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Results for “LUMBOSACRAL PLEXUS”

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PubMed2005

Lumbar plexus blockade with ropivacaine for postoperative pain management in elderly patients undergoing urologic surgeries.

BACKGROUND/AIMS: We evaluated the effectiveness and safety of lumbar plexus blockade with ropivacaine for postoperative pain relief in elderly patients undergoing flank incision for urological surgery. METHODS: 60 urological patients (>65 years old) were chosen randomly for paravertebral lumbar blockade. Postoperatively ropivacaine was used in group I (n = 30) and bupivacaine was administered in group II (n = 30) for lumbar plexus blockade. Heart rates, systolic and diastolic blood pressures, peripheral oxygen saturations, analgesia levels with visual analogue scales (VAS) were measured postoperatively at 5 and 30 min and 1, 3, 6, 8,and 12 h. Patient satisfaction scores and complications were recorded. RESULTS: The hemodynamic parameters of the groups were in the normal ranges (p > 0.05). VAS were significantly decreased at 60 min in both groups (p < 0.05) and no important increase was observed during the first 8 h (p > 0.05). After the 8-hour measurement, analgesic was given to 7 patients in group I and 6 patients in group II (p < 0.05). There were no complications (p > 0.05). Patient satisfaction scores were found to be higher for all patients (p > 0.05). CONCLUSION: In elderly patients, lumbar plexus blockade with ropivacaine can be a simple, safe and effective analgesic technique especially in the early postoperative period after urologic surgeries with flank incision.

Aged↗

PubMedDate not supplied

[The inguinal paravascular technique of lumbar plexus block--anatomical pretests were unsuccessful].

Using 28 anatomic preparations, the boundaries of dye expansion in tissues adjacent to nervous stems have been experimentally studied during the application of lumbar plexus local anesthesia technique via inguinal paravascular approach according to A. Winnie. It has been established that the above technique is not associated with anatomic conditions for simultaneous contact of a model dye solution with 3 basic derivates of the lumbar plexus both at the level of formation and further on. There is massive dye diffusion from femoral nerve perineural space into the intermuscular connective tissues. Compact structure of perineural spaces in musculus psoas major prevents lumbar plexus infiltration. The junction of lumbar and obturator fascia, forming the fascial node between large and small pelvis, excludes any possible contacts between the dye solution and the obturator nerve.

Female↗

PubMed1991

Percutaneous retroperitoneal stimulation of the sacral plexus. Initial report and technical note.

A new percutaneous approach to stimulate the sacral plexus for the treatment of pain is described. The percutaneous electrode is inserted under fluoroscopy through the chosen dorsal and ventral sacral foramen and is advanced into the retroperitoneal layer where the plexus lies. The electrode, can be advanced several centimeters and lies in close proximity to the branches of the sacral plexus. Both motor and sensory responses can be elicited with electrical stimulation. Our initial experience with 4 implanted patients is presented and discussed. Several areas of the nervous system have been target for implantation of stimulating and recording electrodes for management of pain, as well as other indications. This includes parts of the cerebrum, brainstem, spinal cord and peripheral nerves. We report our initial experience with a new approach to stimulation of the peripheral nervous structures. That is stimulation of the sacral plexus through electrodes implanted percutaneously along the plexus in the retroperitoneal area. This initial report is not meant to give clinical results of this methodology, but simply to point to another route to apply electrical stimulation safely to various parts of the nervous system.

Analgesia↗

PubMedDate not supplied

Lumbar plexus neuropathy resulting from retroperitoneal hemorrhage.

A case of lumbar plexus neuropathy occurring in the setting of heparin therapy is reported. Documentation of the site of a retroperitoneal hematoma by CT scan was made prior to the full clinical evolution of lumbar plexus neuropathy resulting from a psoas-muscle hematoma. Two patterns of retroperitoneal bleeding and their respective clinical manifestations are discussed. Early diagnosis of these syndromes may allow for intervention before neurologic compromise is established.

Diagnosis, Differential↗

PubMedDate not supplied

Postoperative pain treatment after open knee surgery: continuous lumbar plexus block with bupivacaine versus epidural morphine.

