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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 obturator nerve is primarily a motor nerve, but it may contribute significant sensory supply to the hip, to the medial aspect of the thigh, to the medial aspect of the femur, and even to the leg (when it provides a twig to the saphenous nerve). Occasionally, an accessory obturator nerve may supply the pectineus muscle and the hip joint.
The Spleen(SP)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Clinical Relevance: The best way to consider the impact of SP 12 on local musculature is to view the cross section at this level, depicted in Figure 4-30. This image illustrates how superficial needling can impact the sartorius muscle with the needle angled in a lateral direction or the iliopsoas muscle when angled perpendicular to the body. A more extreme and deep needle insertion may touch the pectineus muscle but risks injury of the external iliac artery and vein as well as the femoral nerve. Trigger points from the iliopsoas cause pain sensation to travel up the ipsilateral paraspinal lumbar musculature and down the middle anterior portion of the thigh. Sartorius trigger points send pain along the muscle itself. Pectineus pain from trigger point pathology stays in the region over the muscle in the groin.
The Thigh (Anterior and Medial Compartments)
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
The pectineus arises from the superior pubic ramus and inserts upon the pectineal line of the femur, inferior to the lesser trochanter. The pectineus flexes, adducts and medially rotates the thigh at the hip joint. It is innervated usually by the femoral nerve, but occasionally receives supply from the accessory obturator nerve.
Clipping inguinal lymphatics decreases lymphorrhoea after lymphadenectomy following cancer treatment: results from a randomized clinical trial
Published in Scandinavian Journal of Urology, 2021
Palaniappan Ravisankar, Kanuj Malik, Anand Raja, Kathiresan Narayanaswamy
The standard inguinal lymph node dissection was performed as described below. Briefly, an 8- to 14-cm lazy-S incision was made, 3–4 cm below the groin crease. After the incision, the skin flaps were raised to the level of the Scarpa fascia using electrocautery, which was also used to seal any visible leaking lymphatic vessels. The boundaries of the dissection of lymphatic tissue were the inguinal ligament superiorly, the sartorius muscle laterally, the adductor longus muscle medially, and the apex of femoral triangle inferiorly. The floor of the dissection was the femoral vessels and the pectineus, with the superficial and deep nodes removed. The saphenous vein inside the femoral triangle was ligated and dissected. The sartorius muscle transposition was done to cover the exposed femoral vessels.
Pericapsular nerve group block for analgesia of positioning pain during spinal anesthesia in hip fracture patients, a randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2020
Alrefaey K. Alrefaey, Mohamed A. Abouelela
On arrival in the operating theater, automatic noninvasive blood pressure, electrocardiograph, and pulse oximetry were recorded and a wide bore cannula (18 G) was secured. In the PENG group, the block as described by Girón-Arango et al. [10] was performed with the patient in the supine position using ultrasound guidance (high-frequency probe, L7M-A probe7.5 MHz, CHISON, Jiangsu, China). The probe was initially placed in a transverse plane over the anterior inferior iliac spine (AIIS), and then rotated 45 degrees anticlockwise to be roughly aligned with the pubic ramus. As shown in Figure 2, after keeping the iliopectineal imminence| (IPE), the iliopsoas muscle and tendon, the femoral artery, and pectineus muscle were maintained in the view, a 22-gauge, 80-mm needle was introduced from lateral to medial in an in-plane approach. When the tipoff the needle is visualized in the musculofascial plane between the psoas tendon anteriorly and the pubic ramus posteriorly, 20 ml of local anesthetic (LA) solution (bupivacaine 0.25%) was injected in 5-mL increments while observing for adequate fluid spread. Negative aspiration is performed at the start of the injection and after each 5 mls of the injectate. Patients arterial blood pressure and electrocardiographic tracings, respiratory rate, and pulse oximetry were evaluated noninvasively at 5 min intervals for 30 min after the injection. Also, patients were carefully observed to detect any symptom of LA toxicity of the anesthetic agent.
Arthroscopic versus open, medial approach, surgical reduction for developmental dysplasia of the hip in patients under 18 months of age
Published in Acta Orthopaedica, 2019
Serda Duman, Yalkin Camurcu, Hakan Sofu, Hanifi Ucpunar, Deniz Akbulut, Timur Yildirim
Medial approach open reduction was performed through a transverse incision measuring 5 cm in length. After dissecting the adductor longus muscle, broad exposure of the surgical field was achieved with dissection of the pectineus muscle. Tenotomy of the iliopsoas was performed, and the joint capsule was incised. Subsequently, we excised the ligamentum teres, as well as the pulvinar tissue, followed by incision of the transverse acetabular ligament. The femoral head was then reduced into the acetabular cavity. Post-reduction stability was confirmed, and the surgical incision was sutured. A pelvipedal cast was applied in the human position of 100° flexion, < 50° of abduction, and < 10° of internal rotation.