Lateral Femoral Cutaneous Nerve Block Research Articles

Combined Use Of Ultrasound Guided Infraclavicular Block And Lateral Femoral Cutaneous Nerve Block In Upper Extremity Reconstruction Requiring Large Skin Graft: Case Report

Combined nerve blocks of the upper extremity and lower limb in same operation rarely performed due to the risk of systemic toxicity of local anesthetics. Therefore, general anesthesia is generally preferred in this operations. However, use of ultrasound allows reliable deposition of the anesthetic around the nerves, potentially lowering the local anesthetic requirement. In this case report, we present a 44-year-old, ASA physical status I, male patient who was operated for upper extremity reconstruction requiring skin graft from anterolateral thigh region under ultrasound-guided infraclavicular brachial plexus block and lateral femoral cutaneous nerve block. The block was successful and no block-related complications were noted. We think that combining an ultrasound guided infraclavicular brachial plexus block and a lateral femoral cutaneous nerve block is a clinically useful and safe technique and an alternative anesthetic method for procedures requiring skin grafts for the upper extremity.

Atlas of Ultrasound-guided Procedures in Interventional Pain Management

Atlas of Ultrasound-guided Procedures in Interventional Pain Management

Ultrasound guided lateral femoral cutaneous nerve (LFCN) block: Safe and simple anesthesia for harvesting skin grafts

Many burn patients experience more intense pain from the split thickness skin donor site than in the grafted burn wound in their postoperative period. Often, split thickness autografts are harvested from the lateral thigh area, which is innervated by the lateral femoral cutaneous nerve (LFCN). Sonographic nerve localization has been an increasingly popular technique to provide regional nerve blocks and we explore its role in improving pain control during skin harvesting. The LFCN was identified and blocked using ultrasound in 16 patients with a variety of wounds. The donor site was tested and marked after the injection. General anesthesia or sedation was administered after markings were completed. A postoperative survey was performed to assess the return of sensation at the donor site. All blocks were successful with adequate visualization of LFCN using ultrasound. Full anesthesia at the donor site, defined as absence of pain in response to a sharp object prick, was tested at 15min and confirmed at 20min after the block. The size of the anesthetized field ranged from 119 to 630cm2, with a mean surface area of 268.5cm2. Donor site sensation returned within 5–16h with a mean time of 9.1h. Ultrasound guided LFCN block provides a simple and safe choice of anesthesia for harvesting skin from the lateral thigh.

A comparison of femoral/sciatic nerve block with lateral femoral cutaneous nerve block and combined spinal epidural anesthesia for total knee replacement arthroplasty

BackgroundSeveral factors, such as compromised cardiopulmonary function, anticoagulative therapy, or anatomical deformity in the elderly, prevent general anesthesia and neuraxial blockade from being conducted for total knee replacement arthroplasty (TKRA). We investigated the efficacy of femoral/sciatic nerve block with lateral femoral cutaneous nerve block (FSNB) as an alternative procedure in comparison with combined spinal epidural nerve block (CSE) in patients undergoing TKRA.MethodsIn this observational study, 80 American Society of Anesthesiologists physical status I-III patients scheduled for elective unilateral TKRA underwent CSE (n = 40) or FSNB (n = 40). Perioperative side effects, intraoperative medications, duration and remaining amount of intravenous patient-controlled analgesia, rate of satisfaction with the surgical anesthesia and postoperative analgesia, willingness to recommend the same surgical anesthesia and postoperative analgesia to others, and postoperative visual analog scale pain scores were assessed. Statistical analysis was done using Chi-square test, Student's t-test, and repeated-measures analysis of variances.ResultsThere was significantly more use of antihypertensives, analgesics, and sedatives in the FSNB group. There were no significant differences of perioperative side effects, duration and remaining amount of intravenous patient-controlled analgesia, rate of satisfaction with the surgical anesthesia and postoperative analgesia, willingness to recommend the same surgical anesthesia and postoperative analgesia to others, and postoperative visual analog scale scores between the two groups.ConclusionsFSNB with a sophisticated use of antihypertensives, analgesics, and sedatives to supplement insufficient block offers a practical alternative to CSE for TKRAs.

Comparison of ultrasound-guided anterior versus transgluteal sciatic nerve blockade for knee surgery.

