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PubMedDate not supplied

Neurapraxia of the femoral nerve in a modern dancer.

We have presented a case of an acute onset femoral nerve neurapraxia in a pure modern dancer. Repeated mild stretching of the femoral nerve during an established dance routine over a period of several months is implicated as the etiology. The thigh muscles quickly weakened, but regained strength within 3 months. Electromyographic evidence of specific femoral nerve injury initially was negative, but was evident 6 weeks following injury. Overuse syndrome in dancers can cause rapid loss of strength. Other conditions such as herniated intervertebral disc, acute hemorrhage, trauma, iliopsoas rupture, and acute stretching must be ruled out. Complete recovery was the natural outcome.

Athletic Injuries↗
PubMed2005

[Is a blockade of the lateral cutaneous nerve of the thigh an alternative to the classical femoral nerve blockade for knee joint arthroscopy? A randomised controlled study].

BACKGROUND: Gaps in the distribution area of the lateral femoral cutaneous nerve (LFCN) are assumed to be the reason for pain caused by a thigh tourniquet when performing a femoral nerve (FN) block according to Winnie. The aim of the study was to evaluate if a direct single blockade of the LFCN in patients undergoing knee surgery resulted in a better tolerance to the tourniquet with equally good analgesic quality during surgery. METHODS: A total of 40 patients undergoing knee arthroscopy received a proximal blockade of the sciatic nerve and randomly either an FN or an LFCN block. Practicability, onset time, quality of sensory and motor block, and clinical effectiveness during tourniquet and surgery were assessed. RESULTS: Stimulation time was significantly longer in the LFCN than in the FN group. Quality of sensory and motor block was worse in the LFCN than the NF group. Of the LFCN patients 65% indicated troublesome paraesthesia or pain when a tourniquet was placed, compared to 35% of the FN patients. Of the LFCN patients 50% had pain during cutaneous incision, compared to none of the FN group. During the course of surgery, 70% of the LFCN patients needed supplemental systemic analgesia, but this was required by only 30% of the FN group. CONCLUSION: An LFCN block is not a suitable alternative to an FN block for regional anaesthesia. For patients with contraindications for an FN block according to Winnie (e.g. vessel surgery in the groin) other more effective methods are available.

Adult↗
PubMed1998

Postoperative analgesia with "3-in-1" femoral nerve block after prosthetic hip surgery.

PURPOSE: To evaluate the efficacy of a single shot "3-in-1" femoral nerve block for prosthetic hip surgery in association with general anaesthesia on post-operative analgesia. METHODS: Forty patients, ASA 1 to 3, received sham block or "3-in-1" femoral nerve block, following Winnie's landmarks with a nerve stimulator, and 40 ml bupivacaine 0.5% with epinephrine were injected after induction of anaesthesia. Vecuronium, 0.1 mg.kg-1, was added after performing the block and anaesthesia was maintained with isoflurane, oxygen 40% and nitrous oxide 60%. Fentanyl, 1.5 microgram.kg-1, was administered before incision to all patients. Heart rate, blood pressure, fentanyl requirements and FETiso were measured throughout surgery. During the post-operative period, 75 mg diclofenac i.m. and/or 0.1 mg.kg-1 morphine s.c. were administered when pain score was > 3/10 and repeated when necessary. Pain scores at first analgesic intervention, at 24 hr and 48 hr as well as diclofenac and morphine requirements after surgery were recorded. RESULTS: There was no difference in anaesthetic requirements during surgery. The time from performance of sham or "3-in-1" femoral nerve block to the first analgesic intervention (261 +/- 49 min versus 492 +/- 40 min, P < 0.05) and time from extubation to the first analgesic intervention (61 +/- 44 min vs 298 +/- 39 min, P < 0.05) were prolonged in the study group. However, pain scores and the analgesic requirements in the postoperative periods (24 and 48 hr) were similar. CONCLUSION: There is a short-term benefit during the first few postoperative hours in using a single shot "3-in-1" femoral nerve block to complement general anaesthesia for elective hip surgery.

Adjuvants, Anesthesia↗
PubMed1993

[Changes in the femoral nerve and medial articular nerve after medial arthrotomy and replacement of the anterior cruciate ligament].

