Blocks of Nerves of the Trunk
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand in Pediatric Regional Anesthesia, 2019
The genitofemoral nerve is a branch from the lumbar plexus which results from the union of two branches originating from the anterior rami of the first and second lumbar spinal nerves (Figure 4.14). It perforates the psoas muscle obliquely and then runs on its anterior aspect towards the inguinal ligament. It then divides into two terminal branches, at a variable distance from its origin: The femoral branch (lumboinguinal nerve), which accompanies the external iliac artery, passes behind the inguinal ligament and supplies the skin covering Scarpa’s triangle.The genital branch, which enters the inguinal canal, accompanies the spermatic cord and contributes fibers to the cremaster, the scrotum, and, usually, the skin covering the base of the penis. In the female, the nerve runs close to the round ligament of the uterus and supplies the labius majus (and usually the mons pubis).
Complications of Abdominal Wall Surgery and Hernia Repair
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Unlike nerve transection, nerve entrapment can result in the development of serious long-term pain syndromes. Chronic (persisting greater than 12 months) pain after herniorrhaphy has been reported to occur in as many as one-third of cases.42 Genitofemoral neuralgia is a well-described chronic pain syndrome associated with inguinal herniorrhaphy. Symptoms are hyperesthesia in the cutaneous distribution of the genitofemoral nerve and chronic inguinal pain extending to the genitalia and upper thigh. This pain is often exacerbated by walking, hip extension, and pubic tubercle pressure, and can frequently be relieved by hip flexion at rest. Pain and paresthesias associated with nerve entrapment and neuroma formation can initially be managed with local nerve blocks. The iliohypogastric and ilioinguinal nerves can be blocked by using an L1 and an L2 block. Persistent symptoms may require reexploration, with ligation and severance of the involved nerve. The presence of a short-lived response to a local block can help guide therapy toward a specific nerve, but in the absence of such evidence, therapy is best directed empirically at all three nerves. Occasionally, the condition does not respond to appropriate nonsurgical and surgical therapies; in such cases, patients should be referred to a chronic pain specialist.
Paper 2 Answers
James Day, Amy Thomson, Tamsin McAllister, Nawal Bahal in Get Through, 2014
The lateral cutaneous nerve of the thigh as the name suggests is purely a sensory nerve. The genitofemoral nerve splits into a genital branch, which supplies the cremaster muscle and the femoral branch, which supplies sensation to skin on the thigh. The femoral nerve is the largest branch of the lumbar plexus.
Effect of perineural bupivacaine infiltration on reducing inguinodynia in patients undergoing inguinal meshplasty – a randomized controlled trial
Published in Acta Chirurgica Belgica, 2022
Angeline Mary Samy, Amaranathan Anandhi, Gubbi Shamanna Sreenath, Sathasivam Sureshkumar, Srinivasan Swaminathan
Patients in both the control and intervention groups were administered spinal anaesthesia. Patients in the intervention group received perineural bupivacaine infiltration in addition to spinal anaesthesia. After spinal anaesthesia was given, all patients underwent Lichtenstein tension-free meshplasty. There was no difference in the type and dosage of local anaesthetic used in spinal anaesthesia. All the surgical procedures in the present study were carried out by a group of 6 surgeons at or above the level of the surgical registrar who are well experienced in performing hernia surgery. Intraoperatively Ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerve were identified. A total of 2 mL of perineural infiltration of 0.5% bupivacaine was given along these 3 nerves [6].
Intraoperative Complications and Conversion to Laparatomy in Gynecologic Robotic Surgery
Published in Journal of Investigative Surgery, 2022
Ayse Filiz Gokmen Karasu, Gürkan Kıran, Fatih Şanlıkan
Most of the complications were managed within minutes and with robotic assisted suturing when necessary. After three attempts of failed Veress needle entry, a 10 mm trocar entry was accomplished successfully in all cases. There were 9 cases of vascular injury. Six of these were venous of origin (left common iliac vein (n = 1), inferior vena cava (n = 3), external iliac vein (n = 1), and trocar site bleeding (n = 1)). Three cases of bleeding were of arterial origin (uterine artery (n = 1), inferior mesenteric artery (n = 1), and abdominal aorta (n = 1)). All bleeding was managed with robotic instruments utilizing either bipolar coagulation, suturation or surgical clip placement. There was one case of nerve injury. The genitofemoral nerve was cut during lymphadenectomy. It was sutured robotically. All cases of visceral injuries were serosal and managed with suturing There were 4 cases in which uterine rupture (solid organ injury) happened; these were either due to initial manipulator placement or excessive manipulation during surgery. There were no other intraabdominal solid organ injuries. The intraoperative complications are presented in Table 3.
Related Knowledge Centers
- Cremaster Muscle
- Lumbar Nerves
- Lumbar Plexus
- Psoas Major Muscle
- Scrotum
- Mons Pubis
- Mixed Nerve
- Ventral Ramus of Spinal Nerve
- Genital Branch of Genitofemoral Nerve
- Lumboinguinal Nerve