Background:Ultrasound-guided sciatic nerve block, in combination with femoral nerve and lateral femoral cutaneous nerve blocks, is frequently used to induce anesthesia for lower limb surgery. The anterior approach to the sciatic nerve is performed in the supine position and repositioning of the patient between injections is avoidable. We compared the relative utility and efficiency of anterior versus transgluteal sciatic nerve blocks in conjunction with femoral nerve and lateral femoral cutaneous nerve blockade.Materials and Methods:Twenty-four patients were enrolled in this prospective double-blind randomized study and were randomly divided into two equal groups: Anterior (Group A) and transgluteal (Group T). We evaluated the following parameters: ultrasound view quality, procedural duration, onset time to block, quality of anesthesia during surgery and postoperative analgesia, required administration of supplemental sedation or narcotics during surgery, amount of pethidine administered within 24 hours post surgery, and overall patient satisfaction.Results:There were no significant differences between patient groups with regard to the demographic data, onset time to block, quality of ultrasound view, use of narcotics to augment the anesthesia during surgery, and patient satisfaction. Although procedural completion time for the sciatic injection alone was shorter in Group T, the total completion time of all blocks together was significantly less in Group A.Conclusion:Ultrasound-guided anterior blockade of the sciatic nerve has advantages over the transgluteal approach — it provides efficient anesthesia and results in excellent patient satisfaction.

Peripheral nerve block for anesthesia in patients having knee arthroplasty

Total knee arthroplasty is an effective surgical modality for osteoarthritis of the knee. Because the population is aging, the number of TKA procedures is increasing every year [1]. Both general and diverse types of regional anesthesia have been used successfully for this surgery. Femoral nerve block (FNB) was first described in 1973 and used either as a single nerve or 3-in-1 block (including the femoral nerve, the lateral cutaneous nerve, and the obturator nerve), both as an independent anesthetic modality and as an analgesic adjunct to other anesthetic techniques. In this issue of Korean Journal of Anesthesiology, Kim et al. [2] reported a study of peripheral nerve block for total knee arthroplasty. The authors conclude that femoral/sciatic nerve block with lateral femoral cutaneous nerve block can be an alternative to spinal epidural anesthesia in patients having total knee arthroplasty. They did not recommend peripheral nerve blockade as a first choice, because it is associated with a higher use of antihypertensives, analgesics, and sedatives. Nonetheless, peripheral nerve blockade showed comparable patient satisfaction and postoperative analgesia to spinal epidural anesthesia. This report is likely to create controversy because a higher use of antihypertensives, analgesics, and sedatives are associated with incomplete anesthesia. FNB does not consistently produce anesthesia of the obturator nerve [3]. The obturator nerve or sciatic nerve supplies the knee joint. Consequently, the sensation in the back of the knee can be intact after FNB. Sciatic innervations in the back of the knee is a relatively minor contribution to postoperative pain after TKA [4]. The authors argued that sparing the obturator nerve is the main cause of insufficient anesthesia. In the previous report, the addition of the obturator nerve block to FNB improves postoperative analgesia after TKA [5]. In contrast, Bouaziz et al.[6] showed that efficacy of the obturator nerve block is not sufficient as the cutaneous contribution of the obturator nerve is absent in 57% of patients. Further investigations are required to confirm the anesthetic effect of obturator nerve block for TKA. Recently, peripheral nerve blocks are widely used for low extremity surgery, but they are still less common spinal anesthesia, mainly because of the increased time and expertise required as well as the delayed recovery associated with their use. The increased time required to perform peripheral nerve block can be reduced by placing peripheral nerve blocks preoperatively in the block room. Compared with neuroaxial (spinal/epidural) anesthesia, FNB minimizes hypotension, urinary retention, pruritis, and elimi nates the risk of spinal hematoma and infection. Moreover, patients with hemodynamical instability, antiplatelet, or anticoagulant therapy can undergo a lower extremity nerve block without significant risk. The anatomical deformity caused by a degenerative change in elderly patients occasionally makes neuroaxial block inappropriate to surgical anesthesia for low extremity surgery. These benefits of lower extremity peripheral nerve block satisfy its use as an alternative anesthesia in patients undergoing lower extremity surgery. Despite these benefits, complications of peripheral nerve block limit its use for surgery. The common complications of FNB include

