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Asia-Pacific Journal of Sports... Apr 2024Anterior cruciate ligament (ACL) reconstruction is commonly associated with moderate-to-severe postoperative pain. Notably, various pain control strategies, a femoral...
BACKGROUND
Anterior cruciate ligament (ACL) reconstruction is commonly associated with moderate-to-severe postoperative pain. Notably, various pain control strategies, a femoral nerve block (FNB) with a lateral femoral cutaneous nerve block (LFCNB), adductor canal block (ACB) with LFCNB, or periarticular cocktail injection (PI), have been investigated. However, no studies compare the effects of FNB with LFCNB, ACB with LFCNB, and PI for pain control after ACL reconstruction. This study aimed to evaluate the impact of FNB with LFCNB, ACB with LFCNB, and PI for pain relief in the early postoperative period after ACL reconstruction.
METHODS
This retrospective controlled clinical trial enrolled 299 patients who underwent primary ACL reconstruction at our hospital between April 2016 and October 2022. We categorized these cases into groups based on the use of PI (PI group), FNB with LFCNB (FNB group), and ACB with LFCNB (ACB group) for pain management. We selected 40 cases each, with matched age, sex, and body mass index (BMI) from each group, resulting in 120 cases for analysis. In the FNB and ACB groups, 0.75% ropivacaine 15 ml was injected under ultrasound guidance preoperatively. In the PI group, a mixture of 0.75% ropivacaine 20 ml, normal saline 20 ml, and dexamethasone 6.6 mg was injected half at the start of surgery and the rest just before wound closure. Patient demographics (age, sex, height, body weight, and BMI) and surgical data (the requirement for meniscal repair, operative time, and tourniquet inflation time) were analyzed. After ACL reconstruction, patients' numerical rating scale pain scores (NRS) (0-10) were recorded at 30 min and 4, 8, 12, 24, 48, and 72 h postoperatively. NRS were then compared among the three groups using analysis of variance. In addition, within each group, these data were compared between the NRS ≥7 and NRS ≤6 groups using a -test.
RESULTS
There were no significant differences in patient demographics and surgical data. Pain scores were significantly higher in the PI group than in the FCB and ACB groups 30 min postoperatively, but they were lower at 12, 24, 48, and 72 h postoperatively. In the FNB group, there were no significant differences in the demographic and surgical data by NRS pain score. In the ACB group, the number of men was significantly higher in the NRS ≥7 group than in the NRS ≤6 group (p = 0.015). In the PI group, tourniquet inflation time was significantly longer in the NRS ≥7 group than in the NRS ≤6 group (p = 0.008).
CONCLUSIONS
Following ACL reconstruction using a hamstring autograft, periarticular cocktail significantly reduced early postoperative pain compared with nerve block combinations.
PubMed: 38584974
DOI: 10.1016/j.asmart.2024.03.001 -
Perioperative Medicine (London, England) Apr 2024Unanticipated symptoms of peripheral nerve damage following surgery are distressing to both the patient and their clinical team, including surgeons, anesthesiologists,...
BACKGROUND
Unanticipated symptoms of peripheral nerve damage following surgery are distressing to both the patient and their clinical team, including surgeons, anesthesiologists, and neurologists. The causes that are commonly considered for perioperative neuropathy can include surgical trauma, positioning-related injury, or injury related to a regional anesthetic technique. However, these cases often do not have a clear etiology and can occur without any apparent periprocedural anomalies. Postoperative inflammatory neuropathy is a more recently described, and potentially underrecognized cause of perioperative neuropathy which may improve with corticosteroid therapy. Therefore, it is an important etiology to consider early in the evaluation of perioperative neuropathy.
CASE PRESENTATION
An otherwise healthy patient presented for left anterior cruciate ligament reconstruction. He underwent femoral and sciatic ultrasound-guided single-injection peripheral nerve blocks preoperatively, followed by a general anesthetic for the surgical procedure. He developed postoperative neuropathy in the sciatic distribution with both sensory and motor deficits. The patient received multi-disciplinary consultations, including neurology and pain management, and a broad differential diagnosis was considered. Based on neurological evaluation and imaging studies, a final diagnosis of post-surgical inflammatory neuropathy was made. The patient's course improved with conservative management, but immunosuppressive treatment may have been considered for a more severe or worsening clinical course.
CONCLUSIONS
There are limited publications describing postoperative inflammatory neuropathy, and this case serves to illustrate a potentially under-recognized and multifactorial cause of postoperative neuropathy. Perioperative neuropathies are a complication that surgeons and anesthesiologists strive to avoid; however, prevention and treatment of this condition have been elusive. Increased reporting and investigation of postoperative inflammatory neuropathy as one cause for this complication will help to further our understanding of this potentially devastating complication.