The effect of combined medial arthrotomy (Payr's approach) and replacement of the anterior cruciate ligament upon the femoral nerve and the medial articular nerve has been studied. Resection and prosthetic replacement of the anterior cruciate ligament was performed on the right hindlimb of twelve Merino sheep. Three unoperated animals served as controls. Eight to 48 weeks after the operation, myelinated axons of the femoral nerve and the medial articular nerve were examined using morphological and morphometric methods. Compared with the un-operated control side, only discrete morphological alterations were detectable, such as an increase in non-circular axons. In contrast, considerable morphometric changes were observed: A decrease in large axons and an increase in small axons were found in the femoral nerve of the operated side resulting in a significant reduction in axon diameter (p < or = 0.05). This decrease in axon diameter was associated with a significant increase in the number of axons. Both changes persisted throughout the period examined (48 weeks). Similar changes, i.e. increase in small axons, decrease in large axons and reduction in mean axon diameter were also observed in the medial articular nerve. The results show that medial arthrotomy with prosthetic replacement of the anterior cruciate ligament results in irreversible changes of the femoral nerve and the medial articular nerve. These findings indicate that the medial articular nerve is injured during medial arthrotomy. Mechanisms are discussed which may explain the alterations observed in the femoral nerve a long distance (30 to 35 cm) away from the operation site.

Animals↗
PubMed2001

The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects.

UNLABELLED: We investigated the incidence of bacterial and vascular or neurological complications resulting from femoral nerve catheters used for postoperative analgesia. Patients requiring continuous femoral blockade were consecutively included. Using surgical aseptic procedure, 211 femoral nerve catheters were placed (short-beveled insulated needle, peripheral nerve stimulator). After 48 h, each catheter was removed and semiquantitative bacteriological cultures were performed on each distal catheter tip. Postoperative analgesia and antibiotics were standardized. All complications during the insertion of the catheters and postoperatively (after 48 h and 6 wk) were noted. Few initial complications with no immediate or delayed complications were noted (20 difficult insertions, 3 impossible injections, 3 ineffective catheters, and 12 vascular punctures). After 48 h, 208 catheters were analyzed; 57% had positive bacterial colonization (with a single organism in 53%). The most frequent organisms were Staphylococcus epidermidis (71%), Enterococcus (10%), and Klebsiella (4%). Neither cellulitis nor abscess occurred. Three transitory bacteremias likely related to the catheter occurred. After 6 wk, no septic complications were noted. One femoral paresthesia, partially recovered 1 yr later, was noted. We conclude that the risk of bacterial complications is small with femoral nerve catheters, although the rate of colonization is frequent. IMPLICATIONS: In this prospective study, continuous femoral nerve catheters were effective for postoperative analgesia but had a frequent rate of bacterial catheter colonization. We found no serious infections after short-term (2-day) infusion. Side effects were few, but one nerve injury occurred.

Adolescent↗
PubMed1977

[Paralysis of the femoral nerve after abdominal and vaginal surgery].

Damages of the femoral nerve during gynaecological operations are more frequent than generally supposed. They are observed after abdominal and vaginal operations caused by pressure on the nerve. During abdominal procedures an unsuitable self-retaining retractor is due to the paralysis. If the legs of the patients are deposited on the shoulder-back-parties of the assistants during vaginal procedures there is the danger of pressing the femoral nerve against the inguinal ligament by strong bending and abduction of the thighs. We report about 3 cases of paralysis of this nerve; recommendations for avoidance are given.

Abdomen↗
PubMed1987

Transient simultaneous sciatic and femoral nerve palsy secondary to iliacus and gluteal hematomas following heparinization for pulmonary embolus in a patient with posterior hip dislocation.

Sciatic nerve palsy as a result of a posterior hip dislocation has been reported in the literature. Femoral nerve palsy as a result of a iliacus hematoma has also been documented. However, a simultaneous sciatic and femoral nerve palsy occurring after heparinization for a pulmonary embolus in a patient with a posterior hip dislocation has not been reported. This combined nerve palsy was found in a 64-year-old white woman who had been involved in a motor vehicle accident and sustained a posterior hip dislocation. This patient subsequently had a pulmonary embolism, was heparinized, and then developed a large iliacus and gluteal hematoma, resulting in a simultaneous sciatic and femoral nerve palsy. Without treatment, the patient regained motor and sensory of the sciatic nerve in a few days, and a gradual improvement of function of her femoral nerve was evident over several months.

