No description available.

No description available.

No description available.

No description available.

No description available.

Knowledge of the course of the pudendal nerve (PN) is important when performing perineal surgery. Distances between landmarks were measured after PN dissections in 71 cadavers and after perineal procedures on 30 cadavers. Separate inferior rectal nerve (IRN) entry and medial position of the PN/IRN with shortened sacrospinous ligaments were often seen in black individuals. A PN block should therefore be placed more proximally and medially. The Richter’s stitch should be placed further from the ischial spine. During ischioanal procedures the IRN is at risk in white females, as it was more superficial. The dorsal nerve of the clitoris/penis (DNC/DNP) is in danger during the outside-in procedures in white or obese individuals, as it was closer to the inferior pubic ramus. The dorsal penile nerve block should be administered deeper in white and obese individuals, as the DNP was deeper. The above-mentioned findings should be verified in a clinical setting. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Anatomy / Unrestricted

La radiculopathie cervicale caudale a été identifiée comme cause de boiterie affectant le membre antérieur chez le cheval. Les affections dégénératives des articulations intervertébrales des processus articulaires entraînent un remodelage périarticulaire pouvant comprimer les racines du nerf spinal ou leur rameau ventral. Les objectifs de l’étude étaient de décrire la réalisation d’injections échoguidées périneurales du rameau ventral des nerfs spinaux cervicaux 7 et 8 (RV7 et RV8), d’évaluer sur des cadavres de chevaux par dissection la diffusion péri-nerveuse d’une solution colorée ainsi que de décrire chez des chevaux sains les signes cliniques associés à une anesthésie périneurale échoguidée du RV7 et RV8 individuellement. Dans l’étude post-mortem, 5 RV7 et 5 RV8 ont été visualisés échographiquement et colorés par une injection de 7 ou 14 ml de solution colorée. Une portion du tronc nerveux a été trouvée coloré pour chaque injection. La coloration était uniforme transversalement sur toute la largeur du nerf et couvrait une longueur supérieure à 2 cm pour 8 RV alors qu’une coloration de la moitié crâniale du RV sur une longueur de moins de 2 cm pour un RV7 et un RV8. L’étude sur cheval sain portait sur 4 chevaux sains sans image radiographique anormale de la colonne cervicale. Six RV7 et 8 RV8 ont été anesthésiés de la Lidocaïne 2% mélangés à du iohexol. Toutes les injections ont entraîné boiterie antérieure ipsilatérale de l’injection. Les boiteries les plus sévères correspondaient à une parésie du nerf suprascapulaire pour RV7 et à une parésie radiale pour RV8. Cette étude a montré qu’il était possible de réaliser une injection périneurale des RV 7 et RV8 chez le cheval et que l’anesthésie tronculaire des deux racines provoque une atteinte motrice essentiellement de la fonction nerveuse. Ces résultats contribuent à mieux comprendre la symptomatologie des compressions nerveuses cervicales chez le cheval. / Caudal cervical radiculopathy has been identified as a cause of frontlimb lameness in horses. Degenerative conditions of articular process joint result in periarticular remodeling responsible for compression of spinal nerve roots or their ramus ventralis (RV). The objectives of the study were to describe how to perform perineural RV injection under ultrasonographic guidance, to evaluate on cadaver perineural RV staining after a dye solution injection, as well as describe clinical signs associated with a perineural ultranosonography-guided anesthesia of RV7 and RV8 respectively. In the post-mortem study, the RV of the spinal cervical nerves was visualized in all cadavers. Eight RV had a uniform transversal staining of the nerve trunk that covered longitudinally a distance greater than 2 cm. One C7 and one C8 RV showed incomplete transversal staining with a more concentrated color on its half cranial aspect and a longitudinal coverage of less than 2 cm. The in vivo study included 6 RV7 and 8 RV8 perineural injections of a local anesthetic agent, performed on 4 horses that had no abnormal finding on cervical radiographs. All anesthetic injections (lidocaine 2% and iohexol) resulted in modifications of the locomotion with variable degree of lameness on the ipsilateral frontlimb. Severe lameness was characteristic of a suprascapular paresis for RV7 and a radial paresis for RV8. Mild to moderate lameness on the ipsilateral frontlimb included decreased anterior phase of the stride, intern circumduction of the limb and sometimes stumbling for that same frontlimb. Signs of ataxia on the hindlimbs were encountered for 3 injections. This study showed that it is possible to perform perineural injections of RV7 and RV8 in horses and that perineural anesthesia of RV7 and RV8 results in motor dysfunction. These findings constitute a contribution to understanding clinical signs associated with cervical nerve compression in horses.