BACKGROUND: Lumbar plexus block was used not only for the proposal of lower limb surgery, but also for that of pain control in the pain clinic. The aim of our study was to evaluate the motor, sensory function and the anatomic parameters after posterior approach of the lumbar plexus block with the help of a nerve stimulator. METHODS: 30 patients of low back pain radiating to lower extremities were randomized into two groups. We performed the psoas compartment block guided by C-arm fluoroscope. With the pateints in prone position, a 100 mm insulated needle was introduced at the surface of L5 transverse process. Stimulation of femoral nerve was used to optimize the needle placement at the center of lumbar plexus (Dancing Patella). 1% mepivacaine hydrochloride (0.2 ml/kg) solution in group 1 (n=11) and 0.5% mepivacaine hydrochloride (0.2 ml/kg) solution in group 2 (n=19) were then injected. We measured the minimal current, distance of puncture site from midline, distance from skin to transverse process, distance from skin to the point of maximal twitch, and distance from transverse process to the point of maximal twich. Motor and sensory functions were measured at 5, 15, 30, 45, 60, 90 and 120 min after procedure. RESULTS: Anatomical parameters were as follows; distance of puncture site from midline was 42.6 5.6 mm, distance from skin to transverse process was 52.9 +/- 7.0 mm, distance from skin to the point of maximal twitch was 68.8+/-5.6 mm, and distance from transverse process to the point of maximal twich is 15.9+/-3.9 mm. Difference in attenuated motor function(hip adduction, knee extension) was observed between two groups (P<0.05). Hip adduction and knee extension were recovered 60 min after injection in group 1. In group 2, knee extension was attenuated above 2 hours. We observed significant hip flexion attenuation 90 and 120 min (group 1 and group 2, etc) after injection Sensory blockade was recovered 120 min after injection in both groups. CONCLUSIONS: It is suggested that above mentioned anatomical parameters would be useful for the safe blockade. We found that recovery of attenuated hip flexion is crucial for the discharge criteria of ambulating outpatient with the low back pain.
Femoral Nerve ; Hip ; Humans ; Knee ; Low Back Pain ; Lower Extremity ; Lumbosacral Plexus* ; Mepivacaine ; Needles ; Outpatients ; Pain Clinics ; Prone Position ; Punctures ; Sensation ; Skin

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Ultrasonography ; Ultrasonography, Interventional

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Catheters

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Nerve Block

Chronic pathological pain is sustained by mechanisms of peripheral and central sensitization, which are being increasingly investigated at the molecular and cellular levels. The molecular mechanisms of sensitization that occur in peripheral nociceptors and the dorsal horns of the spinal cord are putative targets for context-dependent drugs. Pregabalin and gabapentin are analogs of the neurotransmitter gamma-aminobutyric acid (GABA). They are alpha2-delta ligands that have analgesic, anticonvulsant, and anxiolytic activity. Alpha2-delta is an auxiliary protein associated with voltage-gated calcium channels. They bind potently to the subunit resulting in modulation of calcium channels and reduction in the release of several neurotransmitters. This review discusses the pharmacology of these medications briefly as well as available clinical applications in pain management.
Amines ; Animals ; Calcium Channels ; Central Nervous System Sensitization ; Chronic Pain ; Cyclohexanecarboxylic Acids ; gamma-Aminobutyric Acid ; Horns ; Ligands ; Neuralgia ; Neurotransmitter Agents ; Nociceptors ; Pain Management ; Spinal Cord ; Pregabalin

There are rare but serious complications-especially risk of paraplegia when instrumentation by surgery is used to correct a spinal deformity. Wake-up tests may be necessary during scoliosis or kyphosis surgery to ensure that spinal function remains intact. We tried four spinal fusions for ankylosing spondylitis of a 62 year-old woman. We were not able to fix the rod for fusion because of a presenting positive wake-up test in the previous two prone-positioned operations. In last operation we decided on normotensive anesthesia with fentanyl-propofol in a lateral decubitus position, and then surgical instrumentation was completed after we made sure of a negative weak-up test. There were no postoperative sequelae. The lateral approach to the thoracic disc space during spinal fusion may produce minimum disruption of the normal spinal musculoskeletal anatomy, avoid retraction of the spinal cord and preserve the neurovascular bundle and the segmental radicular arteries to the spinal cord.
Anesthesia ; Arteries ; Congenital Abnormalities ; Female ; Humans ; Kyphosis ; Middle Aged ; Paraplegia ; Scoliosis ; Spinal Cord ; Spinal Fusion* ; Spondylitis, Ankylosing ; Surgical Instruments