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  1 / 2523 MEDLINE  
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[PMID]:29215481
[Au] Autor:Xu Z; Fleming FJ; Justiniano CF; Becerra AZ; Boodry CI; Aquina CT; Temple LK; Speranza JR
[Ad] Endereço:Department of Surgery, University of Rochester Medical Center, Rochester, New York.
[Ti] Título:Trends in Surgeon-Level Utilization of Sacral Nerve Stimulator Implantation for Fecal Incontinence in New York State.
[So] Source:Dis Colon Rectum;61(1):107-114, 2018 Jan.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There is a paucity of real-world data regarding surgeon utilization of sacral nerve stimulation for fecal incontinence compared with anal sphincteroplasty. OBJECTIVE: This study aims to examine trends in sacral nerve stimulation use compared with sphincteroplasty for fecal incontinence and surgeon-level variation in progression to implantation of the pulse generator. DESIGN: This is a population-based study. PATIENTS: Patients with fecal incontinence between 2011 and 2014 in New York who underwent stage 1 of the sacral nerve stimulation procedure were selected. For the comparison with sphincteroplasty, patients with fecal incontinence who underwent anal sphincteroplasty between 2008 and 2014 were included. MAIN OUTCOME MEASURES: The main outcomes after sacral nerve stimulation generator placement were unplanned 30-day admission, emergency department visit within 30 days, revision or explant of leads or generator, and 30-day mortality. RESULTS: Six hundred twenty-one patients with fecal incontinence underwent a stage 1 procedure with 79.7% progressing to stage 2. There has been an increase in the number of sacral nerve stimulation cases per year as well as the number of surgeons performing the procedure. The rate of progression to stage 2 among patients treated by colorectal surgeons was 80.2% compared with 77.0% among those treated by noncolorectal surgeons. Among those who completed stage 2, there were 3 (0.5%) unplanned 30-day admissions, 24 (4.4%) emergency department visits within 30 days, and 0 mortalities within 30 days. Thirty-two (6.5%) patients had their leads or pulse generator revised or explanted. There was a significant decrease in annual sphincteroplasty cases and the number of providers performing the procedure starting in 2011. LIMITATIONS: We lacked data regarding patient and physician decision making and the severity of disease. CONCLUSIONS: Sacral nerve stimulation for fecal incontinence is increasing in popularity with an increasing number of surgeons utilizing sacral nerve stimulation for fecal incontinence rather than sphincteroplasty. See Video Abstract at http://links.lww.com/DCR/A450.
[Mh] Termos MeSH primário: Terapia por Estimulação Elétrica/utilização
Incontinência Fecal/cirurgia
Plexo Lombossacral/cirurgia
Esfincterotomia/métodos
[Mh] Termos MeSH secundário: Idoso
Canal Anal/cirurgia
Terapia por Estimulação Elétrica/tendências
Eletrodos Implantados/tendências
Eletrodos Implantados/utilização
Feminino
Seres Humanos
Masculino
Meia-Idade
New York
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171215
[Lr] Data última revisão:
171215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000941


  2 / 2523 MEDLINE  
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[PMID]:27779312
[Au] Autor:Zerbib F; Siproudhis L; Lehur PA; Germain C; Mion F; Leroi AM; Coffin B; Le Sidaner A; Vitton V; Bouyssou-Cellier C; Chene G; CONSTIMOD study investigators
[Ad] Endereço:Department of Gastroenterology, Bordeaux University Hospital, and Université de Bordeaux and Institut National de la Santé et de la Recherche Médicale (INSERM) CIC 1401, Bordeaux, France.
[Ti] Título:Randomized clinical trial of sacral nerve stimulation for refractory constipation.
[So] Source:Br J Surg;104(3):205-213, 2017 Feb.
