Femoral Nerve Blocks
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The Femoral Nerve Block Characteristics Using Ropivacaine 0.2% Alone, with Epinephrine, Or with Lidocaine and Epinephrine
SCIENTIFIC ARTICLES THE FEMORAL NERVE BLOCK CHARACTERISTICS USING ROPIVACAINE 0.2% ALONE, WITH EPINEPHRINE, OR WITH LIDOCAINE AND EPINEPHRINE A.M. TAHA1,2 AND A.M. ABD-ELmaKSOUD31* Keywords: anesthetic techniques, regional, femoral; anaesthetics local, ropivacaine; equipment, ultrasound machines. Abstract Background: The objective of this study was to evaluate the femoral nerve block characteristics (onset, success rate and duration) using ropivacaine 0.2% alone; with epinephrine, or with lidocaine and epinephrine compared with that using ropivacaine 0.5%. Methods: Ninety six patients were included in this prospective controlled double blind study and were randomly allocated into four equal groups (n=24). All the patients received ultrasound guided femoral nerve block using 15 ml of either ropivacaine 0.5% (group 1), ropivacaine 0.2% (group 2), ropivacaine 0.2% with epinephrine (group 3) and ropivacaine 0.2% with lidocaine and epinephrine (group 4). The block onset, success rate and duration were recorded. Results: The motor onset was significantly delayed in group 2 (compared with the other three groups) and in group 3 (compared with group 4). However, the block success rate and duration were comparable in the four groups. Conclusion: In femoral nerve block, ropivacaine 0.2% may have a comparable success rate and duration to ropivacaine 0.5% but with a remarkably delayed motor onset that may be improved by adding epinephrine. Addition of lidocaine may further accelerate the motor onset. Introduction The femoral nerve block (FNB) is a commonly indicated block, and ropivacaine is a widely used long acting local anesthetic (LA)1,2. Peripheral nerve blocks can provide excellent anesthesia and postoperative analgesia 3,4. -
Ultrasound Guided Femoral Nerve Block
Ultrasound Guided Femoral Nerve Block Michael Blaivas, MD, FACEP, FAIUM Clinical Professor of Medicine University of South Carolina School of Medicine AIUM, Third Vice President President, Society for Ultrasound Medical Education Past President, WINFOCUS Editor, Critical Ultrasound Journal Sub-specialty Editor, Journal of Ultrasound in Medicine Emergency Medicine Atlanta, Georgia [email protected] Disclosures • No relevant disclosures to lecture Objectives • Discuss anatomy of femoral nerve • Discuss uses of femoral nerve block classically and 3-in-1 variant • Discuss technique of femoral nerve blockade under ultrasound • Discuss pitfalls and potential errors Femoral Nerve Block Advantages • Many uses of regional nerve blocks • Avoid narcotics and their complications • Allow for longer term pain control • Can be used in patients unfit for sedation – Poor lung health – Hypotensive – Narcotic dependence or sensitivity Femoral Nerve Blocks • Wide variety of potential indications for a femoral nerve block – Hip fracture – Knee dislocation – Femoral fracture – Laceration repair – Burn – Etc. Nerve Blocks in Community vs. Academic Setting • Weekend stays • Night time admissions • Time to get consult and clear • Referral and admission patters • All of these factors can lead to patients spending considerable time prior to OR • Procedural sedation vs. block Femoral Nerve Blocks • Several basic principles with US also • Specialized needles +/- • No nerve stimulator • Can see nerve directly and inject directly around target nerve or nerves • Only -
Electrophysiological Study of the Posterior Cutaneous Femoral Nerve
