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Aim: To evaluate the feasibility and efficacy of ultrasound guidance technique for the treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy).
Methods: 25 patients (10 males and 15 females); age 17–68 years; with meralgia paresthetica are diagnosed clinically by electromyography. A needle was inserted targeting the LFCN with ultr...
Citations
... 182 The authors found multiple case series of patients with meralgia paresthestica, receiving (series of) LFCNB with LA with or without steroid with prolonged relief up to from 2 months to 1 year. [184][185][186][187] The remaining literature spans case reports describing the use of USG LFCNB, pRFA, alcohol neurolysis, and cryoneurolysis for the treatment of chronic pain. [188][189][190][191][192] The limited number of studies did not identify any adverse events with USG LFCNB. ...
... 204 These studies supported the methodology used by Choi and colleagues who targeted inferomedial, superomedial, and superolateral GN branches due to their proximity to bony structures (junction of the metaphysis and epiphysis of the femur and tibia). 186,205 However, mixed pain responses to these blocks were noted, spurring the continued search for the best anatomic targets. Recently, revised anatomic targets for GN blockade and RFA were proposed and will have to be further investigated. ...
This article summarizes clinical expert recommendations and findings for the application of ultrasound-guided procedures in chronic pain management. Data on analgesic outcomes and adverse effects were collected and analyzed and are reported in this narrative review. Ultrasound guidance offers opportunities for the treatment of pain, with focus in this article on greater occipital nerve, trigeminal nerves, sphenopalatine ganglion, stellate ganglion, suprascapular nerve, median nerve, radial nerve, ulnar nerve, transverse abdominal plane block, quadratus lumborum, rectus sheath, anterior cutaneous abdominal nerves, pectoralis and serratus plane, erector spinae plane, illioinguinal/iliohypogastric/genitofemoral nerve, lateral femoral cutaneous nerve, genicular nerve, and foot and ankle nerves.
... The LCFN has a highly variable exit course, which is one of the major reasons for the failure of the local nerve blocks. The use of ultrasound guidance for nerve blocks has shown a cent percent success rate as reported by Tagliafico et al. [12] and Khodair et al. [13] though the proportion of the population requiring multiple injections varied among the two studies. ...
... Những năm gần đây nhờ kỹ thuật siêu âm phát triển, những nhánh thần kinh nhỏ cũng có thể được định vị và phong bế giúp giảm đau vùng thần kinh chi phối. Gần đây phương pháp phong bế LFCN được ứng dụng giảm đau phối hợp sau mổ vùng khớp háng, đau do dị cảm [10] Ahmed Thallaj báo cáo phối hợp gây tê LFCN và PENG (pericapsular nerve group) giảm đau sau mổ thay khớp háng cho BN nam 65 tuổi có nhiều bệnh phối hợp: lupus ban đỏ, suy tuyến giáp, suy tuyến thượng thận , thiếu máu cơ tim, suy tim, tăng áp động mạch phổi, phân suất tống máu EF 15% …phân loại ASA IV cho kết quả giảm đau sau mổ tốt, ổn định huyết động, điểm đau VAS duy trì 2 điểm khi nghỉ và 3 điểm khi vận động trong suốt 48 giờ sau mổ [1]. ...
Hiện nay, tuổi thọ con người ngày càng tăng, tuy nhiên người có tuổi trên 100 không nhiều, đặc biệt người 105 tuổi lại càng hiếm. Người cao tuổi thường có những suy giảm chức năng các cơ quan trong cơ thể nên khi vô cảm và phẫu thuật cho người cao tuổi phải đối diện với nhiều nguy cơ. Lựa chọn phương pháp vô cảm phù hợp để bảo đảm an toàn trong phẫu thuật, tạo điều kiện cho bệnh nhân sớm hồi phục sức khỏe sau phẫu thuật là vô cùng quan trọng. Báo cáo trường hợp lâm sàng: Phối hợp gây tê vùng để vô cảm phẫu thuật kết liên mấu chuyển xương đùi trên bệnh nhân 105 tuổi: Gây tê thần kinh đùi bì ngoài (LFCN- lateral femoral cutaneous nerve) giảm đau để chuẩn bị tư thế gây tê tủy sống, gây tê tủy sống kết hợp đặt catheter ngoài màng cứng (NMC) để giảm đau trong và sau phẫu thuật.