The anesthetic and side effects of a continuous lumbar plexus block ("3-in-1" block) were compared with that of epidurally administered morphine after open knee surgery. Twenty-two patients were randomized into two groups in this prospective, double-blind study. At the end of surgery, catheters were inserted for all the patients into both the femoral nerve sheath and the epidural space. Pain treatment was given as either bupivacaine in the femoral catheter or morphine in the epidural catheter, with saline in the other catheter. All treatments were given as a bolus dose followed by continuous infusion. If the patients had pain, they were given morphine intramuscularly on demand. The pain scores and supplemental morphine consumption were low in both groups and did not differ significantly. Lumbar plexus block produced a statistically significant a lower incidence of nausea, vomiting, pruritus and urinary retention. Although no significant differences in pain relief were shown between the two methods, we conclude that postoperative lumbar plexus block is preferable for postoperative pain relief because there is a lower frequency of side effects.

Adolescent↗

PubMed1988

Lumbar plexus block in children: a comparison of two procedures in 50 patients.

Two techniques for blocking the lumbar plexus were prospectively evaluated in 50 children undergoing surgery in the hip region and randomly allocated to one of two equal groups. A variant of the "psoas compartment block" and the classic technique were used in groups 1 (n = 25) and 2 (n = 25), respectively. All procedures were carried out under light general anesthesia with the patients in the lateral position using insulated needles and electrical stimulation. Both procedures were effective, allowing completion of surgery without additional treatment in almost all patients. However, the distribution of analgesia differed: 23 (ipsilateral) lumbar and sacral plexus blocks and 2 (ipsilateral) lumbar blocks alone were produced in group 2, compared to 22 areas of anesthesia comparable to those that might be associated with a lumbar epidural block and two ipsilateral lumbar plexus blocks in group 1. The two techniques are not, therefore, mere variants of the same basic approach to the lumbar plexus. The procedure described by Winnie et al. (Anesthesiol Rev 1974;1:11-6) was more suitable for providing unilateral blockade than the "psoas compartment block."

Adolescent↗

PubMed1991

[Complications during the use of a catheter for continuous lumbar plexus block during implantation of a total hip endoprosthesis].

A 78-year-old female patient undergoing a hip operation received a catheter for continuous lumbar plexus blockade. The catheter was positioned without complications but its removal had apparently proved to be difficult. The catheter entered the operative site and its tip was coagulated by the coagulation forceps. There were no subsequent complications.

Aged↗

PubMed2002

Lumbar paravertebral nerve block in the management of pain after total hip and knee arthroplasty: a randomized controlled clinical trial.

The accepted mode of pain management after total hip or knee arthroplasty is patient-controlled analgesia. This study evaluates the efficacy of lumbar paravertebral nerve block in diminishing postoperative pain when used as an adjunct to patient-controlled analgesia. A total of 115 arthroplasty patients received postoperatively a lumbar paravertebral nerve block (block, n = 57) or a sham procedure (control, n = 58). The block group required approximately 10 mg less morphine for pain control than the control group during the first 4 hours postoperatively (P<.001). There were no significant differences in morphine use between the groups 4 to 24 hours postoperatively. Visual analog scale pain score measurements at 4, 8, and 24 hours did not differ significantly between the groups. Paravertebral nerve block of the lumbar plexus is an invasive procedure with some risk. Considering the added risk and minimal benefits, routine use of this procedure is not supported.

Analgesia, Patient-Controlled↗

PubMed2005

Anatomy and imaging of lumbar plexus.

Sensory and motor innervation of the whole lower limb is due to lumbo-sacral-plexus that arises from the spinal roots L1-S3. The whole lower limb can be blocked from its origin to the foot for surgical procedures or for postoperative analgesia. Single or continuous lumbar plexus blockade can be an alternative to general anesthesia and central block in elective and traumatic hip or femur repair, for knee surgery and for postoperative analgesia. To understand the relative plexus depth and the relationship between the plexus and the closer structure in order to avoid complicance, the aid of imaging technique such as CT-scan, MRI and ultrasounds can be considered.

Anesthesia, Spinal↗

PubMed2002

Continuous three-in-one block for postoperative pain after lower limb orthopedic surgery: where do the catheters go?

