RESUMEN
The purpose of this study was to describe the relation of the lumbar plexus with the psoas major and with the superficial and deep landmarks close to it. Four cadavers were dissected and 22 computed tomography files of the lumbosacral region studied. Cadaver dissections demonstrated that the lumbar plexus, at the level of L5, is within the substance of the psoas major muscle rather than between this muscle and the quadratus lumborum. The femoral nerve lies between the lateral femoral cutaneous and obturator nerves. However, while the lateral femoral cutaneous nerve is in the same fascial plane as the femoral nerve, the obturator nerve can be found in the same plane as the two other nerves or in its own muscular fold. Radiological data provided the following measurements: the femoral nerve is at a depth of 9.01 +/- 2.43 cm; the psoas major medial border is at 2.73 +/- 0.64 cm from the median sagittal plane; and its lateral border is at 6.41 +/- 1.61 cm from the same plane. It is concluded that the lumbar plexus is within the psoas major, that the obturator nerve localization within the psoas major varies and that computed tomography data define precisely the relationship of the lumbar plexus with superficial and deep landmarks.
Asunto(s)
Plexo Lumbosacro/anatomía & histología , Bloqueo Nervioso , Tejido Adiposo/diagnóstico por imagen , Adolescente , Adulto , Anciano , Disección , Femenino , Nervio Femoral/anatomía & histología , Humanos , Disco Intervertebral/diagnóstico por imagen , Vértebras Lumbares/anatomía & histología , Plexo Lumbosacro/diagnóstico por imagen , Región Lumbosacra , Masculino , Persona de Mediana Edad , Nervio Obturador/anatomía & histología , Músculos Psoas/anatomía & histología , Músculos Psoas/diagnóstico por imagen , Músculos Psoas/inervación , Tomografía Computarizada por Rayos XRESUMEN
A combination of lumbar plexus block, by a posterior technique, and sciatic nerve block can be a useful technique for outpatient anaesthesia. The purpose of this study was to examine the clinical characteristics of these blocks using lidocaine and to measure the serum lidocaine concentrations. Forty-five patients, undergoing lower extremity surgery, were studied. Sciatic nerve and lumbar plexus blocks were made with lidocaine, 680 mg with adrenaline 0.3 mg. For each patient the following data were collected: weight, age, sex, site of surgery, time to perform each block, needle depth, speed of onset of the sensory and motor blocks in the territories of the sciatic, femoral, obturator and lateral cutaneous (sensory) nerves and postoperative analgesic requirements. Lidocaine serum concentrations were measured in ten of these patients at 0, 2, 5, 10, 30, 60, 90 and 120 min after the second block. Analgesia was complete in 88% (40/45) of the patients. The remaining five patients needed analgesics (fentanyl 150 micrograms or less). Despite the high dose of lidocaine, the serum concentrations were within safe limits (mean +/- SD) (CMAX = 3.66 +/- 2.21 micrograms.ml-1). Only one patient had a serum concentration > 5 micrograms.ml-1 (CMAX = 9.54 micrograms.ml-1). This was associated with a contra-lateral extension of the block. We conclude that this combination of blocks is a valuable alternative for unilateral lower extremity anaesthesia. However, clinicians must be aware of the implications of a contra-lateral extension of the block.
Asunto(s)
Lidocaína , Plexo Lumbosacro , Bloqueo Nervioso/métodos , Nervio Ciático , Adolescente , Adulto , Anciano , Analgésicos/administración & dosificación , Estimulación Eléctrica , Femenino , Nervio Femoral/efectos de los fármacos , Humanos , Pierna/inervación , Pierna/cirugía , Lidocaína/administración & dosificación , Lidocaína/sangre , Plexo Lumbosacro/efectos de los fármacos , Masculino , Persona de Mediana Edad , Neuronas Motoras/efectos de los fármacos , Neuronas Aferentes/efectos de los fármacos , Nervio Obturador/efectos de los fármacos , Dolor Postoperatorio/prevención & control , Estudios Prospectivos , Nervio Ciático/efectos de los fármacos , Factores de TiempoRESUMEN
Ulnar nerve palsy is a recognized complication of general anaesthesia. Many authors have reported several series of patients and found different incidences. In this literature review, the patho-physiology of the lesion and the anatomical characteristics of the cubital tunnel at the elbow are described together with its related conditions "cubital tunnel compression syndrome" and "recurrent ulnar nerve dislocation at the elbow." A precise and early diagnosis should be made using electromyography to determine the exact location of the lesion and the precise time-relationship of the pathology. The importance of careful positioning of the patient under anaesthesia in the prevention of ulnar nerve palsy is stressed. Unfortunately, treatment of the established lesion gives, at best, mixed results.
Asunto(s)
Anestesia General/efectos adversos , Parálisis/etiología , Nervio Cubital , Codo/inervación , Humanos , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/fisiopatología , Parálisis/fisiopatología , Nervio Cubital/lesiones , Nervio Cubital/fisiopatologíaRESUMEN
Pain due to bone metastasis in hormonodependent cancer (of the breast or the prostates more particularly) can be relieved by surgery directed at the endocrinic system. The most efficient techniques are hypophysectomies and hypophysiolysis (or neuroadenolysis). The intrasellar injection of alcohol through the transnasal-transsphenoidal route is a fairly simple procedure which can be carried out on such fragile patients without too much risk. The authors here report the first results obtained with this procedure in 12 pateints. Full sedation of pain is achieved in 30 to 40 p. cent of the cases. The duration of analgesia varies and pain frequently returns. One of the advantages of this procedure lies in the fact that such an injection may be repeated if necessary. The intrasellar injection of alcohol is but one of the many techniques available to practitioners working in the field of intractable pain.