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2015-10-09T17:06:03Z No. of bitstreams: 2 Tese - Marcos Rassi Fernandes - 2013.pdf: 3024550 bytes, checksum: c4d90a110a9b3b2805efd4361d807ff2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Erika Demachki (erikademachki@gmail.com) on 2015-10-09T17:12:33Z (GMT) No. of bitstreams: 2 Tese - Marcos Rassi Fernandes - 2013.pdf: 3024550 bytes, checksum: c4d90a110a9b3b2805efd4361d807ff2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-09T17:12:33Z (GMT). No. of bitstreams: 2 Tese - Marcos Rassi Fernandes - 2013.pdf: 3024550 bytes, checksum: c4d90a110a9b3b2805efd4361d807ff2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-06-27 / Introduction: The simultaneous assessment of quality of life and functional capacity from the patient's self perception with adhesive capsulitis may contribute to the improvement of health care of this population. Objectives: To describe the techniques and clinical indications of suprascapular nerve block, as well as their complications, based on literature data; to assess the quality of life and functional capacity of patients with adhesive capsulitis at the beginning and end of treatment with blocks and to analyze the factors associated with satisfactory quality of life and better functional capacity. Methods: Prospective clinical study in adults and elderly patients with adhesive capsulitis submitted to weekly treatment with suprascapular nerve blocks, users of a private orthopaedic hospital, located in the city of Goiânia-GO, in the period of august 2010 to february 2012. Quality of life was assessed by the WHOQOL-BREF and functional capacity by DASH at the beginning and end of treatment. The Constant score greater than or equal to 55 points was used for the end of the blocks and the Wilcoxon test to compare the initials and finals scores of the WHOQOL-BREF and DASH. Multiple regression analysis of Poisson was carried out using satisfactory quality of life and better functional capacity as outcomes. Significance level of 5%. Results: Forty-three patients with a mean age of 54,7 years were evaluated. Better scores of quality of life and functional capacity were obtained at the end of treatment, when compared to the initials scores. Patients with age greater than 50 years old were associated with higher scores of quality of life in the physical and psychological WHOQOL-BREF domains and those with better educational level in the physical and environmental domains. Age greater than 50 years old and higher schooling were also associated with better functional capacity of the affected shoulder. Conclusions: There are several techniques and clinical indications for the performance of the suprascapular nerve block. Although rare, complications may occur. Quality of life and shoulder functional capacity of patients with adhesive capsulitis improved at the end of the treatment with suprascapular nerve blocks, being influenced by the higher age and better educational level. / Introdução: A avaliação simultânea da qualidade de vida e da capacidade funcional, a partir da percepção dos próprios pacientes portadores de capsulite adesiva, pode contribuir para a melhoria da atenção à saúde dessa população. Objetivos: Descrever as técnicas e indicações clínicas do bloqueio do nervo supraescapular, bem como suas complicações, a partir de dados da literatura; avaliar a qualidade de vida e a capacidade funcional de pacientes com capsulite adesiva no início e no final do tratamento com bloqueios e analisar os fatores associados à qualidade de vida satisfatória e à melhor capacidade funcional. Métodos: Estudo clínico prospectivo em pacientes adultos e idosos com capsulite adesiva submetidos a tratamento semanal com bloqueios do nervo supraescapular, usuários de um hospital ortopédico privado, localizado na cidade de Goiânia-GO, no período de agosto de 2010 a fevereiro de 2012. A qualidade de vida foi avaliada pelo WHOQOL-BREF e a capacidade funcional pelo DASH, tanto no início quanto no final do tratamento. O escore de Constant maior ou igual a 55 pontos foi utilizado para o término dos bloqueios e o teste de Wilcoxon para comparar os escores iniciais e finais do WHOQOL-BREF e DASH. Foi realizada análise de regressão multivariada de Poisson, utilizando como desfechos a qualidade de vida satisfatória e a melhor capacidade funcional. Nível de significância de 5%. Resultados: Foram avaliados 43 pacientes, com idade média de 54,7 anos. Foram obtidos melhores escores de qualidade de vida e capacidade funcional no final do tratamento, quando comparados aos escores iniciais. Pacientes com idade maior que 50 anos foram associados a escores mais elevados de qualidade de vida nos domínios físico e psicológico do WHOQOL-BREF e aqueles com melhor nível educacional nos domínios físico e ambiental. Idade maior que 50 anos e maior escolaridade também foram associados à melhor capacidade funcional do ombro acometido. Conclusões: Existem diversas técnicas e indicações clínicas para a realização do bloqueio do nervo supraescapular. Apesar de raras, complicações podem ocorrer. A qualidade de vida e a capacidade funcional do ombro dos pacientes com capsulite adesiva melhoraram no final do tratamento com bloqueios do nervo supraescapular, sendo influenciadas pela maior idade e melhor nível educacional.

