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PubMed2006

Relationship of the uterosacral ligament to the sacral plexus and to the pudendal nerve.

We describe the anatomy of the uterosacral ligament with respect to the sacral plexus. In six adult female embalmed cadavers, we identified the uterosacral ligament and its lateral nerve relations. Using the ischial spine as the starting point and measuring along the axis of the uterosacral ligament, we noted that the S1 trunk of the sacral plexus passes under the ligament 3.9 cm [95% confidence interval (CI), 2.1-5.8 cm] superior to the ischial spine. The S2 trunk passes under the ligament at 2.6 cm (95% CI; 1.5, 3.6 cm), the S3 trunk passes under the ligament at 1.5 cm (95% CI; 0.7, 2.4 cm), and the S4 trunk passes under the ligament at 0.9 cm (95% CI; 0.3, 1.5 cm) superior to the ischial spine. The pudendal nerve forms lateral to the uterosacral ligament. Our data demonstrate that the S1-S4 trunks of the sacral plexus, not the pudendal nerve, are vulnerable to injury during uterosacral ligament suspension.

Female↗
PubMed2001

Patient satisfaction and effectiveness of lumbar plexus and sciatic nerve block for total knee arthroplasty.

The purpose of this study was to evaluate the efficacy of combined lumbar plexus block techniques for total knee arthroplasty. Long-acting local anesthetics were used to ensure adequate intraoperative and postoperative anesthesia and analgesia. All patients undergoing total knee arthroplasty at our institution were offered lumbar plexus block after obtaining informed consent. Patients for study were a continuous group of 87 patients over a 1-year period. A subset of 40 patients was studied for postoperative analgesia effect. All patients were contacted by phone for a satisfaction survey. There were 87 patients who received initial lumbar plexus and sciatic nerve blocks, 78% (68 of 87) of whom had adequate initial blocks. Sixteen patients (22%) required conversion to general anesthesia intraoperatively because of inadequate anesthesia. A subset of patients studied for postoperative analgesia revealed an average time of 13 hours before the first request for supplemental narcotics. There were no complications related to the lumbar plexus block in our study group of patients. There was a 92% overall satisfaction rate with the anesthesia provided by the lumbar plexus block. Lumbar plexus block can be used successfully for total knee arthroplasty. Lumbar plexus block appears to have advantages for early postoperative analgesia, leading to increased patient comfort and satisfaction.

Aged↗
PubMed1989

Extent of blockade with various approaches to the lumbar plexus.

The extent of blockade when four different techniques were used for blocking the lumbar plexus was prospectively evaluated in 80 adult patients. The extent of blockade was measured by testing motor function of all nerves except the lateral and posterior femoral cutaneous nerves, which were evaluated by pinprick response. The posterior approaches of Dekrey at L3 (n = 20) and Chayen at L4-5 (n = 20) proved similarly effective in producing blockade of the femoral, obturator, and lateral femoral cutaneous nerves, as well as the nerves to the psoas muscle. The anterior approach of Winnie (femoral sheath or 3-in-1 block) using paresthesia (n = 20) or peripheral nerve stimulation (n = 20) proved effective in producing blockade of the femoral and lateral femoral cutaneous nerves, but ineffective for obturator nerve blockade. None of the four techniques produced blockade of the sacral plexus. Perhaps our means of assessing blockade (motor) is what produced the difference between our findings and those of others.

Humans↗
PubMed1995

An anatomical analysis of the dorsoventral relationship between the sacral plexus and the pudendal nerve in man by use of computer aided three-dimensional reconstruction.

In order to investigate the dorsoventral relationship between the sacral plexus and the pudendal nerve in man, morphological examination was performed on one pelvic half of a male cadaver. The second and third spinal nerves were removed en bloc and sectioned serially for three-dimensional reconstruction imaging of the selected sections. Comparison of the sequential images revealed that the root of the pudendal nerve is first situated ventral to the caudal root of the sacral plexus, and that the former and the latter are shifted cranialward and caudalward, respectively, at the point of exit from the second anterior sacral foramen.

Humans↗
PubMed1998

[Total spinal anesthesia after posterior lumbar plexus block].

We report a case of total spinal anaesthesia which occurred after a lumbar plexus block using a posterior approach. After total hip arthroplasty under general anaesthesia, a lumbar plexus block was performed according to Winnie's landmarks at the L4 interspace using a nerve stimulator. Aspiration test for blood and spinal fluid were both negative, as well as a test dose of 3 mL lidocaine 2%-bupivacaine 0.5%. One minute after the injection of 27 mL of the same mixture, a complete anaesthetic block occurred with hypotension and loss of consciousness requiring intubation and controlled ventilation during 3h30, without sequelae. Lumbar plexus block using a posterior approach must be performed cautiously and a slow and fractionated injection of the full dose is recommended.

Aged↗
PubMed1977

[Post-traumatic and post-operative paresis of the leg plexus (author's transl)].