UNLABELLED: Continuous three-in-one block is widely used for postoperative analgesia after proximal lower limb surgery, but location of the catheter has not been well addressed in the literature. We prospectively studied, in 100 patients, the characteristics of catheter threading under the iliac fascia and the correlations between catheter tip location and effective sensory and motor blockade of the three principal nerves of the lumbar plexus. Postoperatively, in conscious patients, 16 to 20 cm of a catheter was placed in the fascial sheath after femoral nerve location with a nerve stimulator. Contrast media (3 mL Iopamidol 390) was injected, and the catheter tip was located by means of an anteroposterior pelvic radiograph. An equal-volume mixture of 0.5% bupivacaine/2% lidocaine with epinephrine (30 mL) was injected through the catheter. Patient and catheter-insertion characteristics were noted. Thirty minutes after injection, sensory blockade was evaluated in the cutaneous territories of the lateral femoral cutaneous, femoral, and obturator nerves, along with motor blockade of the last two nerves. Pain scores at 30 min were also recorded. Seven block failures were noted. The tip of the catheter reached the lumbar plexus (Group 1) in 23% of the patients and lay deep to the medial (Group 2) or lateral (Group 3) part of the fascia iliaca in 33% and 37% of the patients, respectively. Demographic data and catheter threading characteristics were comparable among the groups. A three-in-one block was noted in 91% of Group 1 patients, but in only 52% and 27% of Group 2 and 3 patients, respectively (P < 0.05). Comparing Group 2 and 3 patients, sensory block was achieved in respectively 100% and 94% for the femoral nerve, 52% and 94% for the lateral femoral cutaneous nerve (P < 0.05), and 82% and 27% for the obturator nerve (P < 0.05). Visual analog scale pain scores on movement were significantly lower in Group 1 patients (P < 0.05). We conclude that during a continuous three-in-one block, the threaded catheter rarely reached the lumbar plexus. The quality of sensory and motor blockade and initial pain relief depend on the location of the catheter tip under the fascia iliaca. IMPLICATIONS: The course of a continuous three-in-one block catheter is unpredictable. Only 23% of the catheters lie near the lumbar plexus. The success of sensory and motor blocks, as well as postoperative analgesia, depend on the position of the catheter under the fascia iliaca.

Anesthetics, Local↗

PubMedDate not supplied

The "three-in-one block" for treatment of pain in a patient with acute herpes zoster infection.

BACKGROUND AND OBJECTIVES: Herpes zoster infection in elderly patients frequently results in disabling pain, carries a high risk of postherpetic neuralgia (PHN), and can pose a significant therapeutic challenge. METHODS: We describe a successful use of the perivascular technique of lumbar plexus blockade ("three-in-one block") for treatment of pain during acute herpes zoster infection in an 82-year-old severely ill patient in whom other modalities were contraindicated. RESULTS: Three-in-one block using 40 mL of 0.25% bupivacaine with 1:300,000 epinephrine resulted in excellent pain relief that lasted for 2 weeks. CONCLUSIONS: The perivascular technique of lumbar plexus blockade may be a useful alternative to epidural and paravertebral techniques of lumbar blockade in the occasional patient for whom these other approaches are contraindicated.

Acute Disease↗

PubMed1993

Interconnections of the upper ventral rami of the human sacral plexus: a reappraisal for dorsal rhizotomy in neurostimulation operations.

The extension of a dorsal rhizotomy in bladder stimulation patients is partly determined by connections between the ventral rami of the second, third, and fourth sacral spinal nerves. The literature is inconclusive on interconnections of these ventral rami in the human sacral plexus. The sacral plexuses of ten human cadavers were dissected in this gross anatomy study. In nine cases a branch connecting the ventral rami of the second and third sacral spinal nerves was found. Electron microscopy demonstrated the presence of thick myelinated fibers in this branch. In the male plexuses this branch formed the only link between the second sacral spinal segment and the pelvic plexus. The ventral ramus of the second sacral nerve always contributed to the pudendal nerve, whereas involvement of the ventral rami of the first and third sacral nerves differed individually and intersexually.

Female↗

PubMed2003

Variability in determination of point of needle insertion in peripheral nerve blocks: a comparison of experienced and inexperienced anaesthetists.

Accurate identification of surface landmarks is essential for the successful performance of peripheral nerve blocks. The variability between experienced and inexperienced practitioners in identifying anatomical landmarks has not been studied previously. Anaesthetists were asked to identify the point of needle insertion for posterior lumbar plexus and sciatic nerve blocks on a volunteer using a standard textbook description. The chosen point for needle insertion was described in terms of X and Y co-ordinates, measured in millimetres, from a zero reference point marked on a volunteer's back. Fifteen experienced and 22 inexperienced anaesthetists took part in the study. The lumbar plexus block mean [range] values for the X, Y co-ordinates were 80 [62-108], 66 [46-86] and 92 [49-150], 62 [0-131] in the experienced and inexperienced groups, respectively. The sciatic nerve block X, Y co-ordinates were 77 [62-99], 70 [49-89] and 68 [29-116], 62 [26-93] in the experienced and inexperienced groups, respectively. The variance for the point of needle insertion was significantly greater in the inexperienced group (p <0.01) for both the lumbar plexus and sciatic nerve blocks. We conclude that with increasing experience, there is decreased variability in determining the point of needle insertion using anatomical landmarks.

