Surgical and radiologic anatomy : SRA
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The pudendal nerve may become entrapped either within the pudendal canal or near the sacrotuberous ligament resulting in a partial conduction block. The goal of the present anatomical study was to assess a new transgluteal injection technique in terms of the precise injection site and the resulting distribution of the injected agent. ⋯ This easily performed technique should provide a new approach for treating perineal neuralgia via pudendal nerve block in the consultation room without the need for computed tomography.
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Twenty-four cadavers (48 sides) were used to clarify the terminal insertional segment and communications of the vertebral nerve in the cervical region under a surgical microscope. After displacing the prevertebral muscles (longus colli and longus capitis) laterally, the ventral parts of the transverse foramen of vertebrae (from C2 to C6) were removed, and the insertional segment and communicates of the vertebral nerve surrounding the vertebral artery were observed. The results showed: (1) the vertebral nerve ascended along the ventral or mediodorsal vertebral artery and terminated mainly at C3 (22/36 sides) but not terminated at C4 or C5 only; (2) the superficial communicates from the cervical sympathetic trunk ran in a proximal and distal direction when the fibers entered the anterior branches of the cervical nerves. ⋯ In conclusion, the vertebral nerve and the fibers surrounding the vertebral artery could be considered as a stable deep pathway of cervical sympathetic nerves. The deep pathway (vertebral nerve and its branches) with the superficial pathways (cervical sympathetic trunk and its branches) formed a sympathetic nervous "plexus" in the cervical region. This sympathetic nervous "plexus" may be involved in the effects of cervical ganglionic blockade.
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Lesion of the lateral femoral cutaneous nerve (LFCN) represents the main complication during minimally invasive anterior approach dissection to the hip joint. The aim of this anatomical study was to describe the different presentation features of the LFCN at the thigh and particularly to determine the potential location of damage during minimally invasive anterior approach for total hip replacement. ⋯ According to this study, numerous anatomical variations of the LFCN at the thigh should be considered when performing anterior approach to the hip joint. Different mechanisms of injury during surgery should be considered especially during minimally invasive total hip replacement, such as section of the gluteal or the femoral branch where it crosses the anterior margin of the TFL or stretching of the femoral branch due to retractors positioned into the intermuscular space between sartorius and TFL. According to the map of "danger zones" reported, the author policy consists of positioning the skin incision as lateral and distal to the ASIS as possible.
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The aim of this study was first to define first the anatomical relationships between the musculocutaneous nerve and the coracobrachialis, and then the induced modifications of these relationships by a preglenoid transposition of the vertical part of the coracoid process. ⋯ Lesion of the musculocutaneous nerve is a known complication of the coracoid bone block abutment procedure (Latarjet-Bristow). From this study we know that they are due to lengthening of the nerve and modification of the penetration angle of the nerve into the coracobrachialis. We also infer that some motor nerve destined to the coracobrachialis might be damaged during the proximal medial release of the muscle after the detachment of the pectoralis minor muscle.
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Satisfactory analgesia cannot be achieved in every obturator nerve block. To attempt to improve the success rate of obturator nerve block, this study describes the detailed anatomy of the obturator region and canal. Eleven (5 female and 6 male) cadavers, totally 22 sides were dissected. ⋯ The presence of the branches of the obturator artery and vein alongside the obturator nerve may increase the risk of injury to these structures during anaesthetic procedures. The anterior division of the obturator nerve has a close relationship with these vessels. To provide complete analgesia, the obturator nerve should be blocked in the obturator canal or at its external orifice.