PubMed: 38566245
DOI: 10.1186/s13741-024-00384-w -
Science Progress 2024Acute limb ischemia (ALI) is a rapid decrease in lower limb blood flow due to acute occlusion of peripheral arteries or bypass grafts. This study aimed to establish an...
OBJECTIVE
Acute limb ischemia (ALI) is a rapid decrease in lower limb blood flow due to acute occlusion of peripheral arteries or bypass grafts. This study aimed to establish an ALI model using microsized gelatin beads and to investigate the pathophysiological conditions.
METHODS
Male Sprague-Dawley rats were anesthetized, and a low or high dose of microsized gelatin beads was administered into the left femoral artery on days 0 and 7. A control, that is, normal saline (NS) group in which NS was administered in the left femoral artery, a femoral artery cut (FAC) group in which the left femoral artery was cut, and a sciatic nerve cut (SNC) group in which the left sciatic nerve was cut were prepared. After 21 days, the temperature changes and the muscle weights in the lower limbs were measured. To assess nerve damage, the L1-6 sympathetic ganglia were immunostained with activating transcription factor 3 (ATF3) antibody.
RESULTS
In the Low-dose, High-dose, and FAC groups, a decrease in temperature was predominantly observed in the left limb. In the High-dose and SNC groups, the weight of the soleus muscle and extensor digitorum longus in the left limb decreased; however, no weight changes were observed in the Low-dose and FAC groups. Conversely, the weight of the gastrocnemius muscle significantly decreased in the Low-dose, High-dose, FAC, and SNC groups. In the High-dose and SNC groups, the number of ATF3-positive cells in the sympathetic ganglia significantly increased, and in the Low-dose, a small number of ATF3-positive cells were observed. However, ATF3-positive cells were rarely observed in the FAC and NS groups.
CONCLUSION
We established an ALI rat model using microsized gelatin beads. The results of this study suggest that autonomic neuropathy in ALI is related to both muscle damage and peripheral neuropathy.
Topics: Rats; Animals; Male; Rats, Sprague-Dawley; Gelatin; Ischemia; Muscle, Skeletal; Sciatic Nerve
PubMed: 38490165
DOI: 10.1177/00368504241231656 -
Neurophysiologie Clinique = Clinical... May 2024To assess a potential efficacy signal, safety and feasibility of neuromuscular electrical stimulation (NMES) therapy as an adjunct to standard care in patients with...
OBJECTIVE
To assess a potential efficacy signal, safety and feasibility of neuromuscular electrical stimulation (NMES) therapy as an adjunct to standard care in patients with diabetic sensorimotor polyneuropathy (DSPN).
METHODS
In this single-centre, prospective, cohort, proof-of-concept study, 25 patients with DSPN consented to at least one daily 30-minute NMES therapy session (Revitive® IX) for 10 weeks, with 20 patients completing the study. The primary outcome measure was nerve conductivity assessed using a nerve conduction study of the sural, superficial peroneal, common peroneal and tibial nerves at 10 weeks compared to baseline. Secondary outcomes included superficial femoral artery (SFA) haemodynamics during NMES therapy compared to rest and quality-of-life at 10 weeks compared to baseline.
RESULTS
At 10 weeks, there were significant increases in sural sensory nerve action potential amplitude and conduction velocity (p < 0.001), superficial peroneal sensory nerve action potential amplitude (p = 0.001) and conduction velocity (p = 0.002), common peroneal nerve conduction velocity (p = 0.004) and tibial nerve compound muscle action potential amplitude (p = 0.002) compared to baseline. SFA volume flow and time-averaged mean velocity significantly increased (p ≤ 0.003) during NMES compared to rest. Patient-reported Michigan Neuropathy Screening Instrument scores significantly decreased (p = 0.028) at 10 weeks compared to baseline. Three unrelated adverse events occurred, and 15 participants adhered to treatment.
CONCLUSIONS
NMES therapy as an adjunct to standard care for 10 weeks significantly increased lower limb nerve conductivity in patients with DSPN and may be beneficial in the treatment of DSPN.
Topics: Humans; Male; Middle Aged; Female; Diabetic Neuropathies; Prospective Studies; Aged; Electric Stimulation Therapy; Neural Conduction; Proof of Concept Study; Adult; Cohort Studies; Treatment Outcome; Peroneal Nerve
PubMed: 38422719
DOI: 10.1016/j.neucli.2024.102943 -
Pain Physician Feb 2024Infrapatellar neuropathy arises from traumatic, iatrogenic, or compression injury to the infrapatellar branch (IB) of the saphenous nerve. The risk of infrapatellar...