Post-traumatic and post-operative leg-plexus paresis is often misdiagnosed as sciatic or femoral paresis and thus falsely thought to be rare. In 20 post-traumatic cases the cause was predominantly or exclusively due to sacral plexus damage, with paralysis of the muscles innervated by the sciatic nerve and of the gluteal muscles. The most frequent cause was severe pelvic trauma with ring fracture of the pelvis, separation of the symphysis and iliosacral gap or fracture of the hip joint. Postoperative leg-plexus paresis was noted in eight cases after total hip-joint replacement (predominantly damage to the lumbar plexus) and twice after operatively treated fracture of the acetabulum. Both pressure and tearing lesions can be the basic cause.

Adolescent↗
PubMedDate not supplied

[Modes of balanced regional anesthesia in patients with lower extremity injuries].

The basic hemodynamic (systolic blood pressure (BP), diastolic BP, heart rate, stroke volume, cardiac output, RPP) and respiratory parameters (respiratory rate, tidal volume, respiratory minute volume) during operations on the lower extremities under epidural anesthesia (n=24; Group 1) versus lumbar plexus block by the 3-in-1 technique (n= 23; Group 2) were studied in 47 traumatological patients. With balanced epidural anesthesia, there was a short-term decrease in hemodynamic parameters and a worse external respiratory function; in 5 patients requiring its performance WL, balanced block of peripheral nerves of the lumbar plexus was, on the contrary, marked by a greater hemodynamic and respiratory stability.

Adolescent↗
PubMed1995

[Nerve block analgesia after surgery of the knee].

Lumbar plexus block via the inguinal approach is indicated for analgesia following knee surgery. The technique consists in an injection of the anaesthetic solution through a catheter placed into the space limited by the fascia of the iliopsoas muscle. In this area are the different nervous roots which constitute the plexus. A good technique and a good knowledge of the anatomy of this region are necessary for a successful block and for the safety of the patient.

Anesthetics, Local↗
PubMed1994

[The use of 2-chloroprocaine for a combined lumbar plexus and sciatic nerve block].

A combination of the lumbar plexus and sciatic nerve blocks using 2-chloroprocaine (2-CP) for unilateral lower extremity anaesthesia was studied. The purpose of this work was to evaluate the efficacy of 2-CP for ambulatory surgery of short duration with this combination of blocks. Twenty-five patients ASA 1 and 2 were studied. The techniques used have been described by Winnie and Labat. A total dose of 60 ml of 2-CP 3% was injected. Latency time before anaesthesia was approximately seven min for the lumbar plexus and 14 min for the sciatic nerve. The mean duration of the motor block was 71 +/- 16 min, 76.8 +/- 15.3 min and 75 +/- 12.7 min for the sciatic, femoral and obturator nerves respectively. The mean duration of the sensory block was 88.7 +/- 20.9 min, 83.3 +/- 16.4, 79.7 +/- 17.8 min and 93.7 +/- 22 min for the sciatic, femoral, obturator and lateral femoral cutaneous nerves respectively. Success rate was 92% and no major complication occurred. We conclude that a combination of the lumbar plexus and the sciatic nerve blocks with 2-CP is a useful technique for ambulatory surgery of short duration.

Adult↗
PubMed2002

Lumbar plexus block with perineural catheter and sciatic nerve block for total hip arthroplasty.

This case series describes the use of continuous lumbar plexus block with sciatic nerve block as an alternative anesthetic for total hip arthroplasty (THA). A retrospective chart review was performed on 10 consecutive patients who underwent THA at Walter Reed Army Medical Center using continuous lumbar plexus block and sciatic nerve block for anesthesia. Continuous lumbar plexus block with sciatic nerve block without concurrent general anesthesia has not been described previously for THA. Peripheral nerve block may provide superior intraoperative outcomes, as suggested by lower operative blood loss and potentially lower transfusion exposure. Lumbar plexus block with perineural catheter and sciatic nerve block with perioperative sedation is an effective alternative to general anesthesia for THA.

Aged↗
PubMed2005

The mini-invasive anterior extra peritoneal approach to the pelvis.

Retroperitoneal pelvic tumours are rare and their surgical approach is challenging. Various surgical approaches have been proposed. We present here an original mini-invasive anterior retroperitoneal approach the pelvic retroperitoneum, which was successful in a 26-year-old woman who had a benign schwannoma of the left sacral plexus. This technique presents advantages over other techniques that were considered in this case, as the least invasive and safest procedure.

Abdominal Muscles↗
PubMed1990

Sacral plexus injury after radiotherapy for carcinoma of cervix.

A 42-year-old woman developed lower extremity weakness and sensory loss 1 year after external and intracavitary radiotherapy for Stage IB carcinoma of cervix. She has been followed for 5 years posttreatment, and the neurologic abnormalities have persisted, but no evidence of recurrent carcinoma has been found. We believe this to be a rare case of sacral plexus radiculopathy developing as a late complication after radiotherapy. Suggestions are made for improving the radiotherapy technique to prevent this complication in future cases.

Adult↗
PubMedDate not supplied

Bilateral fascia iliaca catheters for postoperative pain control after bilateral total knee arthroplasty: a case report and description of a catheter technique.