Bakgrund: Inom förlossningsvården används en typ av bedövning kallad pudendusblockad (PDB). Denna bedövning kan administreras på två olika sätt; antingen genom så kallad inre eller yttre teknik. Den yttre tekniken introducerades 2015, dess praktiska för- och nackdelar är ännu inte utförligt dokumenterade i litteraturen.  Syfte: Att utforska barnmorskors erfarenheter av yttre pudendusblockad vid inspektion och suturering postpartum.  Metod: Studien genomfördes med en kvalitativ design. Insamlad data består av intervjuer från totalt tio barnmorskor från två sjukhus i södra Sverige. Dataanalysen genomfördes med kvalitativ innehållsanalys.  Resultat: Resultaten av studien indikerar bland annat att yttre PDB är en uppskattad bedövningsteknik i regionerna, de intervjuade barnmorskorna angav att de använde yttre PDB i majoriteten av alla förlossningar. Över lag var också samtliga deltagare positiva till bedövningen; den upplevs framför allt som en säker smärtlindring, lätt att administrera och kvinnorna ansågs väl bedövade inför suturering. Några väsentliga negativa aspekter kunde enligt deltagarna ej påvisas.  Slutsats: Yttre PDB är en uppskattad bedövningsform som används i stor utsträckning på båda sjukhusen. / Background: Pudendal nerve block (PNB) is a common anesthetic used in maternity care. This anesthesia can be administered in two different ways; either through the so-called inner or outer technique. The outer technique introduces 2015, its practical pros and cons have not yet been thoroughly described in literature.  Purpose: To explore midwives experiences of outer pudendal nerve block during inspection and suturing after delivery.  Method: The study is conducted with a qualitative design. Collected data consists of interviews from a total of ten midwives from two hospitals in southern Sweden. Data has been analyzed with qualitative content analysis. Result: The results of the study indicate for instance that outer PNB is an appreciated technique for anesthesia in the examined geographical region, the interviewees stated that they use outer PNB in the majority of all cases. Furthermore, every interviewee was positive towards the treatment; most importantly, it is viewed as a safe method, easy to administer and patients are well anaesthetized for suturing. No primary negative aspect could be concluded from the interviews.  Conclusion: Outer PNB is an appreciated technique that is used to a large extent at the hospitals surveyed in this study.

Indiana University-Purdue University Indianapolis (IUPUI) / This thesis describes a novel method to reversibly and safely block nerve conduction using a low frequency alternating current (LFAC) waveform at 1 Hz applied through a bipolar extrafascicular electrode. This work follows up on observations made on excised mammalian peripheral nerves and earthworm nerve cords. An in-situ electrophysiology setup was used to assess the LFAC waveform on propagating action potentials (APs) within the cervical vagus nerve in anaesthetized Sprague-Dawley rats (n = 12). Two sets of bipolar cuff or hook electrodes were applied unilaterally to the cervical vagus nerve, which was crushed rostral to the electrodes to exclude reflex effects on the animal. Pulse stimulation was applied to the rostral electrode, while the LFAC conditioning waveform was applied to the caudal electrode. The efferent volley, if unblocked, elicits acute bradycardia and hypotension. The degree of block of the vagal stimulation induced bradycardia was used as a biomarker. Block was assessed by the ability to reduce the bradycardic drive by monitoring the heart rate (HR) and blood pressure (BP) during LFAC alone, LFAC with vagal stimulation, and vagal stimulation alone. LFAC applied via a hook electrode (n = 7) achieved 86.6 +/- 11% block at current levels 95 +/- 38 uAp (current to peak). When applied via a cuff electrode (n = 5) 85.3 +/- 4.60% block was achieved using current levels of 110+/-65 uAp. Furthermore, LFAC was explored on larger vagal afferent fibers in larger human sized nerve bundles projecting to effects mediated by a reflex. The effectiveness of LFAC was assessed in an in-situ electrophysiological setup on the left cervical vagus in anaesthetized domestic swine (n = 5). Two bipolar cuff electrodes were applied unilaterally to the cervical vagus nerve, which was crushed caudal to the electrodes to eliminate cardiac effects. A tripolar extrafascicular cuff electrode was placed most rostral on the nerve for recording of propagating APs induced by electrical stimulation and blocked via the LFAC waveform. Standard pulse stimulation was applied to the left cervical vagus to induce the Hering-Breuer reflex. If unblocked, the activation of the Hering-Breuer reflex would cause breathing to slow down and potentially cease. Block was quantified by the ability to reduce the effect of the Hering-Breuer reflex by monitoring the breathing rate during LFAC alone, LFAC and vagal stimulation, and vagal stimulation alone. LFAC achieved 87.2 +/- 8.8% (n = 5) block at current levels of 0.8 +/- 0.3 mAp. Compound nerve action potentials (CNAP) were monitored directly. They show changes in nerve activity during LFAC, which manifests itself as the slowing and amplitude reduction of components of the CNAPs. Since the waveform is balanced, all forward reactions are reversed, leading to a blocking method that is similar in nature to DC block without the potential issues of toxic byproduct production. These results suggest that LFAC can achieve a high degree of nerve block in both small and large nerve bundles, resulting in the change in behavior of a biomarker, in-vivo in the mammalian nervous system at low amplitudes of electrical stimulation that are within the water window of the electrode.