logy & N ro eu u r e o N p h f y o s l i a o l n o Brooks, J Neurol Neurophysiol 2011, 2:5 r g u y o J Journal of Neurology & Neurophysiology ISSN: 2155-9562 DOI: 10.4172/2155-9562.1000119 Research Article Article OpenOpen Access Access Electrophysiological Study of the Posterior Cutaneous Femoral Nerve: Normative Data Brooks1*, Silva C MD2, Kai MR2 and Leal GXP2 1Setor de Eletroneuromiografia do Instituto de Assistência à Saúde do Servidor Público Estadual de São Paulo – São Paulo- Brasil 2Hospital do Servidor Publico Estadual de São Paulo, São Paulo, Brazil Abstract The posterior cutaneous femoral nerve provides cutaneous inervation of the posterior surface of the thigh and leg, as well as the skin of the perineum. Using Dumitru et al. [1] technique for the assessment of this nerve, we studied one hundred and sixteen limbs from fifty-eight healthy volunteers. The mean values for the posterior cutaneous femoral nerve were as follows: onset latency 2.0 msec (±0.5), amplitude 7.0µV (±2.1), nerve conduction velocity 52 m/s (±4). The assessment of the posterior femoral cutaneous nerve is simple and reproducible. The results of this standardization were similar to the ones described in international literature. Keywords: Femoral nerve; Posterior cutaneous nerve Results Introduction The mean values for the posterior cutaneous femoral nerve were as follows: onset latency 2.0msec (±0.5), amplitude 7.0µV (±2,1), nerve The posterior cutaneous nerve of the thigh leaves the pelvis through conduction velocity 52 m/s (±4); Table 1 summarizes our findings. -
The International Student Journal of Nurse Anesthesia
Volume 15 Issue 1 Spring 2016 The International Student Journal of Nurse Anesthesia TOPICS IN THIS ISSUE Ondansetron to prevent SAB-induced Hypotension Hyperthermic Intraperitoneal Chemotherapy Carnitine Palmitoyltransferase Deficiency Adductor Canal vs. Femoral Nerve Block Ketamine Induction for Awake Intubation Airway Management for Tracheostomy TIVA for Gastroenterology Procedures Hematoma Following Thyroidectomy Tranexamic Acid in Trauma Tracheoesophageal Fistula Reintubation in the PACU Venous Air Embolism Emergence Delirium Preventing OR Fires INTERNATIONAL STUDENT JOURNAL OF NURSE ANESTHESIA Vol. 15 No. 1 Spring 2016 Editor Vicki C. Coopmans, CRNA, PhD Associate Editor Julie A. Pearson, CRNA, PhD Editorial Board Laura Ardizzone, CRNA, DNP Memorial Sloan Kettering Cancer Center; NY, NY MAJ Sarah Bellenger, CRNA, MSN, AN Darnall Army Medical Center; Fort Hood, TX Laura S. Bonanno, CRNA, DNP Louisiana State University Health Sciences Center Carrie C. Bowman Dalley, CRNA, MS Georgetown University Marianne Cosgrove, CRNA, DNAP Yale-New Haven Hospital School of Nurse Anesthesia LTC Denise Cotton, CRNA, DNAP, AN Winn Army Community Hospital; Fort Stewart, GA Janet A. Dewan, CRNA, PhD Northeastern University Kären K. Embrey CRNA, EdD University of Southern California Millikin University and Rhonda Gee, CRNA, DNSc Decatur Memorial Hospital Marjorie A. Geisz-Everson CRNA, PhD University of Southern Mississippi Johnnie Holmes, CRNA, PhD Naval Hospital Camp Lejeune Anne Marie Hranchook, CRNA, DNP Oakland University-Beaumont Donna Jasinski, -
A Comprehensive Curriculum of the History of Regional Anesthesia
University of Massachusetts Medical School eScholarship@UMMS Anesthesiology and Perioperative Medicine Publications Anesthesiology and Perioperative Medicine 2019-09-18 A Comprehensive Curriculum of The History of Regional Anesthesia Gustavo Angaramo University of Massachusetts Medical School Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/anesthesiology_pubs Part of the Anesthesia and Analgesia Commons, Anesthesiology Commons, History of Science, Technology, and Medicine Commons, and the Medical Education Commons Repository Citation Angaramo G, Savage J, Arcella D, Desai MS. (2019). A Comprehensive Curriculum of The History of Regional Anesthesia. Anesthesiology and Perioperative Medicine Publications. Retrieved from https://escholarship.umassmed.edu/anesthesiology_pubs/193 Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Anesthesiology and Perioperative Medicine Publications by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. Journal of Clinical Anesthesia and Pain Medicine Research Article A Comprehensive Curriculum of The History of Regional Anesthesia This article was published in the following Scient Open Access Journal: Journal of Clinical Anesthesia and Pain Medicine Received August 30, 2019; Accepted September 12, 2019; Published September 18, 2019 1 Gustavo Angaramo , James Savage, Abstract David Arcella and Manisha S. Desai1* Department of Anesthesiology and Perioperative The study of the past with regards to medical history has been an underemphasized Medicine, University of Massachusetts Medical component of the medical school curriculum for several reasons. School, Worcester, Massachusetts. -