Anesthesiology↗

PubMed1976

The syndrome of retroperitoneal hemorrhage and lumbar plexus neuropathy during anticoagulant therapy.

A syndrome of retroperitoneal hemorrhage during anticoagulant therapy associated with nerve involvement in femoral nerve or lumbar plexus is described. Twenty-one cases were collected from the English-language literature, and five new cases were added for review and analysis. In these 26 cases spontaneous hemorrhage occurred under iliopsoas fascia in the retroperitoneal space. The clinical picture, involved nerves, laboratory findings of coagulation studies, anemia, and the outcome of these cases are summarized and discussed. Retroperitoneal space may contain a large quantity of internal hemorrhage. Irreversible damage of lumbar plexus or femoral nerve may result from entrapment of nerves in the hematoma. Laboratory coagulation studies may guide effective administration of anticoagulant therapy and minimize hemorrhagic complication, but they will not eliminate the risk of hemorrhage completely.

Adult↗

PubMedDate not supplied

Continuous versus single-injection lumbar plexus blocks: comparison of the effects on morphine use and early recovery after total knee arthroplasty.

BACKGROUND AND OBJECTIVES: Continuous lumbar plexus infusion of local anesthetic after total knee arthroplasty has been shown to improve analgesia and early recovery as compared with patient-controlled analgesia (PCA) morphine. Any benefit of an infusion over a single-injection lumbar plexus block has not been directly shown however. METHODS: In a double-blind, randomized, controlled trial, 32 patients undergoing total knee arthroplasty were randomly allocated to 1 of 2 groups: 0.1% levobupivacaine infusion or saline infusion. Preoperatively, all patients received a lumbar plexus block with 25 mL 0.5% levobupivacaine using a posterior approach with a catheter left in situ, a sciatic nerve block with 15 mL 0.5% levobupivacaine, and a spinal anesthetic. At the end of surgery, 0.1% levobupivacaine or saline was infused into the catheter at 10 mL/h for 48 hours. All patients also received PCA morphine. The primary endpoint was morphine use from the PCA machine. Secondary endpoints included pain scores, day of first postoperative mobilization, and nausea. RESULTS: Patients receiving the levobupivacaine infusion used significantly less morphine than those receiving saline (19 mg [interquartile range (IQR) 8.5-29.5] vs 32 mg [IQR 23.5-53.0], P = .04) and also mobilized earlier postoperatively (day 1 or 2 [levobupivacaine] vs day 2 or 3 [saline], P = .001). Pain scores were similar. CONCLUSION: Postoperative infusion of local anesthetic around the lumbar plexus reduces morphine requirement and improves early recovery after total knee arthroplasty as compared with a single-injection block.

Aged↗

PubMed1983

Sacral plexus nerve sheath tumor: case report.

A young woman with chronic sciatica was found to have an intrapelvic sacral plexus nerve sheath tumor. Computed tomography of the pelvis was used to delineate this unusual site of tumor development. The case report and a discussion of pelvic nerve sheath tumors are presented.

Adult↗

PubMed1989

[The posterior sacral plexus].

The posterior sacral branches, when connecting, form the posterior sacral plexus and its terminal branch, the posterior gluteal nerve that we suggest be called the inter-gluteal nerve because of its course and territory. Apart from their anatomic interest, their lesions can explain some neuralgias in sacrococcygeal attacks.

Back Pain↗

PubMed2002

Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in a patient with severe aortic stenosis.

PURPOSE: To report the use of a combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in an elderly patient with severe aortic stenosis. CLINICAL FEATURES: In an 87-yr-old lady with severe aortic stenosis and fracture of the right trochanter due to a fall, a combined right-sided paravertebral lumbar plexus and parasacral sciatic nerve block was used successfully for operative reduction of the fracture. A moderate amount of phenylephrine was required to maintain adequate systemic blood pressure despite the largely unilateral nature of the blocks. CONCLUSION: Combined paravertebral lumbar plexus and parasacral sciatic nerve block can be a viable alternative to general anesthesia and epidural or spinal block for hip surgery in patients with severe aortic stenosis.

Aged↗