BACKGROUND
Infrapatellar neuropathy arises from traumatic, iatrogenic, or compression injury to the infrapatellar branch (IB) of the saphenous nerve. The risk of infrapatellar neuropathy has been shown to depend on the IB's anatomical course. The infrapatellar branch of the saphenous nerve (ISBN) has been discovered to take varying courses, and the IB can emerge directly from the femoral nerve. The variety of the IBSN's courses and the prevalence of cases involving the infrapatellar branch of the femoral nerve (IBFN) call the uniform IB course described in textbooks into question.
OBJECTIVES
In this study, we aim to identify sites of IB emergence and their anatomical relations and evaluate them for their risk of neuropathy.
STUDY DESIGN
The study is an anatomical prospective pilot study.
SETTING
The setting is a single-center cadaveric study performed at the anatomical institute of the Medical University of Vienna.
METHODS
Twenty-two anatomical specimens were evaluated for the relationship of their IBs to anatomical risk sites. The subsartorial course, distal sartorial penetration, and the crossing of the medial femoral epicondyle were assessed. The measurements and relations of the IB were determined with callipers and assessed by computational modelling.
RESULTS
Nine IBs originated from the saphenous nerve, 11 originated from the femoral nerve, and 2 originated from both. The subsartorial course was most frequent in IBs of saphenous origin. Penetrating and profound distal sartorial relations correlated moderately with emergence type and were highest in the saphenous group. The crossing of the medial femoral epicondyle was the most common relation of IBs that emerged femorally.
LIMITATIONS
The study's limitations were the low number of cadavers to examine and the confining of the exploration of knee extension to anatomical specimens that restricted an inferential analysis.
CONCLUSION
Infrapatellar innervation can emerge from the saphenous nerve, the femoral nerve, or a combination of both, and the origin of the innervation determines the clinical risk for infrapatellar neuropathy. While innervation from the IBSN may lead to compression at the subsartorial course, distal sartorial penetration, and the crossing of the medial femoral epicondyle, innervation from the IBFN carries reduced anatomical risk for infrapatellar neuropathy.
Topics: Humans; Pilot Projects; Prospective Studies; Knee; Knee Joint; Femoral Nerve; Peripheral Nervous System Diseases; Cadaver
PubMed: 38324796
DOI: No ID Found -
Pakistan Journal of Medical Sciences 2024To determine the efficacy of steroid injections for pain relief in patients with meralgia paresthetica (MP). (Review)
Review
OBJECTIVE
To determine the efficacy of steroid injections for pain relief in patients with meralgia paresthetica (MP).
METHODS
All the literature published until March 2023 was explored from several databases, including EBSCO, PubMed, EMBASE, Cochrane Library, Google Scholar, and Scopus. Articles investigating the change in pain status of MP patients after steroid injection were included. The primary outcomes were complete pain relief, pain scores at 15 days and one month after intervention. When compared to the baseline, the secondary outcomes for the steroid group included pain scores at the end of treatment and quality of life, which were further evaluated by two factors, namely mental and physical health.
RESULTS
The analysis of the studies validated that steroids were significantly successful in providing complete pain relief (p-value = 0.00001), and in reducing the pain score of patients with meralgia paresthetica at 15 days (p-value = 0.02), but not at one month (p-value = 0.79) as compared to the control group. The analysis did not reveal any significant subgroup differences among various steroids (P = 0.52; CI: 0.01 - 0.10; RR: 0.04; I = 0%). Mental health (MD = 4.23; 95% CI = 0.42 to 8.03; p = 0.03, I2 = 0%) was significantly improved in the steroid group when compared with baseline.
CONCLUSION
Steroids injections can play an important role in improving symptoms and complications of meralgia paresthetica, especially in the short term.
PubMed: 38196491
DOI: 10.12669/pjms.40.1.8162 -
Cureus Dec 2023Femoral nerve palsy is a rare, but significant complication following percutaneous coronary intervention (PCI) for conditions such as myocardial infarction. We present a...
Femoral nerve palsy is a rare, but significant complication following percutaneous coronary intervention (PCI) for conditions such as myocardial infarction. We present a case of a 61-year-old male patient who presented for cardiac rehabilitation following an emergent PCI procedure for cardiac arrest secondary to ST-elevation myocardial infarction. He later developed right lower extremity weakness and severe neuropathic pain on arrival to the acute rehabilitation unit. After physical examination and electrodiagnostic studies, he was determined to have a right femoral nerve neuropathy. This case report highlights the clinical course, physical examination/electrodiagnostic findings, and subsequent pain management of femoral nerve palsies.