Femoral and Sciatic Nerve Blocks for Total Knee Replacement in an Obese Patient with a Previous History of Failed Endotracheal Intubation −A Case Report−
Anesth Pain Med 2011; 6: 270~274 ■Case Report■ Femoral and sciatic nerve blocks for total knee replacement in an obese patient with a previous history of failed endotracheal intubation −A case report− Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea Jong Hae Kim, Woon Seok Roh, Jin Yong Jung, Seok Young Song, Jung Eun Kim, and Baek Jin Kim Peripheral nerve block has frequently been used as an alternative are situations in which spinal or epidural anesthesia cannot be to epidural analgesia for postoperative pain control in patients conducted, such as coagulation disturbances, sepsis, local undergoing total knee replacement. However, there are few reports infection, immune deficiency, severe spinal deformity, severe demonstrating that the combination of femoral and sciatic nerve blocks (FSNBs) can provide adequate analgesia and muscle decompensated hypovolemia and shock. Moreover, factors relaxation during total knee replacement. We experienced a case associated with technically difficult neuraxial blocks influence of successful FSNBs for a total knee replacement in a 66 year-old the anesthesiologist’s decision to perform the procedure [1]. In female patient who had a previous cancelled surgery due to a failed tracheal intubation followed by a difficult mask ventilation for 50 these cases, peripheral nerve block can provide a good solution minutes, 3 days before these blocks. FSNBs were performed with for operations on a lower extremity. The combination of 50 ml of 1.5% mepivacaine because she had conditions precluding femoral and sciatic nerve blocks (FSNBs) has frequently been neuraxial blocks including a long distance from the skin to the used for postoperative pain control after total knee replacement epidural space related to a high body mass index and nonpalpable lumbar spinous processes. -
Femoral Nerve Block Versus Spinal Anesthesia for Lower Limb
Alexandria Journal of Anaesthesia and Intensive Care 44 Femoral Nerve Block versus Spinal Anesthesia for Lower Limb Peripheral Vascular Surgery By Ahmed Mansour, MD Assistant Professor of Anesthesia, Faculty of Medicine, Alexandria University. Abstract Perioperative cardiac complications occur in 4% to 6% of patients undergoing infrainguinal revascularization under general, spinal, or epidural anesthesia. The risk may be even greater in patients whose cardiac disease cannot be fully evaluated or treated before urgent limb salvage operations. Prompted by these considerations, we investigated the feasibility and results of using femoral nerve block with infiltration of the genito4femoral nerve branches in these high-risk patients. Methods: Forty peripheral vascular reconstruction of lower limbs were performed under either spinal anesthesia (20 patients) or femoral nerve block with infiltration of genito-femoral nerve branches supplemented with local infiltration at the site of dissection as needed (20 patients). All patients had arterial lines. Arterial blood pressure and electrocardiographic monitoring was continued during surgery, in PACU and in the intensive care units. Results: Operations included femoral-femoral, femoral-popliteal bypass grafting and thrombectomy. The intra-operative events showed that the mean time needed to perform the block and dose of analgesics and sedatives needed during surgery was greater in group I (FNB,) compared to group II [P=0.01*, P0.029* , P0.039*], however, the time needed to start surgery was shorter in group I than in group II [P=0. 039]. There were no block failures in either group, but local infiltration in the area of the dissection with 2 ml (range 1-5 ml) of 1% lidocaine was required in 4 (20%) patients in FNB group vs none in the spinal group. -
AORN Guideline for Patients Receiving Local-Only Anesthesia Evidence Table
