Inguinal Paravascular (Lumbar Plexus) Neurolytic Block—Description of a Catheter Technique: Case Report

1998 ◽  
Vol 23 (2) ◽  
pp. 214-218
Author(s):  
Abdullah M. Kaki ◽  
Geraint W. Lewis
Keyword(s):  
Case Report ◽  
Guide Wire ◽  
Femoral Nerve ◽  
Psoas Muscle ◽  
Pathologic Fracture ◽  
Sensory Block ◽  
Lumbar Plexus ◽  
Catheter Technique ◽  
Neurolytic Block ◽  
The Right

Background and ObjectivesWe provided care for a 47-year-old female with a history of lung carcinoma and bony metastases who sustained a pathologic fracture of the right acetabulum causing severe and uncontrolled pain in the right groin. Her pain was rated as 8-10 on a 10-point visual analog scale (VAS). Her terminal disease and poor surgical risk precluded therapeutic operative intervention. Consequently, a neurolytic block of the lumbar plexus was performed as a palliative measure.MethodsA modified inguinal paravascular (lumbar plexus) block technique was used. A 17-gauge Tuohy needle was inserted in the groin area just lateral to femoral artery and 1 cm below the inguinal ligament. A guide wire was threaded through the needle and subsequently an angiogram catheter was introduced over the wire into the psoas muscle. Radiographic confirmation of the position was obtained, and the catheter was secured in place. A prognostic block using an infusion of 0.25% bupivacaine at 5 mL/h was initiated for the first 2 days. On the third day a neurolytic block with 6% phenol was performed.ResultsMarked pain relief was experienced by the patient (VAS: 0-1). Sensory block in the femoral, lateral femoral cutaneous, and obturator nerve distributions was elicited. Motor weakness in the femoral nerve was demonstrated. Narcotic use was markedly reduced, and the patient was discharged to home in a pain-free state.ConclusionsThis case report supports the feasibility of placing a catheter via a modified anterior inguinal paravascular block technique and its subsequent use for both local anesthetic infusion and neurolytic block of the lumbar plexus.

scholarly journals Spontaneous retroperitoneal hematoma in a COVID-19 patient

2021 ◽  
Vol 2 (4) ◽  
pp. 377-385
Author(s):  
Ana Sekulić ◽  
Olivera Marinković ◽  
Davor Mrda ◽  
Borislav Tošković ◽  
Marija Zdravković ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Mortality Rate ◽  
Anticoagulant Therapy ◽  
Psoas Muscle ◽  
Bleeding Complications ◽  
Thromboembolic Events ◽  
Life Threatening ◽  
The Right ◽  
Radiological Examinations

Introduction: The infection caused by the SARS-CoV-2 virus is known to cause a hypercoagulable condition resulting in acute thrombotic events. Thromboembolic events occur in as many as 21.0% of cases with a mortality rate of about 74.0% in persons infected with COVID-19. Anticoagulant therapy is used in severe COVID-19 infections in order to prevent thrombosis and has been shown to reduce mortality. The use of anticoagulants is not without risks. Bleeding complications can range from mild to severe or even life-threatening, such as retroperitoneal bleeding into the psoas muscle. Case report: We present a case of a patient who developed a complication of bleeding into the retroperitoneal space during the treatment of bilateral bronchopneumonia caused by the SARS-CoV-2 virus. After the diagnosis was established, on the basis of a clinical examination, laboratory and radiological examinations, and after initial conservative treatment at the UHMC Bežanijska kosa, the patient underwent embolization of the left lumbar arteries from the right inguinal fossa, during procedural analgosedation. After the radiological procedure, the recovery was satisfactory, but due to the impossibility of resorption of an encapsulated hematoma with a zone of central necrosis, a mini left lumbotomy and evacuation of the hematoma were performed. The patient was discharged from the hospital on the 23rd day of admission in stable general condition. Conclusion: The effect of anticoagulant therapy, especially in patients with existing risk factors, early diagnosis, and prompt therapy of spontaneous retroperitoneal hematomas is imperative to reduce mortality from this severe complication, in patients with the COVID-19 infection.

Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

2021 ◽  
pp. 219256822110491
Author(s):  
Ram Alluri ◽  
Nicholas Clark ◽  
Evan Sheha ◽  
Karim Shafi ◽  
Matthew Geiselmann ◽  
...  
Keyword(s):  
Prone Position ◽  
Interbody Fusion ◽  
Femoral Nerve ◽  
Psoas Muscle ◽  
Lateral Decubitus Position ◽  
Lumbar Plexus ◽  
Lumbar Interbody Fusion ◽  
Posterior Edge ◽  
Disc Space ◽  
Lateral Decubitus

Study Design Cadaveric study. Objective To compare the position of the femoral nerve within the lumbar plexus at the L4-L5 disc space in the lateral decubitus vs prone position. Methods Seven lumbar plexus specimens were dissected and the femoral nerve within the psoas muscle was identified and marked with radiopaque paint. Lateral fluoroscopic images of the cadaveric specimens in the lateral decubitus vs prone position were obtained. The location of the radiopaque femoral nerve at the L4-L5 disc space was normalized as a percentage of the L5 vertebral body (0% indicates posterior location and 100% indicates anterior location at the L4-L5 disc space). The location of the femoral nerve at L4-L5 in the lateral decubitus vs prone position was compared using a paired t test. Results In the lateral decubitus position, the femoral nerve was located 28% anteriorly from the posterior edge of the L4-L5 disc space, and in the prone position, the femoral nerve was relatively more posterior, located 18% from the posterior edge of the L4-L5 disc space ( P = .037). Conclusions The femoral nerve was on average more posteriorly located at the L4-L5 disc space in the prone position compared to lateral decubitus. This more posterior location allows for a larger safe zone at the L4-L5 disc space, which may decrease the incidence of neurologic complications associated with Lateral lumbar interbody fusion in the prone vs lateral decubitus position; however, further studies are needed to evaluate this possible clinical correlation.

scholarly journals COMPARATIVE STUDY OF LUMBAR PLEXUS PATH ON THE LEFT AND RIGHT SIDES THROUGH THE PSOAS MUSCLE

2018 ◽  
Vol 17 (4) ◽  
pp. 262-265
Author(s):  
Emiliano Neves Vialle ◽  
Luiz Roberto Gomes Vialle ◽  
Letícia Cardoso Ern ◽  
Luis Miguel Duchén Rodríguez ◽  
Grover Coaquira Huayta ◽  
...  
Keyword(s):  
Psoas Muscle ◽  
Transverse Process ◽  
Lateral Approach ◽  
Anatomical Landmark ◽  
Wilcoxon Test ◽  
Lumbar Plexus ◽  
Level Of Evidence ◽  
Left And Right ◽  
The Mean ◽  
The Right

ABSTRACT Objective: Spine surgery with a minimally invasive lateral approach and validate possible anatomical differences between the right and left sides. Methods: Four measurements (cm) were taken on 38 cadavers: the distance between the lumbar plexus and the transverse process (L4-L5) and the distance between the lumbar plexus and the midline of the lumbar spine, both on the right and left sides. Results: The mean distance between the lumbar plexus and the transverse process of L4-L5 was 1.03 cm and the distance to the midline was 3.99 cm for the right side. The averages of the left side were 1.13 cm and 3.38 cm, respectively. There is statistical difference between the sides (p<0.05) using the non-parametric Wilcoxon test. Conclusions: The authors suggest that the transverse process might be used as an anatomical landmark to define the surgical approach through the psoas muscle. Level of Evidence IV; Cadaveric study.

Advanced myeloma masquerading as chronic shoulder pain in a 48-year-old man: a diagnostic dilemma

2020 ◽  
Vol 13 (5) ◽  
pp. e231219
Author(s):  
Rajarshi Bhadra ◽  
Teodora Nikova ◽  
Meyappan Somasundaram ◽  
Keyvan Ravakhah
Keyword(s):  
Multiple Myeloma ◽  
Case Report ◽  
Early Diagnosis ◽  
Shoulder Pain ◽  
Pathologic Fracture ◽  
Diagnostic Dilemma ◽  
History Of ◽  
Low Threshold ◽  
The Right ◽  
Chronic Shoulder Pain

Although solitary plasmacytomas may occasionally present as collar bone swellings or fractures, multiple myeloma involving clavicle is extremely rare. Ten to forty per cent of multiple myeloma cases are asymptomatic and are incidental diagnoses. Our case report describes an entirely benign presentation like chronic shoulder pain masquerading advanced myeloma, thereby posing a significant diagnostic dilemma. We present a 48-year-old man who presented with chronic bilateral shoulder pain with no history of trauma and was eventually diagnosed with advanced multiple myeloma and pathologic fracture of the right clavicle. It is, therefore, evident that a low threshold for suspicion can lead to early diagnosis and initiation of treatment and better survival.

Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study

2019 ◽  
Vol 44 (4) ◽  
pp. 483-491 ◽  
Author(s):  
Kris Vermeylen ◽  
Matthias Desmet ◽  
Ine Leunen ◽  
Filiep Soetens ◽  
Arne Neyrinck ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Psoas Muscle ◽  
Sensory Block ◽  
Lumbar Plexus ◽  
Anatomical Location ◽  
Double Blind ◽  
Clinical Trial Registration ◽  
Lateral Region ◽  
Volunteer Study ◽  
Fascia Iliaca Compartment Block

Background and objectivesLumbar plexus block has been used to provide postoperative analgesia after lower limb surgery. The fascia iliaca compartment block (FICB) has been proposed as an anterior approach of the lumbar plexus targeting the femoral, obturator and lateral femoral cutaneous nerve. However, both radiological and clinical evidence demonstrated that an infra-inguinal approach to the fascia iliaca compartment does not reliably block the three target nerves.We hypothesized that a supra-inguinal approach of the fascia iliaca compartment results in a more consistent block of the three target nerves than an infra-inguinal approach.MethodsWe performed a randomized controlled, double-blind trial in 10 healthy volunteers. Both an infra-inguinal FICB (I-FICB) and a supra-inguinal FICB (S-FICB) were performed on the left or the right side in each volunteer. Forty milliliters of lidocaine 0.5% was injected with each approach. Sensory and motor block and spread of local anesthetics (LA) on MRI were assessed.ResultsAfter an S-FICB, 80% of the volunteers had a complete sensory block of the medial, anterior and lateral region of the thigh, compared with 30% after an I-FICB (p=0.035). There was an insignificant effect on motor function with both approaches. After an S-FICB, in 8 out of 10 volunteers there was spread of LA in the expected anatomic location of the obturator nerve on MRI compared with 1 out of 10 volunteers after an I-FICB (p=0.0017). The cranial spread of LA after an S-FICB on MRI was higher than after an I-FICB (p=0.007), whereas there was a more caudal spread of LA on MRI after an I-FICB than after an S-FICB (p=0.005).ConclusionsAn S-FICB produces a more complete sensory block of the medial, anterior and lateral region of the thigh, compared with an I-FICB. Our study demonstrates that an S-FICB with 40 mL of LA more reliably spreads LA to the anatomical location of the three target nerves of the lumbar plexus on MRI than an I-FICB. An S-FICB also leads to a more consistent spread in a cranial direction under the fascia iliaca and around the psoas muscle.Clinical trial registrationThis work was registered with the European clinical trial registry: Identifier Eudra CT 2015-004607-24.

Avulsion Fracture and Myositis Ossificans in a Professional Teenage Dancer: A Case Report

2015 ◽  
Vol 30 (2) ◽  
pp. 111-114 ◽  
Author(s):  
Ozgur Tosun ◽  
Muhabbet D Koralp ◽  
Aliye Tosun ◽  
Levent Celebi ◽  
Nail Bulakbaşi
Keyword(s):  
Case Report ◽  
Avulsion Fracture ◽  
Myositis Ossificans ◽  
Lumbar Vertebrae ◽  
Psoas Muscle ◽  
Transverse Process ◽  
Lateral Flexion ◽  
Avulsion Fractures ◽  
Flexion Extension ◽  
The Right

Fractures of the transverse processes in the lumbar vertebrae occur as the result of major forces such as direct blunt trauma, violent lateral flexion-extension forces, avulsion of the psoas muscle, or Malgaigne fractures of the pelvis. Dancers make repeated and forceful hyperextension and flexions of the spine, which may cause fractures of the transverse processes of the lumbar vertebrae. Repeated trauma of muscles in dancers may cause avulsion fractures and myositis ossificans. Herein, we report MRI and CT findings of an avulsion from the right transverse process of the L2 and L3 vertebrae in a 16-year-old professional teenage dancer, who responded to conservative treatment.

scholarly journals Lesion of the femoral nerve caused by a hydatid cyst of the right psoas muscle