PubMed: 38192939
DOI: 10.7759/cureus.50240 -
Anatomy & Cell Biology Mar 2024The current cadaveric report describes an unusual morphology of the sartorius muscle (SM), the biceps-bicaudatus variant. The SM had two (lateral and medial) heads, with...
The current cadaveric report describes an unusual morphology of the sartorius muscle (SM), the biceps-bicaudatus variant. The SM had two (lateral and medial) heads, with distinct tendinous origins from the anterior superior iliac spine. The lateral head was further split into a lateral and a medial bundle. The anterior cutaneous branch of the femoral nerve emerged between the origins of the lateral and medial heads. SM morphological variants are exceedingly uncommon, with only a few documented cases in the literature, and several terms used for their description. Although their rare occurrence, they may play an important role in the differential diagnosis of entrapment syndromes, in cases of neural compressions, such as meralgia paresthetica, while careful dissection during the superficial inter-nervous plane of the direct anterior hip approach is of utmost importance, to avoid adverse effects due to the altered SM morphology.
PubMed: 38167711
DOI: 10.5115/acb.23.254 -
BioRxiv : the Preprint Server For... Dec 2023Charcot-Marie-Tooth 1A is a demyelinating peripheral neuropathy caused by the duplication of peripheral myelin protein 22 (), which produces muscle weakness and loss of...
Charcot-Marie-Tooth 1A is a demyelinating peripheral neuropathy caused by the duplication of peripheral myelin protein 22 (), which produces muscle weakness and loss of sensation in the hands and feet. A recent case-only genome wide association study by the Inherited Neuropathy Consortium identified a strong association between variants in signal induced proliferation associated 1 like 2 () and strength of foot dorsiflexion. To validate as a candidate modifier, and to assess its potential as a therapeutic target, we engineered mice with a deletion in and crossed them to the C3-PMP22 mouse model of CMT1A. We performed neuromuscular phenotyping and identified an interaction between deletion and muscular endurance decrements assayed by wire-hang duration in C3-PMP22 mice, as well as several interactions in femoral nerve axon morphometrics such as myelin thickness. Gene expression changes suggested an involvement of in cholesterol biosynthesis, which was also implicated in C3-PMP22 mice. Though several interactions between deletion and CMT1A-associated phenotypes were identified, validating a genetic interaction, the overall effect on neuropathy was small.
PubMed: 38076977
DOI: 10.1101/2023.11.30.569428 -
Journal of Intensive Care Medicine Jun 2024Femoral cannulated extracorporeal membrane oxygenation (ECMO) has been associated with neurologic complications in the lower extremity ipsilateral to the cannulation.... (Review)
Review
BACKGROUND
Femoral cannulated extracorporeal membrane oxygenation (ECMO) has been associated with neurologic complications in the lower extremity ipsilateral to the cannulation. There is uncertainty about the prevalence of these complications and their mechanisms of development.
OBJECTIVE
Aim of this systematic review was to investigate the prevalence of neurological complications after ECMO and to describe possible underlying mechanisms.
METHOD
A systematic literature search was performed in Medline-Ovid, Embase, Cochrane Library, CINAHL, and PEDro until April 2021 for clinical trials in English or German language which quantified neurologic complications in the lower extremity ipsilateral to the ECMO cannulation of adults. The complications had to be delimitable to intensive care unit-acquired weakness. Methodological quality was assessed by 2 independent investigators using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute.
RESULTS
Eight observational studies were included in the synthesis. Study quality was good to fair in 88% of the papers. Overall, 47 of 202 patients (23.3%; ranging from 3% to 48% across studies) with femoral ECMO cannulation showed neurologic complications of the lower extremity ipsilateral to the cannulation. Peripheral ischemia and compression of nerves by the ECMO cannula are discussed as mechanisms of injury.
CONCLUSION
The occurrence of neurological complications after ECMO was common and can lead to long-term impairment. The mechanisms are largely unknown but currently there is no sufficient evidence for the involvement of ECMO. Standardized assessments are needed to systematically screen for neurological complications early after ECMO, to enable countermeasures and prevent further complications.
Topics: Adult; Humans; Extracorporeal Membrane Oxygenation; Lower Extremity; Nervous System Diseases; Observational Studies as Topic; Prevalence
PubMed: 38018080
DOI: 10.1177/08850666231217679