AORN Guideline for Patients Receiving Local-Only Anesthesia Evidence Table SAMPLE SIZE/ CONTROL/ OUTCOME CITATION EVIDENCE TYPE INTERVENTION(S) CONCLUSION(S) POPULATION COMPARISON MEASURE(S) SCORE CONSENSUS REFERENCE # REFERENCE 1 Lirk P., Picardi S. and Hollmann, M. W. Local Literature Review n/a n/a n/a n/a The mechanism of action and VA anaesthetics: 10 essentials. 2014 access pathways of local anesthetics and their pharmokinetics are increasingly understood and appreciated. 2 Calatayud, Jesús, M.D.,D.D.S., Ph.D., González, Õngel, Expert Opinion n/a n/a n/a n/a A review of the discovery and VA M.D., D.D.S., Ph.D. History of the development and evolution of local anesthesia evolution of local anesthesia since the coca leaf. from the Spanish discovery of Anesthesiology. 2003;98(6):1503-1508. the coca leaf in America. 3 Gordh T, M.D., Gordh, Torsten E.,M.D., Ph.D., Lindqvist Literature Review n/a n/a n/a n/a Before the introduction of VA K, M.Sc. Lidocaine: The origin of a modern local lidocaine, the choice of local anesthetic. Anesthesiology. 2010;113(6):1433-1437. anesthetics was limited. https://doi.org/10.1097/ALN.0b013e3181fcef48. doi: Lidocaine's onset was 10.1097/ALN.0b013e3181fcef48. substantially faster and longer lasting than procaine. 4 Volcheck G.W., Mertes, P. M. Local and general Literature Review n/a n/a n/a n/a Whether to test the local VA anesthetics immediate hypersensitivity reactions. 2014 anesthetic causing the allergic reaction or an alternative agent depends on the expected future need of the specific local anesthetic. -
The Use of Buffering Solutions in the Pediatrics Local Anesthesia to Reduce the Pain of Minor Procedures
Volume 2- Issue 1 : 2018 DOI: 10.26717/BJSTR.2018.02.000695 Eduardo de Oliveira Duque-Estrada. Biomed J Sci & Tech Res ISSN: 2574-1241 Mini Review Open Access The Use of Buffering Solutions in the Pediatrics Local Anesthesia to Reduce the Pain of Minor Procedures Eduardo de Oliveira Duque-Estrada MD* Received: January 17, 2018; Published: January 25, 2018 *Corresponding author: Eduardo de Oliveira Duque-Estrada, Ex-Professor of Pediatrics and Pediatric Surgery, Teresópolis Schoolof Medicine, Rio de Janeiro, Rua Jose da Silva Ribeiro 119 apt 11 São Paulo, SP Brazil CEP: 05726-130, Email: Abstract The local anesthetics are widely u sed in minor pediatric surgical procedures. The major problem with their use is the resulted pain experienced by the patients at the time of injection. To discuss those situations in the light of the medical literature we present this mini-review. Key words: Local Injection; Pain; Buffer; pH; Lidocaine; Pediatric Surgery Procedure Introduction Table 1: Techniques for injection pain control*. a eutectic mixture of lidocaine and prilocaine (EMLA) cream [17] S.No Techniques for injection pain control before infiltration, and local external cooling (cryoanalgesia) have 1. Warming the anesthetic solution [18,19] (Table 1). also been used to reduce the pain of infiltration of local anesthetic 2. Buffering the anesthetic Buffering the Anesthetic 3. Injection technique 4. Distraction Local anesthesia is extremely useful either as the sole method the best results on the minor surgery in general [3,6]. Blocking 5. Combination anesthetic technique the pain pathway with local anesthetic solution will also reduce 6. Cooling of skin the family stress response to the surgical procedure. -
Lower Extremity Focal Neuropathies
LOWER EXTREMITY FOCAL NEUROPATHIES Lower Extremity Focal Neuropathies Arturo A. Leis, MD S.H. Subramony, MD Vettaikorumakankav Vedanarayanan, MD, MBBS Mark A. Ross, MD AANEM 59th Annual Meeting Orlando, Florida Copyright © September 2012 American Association of Neuromuscular & Electrodiagnostic Medicine 2621 Superior Drive NW Rochester, MN 55901 Printed by Johnson Printing Company, Inc. 1 Please be aware that some of the medical devices or pharmaceuticals discussed in this handout may not be cleared by the FDA or cleared by the FDA for the specific use described by the authors and are “off-label” (i.e., a use not described on the product’s label). “Off-label” devices or pharmaceuticals may be used if, in the judgment of the treating physician, such use is medically indicated to treat a patient’s condition. Information regarding the FDA clearance status of a particular device or pharmaceutical may be obtained by reading the product’s package labeling, by contacting a sales representative or legal counsel of the manufacturer of the device or pharmaceutical, or by contacting the FDA at 1-800-638-2041. 2 LOWER EXTREMITY FOCAL NEUROPATHIES Lower Extremity Focal Neuropathies Table of Contents Course Committees & Course Objectives 4 Faculty 5 Basic and Special Nerve Conduction Studies of the Lower Limbs 7 Arturo A. Leis, MD Common Peroneal Neuropathy and Foot Drop 19 S.H. Subramony, MD Mononeuropathies Affecting Tibial Nerve and its Branches 23 Vettaikorumakankav Vedanarayanan, MD, MBBS Femoral, Obturator, and Lateral Femoral Cutaneous Neuropathies 27 Mark A. Ross, MD CME Questions 33 No one involved in the planning of this CME activity had any relevant financial relationships to disclose. -