Female↗
PubMed1990

Bilateral femoral nerve neuropathy following blunt trauma. Case report.

A unique case of bilateral compressive injury of the femoral nerves is reported in a 19-year-old man. Traumatic femoral nerve neuropathy following operative injury, penetrating injury, anticoagulant therapy with hemorrhage, and stretch injury has been described previously, and the literature concerning this unusual clinical problem is reviewed. Bilateral traumatic femoral nerve neuropathy resulting from compressive injury has not been previously reported.

Adult↗
PubMedDate not supplied

Histologic effect of doxycycline sclerotherapy on rat femoral nerve.

BACKGROUND: This study stems from an encounter with a phrenic nerve paralysis in a patient following doxycycline sclerotherapy for treatment of chylous fistula. The purpose of this study is to identify possible histologic evidence of doxycycline-induced nerve injury. METHODS: The femoral nerves of CD rats were used as the in vivo animal model. The nerves were exposed to varying concentrations doxycycline and normal saline was the control. The nerves were studied at several time intervals using two different staining techniques. RESULTS: The results suggest that topical doxycycline induces tissue reactions which are different from normal saline. These reactions include stimulation of a local giant cell inflammatory reaction and disruption of the myelin sheath. CONCLUSIONS: Despite the fact that this study does not give physiologic evidence of neurotoxicity, the histologic results suggest that topical doxycycline may cause nerve damage directly or indirectly. We conclude that doxycycline should not be used for sclerotherapy where unprotected nerves are exposed to the agent until further physiologic tests are performed to prove its safety.

Administration, Topical↗
PubMed1991

[Femoral nerve lesion in heparin therapy].

Two case reports on femoral nerve lesion due to hematoma in the iliopsoas muscle or as the case may be in the iliacus muscles on both sides are presented with review of the literature. Synopsis of the reported cases--certainly a minority of anticoagulant therapy complications nevertheless increasingly mentioned in the literature--suggests that there might be a higher risk of bleeding for women within the first week of so-called high-dose heparin therapy. Coagulation studies do not contribute essentially in preventing retroperitoneal haematoma since they are within therapeutic limits in many cases. So clinical observation is crucial in the diagnosis of this complication of heparin therapy, which might occur more frequently under concomitant administration of acetacylic acid. Early surgical decompression of the femoral nerve seems to provide better results seen on follow-up than conservative treatment, especially in patients with rapid onset of severe limb weakness.

Blood Coagulation Tests↗
PubMedDate not supplied

Femoral nerve block with 0.25% or 0.5% bupivacaine improves postoperative analgesia following outpatient arthroscopic anterior cruciate ligament repair.

BACKGROUND AND OBJECTIVES: Femoral nerve block is effective in reducing postoperative pain after inpatient knee surgery. We studied its efficacy compared with standard analgesia following outpatient anterior cruciate ligament repair, including the duration of analgesia and the effect of different concentrations of bupivacaine. METHODS: After Institutional Review Board approval and informed consent, we prospectively randomized patients to receive, in a blinded fashion, either a sham block, a femoral nerve block with 25 mL 0.25% bupivacaine, or with 25 mL 0.5% bupivacaine after anterior cruciate ligament repair under epidural anesthesia. Verbal analog pain scores were evaluated by a blinded observer at 20 and 40 minutes after injection. Patients with pain >4 (out of 10) were assessed for the presence of a block and offered a supplemental block if no anesthesia was present at either evaluation. By prospective agreement, any study group with 6 failures was excluded from further recruitment. After discharge, patients recorded pain scores and analgesic consumption in a diary, and estimated the time at which they perceived that analgesia and sensory block from the femoral nerve block resolved, based on an increase in pain, sensation, and strength in the leg. RESULTS: In the sham block group, 6 of 12 patients reported inadequate analgesia in the postanesthesia care unit (4 at 20 minutes, 2 at 40 minutes; greater than other groups, P <.003) and were excluded from further study. Patients with sham blocks had higher pain scores 20 minutes after the block, and requested intravenous analgesia more often. Bupivacaine 0.25% and 0.5% provided 23.2 +/- 7 and 25.7 +/- 11 hours of analgesia, respectively. CONCLUSIONS: Femoral nerve block with 0.25% bupivacaine contributes significantly to multimodal postoperative analgesia in the immediate postoperative period following outpatient anterior cruciate ligament repair. Both doses of bupivacaine studied provided analgesia for the first night after surgery.