Ultrasound-guided Lateral Femoral Cutaneous Nerve Block in Meralgia Paresthetica

Meralgia paresthetica is a rarely encountered sensory mononeuropathy characterized by paresthesia, pain or sensory impairment along the distribution of the lateral femoral cutaneous nerve (LFCN) caused by entrapment or compression of the nerve as it crossed the anterior superior iliac spine and runs beneath the inguinal ligament. There is great variability regarding the area where the nerve pierces the inguinal ligament, which makes it difficult to perform blind anesthetic blocks. Ultrasound has developed into a powerful tool for the visualization of peripheral nerves including very small nerves such as accessory and sural nerves. The LFCN can be located successfully, and local anesthetic solution distribution around the nerve can be observed with ultrasound guidance. Our successfully performed ultrasound-guided blockade of the LFCN in meralgia paresthetica suggests that this technique is a safe way to increase the success rate.

Meralgia Paresthetica

Meralgia paresthetica (MP) is an entrapment pain syndrome of the lateral femoral cutaneous nerve (LFCN) of thigh. Diagnosis is principally made on clinical ground with pain and paresthesia of the anterolateral thigh. Electrophysiological test and nerve block play important roles when the diagnosis is uncertain. Clinicians should be aware of the various etiological factors that can be potentially modified or treated. Most of the patients respond to conservative management including nerve block. Surgical options should be considered in patients refractory to those treatment options. Anesthesiologists are commonly involved in the management of MP because of their expertise in pain management and performance of the LFCN block. Blockade of the LFCN with local anesthetics and steroid serves both the diagnostic and therapeutic role.

Ultrasound-Guided Lateral Femoral Cutaneous Nerve Block: Comparison of Two Techniques

The aim of this study was to compare the feasibility and efficacy between two techniques of ultrasound-guided lateral femoral cutaneous nerve with or without locating the nerve. The study enrolled 106 patients undergoing knee surgery who received 5 ml of 1% mepivacaine immediately under the inguinal ligament 1 to 2 cm medial to the anterior superior iliac spine (subinguinal technique) or around the lateral femoral cutaneous nerve located (nerve-targeting technique). The time required to perform the block and the onset time of the block were similar for both techniques. However, a significantly higher percentage of patients obtained loss of pinprick sensation on the lateral thigh within 10 minutes with the subinguinal technique than with the nerve-targeting technique. The findings suggest that ultrasound-guided lateral femoral cutaneous nerve blocks can be easily performed and that injecting local anaesthetic immediately under the inguinal ligament rather than around the nerve itself blocks the nerve more reliably.

Bonica's Management of Pain, 4th Edition.

