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Blocks of Nerves of the Lumbar Plexus Supplying the Lower Extremities
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The technique is based on the fact that the obturator, femoral, and lateral cutaneous nerves pass over the iliacus muscle. Thus, injecting sufficient amounts of local anesthetics below the fascia iliaca would result in blocking these three nerves due to the diffusion of the anesthetic solution at the surface of the iliacus muscle.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The psoas major muscle joins the iliacus muscle, which originates broadly over the inner aspect of the iliac wing of the pelvis. This becomes the iliopsoas muscle and inserts on the lesser trochanter of the femur and thus flexes the thigh at the hip joint. The action of this muscle results in the leg becoming shortened and externally rotated following a fracture of the neck of the femur.
The neurological examination
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Iliopsoas muscle: Psoas and iliacus muscles (Figure 11.2a) Innervation: Upper part of iliac fossa to lesser trochanter (iliacus). Psoas major: Lumbar nerves (L1, L2, and L3).Iliacus: Femoral nerve (L2 and L3).Function: Flexion of hip joint.Physical examination: The patient lies supine with the leg flexed at the knee and hip and tries to flex the thigh against resistance.
External iliac artery injury following total hip arthroplasty via the direct anterior approach—a case report
Published in Acta Orthopaedica, 2020
Ellen Burlage, Jasper G Gerbers, Bob R H Geelkerken, Wiebe C Verra
Speculation remains as to what caused the active bleeding in our case. The frequently mentioned causes of direct damage to the external iliac artery seem unlikely. Reaming of the acetabulum occurred without complications and thereafter there were no signs of significant blood loss. Neither drills nor screws were necessary to fix the acetabular component. Because the iliac vessels run along the iliacus muscles the retractor has to cross the iliopsoas muscle to cause direct damage to the external iliac artery (Kawasaki 2012, Sullivan et al. 2019). In our case we had no indication during surgery that the Hohmann retractors were located out of the correct anatomical location and we do not believe they were inserted too deep or medially. Considering the type of damage, a nearby circular defect of the artery and repair by end-to-end anastomosis could argue for being a direct cause. The force that esd applied to the external iliac artery could be an indirect cause for the bleeding. Excessive limb manipulation to enact joint dislocation, relocation, and traction by retractors can exert longitudinal stress to the iliac vessels. The external iliac artery is at less risk of tearing due to its thicker intima and flexibility. The presence of atherosclerotic plaques increases the risk of intimal dissection resulting in thrombosis and distal ischemia (Shoenfeld et al. 1990). In our case the hemorrhagic shock occurred as a result of bleeding from the external iliac artery. Therefore the characteristics of this case seem to be less suitable for the pathophysiology of indirect causes of vascular damage.
Surgical anesthesia for revision total hip arthroplasty with quadratus lumborum and fascia iliaca block
Published in Baylor University Medical Center Proceedings, 2019
Johanna Blair de Haan, Nadia Hernandez, Sophie Dean, Sudipta Sen
The blocks were performed under ultrasound guidance with the patient in the supine position in the preoperative holding area. A high-frequency linear ultrasound transducer and a 21-gauge blunt-tipped echogenic needle were used for both blocks. The FI block was performed as described by Hebbard et al.3 Using the ultrasound transducer in a parasagittal plane, the anterior superior iliac spine was identified. The ultrasound probe was translated medially until the “bowtie” of the FI appeared over the iliacus muscle, bound cranially by the internal oblique muscle and caudally by the sartorius muscle. Following skin sterilization, the needle was advanced in plane in a caudal-to-cranial direction until normal saline was seen to spread underneath the FI over the iliacus muscle, and 20 mL of 0.5% bupivacaine hydrochloride was deposited in this location. We then performed the QL type 1 block as described by Blanco and McDonnell.4 The ultrasound probe was placed between the iliac crest and the lower costal margin in a transverse orientation, and the external oblique, internal oblique, and transverse abdominis were identified. The probe was translated posteriorly and laterally until the transverse abdominis muscle terminated superficial to the QL muscle. The skin was sterilized. The needle was advanced in plane from anterior to posterior until the tip was positioned between the QL and internal oblique, medial to the termination of the transverse abdominis, and 20 mL of 0.5% bupivacaine hydrochloride was injected.
Surgical options for meralgia paresthetica: long-term outcomes in 13 cases
Published in British Journal of Neurosurgery, 2019
Zeki Serdar Ataizi, Kemal Ertilav, Serdar Ercan
Meralgia paresthetica (MP) is an entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN). It causes burning, coldness, pain, tingling, sensory loss, or local hair loss in the distribution of the lateral femoral cutaneous nerve. Meralgia paresthetica, also known as Bernhardt-Roth, was first described by Hager in 1885.1 The LFNC arises from the L2 and L3 spinal nerve roots. It travels downward lateral to the psoas muscle and then crosses the iliacus muscle. It divides into the anterior and posterior branches by entering the thigh below, through or above the inguinal ligament. Its anterior branch penetrates to the fascia lata approximately 10 cm inferior to the anterior superior iliac spine (ASIS) and carries sensation from the anterior and lateral sides of the thigh. The smaller posterior branch innervates the skin of the lateral aspect of the leg from the greater trochanter to the mid-thigh.2–5