Adult↗
PubMed2006

[Acute pain management in proximal femoral fractures: femoral nerve block (catheter technique) vs. systemic pain therapy using a clinic internal organisation model].

BACKGROUND: The aim of this study was to compare safety and efficacy of catheter-mediated femoral nerve block analgesia with systemic pain therapy in patients with proximal femoral fractures in the pre-operative and post-operative setting using a protocol for coordinating pain management. METHODS: In a prospective randomised trial of patients attending the emergency department, 100 individuals were selected with a clinically diagnosed proximal femoral fracture. Patients were divided into two equal groups A and B. Group A (n=50) received a catheter-mediated femoral nerve block with 1% prilocaine (40 ml) and post-operatively 0.2% ropivacaine (30 ml) 6 hourly. Group B (n=50) initially received intravenous metamizol (1 g) and a fixed combination of oral tilidine (100 mg) + naloxone (8 mg). Patients aged 90 years or more received a reduced dose (tilidine 75 mg + naloxone 6 mg). In the post-operative period regular oral ibuprofen (400 mg, 8 hourly) in addition to oral tilidine (50 mg) + naloxone (4 mg) was given as required for break through pain. Pain intensity was measured using a verbal rating scale (VRS) from 1 to 5: pain free (=1), mild pain (=2), moderate pain (=3), severe pain (=4), excruciating pain (=5). Pain scores were recorded at rest (R), during passive anteflection (30 degrees) of the hip (PA) on arrival and at 15 and 30 min after initial administration of analgesia. Thereafter, recordings were made 4 times a day up to the third post-operative day. RESULTS: Pain scores were comparable for both groups on admission (VRS in R 2.50 vs. 2.46; VRS during PA 4.30 vs. 4.34). Significant pain relief was achieved in both groups following initial administration of analgesia, but the total pain scores in group A were significantly lower than in group B (VRS in R 1.22 vs. 1.58, p<0.01 and VRS during PA 2.66 vs. 3.26; p<0.001). No difference was noted between the two groups during the first 3 post-operative days. No severe complications occurred as a result of analgesia, however, the catheter was dislodged in 20% of patients in group A resulting in the need for systemically administered analgesia. CONCLUSION: All patients presenting with proximal femoral fractures should receive adequate analgesia within the emergency department even prior to radiographic imaging. Femoral nerve block should be considered as the method of choice. The insertion of a femoral nerve block catheter has the dual advantage of early analgesia permitting repeated clinical examination in addition to continued post-operative pain management. The cumbersome logistics inherent in this technique within the clinical setting limits its practical application. An initial single-shot regional nerve block followed by a systemic post-operative analgesia protocol was considered an appropriate alternative. The execution of safe, consistent and appropriate regional nerve block anaesthesia is reliant on formal guidelines and protocols as agreed by the multidisciplinary teams involved with patient-directed pain management and good clinical practice.

Acute Disease↗
PubMed2001

Minimum local anesthetic volume blocking the femoral nerve in 50% of cases: a double-blinded comparison between 0.5% ropivacaine and 0.5% bupivacaine.