Homenagem a August Karl Gustav Bier Por Ocasião Dos 100 Anos Da
Rev Bras Anestesiol ARTIGO DIVERSO 2008; 58: 4: 409-424 MISCELLANEOUS Homenagem a August Karl Gustav Bier por Ocasião dos 100 Anos da Anestesia Regional Intravenosa e dos 110 Anos da Raquianestesia* Eulogy to August Karl Gustav Bier on the 100th Anniversary of Intravenous Regional Block and the 110th Anniversary of the Spinal Block Almiro dos Reis Jr, TSA1 RESUMO Unitermos: ANESTESIA, Regional: subaracnóidea, venosa; Reis Jr. A — Homenagem a August Karl Gustav Bier por Ocasião dos ANESTESIOLOGIA: história. 100 Anos da Anestesia Regional Intravenosa e dos 110 Anos da Raquianestesia SUMMARY JUSTIFICATIVA E OBJETIVOS: August Karl Gustav Bier foi o in- Reis Jr A — Eulogy to August Karl Gustav Bier on the 100th Anni- trodutor de duas importantes técnicas de anestesia regional: a versary of Intravenous Regional Block and the 110th Anniversary of anestesia regional intravenosa e a anestesia subaracnóidea, Spinal Block. ambas até hoje amplamente empregadas. Completando neste ano de 2008 a primeira delas 100 anos e a segunda 110 anos de exis- BACKGROUND AND OBJECTIVES: August Karl Gustav Bier in- tência, seria mais do que justo prestarmos uma homenagem ao no- troduced two important techniques in regional block: intravenous tável médico que as criou. regional block and subarachnoid block, widely used nowadays. Since the first one celebrates its 100th anniversary and the second CONTEÚDO: O texto relata os dados familiares, estudantis inici- its 110th anniversary, it is only fair that we pay homage to this ex- ais, do curso acadêmico e da residência médica, as atividades pro- traordinary physician who created them. fissionais e universitárias, a personalidade, a aposentadoria e o falecimento de A. -
Veterinary Anesthetic and Analgesic Formulary 3Rd Edition, Version G
Veterinary Anesthetic and Analgesic Formulary 3rd Edition, Version G I. Introduction and Use of the UC‐Denver Veterinary Formulary II. Anesthetic and Analgesic Considerations III. Species Specific Veterinary Formulary 1. Mouse 2. Rat 3. Neonatal Rodent 4. Guinea Pig 5. Chinchilla 6. Gerbil 7. Rabbit 8. Dog 9. Pig 10. Sheep 11. Non‐Pharmaceutical Grade Anesthetics IV. References I. Introduction and Use of the UC‐Denver Formulary Basic Definitions: Anesthesia: central nervous system depression that provides amnesia, unconsciousness and immobility in response to a painful stimulation. Drugs that produce anesthesia may or may not provide analgesia (1, 2). Analgesia: The absence of pain in response to stimulation that would normally be painful. An analgesic drug can provide analgesia by acting at the level of the central nervous system or at the site of inflammation to diminish or block pain signals (1, 2). Sedation: A state of mental calmness, decreased response to environmental stimuli, and muscle relaxation. This state is characterized by suppression of spontaneous movement with maintenance of spinal reflexes (1). Animal anesthesia and analgesia are crucial components of an animal use protocol. This document is provided to aid in the design of an anesthetic and analgesic plan to prevent animal pain whenever possible. However, this document should not be perceived to replace consultation with the university’s veterinary staff. As required by law, the veterinary staff should be consulted to assist in the planning of procedures where anesthetics and analgesics will be used to avoid or minimize discomfort, distress and pain in animals (3, 4). Prior to administration, all use of anesthetics and analgesic are to be approved by the Institutional Animal Care and Use Committee (IACUC).