... US-guided LFCN blocks enable effective, economical, and safe treatment techniques for MP (10,12). To date, in a few case series and studies, the effect of US-guided LFCN blocks for MP have been investigated, but there is no randomized controlled trial evaluating the efficacy of LFCN blocks for MP treatment (13)(14)(15)(16)(17). TENS is a safe physical therapy approach that aims to reduce pain by inhibiting nociceptors, blocking the transmission of pain in the afferent nerve or sympathetic system control and opioid release (18)(19). ...
... NO increases vascular microcirculation and reduces inflammation (37,38). In studies regarding MP, local anesthetics and glucocorticoids were used similar to our study (10)(11)(12)(13)(14)(15)(16)(17)(18) because the use of this combination prolongs the duration of analgesic action (39)(40)(41). However, there is no clear consensus on the In the literature, the efficacy of local glucocorticoid and anesthetic activity on peripheral neuropathy has been investigated in many studies (42)(43)(44)(45), but studies have not shown any effect on peripheral neuropathic pain symptoms in MP. ...
Background:
Meralgia paresthetica (MP) is an entrapment mononeuropathy of the lateral femoral cutaneous nerve (LFCN), in which conservative treatment options are not always sufficient.
Objectives:
The aim of this study was to evaluate the efficacy of ultrasound (US)-guided LFCN injection in the management of MP by comparing with transcutaneous electrical nerve stimulation (TENS) therapy and sham TENS therapy.
Study design:
A prospective, randomized, sham-controlled study.
Setting:
Health Sciences University Training and Research Hospital in Turkey.
Methods:
Patients diagnosed with LFCN compression with clinical and electrophysiological findings were included in this study. Patients were randomly assigned to 3 groups: (1) US-guided injection group, (2) TENS group, and (3) sham TENS group. The blockage of the LFCN was performed for therapeutic MP management in group 1. Ten sessions of conventional TENS were administered to each patient 5 days per week for 2 weeks, for 20 minutes per daily session in group 2, and sham TENS was applied to group 3 with the same protocol. Visual Analog Scale (VAS), painDETECT questionnaire, Semmes-Weinstein monofilament test (SWMt), Pittsburgh Sleep Quality Index (PSQI), and health-related quality of life (36-Item Short Form Health Survey [SF-36]) at onset (T1), 15 days after treatment (T2), and 1 month after treatment (T3) were used for evaluation. Patients and the investigator who evaluated the results were blinded to the treatment protocol during the study period.
Results:
A total of 54 of the 62 patients (group 1 n = 17, group 2 n = 16, group 3 n = 21) completed the study, 3 patients from group 1, 4 patients from group 2, and 1 patient from group 3 dropped out during the follow-up period. The mean changes in painDETECT and SWMt scores showed a statistically significant difference between groups in favor of group 1 at T2 and T3 compared with T1 (P < 0.05). There was no statistically significant difference between groups in terms of VAS, SF-36, and PSQI scores (P > 0.05). In-group analysis of VAS scores showed a statistically significant decrease in T2 and T3 compared with T1 in group 1 (P < 0.05). In-group analysis of the VAS scores statistically significant decrease was shown in T2 compared with T1 in group 2 (P < 0.05). In-group analysis of painDETECT scores statistically significant decrease was shown in T2 and T3 compared with T1 in all groups (P < 0.05). In-group analysis of SWMt scores statistically significant decrease was shown in T2 and T3 compared with T1 in group 1 (P < 0.05). In-group analysis of SF-36 and PSQI scores, there was no statistically significant decrease in all groups (P > 0.05).
Limitations:
The limitation of the study was a short follow-up period.
Conclusions:
US-guided LFCN injection and TENS may be therapeutic options for MP treatment, however, for patients with neuropathic pain symptoms, US-guided LFCN injection may be a safe and alternative method to conservative treatment.
Key words:
Meralgia paresthetica, ultrasound-guided injection, transcutaneous electrical nerve stimulation.
... Many investigators have reported the efficacy of nerve blocks, although the evidence is conflicting [46]. Promising therapies include mixing corticosteroids with local anesthetics [47][48][49]. Although the proofs are comprised of small sample studies, the improvement with repeated injections is significant and consistent during the short follow up [47][48][49]. ...
... Promising therapies include mixing corticosteroids with local anesthetics [47][48][49]. Although the proofs are comprised of small sample studies, the improvement with repeated injections is significant and consistent during the short follow up [47][48][49]. ...