[Is] ISSN:1365-2168
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Open studies have reported favourable results for sacral nerve stimulation in the treatment of refractory constipation. Here, its efficacy was assessed in a double-blind crossover RCT. METHODS: Patients with at least two of the following criteria were included: fewer than three bowel movements per week; straining to evacuate on more than 25 per cent of attempts; or sensation of incomplete evacuation on more than 25 per cent of occasions. Response to therapy was defined as at least three bowel movements per week and/or more than 50 per cent improvement in symptoms. Responders to an initial 3-week peripheral nerve evaluation were offered permanent implantation of a pulse generator and were assigned randomly in a crossover design to two 8-week intervals of active or sham stimulation. At the end of the two trial periods, the patients received active stimulation until the final evaluation at 1 year. RESULTS: Thirty-six patients (34 women; mean(s.d.) age 45(14) years) underwent peripheral nerve evaluation. Twenty responded and received a permanent stimulator. A positive response was observed in 12 of 20 and 11 of 20 patients after active and sham stimulation periods respectively (P = 0·746). Pain related to the device occurred in five patients and wound infection or haematoma in three, leading to definitive removal of the pulse generator in two patients. At 1 year, 11 of the 20 patients with an implanted device continued to respond. Stimulation had no significant effect on colonic transit time. CONCLUSION: These results do not support the recommendation of permanent implantation of a pulse generator in patients with refractory constipation who initially responded to temporary nerve stimulation. Registration number: NCT01629303 (http://www.clinicaltrials.gov).
[Mh] Termos MeSH primário: Constipação Intestinal/terapia
Terapia por Estimulação Elétrica/métodos
Plexo Lombossacral
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Estudos Cross-Over
Método Duplo-Cego
Terapia por Estimulação Elétrica/instrumentação
Feminino
Seguimentos
Seres Humanos
Neuroestimuladores Implantáveis
Masculino
Meia-Idade
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171215
[Lr] Data última revisão:
171215
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161026
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1002/bjs.10326


  3 / 2523 MEDLINE  
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[PMID]:29112568
[Au] Autor:Lambrescak E; Wyart V; Meurette G; Faucheron JL; Thomas C; Atienza P; Lehur PA; Etienney I
[Ad] Endereço:1 Department of ColoProctology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France 2 Colorectal Unit, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes, France 3 Colorectal Unit, Department of Surgery, Grenoble Alps University Hospital, Grenoble, France.
[Ti] Título:Sacral Nerve Stimulation for Fecal Incontinence: How Long Should the Test Phase Be?
[So] Source:Dis Colon Rectum;60(12):1314-1319, 2017 Dec.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Decision-making for pulse generator implantation for sacral nerve stimulation in the management of fecal incontinence is based on the results of a test phase. Its duration is still a matter of debate. OBJECTIVE: The purpose of this study was to determine whether an early positive response during the test phase could predict implantation of a permanent sacral nerve pulse generator. DESIGN: This was a short-term observational cohort study. A positive response was defined as a >50% decrease of fecal leaks compared with baseline. A multivariate logistic regression was computed to predict pulse generator implantation after the first week of the test phase. SETTINGS: The study was conducted in 3 national referral centers. PATIENTS: From January 2006 to December 2012, 144 patients with fecal incontinence enrolled in a prospectively maintained database completed a 2- to 3-week bowel diary, at baseline and during test phase. MAIN OUTCOME MEASURES: The primary outcome was the clinical decision to implant a pulse generator. The primary predictor was a calculated score including the number of leak episodes, bowel movements, and urgencies and the time to defer defecation expressed in minutes during the first screening test week. RESULTS: After the first, second and third week of the test phase, 81 (56%) of 144, 96 (67%) of 144, and 93 (70%) of 131 patients had a positive test. A permanent pulse generator was implanted in 114. Time to defer defecation increased during the 3 weeks of screening. Urgencies were unchanged. The computed score was predictive of a permanent pulse generator implantation (Se = 72.6% (95% CI, 59.8-83.1); Sp = 100% (95% CI, 78.2-100); c-index = 0.86 (95% CI, 0.78-0.94)). LIMITATIONS: No cost analysis or projection based on our proposal to reduce the test phase has been made. CONCLUSIONS: Permanent pulse generator implantation can be safely proposed early (1-week screening) to fast responders. Nonetheless, permanent implantation may be decided as well in patients exhibiting a delayed response. Whether a rapid response to sacral nerve stimulation could be predictive of a long-term response remains to be determined. See Video Abstract at http://links.lww.com/DCR/A452.
