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At least 19 recordsLinked to original sources
PubMed2006

The effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway.

Total knee arthroplasty (TKA) may result in severe pain, and single-injection femoral nerve blocks (SFNB) have been demonstrated to have a limited duration of analgesia. Continuous femoral nerve blocks (CFNB) can prolong the analgesic duration of SFNB. We prospectively randomized 36 patients undergoing TKA to CFNB versus SFNB and evaluated the effect on hospital length of stay (LOS) as the primary outcome within a standardized clinical pathway. Secondary outcomes included visual analog scale (VAS) pain scores, opioid consumption, and long-term functional recovery at 12 wk. Mean VAS resting scores were significantly lower among patients who received CFNB versus SFNB: first day (1.7 vs 3.3 [P = 0.002]) and second day (0.9 vs 3.2 [P < 0.0001]) after surgery. Mean maximal VAS scores during physical therapy were significantly lower among patients who received CFNB versus SFNB: first day (4.7 vs 6.3 [P = 0.01]) and second day (3.9 vs 6.1 [P = 0.0005]) after surgery. Mean oxycodone consumption was significantly lower among patients who received CFNB versus SFNB: 15 mg versus 40 mg (P = or < 0.0001) on the first day after surgery; 20 mg versus 43 mg (P = 0.0004) on the second day after surgery. There was no difference in hospital LOS (3.8 vs 3.9 days) or long-term functional recovery (117 degrees versus 113 degrees knee flexion at 12 wk) between the two groups. The lack of effect provided by increased duration of analgesia (from CFNB) after TKA may now have minimal impact on hospital LOS and long-term functional recovery in the contemporary healthcare environment within the United States.

Aged↗
PubMed2003

Femoral nerve block for femoral shaft fractures in a paediatric Emergency Department: can it be done better?

BACKGROUND: The relatively simple technique of administering a femoral nerve block is known to be quick, safe and effective in providing prolonged analgesia to children with femoral shaft fracture. Although medical literature supports its use in the emergency setting, no studies have been conducted on how this is undertaken in practice. OBJECTIVE: The aim of this study is to describe the practice of femoral nerve block in previously well children who present to our Emergency Department with femoral shaft fracture. SETTING: This study was conducted at the Emergency Department of a tertiary paediatric hospital in Sydney, Australia. METHODS: A retrospective descriptive study was conducted by gathering data on all patients presenting to the Emergency Department between 1 January 1996 and 1 July 2001 with traumatic fracture to the femoral shaft. Whether femoral nerve block had been performed in the emergency setting; the time taken for femoral nerve block to be performed; the type of local anaesthetic used; the dose of local anaesthetic administered, and the level of training and area of expertise of doctors performing the femoral nerve block were determined from the clinical records. One-way analysis of variance and Student's t-tests were conducted to compare the average dosages of local anaesthetic used by the different medical sub-specialities involved. Student's t-tests were applied to analyse the time differences for performing femoral nerve block between emergency- and non-emergency-based medical staff. RESULTS: The majority (111) of the 117 patients who met the inclusion criteria for the study had isolated femoral shaft fractures (94.9%). Femoral nerve blocks were performed in 97 of our study patients (82.9%). No correlation was found between the age of the child and the time taken for a femoral nerve block. In 76 cases in which a femoral nerve block was given (64.9%), a member of staff external to the Emergency Department performed the procedure. The average time taken for a femoral nerve block to be performed for non-Emergency Department medical staff was significantly longer than for Emergency Department medical staff. In only 37 cases (31.9%), was a femoral nerve block administered within an hour of the time of triage. Doses used by non-anaesthetists were lower than those used by anaesthetists. CONCLUSION: There is unnecessary delay in carrying out this procedure for children with fractures to the femoral shaft. A significant degree of reliance on staff external to the Emergency Department was reported. This paper supports increased training and supervision to promote the more widespread and prompt use of femoral nerve blocks as an important standard of care for the Emergency Department.

Anesthesiology↗
PubMed2003

Comparing the effects of femoral nerve block versus femoral and sciatic nerve block on pain and opiate consumption after total knee arthroplasty.

The goal of this study was to compare femoral and femoral plus sciatic nerve blocks in the postoperative pain management of patients undergoing total knee arthroplasty (TKA). A total of 97 patients participated in a convenience sample, comparative study. Patients who received femoral nerve block only (n = 30) reported statistically higher pain scores (P <.05) and showed 61% higher opiate consumption than those who received femoral and sciatic nerve blocks (n = 67) in the first 24 hours after surgery. The results suggest that the combined femoral and sciatic nerve block provides superior pain management in the early postoperative period after TKA.

Aged↗
PubMed1993

Delayed femoral nerve palsy following femoral vessel catheterization.