UNLABELLED: Recent studies demonstrated that ropivacaine was nearly 40% less potent than bupivacaine in the first stage of labor, but contrasting results have been reported. We, therefore, conducted a prospective, randomized, double-blinded study to determine the effects of the ropivacaine/bupivacaine potency ratio on the minimum volume of local anesthetic required to produce effective block of the femoral nerve in 50% of patients. Fifty adults premedicated with IV midazolam, 0.05 mg/kg, undergoing elective knee arthroscopy received femoral nerve blocks with a multiple-injection technique with a nerve stimulator (contractions of vastus medialis, vastus intermedius, and vastus lateralis were elicited with a 0.5-mA stimulating current). Patients randomly received either 0.5% ropivacaine (n = 25) or 0.5% bupivacaine (n = 25). The anesthetic volume was decided according to Dixon's up-and-down method, starting from 12 mL and being equally divided among the three elicited twitches. Successful nerve block was loss of pinprick sensation in the femoral nerve distribution with concomitant block of the quadriceps muscle within 20 min after injection, as assessed by a blinded observer. Positive or negative responses determined a 3-mL decrease or increase for the next patient, respectively. According to the up-and-down sequences, the minimum local anesthetic volume providing successful nerve block in 50% of cases was 14 +/- 2 mL in the ropivacaine group (95% CI: 12-16 mL) and 15 +/- 2 mL (95% CI: 13-17 mL) in the bupivacaine group (P: = 0.155). We conclude that the volume of 0.5% ropivacaine required to produce effective block of the femoral nerve in 50% of patients is similar to that required when using 0.5% bupivacaine. IMPLICATIONS: Considering the risk for drug-related systemic toxicity, the equipotency ratio between ropivacaine and bupivacaine is crucial for daily practice. Despite the 40% reduction in the analgesic potency of ropivacaine reported during epidural analgesia for labor pain, results of this prospective, randomized, double-blinded study demonstrated that the same volume of 0.5% ropivacaine or 0.5% bupivacaine is required to produce an effective block of the femoral nerve in 50% of cases.

Amides↗
PubMed1993

Femoral nerve neurilemmoma in the iliac fossa.

A rare case of femoral nerve neurilemmoma in the right iliac fossa, presenting as a firm tumour with local discomfort, is described. Modern imaging techniques could not differentiate the tumour. At explorative laparotomy the tumour was identified as a neurilemmoma of the femoral nerve and enucleated. The diagnosis should be borne in mind in cases of retroperitoneal tumours of unclear origin. Inappropriate surgery results in nerve damage and paralysis.

Adult↗
PubMed1980

Nerve blocking of the sciatic and femoral nerves. Continual block with vein catheter on 44 patients.

The accessibility of the sciatic nerve from three directions (anterior, lateral and posterior) has prevented many patients from being moved, especially those who would be endangered by a change of position. A vein catheter is introduced in accordance with the approved technique up to the selected point. The stylus is withdrawn, the catheter is fixed on the skin by a suture or adhesive plaster, and by the use of a precisely fitting syringe the chosen local anesthetic solution is perfused. By this technique we can reblock the patient.

Anesthetics, Local↗
PubMed2004

Analgesia before performing a spinal block in the sitting position in patients with femoral shaft fracture: a comparison between femoral nerve block and intravenous fentanyl.

We conducted this prospective, randomized study to compare the analgesic effect of femoral nerve block and IV fentanyl administration when given to facilitate the sitting position for spinal anesthesia in patients undergoing surgery for femoral shaft fracture. Five minutes before the placement of spinal block, group FEM patients (n = 10) received a femoral nerve block with lidocaine 1.5% 15 mL, and group IVA patients (n = 10) received IV fentanyl 3 microg/kg. Visual analog scale values during positioning (median and range) were lower in group FEM: 0.5 (0-1) versus 3 (2-6) (P < 0.001). Time to perform spinal anesthesia (mean +/- sd) was shorter in group FEM: 1.8 +/- 0.7 min versus 3.0 +/- 1.1 min (P < 0.05). Quality of patient positioning for spinal anesthesia (0 = not satisfactory, 1 = satisfactory, 2 = good, and 3 = optimal) (median and range) was higher in group FEM: 3 (2-3) versus 1.5 (1-3) (P < 0.005). Patient acceptance was less in group IVA (P < 0.05). In one group IVA patient, an oxygen saturation <90% was recorded during the procedure. We conclude that femoral nerve block is more advantageous than IV administration of fentanyl to facilitate the sitting position for spinal anesthesia in patients undergoing surgery for femoral shaft fractures.

Adult↗