[Mh] Termos MeSH primário: Terapia por Estimulação Elétrica/métodos
Incontinência Fecal/terapia
Plexo Lombossacral/fisiologia
Sacro/inervação
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Masculino
Meia-Idade
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171108
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000942


  4 / 2523 MEDLINE  
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[PMID]:28888083
[Au] Autor:Sato M; Hara M; Uchida O
[Ad] Endereço:Department of Anesthesiology, Chiba Children's Hospital, Chiba, Japan.
[Ti] Título:An antero-lateral approach to ultrasound-guided lumbar plexus block in supine position combined with quadratus lumborum block using single-needle insertion for pediatric hip surgery.
[So] Source:Paediatr Anaesth;27(10):1064-1065, 2017 10.
[Is] ISSN:1460-9592
[Cp] País de publicação:France
[La] Idioma:eng
[Mh] Termos MeSH primário: Músculos Abdominais
Agulhas
[Mh] Termos MeSH secundário: Criança
Seres Humanos
Plexo Lombossacral
Bloqueio Nervoso
Decúbito Dorsal
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170910
[St] Status:MEDLINE
[do] DOI:10.1111/pan.13208


  5 / 2523 MEDLINE  
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[PMID]:28830192
[Au] Autor:Eastlack J; Tenorio L; Wadhwa V; Scott K; Starr A; Chhabra A
[Ad] Endereço:1 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
[Ti] Título:Sciatic neuromuscular variants on MR neurography: frequency study and interobserver performance.
[So] Source:Br J Radiol;90(1079):20170116, 2017 Nov.
[Is] ISSN:1748-880X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the frequency of sciatic neuromuscular variants on MR neurography and determine the interobserver variability. METHODS: A retrospective evaluation of 137 consecutive lumbosacral plexus magnetic resonance neurography examinations was performed. All examinations were performed using nerve selective 3D imaging and independently reviewed by two readers for the presence of sciatic neuromuscular variants and piriformis muscle asymmetry. Inter- and intraobserver performance were evaluated. RESULTS: There were a total of 44/268 (16.4%) extremities with sciatic neuromuscular variants. The interobserver performance in the identification of sciatic nerve variants was excellent (kappa values from 0.8-0.9). There was a total of 45/134 (33.6%) patients with piriformis muscle asymmetry. Of these, 7/134 (5.2%) had piriformis muscle atrophy and 38/134 (28.4%) had piriformis muscle hypertrophy. The interobserver performance in the identification of piriformis muscle atrophy and hypertrophy was moderate to good (kappa values from 0.39-0.61). The intraobserver performance revealed kappa values of 0.735 and 0.821 on right and left, respectively. CONCLUSION: Sciatic neuromuscular variants and piriformis muscle asymmetry are frequent on lumbosacral plexus MRN with moderate to excellent interobserver performance. Advances in knowledge: Sciatic neuromuscular variants and piriformis asymmetry on MR neurography are frequent and the prevalence is similar to cumulative prevalence from available scientific series. Interobserver performance for identification of sciatic neuromuscular variants is excellent, and moderate-good for piriformis muscle asymmetry.
