Ultrasound-guided Lateral Femoral Cutaneous Nerve Research Articles

Emergency-physician Performed, Ultrasound-guided Lateral Femoral Cutaneous Nerve Block for Meralgia Paresthetica: A Report of Two Cases.

Neuropathy of the lateral femoral cutaneous nerve, also known as meralgia paresthetica, causes pain and paresthesia to the anterolateral thigh. It commonly results from nerve irritation from extrinsic compression; however, it may occur spontaneously. Symptoms from this condition can be debilitating, and the pain may be ascribed to other conditions leading to delays in diagnosis. Peripheral nerve blockade can be useful both diagnostically and therapeutically for meralgia paresthetica. Two female patients in their sixties presented to the emergency department for chronic, atraumatic, left upper thigh pain. In both cases the patients had hyperalgesia and paresthesia to the anterolateral, upper thigh. The emergency physician performed an ultrasound-guided nerve block of the lateral femoral cutaneous nerve for each patient, which resulted in temporary, complete resolution of their pain. Meralgia paresthetica is an uncommon but painful condition that can elude diagnosis. Physical exam findings such as allodynia and hyperalgesia of the anterolateral thigh in the absence of back pain is suggestive of the diagnosis. Utrasound-guided nerve blockade can be helpful to the emergency physician to confirm the diagnosis and provide non-opioid pain relief to the patient.

Lateral Femoral Cutaneous Nerve Block for Postoperative Pain Control After Total Hip Arthroplasty Using the Direct Anterior Approach: A Single-blinded Randomized Control Trial

Background Total hip arthroplasty (THA) employing the direct anterior approach (DAA) is increasingly performed as a less invasive procedure with faster recovery than other approaches. Unlike other approaches, the skin incision is made on the lateral thigh, distal to the inguinal ligament. However, the effectiveness of ultrasound-guided lateral femoral cutaneous nerve (LFCN) block for postoperative analgesia after THA using DAA has not been investigated.We hypothesized that ultrasound-guided LFCN block using DAA would reduce postoperative pain after THA.

Ultrasound-guided alcohol neurolysis of lateral femoral cutaneous nerve for intractable meralgia paresthetica: a case series.

Meralgia paresthetica is a rare sensory entrapment neuropathy which leads to burning, tingling and numbness in the antero-lateral aspect of thigh. Mostly it runs a benign course, and responds to conservative measures. We present a case series of six patients with intractable meralgia paresthetica with severe pain over antero-lateral thigh along the distribution of lateral cutaneous nerve of thigh which was further confirmed by nerve conduction study. These patients did not respond to the oral anti-neuropathic medications. The two successive diagnostic lateral femoral cutaneous nerve block not only had confirmed the diagnosis but also provided pain relief for a few days. Then the ultrasound-guided lateral femoral cutaneous nerve neurolysis was done using 50% alcohol. In all the patients, there were more than 50% decrease in pain intensity and improvement in quality of life after the procedure, and the relief and improvement were maintained for up to 12 weeks. This case series shows ultrasound-guided lateral femoral cutaneous nerve neurolysis is a safe and effective treatment for intractable meralgia paresthetica and also provides prolonged pain relief and is a good option in avoiding the surgery. Summary points The literature on neurolysis is rare, with only few case reports. This is the first case series on this topic, and it will greatly improve the evidence that ultrasound-guided neurolysis can also be used for intractable meralgia paresthetica patients who do not respond to conservative measures before proceeding to surgery.

Effect of lateral femoral cutaneous nerve-block on pain after total hip arthroplasty: a randomised, blinded, placebo-controlled trial.

BackgroundTotal hip arthroplasty (THA) is a common procedure associated with moderate postoperative pain. No nerve block without loss of motor function has been documented for THA. We hypothesised that an ultrasound-guided lateral femoral cutaneous nerve (LFCN) block added to a multimodal postoperative pain regimen would reduce postoperative pain after THA.MethodsOne hundred patients who had a THA by the posterior approach were evaluated in this randomised, placebo-controlled, blinded, parallel-group trial comparing an ultrasound-guided LFCN-block with either 8 ml of ropivacaine, 7.5 mg/ml, (Group Ropivacaine) or 8 ml of saline (Group Placebo) given postoperatively. Surgery was performed under spinal anaesthesia. The primary outcome was pain (measured on a Visual Analogue Scale (VAS)) 4 h post-blockade during 30° flexion of the hip. Secondary outcomes were pain at rest, pain during movement, oxycodone consumption (0–24 h), time to mobilisation, ability to mobilise, and length of stay. Patients, assessors and all staff involved with patient care were blinded to the intervention.ResultsThere was no difference in primary outcome between Group Ropivacaine and Group Placebo (VAS 27 mm vs. 31 mm, p = 0.41; difference −5 mm (95 % CI: −15 mm - +5 mm). No differences in any of the secondary outcomes were observed. No adverse events, or harms, were observed during the trial.ConclusionPain scores, opioid use, time to mobilisation, and length of stay were low in both Group Ropivacaine and Group Placebo. We found no added analgesic effect of a LFCN-block when combined with paracetamol and ibuprofen after THA by the posterior approach.Trial registrationEudraCT: 2013-004501-12 (December 16th 2013)

Ultrasound-guided lateral femoral cutaneous nerve conduction study.

ObjectiveTo verify the utility of the lateral femoral cutaneous nerve (LFCN) ultrasound-guided conduction technique compared to that of the conventional nerve conduction technique.MethodsFifty-eight legs of 29 healthy participants (18 males and 11 females; mean age, 42.7±14.9 years) were recruited. The conventional technique was performed bilaterally. The LFCN was localized by ultrasound. Cross-sectional area (CSA) of the LFCN and the distance between the anterior superior iliac spine (ASIS) and the LFCN was measured. The nerve conduction study was repeated with the corrected cathode location. Sensory nerve action potential (SNAP) amplitudes of the LFCN were recorded and compared between the ultrasound-guided and conventional techniques.ResultsMean body mass index of the participants was 23.7±3.5 kg/m2, CSA was 4.2±1.9 mm2, and the distance between the ASIS and LFCN was 5.6±1.7 mm. The mean amplitude values were 6.07±0.52 µV and 6.66±0.54 µV using the conventional and ultrasound-guided techniques, respectively. The SNAP amplitude of the LFCN using the ultrasound-guided technique was significantly larger than that recorded using the conventional technique.ConclusionCorrecting the stimulation position using the ultrasound-guided technique helped obtain increased SNAP amplitude.

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.

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.

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 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.