Efficacy of transforaminal epidural magnesium administration when combined with a local anaesthetic and steroid in the management of lower limb radicular pain

2021 ◽  
Author(s):  
Mohammed Awad ◽  
Mina M. Raouf ◽  
Hany K. Mikhail ◽  
Sohair A. Megalla ◽  
Tamer Y. Hamawy ◽  
...  
Keyword(s):  
Local Anaesthetic ◽  
Lower Limb ◽  
Radicular Pain

scholarly journals Perineural local anaesthetic catheter after major lower limb amputation trial (PLACEMENT): results from a randomised controlled feasibility trial

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e029233 ◽  
Author(s):  
David Bosanquet ◽  
Graeme Ambler ◽  
Cherry-Ann Waldron ◽  
Emma Thomas-Jones ◽  
Lucy Brookes-Howell ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Local Anaesthetic ◽  
Lower Limb ◽  
Rating Scale ◽  
Lower Limb Amputation ◽  
Feasibility Trial ◽  
Limb Amputation ◽  
Effectiveness Trial ◽  
Randomised Controlled

ObjectivesTo determine the feasibility of undertaking a randomised controlled effectiveness trial evaluating the use of a perineural catheter (PNC) after major lower limb amputation with postoperative pain as the primary outcome.DesignRandomised controlled feasibility trial.SettingTwo vascular Centres in South Wales, UK.Participants50 patients scheduled for major lower limb amputation (below or above knee) for complications of peripheral vascular disease.InterventionsThe treatment arm received a PNC placed adjacent to the sciatic or tibial nerve at the time of surgery, with continuous infusion of levobupivacaine hydrochloride 0.125% for up to 5 days. The control arm received neither local anaesthetic nor PNC. Both arms received usual perioperative anaesthesia and postoperative analgesia.Primary and secondary outcome measuresThe primary outcomes were the proportion of eligible patients who were randomised and the proportion of recruited patients who provided primary effectiveness outcome data. Secondary outcomes were: the proportion of recruited patients reaching 2 and 6 month follow-up and supplying pain data; identification of key cost drivers; development of an economic analysis framework for a future effectiveness trial; identification of barriers to recruitment and site set-up; and identification of the best way to measure postoperative pain.ResultsSeventy-six of 103 screened patients were deemed eligible over a 10 month period. Fifty (64.5%) of these patients were randomised, with one excluded in the perioperative period. Forty-five (91.3%) of 49 recruited patients provided enough pain scores on a 4-point verbal rating scale to allow primary effectiveness outcome evaluation. Attrition rates were high; 18 patients supplied data at 6 month follow-up. Costs were dominated by length of hospital stay. Patients and healthcare professionals reported that trial processes were acceptable.ConclusionsRecruitment of patients into a trial comparing PNC use to usual care after major lower limb amputation with postoperative pain measured on a 4-point verbal rating scale is feasible. Evaluation of longer-term symptoms is difficult.Trial registration numberISRCTN: 85 710 690. EudraCT: 2016-003544-37.

Regional anaesthesia of the lower limb

2017 ◽  
Author(s):  
Pawan Gupta ◽  
Anurag Vats
Keyword(s):  
Peripheral Nerve ◽  
Local Anaesthetic ◽  
Lower Limb ◽  
Peripheral Nerves ◽  
Femoral Nerve ◽  
Epidural Haematoma ◽  
Detailed Knowledge ◽  
Success Rates ◽  
Nerve Blocks ◽  
Peripheral Nerve Stimulator

Lower limb nerve blocks gained popularity with the introduction of better nerve localization techniques such as peripheral nerve stimulation and ultrasound. A combination of lower limb peripheral nerve blocks can provide anaesthesia and analgesia of the entire lower limb. Lower limb blocks, as compared to central neuraxial blocks, do not affect blood pressure, can be used in sick patients, provide longer-lasting analgesia, avoid the risk of epidural haematoma or urinary retention, provide better patient satisfaction, and have acceptable success rates in experienced hands. Detailed knowledge of the relevant anatomy is essential before performing any nerve blocks in the lower limb as the nerve plexuses and the peripheral nerves are deep and obscured by bony structures and large muscles. The lumbosacral plexus provides sensory and motor innervation to the superficial tissues, muscles, and bones of the lower limb. This chapter covers different approaches and techniques for lower limb blocks, that is, the lumbar plexus, femoral nerve, fascia iliaca, saphenous nerve, sciatic nerve, popliteal nerve, ankle block, forefoot block, and the intra-articular infusion of local anaesthetics. Both peripheral nerve stimulator- and ultrasound-guided approaches are discussed. The use of ultrasound guidance is suggested as it helps in reducing the dose of local anaesthetic required and can ensure circumferential spread of local anaesthetic around peripheral nerves, which hastens the onset of block and improves success rate.

Regional anaesthesia

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Local Anaesthetic ◽  
Lower Limb ◽  
Regional Anaesthesia ◽  
Anatomical Landmarks ◽  
Ultrasound Guided ◽  
Anaesthetic Agents

The regional anaesthesia chapter discusses the pharmacology of local anaesthetic agents, techniques of nerve localisation, practical aspects of ultrasound-guided blocks and the advantages and complications of regional anaesthesia. Common, and clinically useful, blocks for the upper and lower limb are described in detail with pictures of anatomical landmarks and ultrasound appearance to compliment the description. Indications, technique, volumes required and complications are described for each block.

Subjective Nature of Lower Limb Radicular Pain

2005 ◽  
Vol 28 (1) ◽  
pp. 12-14 ◽  
Author(s):  
Geoffrey M. Bove ◽  
Asia Zaheen ◽  
Zahid H. Bajwa
Keyword(s):  
Lower Limb ◽  
Radicular Pain

Local anaesthetic for lower-limb revascularization in high-risk patients

1997 ◽  
Vol 84 (8) ◽  
pp. 1096-1098
Author(s):  
C. A. MacKay ◽  
W. Razik ◽  
M. H. Simms
Keyword(s):  
High Risk ◽  
Local Anaesthetic ◽  
Lower Limb ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Perineural local anaesthetic catheter after major lower limb amputation trial (PLACEMENT): study protocol for a randomised controlled pilot study

Trials ◽  
2017 ◽  
Vol 18 (1) ◽  
Author(s):  
David C. Bosanquet ◽  
Graeme K. Ambler ◽  
Cherry-Ann Waldron ◽  
Emma Thomas-Jones ◽  
Lucy Brookes-Howell ◽  
...  
Keyword(s):  
Pilot Study ◽  
Study Protocol ◽  
Local Anaesthetic ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Randomised Controlled
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