[Mh] Termos MeSH primário: Plexo Lombossacral/diagnóstico por imagem
Imagem por Ressonância Magnética/métodos
Músculo Esquelético/diagnóstico por imagem
Atrofia Muscular/diagnóstico por imagem
Nervo Isquiático/diagnóstico por imagem
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
Meia-Idade
Músculo Esquelético/inervação
Músculo Esquelético/patologia
Atrofia Muscular/patologia
Variações Dependentes do Observador
Radiologistas
Estudos Retrospectivos
Nervo Isquiático/anormalidades
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1259/bjr.20170116


  6 / 2523 MEDLINE  
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[PMID]:28716325
[Au] Autor:Barboglio Romo PG; Gupta P
[Ad] Endereço:Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of Michigan, 1500 East Medical Center Drive, 3875 Taubman Center, Ann Arbor, MI 48109-5330, USA.
[Ti] Título:Peripheral and Sacral Neuromodulation in the Treatment of Neurogenic Lower Urinary Tract Dysfunction.
[So] Source:Urol Clin North Am;44(3):453-461, 2017 Aug.
[Is] ISSN:1558-318X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Sacral and peripheral neuromodulation are minimally invasive surgical procedures that are third-line therapy options for the treatment of patients with idiopathic overactive bladder syndrome. There has been interest in their efficacy in the management of neurogenic lower urinary tract dysfunction (NLUTD). Contemporary data suggest promising outcomes for urinary and bowel symptoms in carefully selected patients with spinal cord injury and/or multiple sclerosis. This article reviews the current literature regarding urinary and bowel outcomes in patients with NLUTD and also discusses contemporary studies that suggest that treatment during particular stages of neurologic injury may prevent long-term urinary sequelae.
[Mh] Termos MeSH primário: Neuroestimuladores Implantáveis
Sintomas do Trato Urinário Inferior/cirurgia
Bexiga Urinaria Neurogênica/cirurgia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Sintomas do Trato Urinário Inferior/etiologia
Plexo Lombossacral
Esclerose Múltipla/complicações
Procedimentos Neurocirúrgicos
Sistema Nervoso Periférico
Traumatismos da Medula Espinal/complicações
Bexiga Urinaria Neurogênica/etiologia
Procedimentos Cirúrgicos Urológicos/métodos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170719
[St] Status:MEDLINE


  7 / 2523 MEDLINE  
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[PMID]:28660835
[Au] Autor:Meister FA; Amygdalos I; Neumann UP; Lurje G
[Ad] Endereço:Department of Surgery and Transplantation, University Hospital RWTH-Aachen , Aachen , Germany.
[Ti] Título:Rectal foreign body insertion as a rare cause of persistent lumbosacral plexus injury.
[So] Source:Ann R Coll Surg Engl;99(6):e191-e192, 2017 Jul.
[Is] ISSN:1478-7083
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Rectal foreign body insertion is a common condition in emergency surgery, which often requires surgical intervention. Here we report a clinical case of rectal foreign body insertion as a rare cause of persistent lumbosacral plexus injury. A 72-year-old man presented to the emergency department complaining of acute bilateral paraplegia with loss of sensation in both legs, as well as total urinary retention. The patient underwent abdominal computed tomography, which showed a rectal foreign body measuring 13 × 11.5 × 10 cm in the lower abdomen and pelvis. Extraluminal assistance through a median laparotomy was required after unsuccessful attempts at transanal recovery alone. After removal of the foreign body, the rectal wall and anorectal sphincter were massively dilated, with severe bruising of the rectal mucosa on proctoscopy. A protective loop-ileostomy was performed. The sacral plexus is located posteriorly in the pelvis. Physiologically, the nerves are well protected by surrounding anatomical structures. Post-traumatic lumbosacral plexus injuries with paraplegia, urinary retention and anorectal sphincter insufficiency occur quite frequently after heavy traffic accidents. Lumbosacral plexus injury as a result of rectal foreign body insertion is rare. Severe neurological deficits through rectal foreign body insertion are rare but known medical conditions. To the best of our knowledge, this is the first reported case of severe and persistent post-traumatic lumbosacral plexus injury through a rectal foreign body.