2010 ◽  
Vol 138 (7-8) ◽  
pp. 502-505 ◽  
Author(s):  
Dragoljub Bilanovic ◽  
Darko Zdravkovic ◽  
Tomislav Randjelovic ◽  
Borislav Toskovic ◽  
Jasna Gacic
Keyword(s):  
Hydatid Disease ◽  
Femoral Nerve ◽  
Psoas Muscle ◽  
Cystic Mass ◽  
Loss Of Function ◽  
Duration Of Symptoms ◽  
Retroperitoneal Tumour ◽  
Vertebral Involvement ◽  
One Year ◽  
The Right

Introduction. Hydatidosis is a human disease caused by the larval form of Echinococcus granulosus. All organs in the human body may be affected by hydatid disease, but excluding liver and lungs, all other organs are considered as uncommon locations. Hydatid disease located in the psoas muscle is uncommon. Case Outline. The authors present a 36-year-old male living in endemic areas of Serbia, admitted due to pain and weakness of the right thigh and weight loss. Duration of symptoms was one year. CT and MRI revealed a big cystic mass (20 cm long) in the right psoas muscle. Neurological investigation showed a loss of function of the right femoral nerve. Serology for Echinococcosis was negative. Surgery was indicated and performed by median laparotomy. Total excision of the cyst was done. Pathohystology confirmed the nature of the cyst. Three years after operation the patient was without any signs of disease relapse. Conclusion. Echinococcal disease of the psoas has been very rarely reported, sometimes associated with paraspinal disease and often with vertebral involvement. Cystic or complex retroperitoneal tumour, pyogenic abscess of the psoas and even tuberculosis should be considered in the differential diagnosis. Treatment of choice is surgery. The greatest danger for the patient is dissemination and anaphylactic reaction. Also, compression of adjacent organs may produce significant morbidity.

scholarly journals Transverse testicular ectopia - case report

2004 ◽  
Vol 132 (11-12) ◽  
pp. 438-440 ◽  
Author(s):  
Dragoljub Zivanovic ◽  
Andjelka Slavkovic ◽  
Jelica Madic ◽  
Dejan Novakovic
Keyword(s):  
Case Report ◽  
Inguinal Hernia ◽  
Inguinal Canal ◽  
Femoral Nerve ◽  
Treatment Modalities ◽  
Left Groin ◽  
Transverse Testicular Ectopia ◽  
Ectopic Testis ◽  
The Right ◽  
Testicular Ectopia

Transverse testicular ectopia is an extremely rare anomaly, characterized by migration of one testis towards the opposite inguinal canal, usually associated with inguinal hernia. Spermatic cord of the ectopic testis originates from the appropriate side. In most reported cases, the accurate diagnosis has not been made before surgery. This is a case report of transverse testicular ectopia in eleven-year-old boy who had undergone an operation for the left inguinal hernia in age often months. At the time of herniorrhaphy, the right testis was absent. Ten years later, during re-operation of the left inguinal hernia, both testis were found in left inguinal canal and easily brought down sequentially through the left groin into the scrotum. The right testis was fixed in the left hemiscrotum, due to shorter funicular elements, and the left was trans-septally moved to the right hemiscrotum (a modified Ombr?danne operation). Ultrasonography and voiding cystoureterography showed no associated genitourinary anomalies and no M?lerian duct remnants. The rupture of gubernaculum and dysfunction of the genito-femoral nerve could explain the etiology of crossed testis ectopia. Although ectopic testis could be localized preoperatively by ultrasonography, CT, MRI, arteriography and venography, correct diagnosis was made intraoperatively in the majority of cases. Treatment modalities include laparoscopic and surgical procedures. Atrophie testis should be removed. If testes are fused, they have to be brought into one hemiscrotum. In cases where testes are completely separated with individual funicular elements and vas deferens, an ipsilateral or contralateral orchiopexy should be performed depending on the length of funicular elements.

Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 251-255 ◽  
Author(s):  
Gruber-Szydlo ◽  
Poreba ◽  
Belowska-Bien ◽  
Derkacz ◽  
Badowski ◽  
...  
Keyword(s):  
Case Report ◽  
Magnetic Resonance Angiography ◽  
Popliteal Artery ◽  
Doppler Ultrasonography ◽  
Histopathological Examination ◽  
Previous History ◽  
Plain Radiography ◽  
Artery Thrombosis ◽  
History Of ◽  
The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

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