BACKGROUND AND OBJECTIVES: The pain following total knee arthroplasty can be associated with significant morbidity, especially in the elderly. Regional anesthetic techniques attenuate or eliminate postoperative pain, which may reduce this morbidity. METHODS: A 74-year-old patient with history of an epidural abscess underwent elective bilateral total knee arthroplasty for degenerative joint disease. Bilateral lumbar plexus catheters were placed via the fascia iliaca compartments. Lidocaine was infused postoperative through both catheters, and serum lidocaine levels were followed. RESULTS: The patient received significant postoperative pain relief based on physical and subjective examination. There were no complications or untoward effects related to the technique. CONCLUSION: Lumbar plexus blockade with continuous local anesthetic infusion via the fascia iliaca compartment is an effective means of providing postoperative analgesia after total knee arthroplasty when epidural analgesia is contraindicated.

Aged↗
PubMed2003

Sciatic nerve palsy after total hip arthroplasty in a patient receiving continuous lumbar plexus block.

UNLABELLED: We report a case of late-onset postoperative sciatic palsy after total hip arthroplasty in a 30-yr-old man with congenital hip dysplasia. The patient was receiving continuous lumbar plexus blockade and had received low-molecular-weight heparin 3 h before the onset of symptoms. Anatomic distinction between the nerve block and the sciatic palsy facilitated rapid diagnosis and treatment of a periarticular hematoma, with resulting neurologic recovery. This case illustrates that, with the expanded role of regional anesthetic techniques in acute pain management, the finding of a new postoperative deficit must be jointly investigated by both anesthesiologists and surgeons. Timely and open communication between services is critical because rapid intervention may be essential to achieving full recovery of an affected nerve. IMPLICATIONS: A case is presented of sciatic palsy developing after total hip arthroplasty in a patient receiving a continuous lumbar plexus block. The case highlights various issues in the use of continuous peripheral nerve blocks for postoperative analgesia.

Adult↗
PubMed1988

[Neural complications of injuries of the pelvis].

5 cases of serious neurological complications of pelvic trauma are reported. All consisted of lesions of the lumbo-sacral plexus. The course is similar to that seen in severe forms of untreated brachial plexus lesions since recovery is always very slow and very incomplete. No curative methods of management were used in the series described. Only secondary palliative surgery was carried out.

Adolescent↗
PubMed2002

Influences of pelvic floor structures and sacral innervation on the response to distension of the cat rectum.

The contributions to the rectal response to distension of the pelvic floor structures surrounding the rectum and of the sacral spinal innervation have never been studied. Using paralysed intercollicularly decerebrate, anaesthesia-free cats, we studied pressure-volume relationships during slow ramp distensions of the rectum. Results obtained from animals with intact pelvic cavities were compared with those following mobilization of the rectum from the pelvic floor musculature. To assess the influences of spinal outflow and afferent input, rectal pressure-volume relationships were measured in the mobilized rectum following bilateral sequential transection of the spinal roots S1 to S3, first dorsal, then ventral. Isolation of the rectum from the pelvic floor structures resulted in a decrease in balloon volume in the lower range of distension pressure but did not affect volumes at higher pressures. The only afferent effect was seen after sectioning of dorsal roots S1, which resulted in a decrease in balloon volume. The only efferent effect was seen after sectioning of ventral roots S3, which decreased balloon volume further. In conclusion, the rectal response to distension depends on the properties of the rectal wall. It may be influenced by somatic inputs, inputs from the myenteric nervous plexus, and from the parasympathetic and sympathetic nervous systems. Afferent inputs and spinal autonomic reflexes may decrease the tone of the rectal musculature during distension.

Animals↗
PubMed1993

Electromyography of the pelvic diaphragm and anal sphincter in dogs with perineal hernia.

The innervation of the levator ani and coccygeal muscles and the external anal sphincter was studied by anatomic dissection in 6 clinically normal male dogs and by electrical stimulation in 5 clinically normal male dogs. Variations in innervation occasionally were found that were comparable to those reported in previous studies. Electromyographic recordings were made from the levator ani and coccygeal muscles and from the anal sphincter in 40 dogs during perineal hernia repair. Spontaneous potentials of 4 types were found in 35 dogs: fibrillation potentials, positive sharp waves, complex repetitive discharges, and fasciculations. Biopsy specimens of the cranial part of the levator ani muscle were taken in 12 dogs during perineal hernia repair. Histologic examination revealed atrophy in 7 specimens. Spontaneous potentials were recorded from all muscles with histologic evidence of atrophy. All examinations of the levator ani muscle concerned the cranial part of this muscle, because the caudal part was absent in all 40 dogs. From combined results of electromyography and histologic examination, it was concluded that atrophy of the muscles of the pelvic diaphragm, which develops in some dogs with perineal hernia, is likely to be of neurogenic origin. Nerve damage is localized in the sacral plexus proximal to the muscular branches of the pudendal nerve or in the muscular branches separately.

Anal Canal↗