[Mh] Termos MeSH primário: Corpos Estranhos
Plexo Lombossacral/lesões
Traumatismos dos Nervos Periféricos/etiologia
Reto
[Mh] Termos MeSH secundário: Idoso
Incontinência Fecal
Corpos Estranhos/complicações
Corpos Estranhos/diagnóstico por imagem
Corpos Estranhos/cirurgia
Seres Humanos
Ileostomia
Masculino
Proctoscopia
Reto/diagnóstico por imagem
Reto/lesões
Reto/cirurgia
Incontinência Urinária
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170630
[St] Status:MEDLINE
[do] DOI:10.1308/rcsann.2017.0109


  8 / 2523 MEDLINE  
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[PMID]:28651520
[Au] Autor:Ke X; Li J; Liu Y; Wu X; Mei W
[Ad] Endereço:Department of anesthesiology and Pain medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, People's Republic of China.
[Ti] Título:Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports.
[So] Source:BMC Anesthesiol;17(1):86, 2017 Jun 26.
[Is] ISSN:1471-2253
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Anesthesia management for patients with severe ankylosing spondylitis scheduled for total hip arthroplasty is challenging due to a potential difficult airway and difficult neuraxial block. We report 4 cases with ankylosing spondylitis successfully managed with a combination of lumbar plexus, sacral plexus and T12 paravertebral block. CASE PRESENTATION: Four patients were scheduled for total hip arthroplasty. All of them were diagnosed as severe ankylosing spondylitis with rigidity and immobilization of cervical and lumbar spine and hip joints. A combination of T12 paravertebral block, lumbar plexus and sacral plexus block was successfully used for the surgery without any additional intravenous anesthetic or local anesthetics infiltration to the incision, and none of the patients complained of discomfort during the operations. CONCLUSIONS: The combination of T12 paravertebral block, lumbar plexus and sacral plexus block, which may block all nerves innervating the articular capsule, surrounding muscles and the skin involved in total hip arthroplasty, might be a promising alternative for total hip arthroplasty in ankylosing spondylitis.
[Mh] Termos MeSH primário: Artroplastia de Quadril
Bloqueio Nervoso/métodos
Espondilite Anquilosante/complicações
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Plexo Lombossacral
Masculino
Meia-Idade
Vértebras Torácicas
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170628
[St] Status:MEDLINE
[do] DOI:10.1186/s12871-017-0358-7


  9 / 2523 MEDLINE  
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[PMID]:28619496
[Au] Autor:Grunert P; Drazin D; Iwanaga J; Schmidt C; Alonso F; Moisi M; Chapman JR; Oskouian RJ; Tubbs RS
[Ad] Endereço:Swedish Neuroscience Institute, Department of Neurosurgery, Seattle, Washington, USA.
[Ti] Título:Injury to the Lumbar Plexus and its Branches After Lateral Fusion Procedures: A Cadaver Study.
[So] Source:World Neurosurg;105:519-525, 2017 Sep.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Neurologic deficits from lumbar plexus nerve injuries commonly occur in patients undergoing lateral approaches. However, it is not yet clear what types of injury occur, where anatomically they are located, or what mechanism causes them. We aimed to study 1) the topographic anatomy of lumbar plexus nerves and their injuries in human cadavers after lateral transpsoas approaches to the lumbar spine, 2) the structural morphology of those injuries, and 3) the topographic anatomy of the lumbar plexus throughout the mediolateral approach corridor. METHODS: Fifteen adult fresh frozen cadaveric torsos (26 sides) underwent lateral approaches (L1-L5) by experienced lateral spine surgeons. The cadavers were subsequently opened and the entire plexus dissected and examined for nerve injuries. The topographic anatomy of the lumbar plexus and its branches, their injuries, and the morphology of these injuries were documented. RESULTS: Fifteen injuries were found with complete or partial nerve transections (Sunderland IV and V). Injuries were found throughout the mediolateral approach corridor. At L1/2, the iliohypogastric, ilioinguinal, and subcostal nerves were injured within the psoas major muscle, the retroperitoneal space, or the outer abdominal muscles and subcutaneous tissues. Genitofemoral nerve injuries were found in the retroperitoneal space. Nerve root injuries occurred within the retroperitoneal space and psoas muscle. Femoral nerve injuries were found only within the psoas major muscle. No obturator nerve injuries occurred. CONCLUSIONS: Lateral approaches can lead to structural nerve damage. Knowledge of the complex plexus anatomy, specifically its mediolateral course, is critical to avoid approach-related injuries.