Northwestern University, Chicago, Illinois. docrahman1@gmail.comBy Scott M. Fishman, M.D., Jane C. Ballantyne, M.D., F.R.C.A., James P. Rathmell, M.D., eds. Philadelphia, Wolters Kluwer/Lippincott, Williams and Wilkins, 2010. Pages: 2,064. Price: $299.00.It has been 9 yr since the third edition of Bonica's Management of Pain was released. Much has changed in the field of pain management in terms of medications, multidisciplinary approaches, nonnarcotic therapies, the explosion of interventional pain techniques, and the struggles the field of pain medicine has undergone and will undergo. It is fair to say that the editors of this new edition were ready and motivated to capture these changes while maintaining the quality of the original 1953 edition.The new edition is divided into six parts. The first part—Basic Considerations—explores the history of pain, pain physiology, anatomy, and the role of genetics and psychology in pain. The second part—Economic, Political, Legal, and Ethical considerations, which is a new addition—covers the medicolegal aspects of pain, particularly the legal action that can come with prescribing controlled substances and performing interventional techniques. The third part—Evaluation of the Pain Patient—details the medical and social evaluation of patients, including disability assessment. The fourth part—Pain Conditions—provides an overview of the different pain conditions, including neuropathic pain disorders, musculoskeletal pain, cancer pain, pain in geriatrics and pediatrics, visceral pain, and low-back pain. The fifth section—Methods for Symptomatic Control—reviews the pharmacology of medications used in pain, injection techniques, psychologic interventions, and surgical options. The final part—Provisions of Pain Treatment—discusses the viability of pain medicine, as well as the training and the future of pain specialists.Bonica's chapters are well organized, have excellent depth, and are quite informative. The online version offers full access, is easy to navigate, and is detailed with excellent imaging. Images are readily transferred for academic presentations. The online full version access of Bonica's textbook is included in the price, unlike the additional fee required by Wall and Melzack's Textbook of Pain, 5th Edition 1; there is no online access for Raj's Practical Management of Pain, 4th Edition .2The new edition offers a detailed physiologic basis per chapter, with clear and concise treatments, making this optimal for multidisciplinary pain board review. Review of the Diagnostic and Statistical Manual of Mental Disorders , 4th Edition ,3the examination of the pain patient, as well as functional capacity, disability evaluation, and pain psychology, were well written. The new edition includes topics that pain physicians encounter, such as the role of acupuncture in pain treatment. The headache chapter was much more comprehensive than that in the previous edition and those in the Wall and Melzack1and Raj2texts. Topics such as thermal radiofrequency ablation, cryoablation, pulsed radiofrequency, and chemical neurolytics were well covered in the newest edition of Bonica's text. The nonsteroidal anti-inflammatory drug chapters of the three major large-volume pain texts had plentiful substance, although the Wall and Melzack book offered numerous tables for individual drug comparisons, making it a little easier to extrapolate the information. The section on spinal cord stimulation, which is a rapidly growing field, was fair compared with those of the other two major texts. However, the 4th Edition of Bonica had superior chapters on peripheral nerve stimulation, cortex, and deep brain stimulation.The only reservation with the new text is its failure to adequately detail common ultrasound-guided nerve blocks, such as the lateral femoral cutaneous nerve block, genitofemoral, ilioinguinal, iliohypogastric, transverses abdominis plane, and other blocks performed in the clinic. In addition, minimal detail is provided regarding some important topics, such as the comparison of steroids, particulate versus nonparticulate, as well as discography and its classifications.What sets this text apart from the other major texts is the detail provided in each chapter. This is more than a mere reference book and is intended to be truly comprehensive. Bonica's Management of Pain, 4th Edition , is truly a well organized, thorough, and easy-to-read textbook. This is an excellent resource for the clinician in residency, in fellowship, or in practice. The detailed chapters, tables, images, and online access make this a complete and reasonably priced edition.To find a complete textbook that covers acute, chronic, and cancer pain, as well as the multidisciplinary approaches, while adding interventional techniques, is very challenging. This new edition of Bonica's book does a very nice job of covering these issues. I strongly recommend this book as a priceless addition to the library of anyone practicing anesthesia, acute pain, noninterventional chronic pain, and interventional pain medicine.Northwestern University, Chicago, Illinois. docrahman1@gmail.com

Ultrasound-guided Nerve Blocks for Post-hernia Repair Pain

Ultrasound-guided Nerve Blocks for Post-hernia Repair Pain

Ultrasound-Guided Anterior Approach to Sciatic Nerve Block: A Comparison with the Posterior Approach

Although the anterior approach to the sciatic nerve block has rarely been performed due to lack of reliable surface anatomical landmarks and technical difficulty, ultrasound guidance may make performance of this approach easier. In this study, we evaluated the clinical use of the ultrasound-guided anterior approach to sciatic nerve block and compared this approach with the posterior approach in adults. One hundred patients undergoing minor knee surgery were randomly divided into two groups to receive anterior and posterior (subgluteal) approaches to sciatic nerve block, using 1.5% mepivacaine 20 mL with epinephrine combined with femoral and lateral femoral cutaneous nerve blocks. Both approaches to sciatic nerve block were performed using a low-frequency, 5 to 2 MHz, curved array transducer. Measurements included block execution time, depth and size of the nerve, needle depth, onset time of sensory and motor blockade, and duration of the block. The sciatic nerve was located significantly deeper and the needle depth was significantly greater in patients undergoing the anterior approach compared with the subgluteal approach. Both approaches were similar for execution time of sciatic nerve block, but the former took less time than the latter to perform all combinations of blocks. Although sensory block in the posterior femoral cutaneous nerve was achieved less often with the anterior approach compared with subgluteal approach (14.9% and 68.1%, respectively; P < 0.001), there were no differences in success rate, onset time or duration of blockade of the peroneal and tibial nerves between the two groups. The anterior approach to sciatic nerve block is performed as easily and successfully as the posterior approach using ultrasound guidance.