... Injection of the mixture of anesthetics would result in a doughnut-shaped nerve due to perineural spreading [48]. Anesthetic combinations that have been used in the studies include methylprednisolone acetate or triamcinolone acetonide combined with mepivacaine or bupivacaine with the varying volume of the substance used [47][48][49][50]. However, in general, 10-15 mL of volume should be adequate for LFCN block [51]. ...
Meralgia Paresthetica (MP) is one of the most common mononeuropathies of the lower limb. MP usually resolves on its own, even without treatment. However, many physicians are not aware of this diagnosis and may confuse patients with another nerve disease such as radiculopathies. Although no motor symptoms are associated with this condition, the sensory dysfunctions are potentially debilitating to patients. The variable course of the lateral femoral cutaneous nerve also complicates treatments. Thus, the author recommends the use of ultrasonography to help locate the nerve. Many treatments for MP are available, but they are supported only by moderate to low-quality evidence. Treatments range from conservative to interventions using nerve blocks and surgery. Without a clear superiority of any treatment, the author concludes that treatment should be done in a stepwise fashion, from the non-invasive to the more invasive treatment if symptoms persist.
... Moreover, ultrasound has been demonstrated to be an effective means of attaining correct needle placement for a variety of blocks, including that for the LFCN [8][9]. Cadaveric studies comparing rates of successful LFCN localization using ultrasound guidance versus anatomic landmarks alone have demonstrated dramatically higher rates of successful needle-to-nerve contact when the ultrasound was utilized [10]. ...
Injury to the lateral femoral cutaneous nerve (LFCN) from compression or entrapment may result in meralgia paresthetica, a painful mononeuropathy of the anterolateral thigh. Surgical decompression of the LFCN may provide relief when conservative management fails. However, the considerable anatomic variability of this nerve may complicate surgical localization and thus prolong operative time. Herein, we report the use of preoperative high-resolution ultrasonography to map the LFCN in a patient with bilateral meralgia paresthetica. This simple, noninvasive imaging technique was seen to be effective at providing precise localization of the entrapped and, in this case, bilateral anatomically variant nerves. Preoperative high-resolution ultrasound mapping of the LCFN can be used to facilitate precise operative localization in the treatment of bilateral meralgia paresthetica. This is especially useful in the setting of suspected unusual nerve anatomy.
... Ultrasound guided perineural steroid injection has been preferred by many pain physician. [44][45][46] ...
Meralgia paraesthetica (MP) is a clinical syndrome produced by entrapment mono-neuropathy of lateral femoral cutaneous nerve (LFCN). It classically presents as numbness, paresthesia or dysesthesia of anterolateral aspect of thigh but sometime it may mimic conditions like lumbar radiculopathy, femoro-acetabular impingement, trochanteric bursitis, etc. Since it has wide spectrum of clinical presentation, it should be the diagnosis of exclusion when causes of anterolateral thigh pain is not explained by other known causes. The aim of this review is to provide an overview of this clinical condition with the emphasis on various clinical presentations and anatomical variations of the lateral femoral cutaneous nerve. Different methods of diagnosis and treatment are also explored and discussed in this paper.
Objective
To examine diagnostic and therapeutic utility of novel ultrasound-guided perineural injection of posterior antebrachial cutaneous nerve in chronic lateral elbow pain.Materials and methodsWe performed a retrospective analysis of ultrasound-guided perineural injection of the posterior antebrachial cutaneous nerve with local anesthetic with or without corticosteroid in patients with chronic lateral elbow pain. Data variables collected included patient demographics, illness course, diagnostic ultrasound findings, immediate pre- and post-injection pain using numeric rating pain scale between 0 and 10, injection complications, and post-injection outcomes.ResultsFifteen patients (9 females and 6 males) with average age 46.9 (range 16–69 years) underwent 20 perineural injections between 2009 and 2019. Patients had on average 84% reduction in pain immediately after the injection (median pre- and post-procedure numeric rating pain scale of 6 and 0, respectively, p < 0.001). Patients had pain relief for an average of 15 h (range 2–48 h) when only local anesthetic was injected, compared with average pain relief of 26.5 days (range 2 h—43 days) when local anesthetic was combined with corticosteroid, p = 0.01.Conclusion
Novel ultrasound-guided perineural anesthetic injections around the posterior antebrachial cutaneous nerve can be performed safely and have diagnostic and potentially therapeutic utility in select patients with chronic refractory lateral elbow pain.