[Mh] Termos MeSH primário: Plexo Lombossacral/lesões
Plexo Lombossacral/patologia
Complicações Pós-Operatórias/patologia
Fusão Vertebral/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Cadáver
Feminino
Seres Humanos
Masculino
Fusão Vertebral/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170617
[St] Status:MEDLINE


  10 / 2523 MEDLINE  
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[PMID]:28396863
[Au] Autor:Strid JM; Pedersen EM; Al-Karradi SN; Bendtsen MA; Bjørn S; Dam M; Daugaard M; Hansen MS; Linnet KD; Børglum J; Søballe K; Bendtsen TF
[Ad] Endereço:Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
[Ti] Título:Real-Time Ultrasound/MRI Fusion for Suprasacral Parallel Shift Approach to Lumbosacral Plexus Blockade and Analysis of Injectate Spread: An Exploratory Randomized Controlled Trial.
[So] Source:Biomed Res Int;2017:1873209, 2017.
[Is] ISSN:2314-6141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Fused real-time ultrasound and magnetic resonance imaging (MRI) may be used to improve the accuracy of advanced image guided procedures. However, its use in regional anesthesia is practically nonexistent. In this randomized controlled crossover trial, we aim to explore effectiveness, procedure-related outcomes, injectate spread analyzed by MRI, and safety of ultrasound/MRI fusion versus ultrasound guided Suprasacral Parallel Shift (SSPS) technique for lumbosacral plexus blockade. Twenty-six healthy subjects aged 21-36 years received two SSPS blocks (20 mL 2% lidocaine-epinephrine [1 : 200,000] added 1 mL diluted contrast) guided by ultrasound/MRI fusion versus ultrasound. Number (proportion) of subjects with motor blockade of the femoral and obturator nerves and the lumbosacral trunk was equal (ultrasound/MRI, 23/26 [88%]; ultrasound, 23/26 [88%]; = 1.00). Median (interquartile range) preparation and procedure times (s) were longer for the ultrasound/MRI fusion guided technique (686 [552-1023] versus 196 [167-228], < 0.001 and 333 [254-439] versus 216 [176-294], = 0.001). Both techniques produced perineural spread and corresponding sensory analgesia from L2 to S1. Epidural spread and lidocaine pharmacokinetics were similar. Different compartmentalized patterns of injectate spread were observed. Ultrasound/MRI fusion guided SSPS was equally effective and safe but required prolonged time, compared to ultrasound guided SSPS. This trial is registered with EudraCT (2013-004013-41) and ClinicalTrials.gov (NCT02593370).
[Mh] Termos MeSH primário: Anestésicos Locais
Plexo Lombossacral/efeitos dos fármacos
Imagem por Ressonância Magnética
Ultrassonografia de Intervenção/métodos
[Mh] Termos MeSH secundário: Adulto
Bloqueio do Plexo Braquial/métodos
Espaço Epidural/efeitos dos fármacos
Epinefrina/administração & dosagem
Feminino
Seres Humanos
Lidocaína/administração & dosagem
Plexo Lombossacral/fisiopatologia
Masculino
Bloqueio Nervoso/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anesthetics, Local); 98PI200987 (Lidocaine); YKH834O4BH (Epinephrine)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170428
[Lr] Data última revisão:
170428
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170412
[St] Status:MEDLINE
[do] DOI:10.1155/2017/1873209



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