Thesis (doctoral)--Uppsala, Sweden, 1984.

Proefschrift Universiteit Maastricht. / Met lit. opg. - Met samenvatting in het Nederlands.

Introduktion Lumbago-ischias definieras som ländryggssmärta med utstrålande smärta från skinkan ut i ett ben och kan till 85 % förklaras av nervrotspåverkan såsom diskbråck och diskbuktningar. Urvalet för kirurgi vid symptomgivande nervrotspåverkan omfattar en sammanvägning av en noggrann anamnes, en radiologisk undersökning och en klinisk undersökning. Den kliniska undersökningen består vanligen av ett testbatteri som anses vara betydelsefullt vid värdering av symtom. Enskilda tester har visat dålig förmåga att diagnostisera symptomgivande nervrotspåverkan, men kombinationer av tester har ökat diskriminativa förmågan. Det saknas tidigare studier som undersöker urvalet till kirurgi vid symptomgivande nervrotspåverkan. Syfte Analysera urvalsprocessen till ryggkirurgi vid unilateral symptomgivande nervrotspåverkan även ur ett könsperspektiv. Metod Detta är en pragmatisk pilotstudie med könsperspektiv. Trettio forskningspersoner, nitton kvinnor och elva män mellan 19 och 77 år, med MRT-verifierad symptomgivande lumbal nervrotspåverkan ingick i studien. En klinisk undersökning med tolv allmänt vedertagna tester genomfördes och nedtecknades i ett protokoll. Sensitivitet, specificitet och area under the curve (AUC) beräknades på enskilda samt grupperingar av test utifrån vilka som operationsanmäldes, även könsskillnader analyserades. Resultat SLR och Foraminatest visade hög sensitivitet för urval till kirurgi, men medelvärden på AUC. Endast en kombination av SLR, Slumptest, Foraminatest och nedsatt kraft, med minst 3 av 4 test positiva, gav hög AUC. Subgruppsanalyser gick inte att genomföra p.g.a. för få deltagare. Slutsats En kombination av test, SLR, Slumptest, Foraminatest och nedsatt kraft visade sig ha bäst diskriminativ förmåga i urvalet till ryggkirurgi. / Introduction Sciatica is defined as lumbal back pain with radiating pain from the gluteus and leg and can be explained by 85% of a nerve root affection caused by for example herniated disc or a bulging disc. The selection for surgery is an aggregate of medical history, a radiologic investigation and a clinical investigation. The clinical examination often consists of a group of tests that is considered important in valuation of symptoms. There is a lack of previous studies that examines the selection for surgery in symptomatic nerve root affection. Aims Analyze the selection process for backsurgery in unilateral nerve root affection also by gender. Methods This is a pragmatic pilotstudie with a gender perspective. Thirty research persons with MRI-verified symptomatic nerve root affection participated in the study. A clinical examination with twelve generally accepted tests was performed and recorded in a protocol. Sensitivity, specificity and area under the curve (AUC) was calculated on single as well as in groups of tests of those selected for surgery, gender differences were also analyzed. Results SLR and foraminatest showed high sensitivity, but average AUC. Only a combination of SLR, Slumptest, Kempstest and impairment in strength showed high AUC. Subgroup analysis was not possible due to few participants. Conclusions A combination of tests, SLR, Slumptest, Kempstest and impairment in strength, showed best accuracy in the selection for backsurgery.

Background Dislocation of catheters within the tissue is a challenge in continuous regional anesthesia. A novel self-coiling catheter design is available and has demonstrated a lower dislocation rate in a cadaver model. The dislocation rate and effect on postoperative pain of these catheters in vivo has yet to be determined and were the subjects of this investigation. Methods After ethics committee approval 140 patients undergoing elective distal lower limb surgery were enrolled in this prospective randomized controlled trial. Preoperatively, patients were randomly assigned and received either the conventional (n = 70) or self-coiling catheter (n = 70) for ultrasound-guided popliteal sciatic nerve block in short axis view and by the in-plane approach from lateral to medial. The primary outcome was pain intensity after surgery and on the following three postoperative days. Secondary outcomes investigated were dislocation rate in situ determined by sonography, catheter movement visible from outside, opioid consumption as well as leakage at the puncture site. Results All catheters were successfully inserted. The study population of self-coiling catheters had significantly lower mean numeric rating scale values than the reference cohort on the first (p = 0.01) and second postoperative days (p < 0.01). Sonographic evaluation demonstrated, 42 standard catheters (60%) and 10 self-coiling catheters (14.3%) were dislocated in situ within the first three postoperative days. The externally visible movement of the catheters at insertion site did not differ significantly between groups through the third postoperative day. The opioid consumption was significantly lower in the self-coiling catheter group on the day of surgery and on the second and third postoperative days (p = 0.04, p = 0.03 and p = 0.04, respectively). Conclusion The self-coiling catheter offers a better postoperative pain control and a lower dislocation rate within the tissue when blocking the popliteal sciatic nerve compared to a conventional catheter. Further trials in large patient cohorts are warranted to investigate the potential beneficial effects of self-coiling catheters for other localisations and other application techniques.