Effective Anesthesia Using Ultrasound-Guided Lateral Femoral Cutaneous Nerve Block in a Patient with Femoral Neck Fracture

外側大腿皮神経ブロックは大腿外側の疼痛に有効である. 従来は上前腸骨棘を指標としたランドマーク法が一般的に行われてきたが, 成功率は高くはなかった. 近年は超音波ガイド下末梢神経ブロックが普及しつつあり, 外側大腿皮神経ブロックも超音波ガイド下に施行することによって, より適切な場所に局所麻酔薬を注入することが可能となった. 症例は77歳, 女性で, 左大腿骨頸部骨折に対し骨接合術が予定された. 肺静脈に血栓を有するため全身麻酔を避け, 外側大腿皮神経ブロックにより麻酔管理を行ったところ, 良好な結果を得たので報告する.

Ultrasound guided lateral femoral cutaneous nerve block: An evaluation of a sub-inguinal ligament approach

Ultrasound guided lateral femoral cutaneous nerve block: An evaluation of a sub-inguinal ligament approach

Ultrasound-Guided Lateral Femoral Cutaneous Nerve Block for Meralgia Paresthetica

Ultrasound-Guided Lateral Femoral Cutaneous Nerve Block for Meralgia Paresthetica

PR_210: Ultrasound-Guided Lateral Femoral Cutaneous Nerve Block: A Case Series

Setting: Tertiary care center. Patients: 2 women, one middle aged and one elderly. Case Descriptions: The lateral femoral cutaneous nerve can be injected with local anesthetic, steroids, or both to aid in the management of meralgia paresthetica or lower-leg procedures. We describe 2 cases of lateral femoral cutaneous nerve blockade using ultrasound guidance in the management of meralgia paresthetica. In both cases, under the guidance of a 12Mhz transducer, the needle was advanced directly next to the nerve using an approach 2cm medial and inferior to anterior superior iliac spine.

The lateral femoral cutaneous nerve block.

The lateral femoral cutaneous nerve block.

Femoral and lateral femoral cutaneous nerve block

Blockade of the lateral femoral cutaneous and femoral nerves is most commonly performed to provide postoperative analgesia for procedures on the knee. It can also provide the sole anesthetic for quadriceps muscle biopsy in the patient at risk for malignant hyperthermia. Recent advancements in understanding pelvic and femoral anatomy have provided additional techniques to improve the clinical success rate of femoral and lateral femoral cutaneous nerve blocks. The relationship of the fascia lata and fascia iliaca to these nerves plays a key role in appropriate needle placement and spread of the local anesthetic injectate. Peripheral nerve stimulation has facilitated the teaching of these techniques and performance of femoral nerve blocks in children under general anesthesia. Continuous femoral catheter infusions have been performed successfully in both children and adults. With understanding of the relevant anatomy and appropriate patient selection, blocks of these nerves have been remarkably safe and effective.

Combined use of axillary block and lateral femoral cutaneous nerve block in upper-extremity injuries requiring large skin grafts

An axillary block and lateral femoral cutaneous nerve block combination was used in 11 patients with upper-extremity injuries requiring large skin grafts. In our experience, this block combination was highly successful. All but one of the patients obtained excellent pain relief (mean visual analog pain scores, 0.2) that required no narcotic analgesics or sedatives. There were no systemic or neurologic side effects attributed to the local anesthetic drugs. We believe that combining an axillary block and a lateral femoral cutaneous nerve block is a clinically useful and effective technique and an excellent anesthetic alternative for procedures requiring large grafts for the upper extremity.

Femoral and lateral femoral cutaneous nerve block for muscle biopsies in children.

Retrospective chart review (1978-1993) of 179 children less than age 18 (10.0 +/- 3.8 SD yrs) undergoing muscle biopsy for determination of susceptibility to malignant hyperthermia provided data. One hundred and forty-six patients received femoral and lateral femoral cutaneous nerve blocks as their primary anaesthetic. We examined age, weight, duration of surgery, time to discharge from hospital, choice and dosage of local anaesthetics, choice and dosage of sedation, postoperative pain medications, and complications. All children receiving this form of anaesthesia remained outpatients. Between 1978 and 1985 procaine (10 mg.kg-1) with hyaluronidase or 2-chloroprocaine (12 mg.kg-1) provided nerve blockade; after 1985, lignocaine (6.8 mg.kg-1), or a combination of lignocaine or mepivacaine and 2-chloroprocaine, were the preferred agents. More recently the combination of 2-chloroprocaine and bupivacaine has been popular. Three patients required admission to the recovery room postoperatively, due to heavy sedation. Forty-three children (29%) received pain medication during recovery. Femoral and lateral femoral cutaneous block anaesthesia with light to moderate sedation is well tolerated in children undergoing anterior thigh procedures.