +/- 351 ng/mL, P = .0004). The T(max) was greater for the lumbar plexus (80 +/- 49 min) than for the combined blocks (38 +/- 22 min, P = .03). There was no relationship between the C(max) and patient age, weight, or body mass index. CONCLUSIONS: The results of this study demonstrate that the plasma ropivacaine concentrations increase quicker when a sciatic-nerve block is added to a lumbar-plexus block, but C(max) remains below the toxicity threshold.

Adult↗
PubMed2000

Psoas compartment block.

The psoas compartment acts as a conduit for the nerve roots of the lumbar plexus. Originating at approximately the 12th thoracic vertebrae, this potential compartment continues on caudally, bordered posterolaterally by fascia of the quadratus lumborum and iliacus muscles, medially by the fascia of the psoas major muscle, and anteriorly by the transversalis fascia. This natural "gutter" acts as a repository for local anesthetic agents and provides an excellent method of unilateral anterior lower extremity anesthesia. After elicitation of a motor evoked response in the muscles of the anterior thigh, 30 to 40 milliliters of local anesthetic is incrementally injected into the compartment. Spread of the anesthetic to all roots of the plexus occurs in 15 to 20 minutes. Profound sensory and motor blockade can be achieved providing surgical anesthesia as well as long duration postoperative pain relief.

Humans↗
PubMed1988

Retroperitoneal nerve sheath tumors: an unusual cause of pelvic mass.

Solitary nerve sheath tumors can arise in peripheral, cranial, or sympathetic nerves at virtually any anatomic site. Although origin along the nerves of the retroperitoneal space is not uncommon, these tumors rarely present as pelvic masses. We describe two patients found to have benign nerve sheath tumors of the sacral plexus. Neurilemomas (schwannomas) and neurofibromas are thought to result from a proliferation of perineural cells. These tumors are characteristically firm, smooth, and asymptomatic. They range in size from 1-2 mm to over 20 cm. Surgical excision can usually be accomplished by enucleation of the tumor without damage to the adjacent nerve. Resection of sacral plexus tumors requires knowledge of pelvic retroperitoneal anatomy to avoid injuries to the nearby vascular and urinary structures.

Adult↗
PubMedDate not supplied

The parasacral sciatic nerve block.

BACKGROUND AND OBJECTIVES: The clinical utility of a new parasacral approach for conduction block of the sciatic nerve was investigated, with critical examination of onset, extent, and success rates when this block was used for surgical procedures below the knee. METHODS: Thirty ASA I-III patients presenting for surgery on the lower limb were enrolled. All received 30 mL of 1.5% lidocaine with 1:200,000 epinephrine following nerve stimulator identification of the sciatic nerve at < or =0.2 mA or less. Trans-sartorial saphenous nerve blocks were performed to provide anesthesia to the medial leg. RESULTS: Overall success for surgical anesthesia with this block was 97%. All components of the sacral plexus could be blocked with this approach, and 93% of patients displayed evidence of obturator nerve motor block. However, no patient displayed evidence of obturator sensory anesthesia that could be mapped. Saphenous nerve blocks were 100% effective in providing surgical anesthesia for the procedures performed. CONCLUSIONS: The parasacral approach to the sciatic nerve exhibits a high success rate, resulting in anesthesia of the entire sacral plexus and generally in motor block of the obturator nerve was an interesting observation.

Adult↗
PubMed1993

MR imaging of the sacral plexus: abnormal findings.

Patients with symptoms of sacral plexopathy, radiculopathy, or sciatica may have disease originating in the neural elements, sacrum, bony pelvis, pelvic soft tissues, or gluteal region. As illustrated in our companion article, the sacral plexus and surrounding structures can be visualized in detail with MR imaging. This pictorial essay illustrates the MR findings in a number of abnormalities affecting the sacral plexus. Multiplanar MR examination is particularly helpful in defining neural levels of involvement by disease in this region.

Abscess↗