We report two cases with a delayed complication of femoral vessel catheterization: femoral nerve entrapment by iliacus hematoma. Both patients had femoral artery catheterization and postoprocedural anticoagulation, followed by iliacus hematoma eruption on the side of catheterization. Diagnosis was confirmed by computed tomography and electrodiagnostic studies. The pathogenesis of iliacus hematoma-induced femoral neuropathy has been studied in detail; however, the authors could find no previous reports of catheterization causing this phenomenon. The association is probably under reported because of the delayed manifestation. Awareness of this complication could (1) minimize the neuropathy, by insuring early diagnosis and treatment and (2) reduce its incidence, by avoiding trauma to the iliacus muscle during catheterization.

Abdominal Muscles↗
PubMed2005

Treatment concepts for idiopathic and iatrogenic femoral nerve mononeuropathy.

Femoral mononeuropathy has many etiologies and is often quite disabling, causing lower extremity paresthesia, anesthesia, pain, or paresis. Despite its morbidity, few therapies have been described to treat the femoral nerve palsy that does not resolve with conservative management or that is refractory to physical therapy. In this report, we present 3 cases of femoral nerve palsy; one as a complication of local nerve block, one as a complication of laparotomy, and one of idiopathic origin. In each case, symptomatic and objective improvement was achieved with femoral neurolysis. We suggest guidelines for the management of those patients who fail to respond to conservative therapy and indications for surgical intervention.

Adult↗
PubMed2000

Proximal and distal motor nerve conduction in obturator and femoral nerves.

OBJECTIVE: To study the proximal and distal motor conduction properties of obturator and femoral nerves. DESIGN: For evaluation of distal motor conduction properties, obturator and femoral nerves were stimulated at the inguinal ligament, and M responses were recorded with needle electrodes from gracilis and rectus femoris muscles. Upper lumbar roots were stimulated with needle electrodes inserted between L1-L2 vertebral laminae. PARTICIPANTS: Sixteen healthy adults, eight of each gender, age 22 to 52 years (mean 37.5). MAIN OUTCOME MEASURES: Description of a method for assessing motor conduction along the obturator nerve and evaluating proximal motor conduction measurements obtained with stimulation of obturator and femoral nerves. RESULTS: Distal motor conduction latencies were 3.9 +/- 0.7 msec for gracilis and 4.6 +/- 0.5msec for rectus femoris after stimulation of obturator and femoral nerves, respectively. Proximal conduction times from lumbar vertebral level were 10.4 +/- 0.3msec for the obturator nerve and 10.8 +/- 0.4msec for the femoral nerve. Conduction velocities of proximal segments of both nerves were similar, 62m/sec for the obturator nerve and 65m/sec for the femoral nerve. Submaximal stimulation of both nerves evoked H-reflex responses from their associated muscles. CONCLUSIONS: Motor conduction properties of the obturator nerve can be assessed by the method described, particularly to differentiate between peripheral, plexus, or radicular lesions that involve the obturator nerve.

Adult↗
PubMed1995

Femoral nerve block in extracapsular femoral neck fractures.

We randomised 50 patients with extracapsular fractures of the femoral neck to receive either a bupivacaine femoral nerve block or systemic analgesia alone. A femoral nerve block was found to be an easy and effective procedure which significantly reduced perioperative analgesic requirements and postoperative morbidity.

Aged↗
PubMed1997

Surgical correction of proximal femoral nerve entrapment.

BACKGROUND: Femoral nerve palsy is usually a result of trauma. Isolated femoral nerve palsy without external trauma is restricted to occasional case reports in various circumstances. CASE DESCRIPTION: Three cases of nontraumatic femoral nerve palsy are reported who presented with pain and weakness. Symptoms were relieved by transection of the iliopectineal arch. This is believed to be a newly described syndrome. An additional case of femoral nerve entrapment following vaginal hysterectomy is described. This case presented only as a pain syndrome. CONCLUSIONS: There is a syndrome of femoral nerve entrapment at the iliopectineal arch that can be easily relieved by sectioning of this arch, analogous to carpal tunnel syndrome. Several cases of femoral nerve palsy previously reported may be examples of this syndrome.

Adult↗
PubMed2001

Intercostal nerve neurotization of the femoral nerve in patients with paraplegia--an anatomical feasibility study.

Neurotization of the brachial plexus is an established procedure in the upper limb. However, neurotization of the lower limb remains experimental. Brunelli reported the use of the ulnar nerve to neurotize the lower limb. Zhao et al reported the use of intercostals nerve to neurotize the lower limb in rats. The aim of the study was to determine the feasibility of using intercostals nerve to neurotize the femoral nerve in human cadavers and to ascertain the ideal intercostals nerve that has the anatomical course that suit this role. Six fresh cadaveric dissection were performed through an extensile midline incision in the postmortem room and the lower six (T7-T12) were identified and traced from their origin. Their length and course identified and charted. T9 and T10 intercostal nerve was thought to be the most suitable nerve as the donor nerve, and the T11 and T12 intercostal nerve could not be free from its intra-muscular course sufficiently to be use as donor.

Feasibility Studies↗